%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66108 %T Evaluating Feasibility and Acceptability of the “My HeartHELP” Mobile App for Promoting Heart-Healthy Lifestyle Behaviors: Mixed Methods Study %A Choo,Jina %A Noh,Songwhi %A Shin,Yura %K healthy lifestyle %K primary prevention %K cardiovascular diseases %K community health nursing %K mobile app %D 2025 %7 2.5.2025 %9 %J JMIR Form Res %G English %X Background: Few mobile apps have strategies for self-monitoring multiple heart-healthy behaviors simultaneously, as well as automated and tailored feedback on individual behavioral outcomes for cardiovascular health. An app named “My HeartHELP” was developed for the general adult population to promote 6 heart-healthy lifestyle behaviors—physical activity, nonsedentary behaviors, healthy eating behaviors, nonsmoking, no alcohol binge drinking, and self-assessment of body weight. Three behavioral strategies were used: (1) text messaging the users for information on cardiovascular health, (2) self-monitoring of 6 heart-healthy behaviors to fill out the blanks of behavioral items, and (3) automated and tailored feedback messaging to users for behavioral outcomes obtained from self-monitoring. Objectives: This study aimed to evaluate the feasibility and acceptability of the “My HeartHELP” app. Methods: The participants were 29 community residents in Seoul, South Korea, who met at least 1 criterion of metabolic syndrome. To evaluate the feasibility, we assessed 3 records, which are as follows: First, the “record for self-monitoring” was determined as feasible if an average percentage for each of the 6 behaviors over 4 weeks was 75% or higher based on percentages of participants who completed to record each of 6 heart-healthy behaviors. Second, the “record for access to the app” was determined as feasible if users accessed at least once a day on average per week. Third, “records for behavioral changes” over 4 weeks were collected via a self-reported questionnaire. To evaluate acceptability, we used an assessment tool comprising 12 items that included subscales for comprehensibility, ease, health benefits, technical completeness, overall satisfaction, and recommendation to others on a 5-point Likert scale. Acceptability was determined as acceptable if the average scores for the total scale and each subscale were 3.5 points or greater. Second, qualitative data were collected through 2 focus groups, each consisting of 14 or 15 participants. All data were collected in June and July 2022. Results: During the 4 weeks, 95.6% (range: 85.8%-97.4%) of the participants adhered to more than 75% of “completion of daily self-monitoring of each heart-healthy behavior,” having met the criterion. The participants accessed the app on average 1.8 (SD 1.70) times per day, meeting the criteria. Participants had positive behavioral changes in all 6 behaviors, of which nonsedentary behavior (10%-28%; χ21=1.76; P<.001) and non–fast-food intake were especially statistically significant (72%-93%; χ21=5.64; P=.03) over 4 weeks. Participants reported 3.8 points for a total score of acceptability and more than 3.5 points for all subscales, which met the criterion. Qualitative data obtained from focus groups indicated that automated and tailored feedback messages motivated participants to promote healthy lifestyles. Conclusions: The “My HeartHELP” app may be a feasible and acceptable mobile app to promote self-monitoring and possibly behavioral changes in heart-healthy lifestyle behaviors. %R 10.2196/66108 %U https://formative.jmir.org/2025/1/e66108 %U https://doi.org/10.2196/66108 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64083 %T A Digital Home-Based Health Care Center for Remote Monitoring of Side Effects During Breast Cancer Therapy: Prospective, Single-Arm, Monocentric Feasibility Study %A Huebner,Hanna %A Wurmthaler,Lena A %A Goossens,Chloë %A Ernst,Mathias %A Mocker,Alexander %A Krückel,Annika %A Kallert,Maximilian %A Geck,Jürgen %A Limpert,Milena %A Seitz,Katharina %A Ruebner,Matthias %A Kreis,Philipp %A Heindl,Felix %A Hörner,Manuel %A Volz,Bernhard %A Roth,Eduard %A Hack,Carolin C %A Beckmann,Matthias W %A Uhrig,Sabrina %A Fasching,Peter A %K breast cancer %K digital medicine %K telehealth %K remote monitoring %K cyclin-dependent kinase 4/6 inhibitor %K CDK4/6 inhibitor %K mobile phone %D 2025 %7 2.5.2025 %9 %J JMIR Cancer %G English %X Background: The introduction of oral anticancer therapies has, at least partially, shifted treatment from clinician-supervised hospital care to patient-managed home regimens. However, patients with breast cancer receiving oral cyclin-dependent kinase 4/6 inhibitor therapy still require regular hospital visits to monitor side effects. Telemonitoring has the potential to reduce hospital visits while maintaining quality care. Objective: This study aims to develop a digital home-based health care center (DHHC) for acquiring electrocardiograms (ECGs), white blood cell (WBC) counts, side effect photo documentation, and patient-reported quality of life (QoL) data. Methods: The DHHC was set up using an Apple Watch Series 6 (ECG measurements), a HemoCue WBC DIFF Analyzer (WBC counts), an iPhone SE (QoL assessments and photo documentation), a TP-Link M7350-4G Wi-Fi router, and a Raspberry Pi 4 Model B. A custom-built app stored and synchronized remotely collected data with the clinic. The feasibility and acceptance of the DHHC among patients with breast cancer undergoing cyclin-dependent kinase 4/6 inhibitor therapy were evaluated in a prospective, single-arm, monocentric study. Patients (n=76) monitored side effects—ECGs, WBC counts, photo documentation, and QoL—at 3 predefined time points: study inclusion (on-site), day 14 (remote), and day 28 (remote). After the study completion, patients completed a comprehensive questionnaire on user perception and feasibility. Adherence to scheduled visits, the success rate of the data transfer, user perception and feasibility, and the clinical relevance of remote measurements were evaluated. Results: Mean adherence to the planned remote visits was 63% on day 14 and 37% on day 28. ECG measurements were performed most frequently (day 14: 57/76, 75%; day 28: 31/76, 41%). The primary patient-reported reason for nonadherence was device malfunction. The expected versus the received data transfer per patient was as follows: ECGs: 3 versus 3.04 (SD 1.9); WBC counts: 3 versus 2.14 (SD 1.14); QoL questionnaires: 3 versus 2.5 (SD 1.14); and photo documentation: 6 versus 4.4 (SD 3.36). Among patients, 81% (55/68) found ECG measurements easy, 82% (55/67) found photo documentation easy, and 48% (33/69) found WBC measurements easy. Additionally, 61% (40/66) of patients felt comfortable with self-monitoring and 79% (54/68) were willing to integrate remote monitoring into their future cancer care. Therapy-induced decreased neutrophil count was successfully detected (P<.001; mean baseline: 4.3, SD 2.2, ×109/L; on-treatment: 1.8, SD 0.8, ×109/L). All-grade neutropenia and corrected QT interval prolongations were detected in 80% (55/68) and 2% (1/42) of patients, respectively. Conclusions: Adherence to scheduled remote visits was moderate, with nonadherence primarily attributed to device-related complications, which may have also affected the success rate of data transfer. Overall, patients considered remote monitoring useful and feasible. The prevalence of reported adverse events was comparable to existing literature, suggesting clinical potential. This initial feasibility study highlights the potential of the DHHC. %R 10.2196/64083 %U https://cancer.jmir.org/2025/1/e64083 %U https://doi.org/10.2196/64083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65418 %T Acceptability and Usability of a Digital Behavioral Health Platform for Youth at Risk of Suicide: User-Centered Design Study With Patients, Practitioners, and Business Gatekeepers %A Tse,Trinity Chloe %A Weiner,Lauren S %A Funkhouser,Carter J %A DeLuise,Danielle %A Cullen,Colleen %A Blumkin,Zachary %A O'Brien,Casey %A Auerbach,Randy P %A Allen,Nicholas B %+ Department of Psychology, University of Oregon, Department of Psychology, Univ of Oregon, Eugene, OR, 97403, United States, 1 5413464075, nallen3@uoregon.edu %K user-centered design %K mobile sensing %K behavior change %K suicide prevention %K digital health %K mental health %D 2025 %7 2.5.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth suicide rates are climbing, underscoring the need to improve clinical care. Personal smartphones can provide an understanding of proximal risk factors associated with suicide and facilitate consistent contact between patients and practitioners to improve treatment engagement and effectiveness. The Vira digital behavior change platform (Vira) consists of a patient smartphone app and a web-based practitioner portal (Vira Pro) that integrates objective mobile sensing data with Health Insurance Portability and Accountability Act (HIPAA)–compliant communication tools. Through Vira, practitioners can continuously assess patients’ real-world behavior and provide clinical tools to enhance treatment via just-in-time behavior change support. Objective: This study aimed to explore the acceptability and usability of the minimal viable product version of Vira through a user-centered design (UCD) approach and to identify barriers to implementing Vira in the context of an adolescent intensive outpatient program. Methods: Over 2 iterative phases, feedback was gathered from adolescent patients (n=16), mental health practitioners (n=11), and business gatekeepers (n=5). The mixed methods UCD approach included individual semistructured interviews (eg, perspectives on treatment and attitudes toward digital tools), surveys (eg, usability), and unmoderated user testing sessions (eg, user experience). Results: Overall, participants expressed optimism regarding Vira, particularly among adolescents, who showed high satisfaction with the app’s interface and design. However, clinicians reported more mixed views, agreeing that it would be useful in treatment but also expressing concerns about the volume and displays of patient data in Vira Pro, workload management, and boundaries. Gatekeepers identified usability issues and implementation barriers related to electronic health records but also recognized Vira’s potential to enhance treatment outcomes. Feedback from stakeholders informed several crucial changes to the platform, including adjustments to data-sharing protocols, user interface enhancements, and modifications to training methods. Conclusions: Vira has a high potential to improve patient engagement and improve clinical outcomes among high-risk youth. Iterative UCD and ongoing stakeholder engagement are essential for developing technology-based interventions that effectively meet the needs of diverse end users and align with clinical workflows. %M 40315450 %R 10.2196/65418 %U https://formative.jmir.org/2025/1/e65418 %U https://doi.org/10.2196/65418 %U http://www.ncbi.nlm.nih.gov/pubmed/40315450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58427 %T Integration of a Mental Health App (e-MICHI) Into a Blended Treatment of Depression in Adolescents: Single-Group, Naturalistic Feasibility Trial %A Lincke,Lena %A Martin-Döring,Tim %A Daunke,Andrea %A Sadkowiak,Antonia %A Nolkemper,Daria Alexandra %A Sproeber-Kolb,Nina %A Bienioschek,Stefanie %A Reis,Olaf %A Kölch,Michael %K adolescents %K major depressive disorder (MDD) %K cognitive behavioral therapy (CBT) %K digital health interventions (DHIs) %K feasibility %K adherence %K outpatient setting %K mobile application %K accessibility %K availability %K efficacy %K mobile phone %D 2025 %7 1.5.2025 %9 %J JMIR Form Res %G English %X Background: Major depressive disorder is a common diagnosis among adolescents. Cognitive behavioral therapy is recommended as the first line of treatment. Digital health interventions, such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face-to-face therapy, and the ability to intensify therapy by incorporating it into the patients’ everyday lives. Challenges such as low adherence rates are common in digital health interventions. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. Objective: An evaluated, cognitive behavioral therapy–based face-to-face therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in outpatient settings. Methods: Adolescents aged 12 to 18 years with major depressive disorder receiving outpatient care were recruited from 2 university hospitals (n=36 included in analysis). The e-MICHI intervention combined daily app engagement over 6 weeks with 3 face-to-face sessions with a therapist. Feasibility was measured using various variables, including an adherence score (0=no or little patient engagement to 3=excellent engagement) and engagement rates (number of modules completed, number of messages sent by participants via the in-app messenger), satisfaction ratings from both participants and therapists, as well as participants’ ratings of the usefulness of the antidepressant strategies covered in the app and the transfer of these strategies to everyday practice. Trends of efficacy were evaluated from multiple perspectives (participant self-rating, independent rater, or therapist), using the Beck Depression Inventory-II, the Children’s Depression Rating Scale-Revised, and the Clinical Global Impressions-Severity Scale. Feasibility metrics were assessed by analyzing their central tendency and dispersion, efficacy data were analyzed using a repeated measures ANOVA. Results: e-MICHI was positively evaluated by both participants and therapists (participants: mean 7.3, SD 1.2 and therapists: mean 7.3, SD 1.1, on a scale from 0=bad to 10=excellent). Participants demonstrated high adherence rates (nearly 80%, n=25, received a “good” or “excellent” adherence score) and showed overall good engagement (app modules completed [maximum 6]: mean 5.03, SD 1.27 and messages sent via messenger: mean 23, SD 22.1). Participants rated the psychoeducational content of the app as particularly useful and reported consistent practice of the e-MICHI strategies in everyday life. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs 3-month follow-up, Beck Depression Inventory-II: mean −6.76, SD 11.49, P=.01; Children’s Depression Rating Scale-Revised: mean −16.45, SD 16.76, P<.001; Clinical Global Impressions-Severity Scale: mean −1.1, SD 1.24, P<.001). Conclusions: While acknowledging its limitations, such as the small number of participants and the limited validity concerning efficacy, this study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings. Trial Registration: German Clinical Trial Register DRKS00022420; https://drks.de/search/en/trial/DRKS00022420/details %R 10.2196/58427 %U https://formative.jmir.org/2025/1/e58427 %U https://doi.org/10.2196/58427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66189 %T Identification of Major Bleeding Events in Postoperative Patients With Malignant Tumors in Chinese Electronic Medical Records: Algorithm Development and Validation %A Li,Hui %A Yao,Haiyang %A Gao,Yuxiang %A Luo,Hang %A Cai,Changbin %A Zhou,Zhou %A Yuan,Muhan %A Jiang,Wei %K machine learning %K electronic medical record %K postoperative patients with malignant tumors %K postoperative bleeding %K tumor surgery %K abdominal %D 2025 %7 1.5.2025 %9 %J JMIR Form Res %G English %X Background: Postoperative bleeding is a serious complication following abdominal tumor surgery, but it is often not clearly diagnosed and documented in clinical practice in China. Previous studies have relied on manual interpretation of medical records to determine the presence of postoperative bleeding in patients, which is time-consuming and laborious. More critically, this manual approach severely hinders the efficient analysis of large volumes of medical data, impeding in-depth research into the incidence patterns and risk factors of postoperative bleeding. It remains unclear whether machine learning can play a role in processing large volumes of medical text to identify postoperative bleeding effectively. Objective: This study aimed to develop a machine learning model tool for identifying postoperative patients with major bleeding based on the electronic medical record system. Methods: This study used data from the available information in the National Health and Medical Big Data (Eastern) Center in Jiangsu Province of China. We randomly selected the medical records of 2,000 patients who underwent in-hospital tumor resection surgery between January 2018 and December 2021 from the database. Physicians manually classified each note as present or absent for a major bleeding event during the postoperative hospital stay. Feature engineering involved bleeding expressions, high-frequency related expressions, and quantitative logical judgment, resulting in 270 features. Logistic regression (LR), K-nearest neighbor (KNN), and convolutional neural network (CNN) models were developed and trained using the 1600-note training set. The main outcomes were accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each model. Results: Major bleeding was present in 4.31% (69/1600) of the training set and 4.75% (19/400) of the test set. In the test set, the LR method achieved an accuracy of 0.8275, a sensitivity of 0.8947, a specificity of 0.8241, a PPV of 0.2024, an NPV of 0.9937, and an F1-score of 0.3301. The CNN method demonstrated an accuracy of 0.8900, sensitivity of 0.8421, specificity of 0.8924, PPV of 0.2807, NPV of 0.9913, and an F1-score of 0.4211. While the KNN method showed a high specificity of 0.9948 and an accuracy of 0.9575 in the test set, its sensitivity was notably low at 0.2105. The C-statistic for the LR method was 0.9018 and for the CNN method was 0.8830. Conclusions: Both the LR and CNN methods demonstrate good performance in identifying major bleeding in patients with postoperative malignant tumors from electronic medical records, exhibiting high sensitivity and specificity. Given the higher sensitivity of the LR method (89.47%) and the higher specificity of the CNN method (89.24%) in the test set, both models hold promise for practical application, depending on specific clinical priorities. %R 10.2196/66189 %U https://formative.jmir.org/2025/1/e66189 %U https://doi.org/10.2196/66189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59631 %T Predicting Transvaginal Surgical Mesh Exposure Outcomes Using an Integrated Dataset of Blood Cytokine Levels and Medical Record Data: Machine Learning Approach %A Waugh,Mihyun Lim %A Mills,Tyler %A Boltin,Nicholas %A Wolf,Lauren %A Parker,Patti %A Horner,Ronnie %A Wheeler II,Thomas L %A Goodwin,Richard L %A Moss,Melissa A %K cytokines %K inflammatory response %K medical record %K pelvic organ prolapse %K polypropylene mesh %K supervised machine learning models %K polypropylene %K mesh surgery %K surgical outcome %K cost-efficiency %K risk factor %K efficacy %K health care data %K female %K informed decision-making %K patient care %K digital health %D 2025 %7 1.5.2025 %9 %J JMIR Form Res %G English %X Background: Transvaginal insertion of polypropylene mesh was extensively used in surgical procedures to treat pelvic organ prolapse (POP) due to its cost-efficiency and durability. However, studies have reported a high rate of complications, including mesh exposure through the vaginal wall. Developing predictive models via supervised machine learning holds promise in identifying risk factors associated with such complications, thereby facilitating better informed surgical decisions. Previous studies have demonstrated the efficacy of anticipating medical outcomes by employing supervised machine learning approaches that integrate patient health care data with laboratory findings. However, such an approach has not been adopted within the realm of POP mesh surgery. Objective: We examined the efficacy of supervised machine learning to predict mesh exposure following transvaginal POP surgery using 3 different datasets: (1) patient medical record data, (2) biomaterial-induced blood cytokine levels, and (3) the integration of both. Methods: Blood samples and medical record data were collected from 20 female patients who had prior surgical intervention for POP using transvaginal polypropylene mesh. Of these subjects, 10 had experienced mesh exposure through the vaginal wall following surgery, and 10 had not. Standardized medical record data, including vital signs, previous diagnoses, and social history, were acquired from patient records. In addition, cytokine levels in patient blood samples incubated with sterile polypropylene mesh were measured via multiplex assay. Datasets were created with patient medical record data alone, blood cytokine levels alone, and the integration of both data. The data were split into 70% and 30% for training and testing sets, respectively, for machine learning models that predicted the presence or absence of postsurgical mesh exposure. Results: Upon training the models with patient medical record data, systolic blood pressure, pulse pressure, and a history of alcohol usage emerged as the most significant factors for predicting mesh exposure. Conversely, when the models were trained solely on blood cytokine levels, interleukin (IL)-1β and IL-12 p40 stood out as the most influential cytokines in predicting mesh exposure. Using the combined dataset, new factors emerged as the primary predictors of mesh exposure: IL-8, tumor necrosis factor-α, and the presence of hemorrhoids. Remarkably, models trained on the integrated dataset demonstrated superior predictive capabilities with a prediction accuracy as high as 94%, surpassing the predictive performance of individual datasets. Conclusions: Supervised machine learning models demonstrated improved prediction accuracy when trained using a composite dataset that combined patient medical record data and biomaterial-induced blood cytokine levels, surpassing the performance of models trained with either dataset in isolation. This result underscores the advantage of integrating health care data with blood biomarkers, presenting a promising avenue for predicting surgical outcomes in not only POP mesh procedures but also other surgeries involving biomaterials. Such an approach has the potential to enhance informed decision-making for both patients and surgeons, ultimately elevating the standard of patient care. %R 10.2196/59631 %U https://formative.jmir.org/2025/1/e59631 %U https://doi.org/10.2196/59631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63028 %T Assessing the Utilization of Electronic Consultations in Genetics: Seven-Year Retrospective Study %A Biswas,Sawona %A So,Joyce %A Wallerstein,Robert %A Gonzales,Ralph %A Tout,Delphine %A DeAngelis,Lisa %A Rajkovic,Aleksandar %K genomic %K e-Consult %K genetic %K utility %K retrospective %K assessment %K effectiveness %K electronic consultation %K healthcare providers %K genetic experts %K university %K consultations %K e-Consult frameworks %K accessibility %K genetic testing %K patient care %D 2025 %7 30.4.2025 %9 %J JMIR Form Res %G English %X Background: Patient and health care provider access to genetic subspecialists is challenging owing to limited number of genetics experts across the United States. The University of California San Francisco (UCSF) Genetics electronic consultation (e-Consult) service was implemented along with the usual referral pathway to improve access to timely genetic expertise through robust asynchronous provider-to-provider communication. Objectives: This study examined the impact of the UCSF Genetics e-Consult service on patient access to genetics expertise. Methods: A retrospective chart review of 622 e-Consult requests was conducted. Data pertinent to e-Consult completion rates, provider response times, consultation content, and adherence to geneticist recommendations were abstracted. Results: From October 2016 to March 2024, the UCSF Genetics e-Consult service received a total of 622 consultation orders, with yearly volumes increasing from 34 in 2017 to 144 in 2023. A total of 360/622 (57.8%) consultations were completed, of which 197/360 (54.6%) were resolved without requiring a specialty care visit. Of the 262/622 (42.1%) e-Consult orders declined by the geneticist reviewer, 184/262 (70.2%) were scheduled for a synchronous genetics visit due to case complexity precluding an appropriate e-Consult response and 29.8% (78/262) were recommended to be referred to a different and more appropriate specialty. Geneticists responded to 83.9% (522/622) of e-Consults within 3 days, with most spending between 5 and 20 minutes on their e-Consult response. Nearly half of the genetics e-Consult requests (69/144; 47.9%) came from primary care providers and pediatricians. Among the 144 e-Consult requests in 2023, 50.6% (73/144) were about diagnostic queries, 17% (25/144) were on symptom management, and 11% (16/144) were about test interpretation. Provider adherence to geneticists’ recommendations was observed in 84% (116/144) of cases. Conclusions: The UCSF Genetics e-Consult service has demonstrated efficiency in providing timely genetic consultations, with a high rate of provider adherence to recommendations. These findings support the potential of e-Consult frameworks as a viable strategy for enhancing access to genetic health care services. %R 10.2196/63028 %U https://formative.jmir.org/2025/1/e63028 %U https://doi.org/10.2196/63028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66889 %T Effect of a Digital Health Exercise Program on the Intention for Spinal Surgery in Adult Spinal Deformity: Exploratory Cross-Sectional Survey %A Brown,Marsalis Christian %A Lin,Christopher Quincy %A Jin,Christopher %A Rohde,Matthew %A Rocos,Brett %A Belding,Jonathan %A Woods,Barrett I %A Ackerman,Stacey J %K adult spinal deformity %K scoliosis %K nonoperative management %K spinal realignment therapy %K digital health %K program evaluation %D 2025 %7 29.4.2025 %9 %J JMIR Form Res %G English %X Background: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic’s (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD. Objective: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users’ intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery. Methods: Individuals were enrolled in the SRT study from October 1, 2023 to September 1, 2024. Participants completed a web-based, cross-sectional survey about their history of prior scoliosis surgery and intent of having surgery before and after use of SRT (on a 4-point Likert scale, where 1 = “No Intent for Surgery” and 4 = “High Intent for Surgery”). Intent for surgery before and after participation in SRT was compared using a nonparametric Wilcoxon signed-rank test for paired data. Annual cost savings per 100,000 beneficiaries by averting spinal fusions were estimated separately for commercial payers and Medicare using published literature and public data sources. Payer expenditures were inflation-adjusted to 2024 US dollars using the Hospital Services component of the Consumer Price Index. Results: A total of 62 NSC members (38.8%) responded to the survey and were enrolled in the SRT program for an average (SD) of 17 (12) weeks. The mean (SD) age was 65.3 (13.5) years, and the majority were female (47/48, 98%) and White (45/46, 98%). Among the SRT users who did not have prior scoliosis surgery (n=56), 14% (8/56) reported a decrease in intent for surgery (that is, a lower Likert score) with the use of SRT. The mean (SD) intent for surgery scores before compared to after SRT were 1.29 (0.53) and 1.14 (0.35), respectively (mean difference 0.15 [P=.006]). Participants with “No Intent for Surgery” pre- versus postuse of SRT (42/56 versus 48/56, respectively) corresponded to an absolute risk reduction of 11% and a number needed to treat of 9 to avert one spinal fusion. Among the 6 participants who transitioned to “No Intent” for spinal surgery with the use of SRT, 3 were aged <65 years and 3 were ≥65 years of age. The annual cost savings from averted spinal surgeries were estimated at US $415,000 per 100,000 commercially-insured beneficiaries and US $617,000 per 100,000 Medicare beneficiaries. Conclusions: SRT is a personalized, scoliosis-specific digital health exercise program with the potential for averting 1 spinal surgery for every 9 participants, resulting in a substantial reduction in payer expenditures while improving the quality of care for commercial payers and Medicare beneficiaries. %R 10.2196/66889 %U https://formative.jmir.org/2025/1/e66889 %U https://doi.org/10.2196/66889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56855 %T Impact of the Kidney Score Platform on Communication About and Patients’ Engagement With Chronic Kidney Disease Health: Pre–Post Intervention Study %A Tuot,Delphine %A Crowley,Susan %A Katz,Lois %A Leung,Joseph %A Alcantara-Cadillo,Delly %A Ruser,Christopher %A Talbot-Montgomery,Elizabeth %A Vassalotti,Joseph %K chronic kidney disease %K CKD %K CKD communication %K CKD knowledge %K patient activation %K kidney %K kidney score platform %K kidney health %K United States %K US %K adult %K aging %K clinical practice %K awareness campaign %K health information %K clinician %K primary care %K longitudinal intervention %K web-based %K mobile health %K mHealth %D 2025 %7 29.4.2025 %9 %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) affects 14% of the US adult population, yet patient knowledge about kidney disease and engagement in their kidney health is low despite many CKD education programs, awareness campaigns, and clinical practice guidelines. Objective: We aimed to examine the impact of the Kidney Score Platform (a patient-facing, risk-based online tool that provides interactive health information tailored to an individual’s CKD risk plus an accompanying clinician-facing Clinical Practice Toolkit) on individual engagement with CKD health and CKD communication between clinicians and patients. Methods: We conducted a pre-post intervention study in which English-speaking veterans at risk for CKD in two primary care settings interacted with the Kidney Score platform’s educational modules and their primary care clinicians were encouraged to review the Clinical Practice Toolkit. The impact of the Kidney Score on the Patient Activation Measure (the primary outcome), knowledge about CKD, and communication with their clinician about kidney health was determined with paired t tests. Multivariable linear and logistic models were used to determine whether changes in outcomes after versus before intervention were influenced by age, race or ethnicity, sex, and diabetes status, accounting for baseline values. Results: The study population (n=76) had a mean (SD) age of 64.4 (8.2) years, 88% (67/76) was male, and 30.3% (23/76) self-identified as African-American. Approximately 93% (71/76) had hypertension, 36% (27/76) had diabetes, and 9.2% (7/76) had CKD according to the laboratory criteria but without an ICD-10 (International Classification of Diseases, 10th Edition) diagnosis. Patient interaction with the Kidney Score did not change the mean Patient Activation Measure (preintervention: 40.7%, postintervention: 40.2%, P=.23) but increased the mean CKD knowledge score (preintervention: 40.0%, postintervention 51.1%, P<.01), and changed the percentage of veterans who discussed CKD with their clinician (preintervention: 12.3%, postintervention: 31.5%, P<.01). Changes did not differ by age, sex, race, or diabetes status. Results were limited by the small sample size due to low recruitment and minimal clinician engagement with the Clinical Practice Toolkit during the COVID-19 pandemic. Conclusions: One-time web-based tailored education for patients can increase CKD knowledge and encourage conversations about kidney health. Increasing patient activation for CKD management may require multilevel, longitudinal interventions that facilitate ongoing conversations about kidney health between patients and clinician teams. %R 10.2196/56855 %U https://formative.jmir.org/2025/1/e56855 %U https://doi.org/10.2196/56855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59640 %T Adolescent Emoji Use in Text-Based Messaging: Focus Group Study %A Minich,Matt %A Kerr,Bradley %A Moreno,Megan %K communication %K text messaging %K smartphones %K emoji %K focus groups %K adolescent %K teen %K youth %K teenagers %K text %K phone %K messaging %K text communication %K emotion %D 2025 %7 28.4.2025 %9 %J JMIR Form Res %G English %X Background: Adolescents increasingly communicate through text-based messaging platforms such as SMS and social media messaging. These are now the dominant platforms for communication between adolescents, and adolescents use them to obtain emotional support from parents and other adults. The absence of nonverbal cues can make it challenging to communicate emotions on these platforms, however, so users rely on emojis to communicate sentiment or imbue messages with emotional tone. While research has investigated the functions of emojis in adult communication, less is known about adolescent emoji use. Objective: This study sought to understand whether the pragmatic functions of adolescent emoji use resemble those of adults, and to gain insight into the semantic meanings of emojis sent by adolescents. Methods: Web-based focus groups were conducted with a convenience sample of adolescents, in which participants responded to questions about their use and interpretation of emojis and engaged in unstructured interactions with one another. Two trained coders analyzed transcripts using a constant comparative coding procedure to identify themes in the discussion. Results: A total of 6 focus groups were conducted with 31 adolescent participants (mean age 16.2, SD 1.5 years). Discussion in the groups generally fell into 4 themes: emojis as humorous or absurd, emokis as insincere or complex expressions of setiment, emojis as straightforward experssions of sentiment, and emojis as having context-dependent meanings. Across themes, participants often described important differences between their own emoji use and emoji use by adults. Conclusions: Adolescent focus group participants described patterns of emoji use that largely resembled those observed in studies of adults. Like adults, our adolescent participants described emojis’ semantic meanings as being highly flexible and context-dependent. They also described both phatic and emotive functions of emoji use but described both functions in ways that differed from the patterns of emoji use described in adult samples. Adolescents described their phatic emoji use as absurd and described their emotive emoji use as most often sarcastic. These findings suggest that emoji use serves similar pragmatic functions for both adolescents and adults, but that adolescents see their emoji use as more complex than adult emoji use. This has important implications for adults who communicate with adolescents through text-based messaging and for researchers interested in adolescents’ text-based communication. %R 10.2196/59640 %U https://formative.jmir.org/2025/1/e59640 %U https://doi.org/10.2196/59640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60612 %T The Motivations of Citizens to Attend an eHealth Course in the Public Library: Qualitative Interview Study %A Standaar,Lucille %A Israel,Adriana Margje %A van der Vaart,Rosalie %A Keij,Brigitta %A van Lenthe,Frank J %A Friele,Roland %A Beenackers,Mariëlle A %A van Tuyl,Lilian Huibertina Davida %K digital health %K help-seeking behavior %K socioeconomic factors %K community health services %K older people %K eHealth %K older adults %K geriatric %K support %K eHealth literacy %K interview %K Netherlands %K thematic data analysis %K health literacy %K mobile phone %D 2025 %7 28.4.2025 %9 %J JMIR Form Res %G English %X Background: There is worldwide recognition of the potential increase of digital health inequity due to the increased digitalization of health care systems. Digital health skill development may prevent disparities in eHealth access and use. In the Dutch context, the public library has started to facilitate support in digital health skill development by offering public eHealth courses. Understanding the motivations of people to seek support may help to further develop this type of public service. Objective: This is a qualitative study on the motivations of citizens participating in an eHealth course offered by public libraries. The study aimed to explore why citizens were motivated to seek nonformal support for eHealth use. Methods: A total of 20 semistructured interviews with participants who participated in an eHealth course were conducted in 7 public libraries across the Netherlands. The interviews were conducted between April and June 2022. Purposive sampling took place in the public library during the eHealth course. The interviews covered participants’ motivations, attitudes, and experiences with eHealth use and their motivations to seek help with eHealth use. Interviews were audio-recorded and transcribed. Themes were identified via a comprehensive thematic data analysis. Results: The participants were 51 to 82 years of age (average 73.5, SD 6.6 y) and 14 (70%) participants were female. Three motivational themes were identified: (1) adapting to an increasingly digital society, (2) sense of urgency facilitated by prior experience in health care, and (3) a need for self-reliance and autonomy. Additionally, participants expressed a general desire for social contact and lifelong learning. A lack of adequate informal support by friends and family for digital skills and positive experiences with formal support from public libraries stimulated the participants to seek formal support for eHealth use. Conclusions: We show that the participants had a feeling of urgency that sparked their motivation to seek nonformal support in the public library. Motivations to participate in the eHealth course stemmed from the need to adapt to the digital society, being a patient or a caregiver, or the need or wish to be independent from others. Participants of the study were mainly older female adults who had native language abilities, up-to-date digital devices, and time. It is likely that other populations experience similar feelings of urgency but have other support needs. Future research should explore the needs and attitudes of nonusers and other users of digital health toward seeking support in eHealth access and use. %R 10.2196/60612 %U https://formative.jmir.org/2025/1/e60612 %U https://doi.org/10.2196/60612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65801 %T School-Based Virtual Reality Programming for Obtaining Moderate-Intensity Exercise Among Children With Disabilities: Pre-Post Feasibility Study %A Lai,Byron %A Wright,Ashley %A Hutchinson,Bailey %A Bright,Larsen %A Young,Raven %A Davis,Drew %A Malik,Sultan Ali %A Rimmer,James H %A , %K disability %K adapted physical activity %K leisure-time exercise %K exercise %K telehealth %K tele-exercise %K cerebral palsy %K pediatric rehabilitation %K intellectual disability %K developmental disability %K child %K high school %K exercise %K mobility %K mobility disability %K cardio %K cardiorespiratory %K cardiometabolic %K feasibility %K virtual reality %K controlled trial %K t test %K VR %K exergame %K mixed method %D 2025 %7 25.4.2025 %9 %J JMIR Form Res %G English %X Background: Children have busy daily schedules, making school an ideal setting for promoting health-enhancing exercise behavior. However, children with mobility disabilities have limited exercise options to improve their cardiorespiratory fitness and cardiometabolic health. Objective: This study aims to test the feasibility of implementing a virtual reality (VR) exercise program for children with mobility disabilities in a high school setting. Methods: A pre- to posttrial single-group design with a 6-week exercise intervention was conducted at a high school. The study aimed to enroll up to 12 students with a disability. Participants were given the option of exercising at home or school. The exercise prescription was three 25-minute sessions per week at a moderate intensity, using a head-mounted VR display. School exercise sessions were supervised by research staff. Home exercise sessions were performed autonomously. Several implementation metrics of feasibility were recorded, including exercise attendance, volume, adverse events or problems, and benefits related to health-related fitness (walking endurance and hand-grip strength). The study also included a qualitative evaluation of critical implementation factors and potential benefits for participants that were not included in the study measures. Outcomes were descriptively analyzed, and 2-tailed t tests were used as appropriate. Results: In total, 10 students enrolled in the program and 9 completed the study (mean age 17, SD 0.6 y). In total, 5 (56%) participants exercised at school, and 4 (44%) exercised at home; 1 participant dropped out prior to exercise. The mean attendance for all 9 completers was 61.1% (11/18 sessions). The mean exercise minutes per week was 35.5 (SD 22) minutes. The mean move minutes per session was 17.7 (SD 11) minutes. The mean minutes per session was 18 (SD 1.4) minutes for school exercisers and 17 (SD 18) minutes for home exercisers, indicating variable responses from home exercisers. The mean rating of perceived exertion per exercise session was 4.3 (SD 2), indicating a moderate intensity that ranged from low to hard intensity. No adverse events or problems were identified. No improvements in walking endurance or hand-grip strength were observed. School exercisers achieved a higher attendance rate (83%) than home exercisers (27%; P<.001) and seemingly had a 2-fold increase in the volume of exercise achieved (school: mean 279, SD 55 min; 95% CI 212‐347; home: mean 131, SD 170 min; 95% CI –140 to 401; P=.10). Qualitative themes relating to implementation factors and benefits to participant well-being were identified. Conclusions: This study identified factors to inform an optimal protocol for implementing a high school–based VR exercise program for children with disabilities. Study findings demonstrated that moderate exercise at school is feasible in VR, but simply providing children with VR exergaming technology at home, without coaching, will not successfully engage them in exercise. Trial Registration: ClinicalTrials.gov NCT05935982; https://clinicaltrials.gov/study/NCT05935982 %R 10.2196/65801 %U https://formative.jmir.org/2025/1/e65801 %U https://doi.org/10.2196/65801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e37160 %T Discussions of Antibiotic Resistance on Social Media Platforms: Text Mining and Mixed Methods Content Analysis Study %A Arquembourg,Jocelyne %A Glaser,Philippe %A Roblot,France %A Metzler,Isabelle %A Gallant-Dewavrin,Mélanie %A Nanguem,Hugues Feutze %A Mebarki,Adel %A Voillot,Paméla %A Schück,Stéphane %K antibiotic ineffectiveness %K antibiotic resistance %K health-related quality of life %K real-world %K social media %K quality of life %K quantitative %K qualitative %K app %K application %K online %K medical information %K French %K users %K antibiotic %K social media use %D 2025 %7 25.4.2025 %9 %J JMIR Form Res %G English %X Background: With the increasing popularity of web 2.0 apps, social media has made it possible for individuals to post messages on antibiotic ineffectiveness. In such online conversations, patients discuss their quality of life (QoL). Social media have become key tools for finding and disseminating medical information. Objective: To identify the main themes of discussion, the difficulties encountered by patients with respect to antibiotic ineffectiveness and the impact on their QoL (physical, psychological, social, or financial). Methods: A noninterventional retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experience with antibiotics, and the impact of their ineffectiveness on their QoL. Messages posted between January 2014 and July 2020 were extracted from French-speaking publicly available online forums. Results: A total of 3773 messages were included in the analysis corpus after extraction and filtering. These messages were posted by 2335 individual web users, most of them being women around 35 years of age. Inefficacy of treatment options and the lack of information regarding the use of antibiotics were among the most discussed topics. QoL was discussed in 63% of the 3773 messages posted. The most common is the physical impact (78%). Patients discussed the persistence of symptoms and adverse effects. The second kind of impact is psychological (65%), characterized by feelings of anxiety or despair about the situation. Conclusions: This social media analysis allowed us to identify a strong impact of the perceived ineffectiveness of antibiotic therapy on patients’ daily life particularly in terms of physical and psychological consequences. These results provide health care experts information directly generated by patients regarding their own experiences. Social media studies constitute a complementary source of evidence that could be used to optimize messages to the public about appropriate use of antibiotics. %R 10.2196/37160 %U https://formative.jmir.org/2025/1/e37160 %U https://doi.org/10.2196/37160 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57212 %T Applying Patient and Health Professional Preferences in Co-Designing a Digital Brief Intervention to Reduce the Risk of Prescription Opioid–Related Harm Among Patients With Chronic Noncancer Pain: Qualitative Analysis %A Elphinston,Rachel A %A Pager,Sue %A Fatehi,Farhad %A Sterling,Michele %A Brown,Kelly %A Gray,Paul %A Hipper,Linda %A Cahill,Lauren %A Ziadni,Maisa %A Worthy,Peter %A Connor,Jason P %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, 296 Herston Road, Herston, 4006, Australia, 61 412662084, rachelel@uq.edu.au %K chronic noncancer pain %K CNCP %K prescription opioid use %K brief intervention %K brief psychological intervention %K co-design %K patient partners %K qualitative research %K digital health %D 2025 %7 25.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Few personalized behavioral treatments are available to reduce the risk of prescription opioid–related harm among patients with chronic noncancer pain. Objective: We aimed to report on the second phase of the co-design of a digital brief intervention (BI) based on patient and health professional preferences. Methods: Eligible patients with chronic noncancer pain (n=18; 10 women; mean age 49.5, SD 6.91 y) from public hospital waitlists and health professionals (n=5; 2 women; mean age 40.2, SD 5.97 y) from pain and addiction clinics completed semistructured telephone interviews or participated in focus groups exploring BI preferences, needs, and considerations for implementation. Grounded theory was used to thematically analyze the data. Results: We identified 5 themes related to intervention content from patient reports: relevance of the biopsychosocial model and need for improved awareness and pain psychology education; nonpharmacological strategies and flexibility when applying coping skills training; opioid use reflection and education, with personalized medication and tapering plans; holistic and patient-inclusive assessment measures and feedback; and inclusion of holistic goals targeting comfort and happiness. Five themes related to the process and guiding principles were identified: therapist guided; engaging features; compassionate, responsive, person-centered care; a digital solution is exciting, maximizing reach; and educate and normalize system and policy challenges. Finally, 5 themes were reflected in the health professionals’ reports: digital health use is rare but desired; digital health is useful for patient monitoring and accessing support; patient motivation is important; a digital BI app is likely beneficial and at multiple care points; and safe medication use and managing pain goals. The reported barriers from health professionals were intervention intensity, potential costs, and patient responsiveness; factors facilitating the implementation were the alignment of digital BIs with clinical models, a stepped-care approach, and feedback. Conclusions: This co-design study identified key content areas, guiding principles, enabling factors, and barriers from both patients and health professionals to guide the development of digital BIs. The knowledge gathered should inform future iterations of co-designing digital BIs for the population most at risk of the harmful effects of opioid medications. %M 40279636 %R 10.2196/57212 %U https://formative.jmir.org/2025/1/e57212 %U https://doi.org/10.2196/57212 %U http://www.ncbi.nlm.nih.gov/pubmed/40279636 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e71676 %T A Portal-Based Intervention (PATTERN) Designed to Support Medication Use Among Older Adults: Feasibility and Acceptability Study %A Pack,Allison %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %K older adults %K multiple chronic conditions %K polypharmacy %K primary care %K medication adherence %K patient portal %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X Background: Poor medication adherence among older adults with multiple chronic conditions and polypharmacy is a public health concern stemming from distinct challenges. Prior interventions have largely used a one-size-fits-all approach or resource-intensive approaches inappropriate for busy primary care clinics. Objective: To address this, Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) was adapted from prior work. PATTERN is a portal-based intervention for monitoring self-reported medication adherence challenges among older adults in primary care. This study sought to implement and evaluate PATTERN’s feasibility and acceptability. Methods: We conducted a patient randomized study with a posttest design. Primary care physicians at the participating health center were informed of the study, and approval was obtained to contact their patients. Patient eligibility included being aged 60 years or older, having prescription medications for ≥8 chronic conditions, and an upcoming visit with a physician who had provided approval. Potentially eligible patients were identified using an electronic health record query, and a research coordinator phoned them to confirm eligibility, assess interest, obtain consent, and conduct enrollment. Randomization occurred following enrollment. Those randomized to PATTERN received a medication adherence assessment in their patient portal accounts several days ahead of their visit. The assessment identified whether a patient was experiencing a medication adherence challenge, and if so, the type (cognitive, psychological, medical, regimen-related, social, or economic). Identified challenges were sent to the patient’s primary care physician. Assessment delivery several days ahead of a visit was thought to offer sufficient time for patients to complete it and clinicians to review any challenges. Approximately 2 weeks after visits, the coordinator recontacted participants to conduct posttest interviews. This ensured clinicians had sufficient time to respond to challenges during or after visits. Posttest interviews measured the self-reported use of the portal, demographic and health characteristics, and for those randomized to PATTERN, intervention satisfaction. Self-reported data were captured in REDCap and analyzed descriptively. Electronic health record data were also analyzed descriptively to objectively identify feasibility, that is, whether intervention arm participants completed the PATTERN assessment. Results: We enrolled 64 participants (32 received usual care, and 32 received intervention). Most were female (66%, 42/64), not Hispanic or Latino (94%, 60/64), and identified as White (58%, 37/64). The average (SD) age was 75 (6.8) years. Most participants (80%) self-reported using the patient portal ≥12 times per year. However, electronic health record data revealed that less than half of all participants randomized to PATTERN (47%, 15/32) completed the medication adherence assessment. Of those who remembered completing it, 60% (3/5) were very satisfied with the experience and 20% (1/5) were a little satisfied. Conclusions: PATTERN has the potential for use with older primary care patients experiencing multiple chronic conditions and polypharmacy. Yet, further adaptation is needed to ensure recipients access their patient portal accounts and complete assessments. Trial Registration: ClinicalTrials.Gov NCT05766423; https://clinicaltrials.gov/study/NCT05766423 %R 10.2196/71676 %U https://formative.jmir.org/2025/1/e71676 %U https://doi.org/10.2196/71676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64212 %T Mobile Health App for Adolescent Asthma Self-Management: Development and Usability Study of the Pulmonary Education and Knowledge Mobile Asthma Action Plan %A He,Xing %A Bian,Jiang %A Berlinski,Ariel %A Guo,Yi %A Simmons,A Larry %A Marshall,S Alexandra %A Greene,Carolyn J %A Brown,Rita Hudson %A Turner,Jessica %A Perry,Tamara T %K asthma self-management %K mobile health %K user-centered design %K usability %K adolescents %K mobile phone %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X Background: Adolescents with asthma are vulnerable to poor asthma outcomes due to inadequate self-management skills and nonadherence to medications. Mobile health (mHealth) apps have shown promise in improving asthma control, medication adherence, and self-efficacy. However, existing mHealth asthma apps lack personalization and real-time feedback and are not tailored for at-risk adolescents. Objective: This study aimed to design, develop, and test a smartphone-based mHealth Asthma Action Plan for adolescents, called Pulmonary Education and Knowledge Mobile Asthma Action Plan (PEAK-mAAP), in preparation for a large-scale randomized controlled trial. Methods: We employed user-centered design principles to develop our app, leveraging our previous work and following guidelines from the National Heart, Lung, and Blood Institute. The app consists of a patient-facing mobile app and a provider-facing portal. A convenience sample of 13 adolescents (aged 12‐20 years) was recruited from the Arkansas Children’s Research Institute database or direct health care provider referrals. Participants underwent a task-based usability assessment followed by the System Usability Scale assessment to measure user satisfaction, interface effectiveness, and overall system usability. Results: PEAK-mAAP integrates 7 core modules supporting personalized asthma self-management, symptom monitoring, medication tracking, and real-time feedback. The mean System Usability Scale score was 83/100 (SD 5.54), indicating high user satisfaction and system usability. Notably, older adolescents (>17 years) reported higher usability scores (87.5) than younger users (77.5), suggesting potential age-related differences in app navigation and engagement. Conclusions: The results demonstrate that PEAK-mAAP is a feasible and user-friendly mHealth intervention for adolescent asthma self-management. While the high usability score reflects a positive user experience, some participants encountered initial usability challenges, highlighting the need for minor refinements and user training materials. The integration of personalized self-management tools and real-time feedback distinguishes PEAK-mAAP from existing asthma apps, addressing key barriers to adherence and engagement. Moving forward, an ongoing randomized controlled trial will assess its clinical effectiveness, long-term engagement, and impact on asthma outcomes, providing further insights into its potential as a scalable solution for adolescent asthma care. %R 10.2196/64212 %U https://formative.jmir.org/2025/1/e64212 %U https://doi.org/10.2196/64212 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e70855 %T Mainstream Smart Home Technology–Based Intervention to Enhance Functional Independence in Individuals With Complex Physical Disabilities: Single-Group Pre-Post Feasibility Study %A Ding,Dan %A Morris,Lindsey %A Novario,Gina %A Fairman,Andrea %A Roehrich,Kacey %A Foschi Walko,Palma %A Boateng,Jessica %+ Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6425 Penn Ave, Suite 401, Pittsburgh, PA, 15206, United States, 1 412 624 1964, dad5@pitt.edu %K physical disabilities %K smart home technology %K assistive technology %K assistive technology service delivery %K functional independence %K participation %K occupational therapy %K artificial intelligence %K AI %D 2025 %7 24.4.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Mainstream smart home technologies (MSHTs), such as home automation devices and smart speakers, are becoming more powerful, affordable, and integrated into daily life. While not designed for individuals with disabilities, MSHT has the potential to serve as assistive technology to enhance their independence and participation. Objective: The study aims to describe a comprehensive MSHT-based intervention named ASSIST (Autonomy, Safety, and Social Integration via Smart Technologies) and evaluate its feasibility in enhancing the functional independence of individuals with complex physical disabilities. Methods: ASSIST is a time-limited intervention with a design based on the human activity assistive technology model, emphasizing client-centered goals and prioritizing individual needs. The intervention follows a structured assistive technology service delivery process that includes 2 assessment sessions to determine technology recommendations, installation and setup of the recommended technology, and up to 8 training sessions. An occupational therapist led the intervention, supported by a contractor and a technologist. Feasibility was evaluated through several measures: (1) the ASSIST Functional Performance Index, which quantifies the number of tasks transitioned from requiring assistance to independent completion and from higher levels of assistance or effort to lower levels; (2) pre- and postintervention measures of perceived task performance and satisfaction using a 10-point scale; (3) the number and types of tasks successfully addressed, along with the costs of devices and installation services; and (4) training effectiveness using the Goal Attainment Scale (GAS). Results: In total, 17 powered wheelchair users with complex physical disabilities completed the study with 100% session attendance. Across participants, 127 tasks were addressed, with 2 to 10 tasks at an average cost of US $3308 (SD US $1192) per participant. Of these tasks, 95 (74.8%) transitioned from requiring partial or complete assistance to independent completion, while 24 (18.9%) either improved from requiring complete to partial assistance or, if originally performed independently, required reduced effort. Only 8 (6.3%) tasks showed no changes. All training goals, except for 2, were achieved at or above the expected level, with a baseline average GAS score of 22.6 (SD 3.5) and a posttraining average GAS score of 77.2 (SD 4.5). Perceived task performance and satisfaction showed significant improvement, with performance score increasing from a baseline mean of 2.6 (SD 1.2) to 8.8 (SD 1.0; P<.001) and satisfaction score rising from an average of 2.9 (SD 1.3) to 9.0 (SD 0.9; P<.001). Conclusions: The ASSIST intervention demonstrated the immediate benefits of enhancing functional independence and satisfaction with MSHT among individuals with complex physical disabilities. While MSHT shows promise in addressing daily living needs at lower costs, barriers such as digital literacy, device setup, and caregiver involvement remain. Future work should focus on scalable models, caregiver engagement, and sustainable solutions for real-world implementation. %M 40272873 %R 10.2196/70855 %U https://rehab.jmir.org/2025/1/e70855 %U https://doi.org/10.2196/70855 %U http://www.ncbi.nlm.nih.gov/pubmed/40272873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59477 %T A Mobile Health App Informed by the Multi-Process Action Control Framework to Promote Physical Activity Among Inactive Adults: Iterative Usability Study %A Hollman,Heather %A Sui,Wuyou %A Zhang,Haowei %A Rhodes,Ryan E %+ Behavioural Medicine Lab, School of Exercise Science, Physical and Health Education, University of Victoria, 3800 Finnerty Rd, Room 173 McKinnon Building, Victoria, BC, V8P 5C2, Canada, 1 250 472 5288, heatherh@uvic.ca %K physical activity %K mobile apps %K mobile health %K mHealth %K usability study %K inactive adults %K smartphone %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps have high potential to address the widespread deficit in physical activity (PA); however, they have demonstrated greater impact on short-term PA compared to long-term PA. The multi-process action control (M-PAC) framework promotes sustained PA behavior by combining reflective (eg, attitudes) and regulatory (eg, planning and emotion regulation) constructs with reflexive (eg, habits and identity) constructs. Usability testing is important to determine the integrity of a mobile health app’s intrinsic properties and suggestions for improvement before feasibility and efficacy testing. Objective: This study aimed to gather usability feedback from end users on a first and a second version of an M-PAC app prototype. Methods: First, 3 workshops and focus groups, with 5 adult participants per group, were conducted to obtain first impressions of the M-PAC app interface and the first 3 lessons. The findings informed several modifications to the app program (eg, added cards with reduced content) and its interface (eg, created a link placeholder image and added a forgot password feature). Subsequently, a single-group pilot usability study was conducted with 14 adults who were not meeting 150 minutes per week of moderate-to-vigorous PA. They used the updated M-PAC app for 2 weeks, participated in semistructured interviews, and completed the Mobile App Usability Questionnaire (MAUQ) to provide usability and acceptability feedback. The focus groups and interviews were recorded, transcribed, and analyzed with content analysis informed by usability heuristics. The MAUQ scores were analyzed descriptively. Results: Participants from the workshops and focus groups (mean age 30.40, SD9.49 years) expressed overall satisfaction with the app layout and content. The language was deemed appropriate; however, some terms (eg, self-efficacy) and acronyms (eg, frequency, intensity, time, and type) needed definitions. Participants provided several recommendations for the visual design (eg, more cards with less text). They experienced challenges in accessing and using the help module and viewing some images, and were unsure how to create or reset the password. Findings from the usability pilot study (mean age 41.38, SD12.92 years; mean moderate-to-vigorous PA 66.07, SD57.92 min/week) revealed overall satisfaction with the app layout (13/13, 100%), content (10/13, 77%), and language (7/11, 64%). Suggestions included more enticing titles and additional and variable forms of content (eg, visual aids and videos). The app was easy to navigate (9/13, 69%); however, some errors were identified, such as PA monitoring connection problems, broken links, and difficulties entering and modifying data. The mean MAUQ total and subscale scores were as follows: total=5.06 (SD1.20), usefulness=4.17 (SD1.31), ease of use=5.36 (SD1.27), and interface and satisfaction=5.52 (SD1.42). Conclusions: Overall, the M-PAC app was deemed usable and acceptable. The findings will inform the development of the minimum viable product, which will undergo subsequent feasibility testing. %M 40267477 %R 10.2196/59477 %U https://formative.jmir.org/2025/1/e59477 %U https://doi.org/10.2196/59477 %U http://www.ncbi.nlm.nih.gov/pubmed/40267477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60854 %T Tailoring Rheumatoid Arthritis Visit Timing Based on mHealth App Data: Mixed Methods Assessment of Implementation and Usability %A Rudin,Robert S %A Santacroce,Leah M %A Ganguli,Ishani %A Solomon,Daniel H %K mobile health %K patient-reported outcomes %K visit timing %K visit frequency %K rheumatoid arthritis %K rheumatology %D 2025 %7 21.4.2025 %9 %J JMIR Form Res %G English %X Background: Visits to medical subspecialists are common, with follow-up timing often based on heuristics rather than evidence. Unnecessary visits contribute to long wait times for new patients. Specialists could enhance visit timing and reduce frequency by systematically monitoring patients’ symptoms between visits, especially for symptom-driven conditions like rheumatoid arthritis (RA). We previously designed an intervention using a mobile health (mHealth) app to collect patient-reported outcomes (PRO). One of several aims of the app was to assist rheumatologists in determining visit timing for patients with RA. The intervention did not reduce visit frequency. Objective: To explore possible reasons for the lack of association between the intervention and visit frequency, we describe app usage, assess usability, and identify barriers and facilitators for using between-visit PRO data to reduce visits when patients’ symptoms are stable. Methods: We analyzed patients’ use of the app by reporting adherence (percent of PRO questionnaires completed during the 12-month study) and retention (use in the last month of the study). To examine rheumatologists’ experiences, we summarized views of the electronic health record (EHR)–embedded PRO dashboard and EHR inbox messages suggesting early or deferred visits. We assessed app usability using the interactive mHealth App Usability Questionnaire for Ease of Use and Usefulness for patients and the System Usability Scale for rheumatologists. We assessed rheumatologist-level effects of intervention usage using Kruskal-Wallis rank sum and equality of proportion tests. We identified barriers and facilitators through interviews and surveys. Results: The analysis included 150 patients with RA and their 11 rheumatologists. Patients answered a median of 53.3% (IQR 34.1%-69.2%) of PRO questionnaires; this proportion varied by rheumatologist (range 40.7%‐67%). Over half of the patients used the app during the final month of the study (56%, range 51%‐65%, by rheumatologists); the median number of months of use was 12 (IQR 9-12). Rheumatologists viewed the dashboard 78 times (17.6% of 443 visits) with significant differences in viewing rates by rheumatologist (range 10%‐66%; P<.01). There were 108 generated messages sent to rheumatologists suggesting a deferred visit (24.4% of 443 visits) with significant differences in message counts received per visit by rheumatologist (range 10.8%‐22.6%; P=.03). Rheumatologists’ reported barriers to offering visit deferrals included already scheduling as far out as they were comfortable and rescheduling complexities for staff. Based on 39 patient interviews and 44 surveys, patients reported 2 main barriers to app usage: questionnaire frequency not being tailored to them and reduced motivation after not discussing PRO data with their rheumatologist. A total of 5 interviewed patients received the option to defer their visits, of which 3 elected to defer the appointment and 2 chose to keep it. Conclusions: While an mHealth app for reporting RA PROs was used frequently by patients, using these data to reduce the frequency of unneeded visits was not straightforward. Better engagement of clinicians may improve the use of PRO data. %R 10.2196/60854 %U https://formative.jmir.org/2025/1/e60854 %U https://doi.org/10.2196/60854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67855 %T Compatibility of the CEN-ISO/TS 82304-2 Health App Assessment Framework With Catalan and Italian Health Authorities’ Needs: Qualitative Interview Study %A Hoogendoorn,Petra %A Shokralla,Mariam %A Willemsen,Romy %A Guldemond,Nick %A Villalobos-Quesada,María %+ National eHealth Living Lab, Public Health and Primary Care Department, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands, 31 654341785, a.p.y.hoogendoorn@lumc.nl %K assessment frameworks %K mobile health %K mHealth %K health apps %K wellness apps %K digital transformation %K Italy %K Catalonia %K diffusion of innovations %K value proposition canvas %D 2025 %7 21.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Health authorities of European Union (EU) member states are increasingly working to integrate quality health apps into their health care systems. Given the current lack of unified EU assessment criteria, the European Commission initiated Technical Specification (TS) CEN-ISO 82304-2:2021—Health and wellness apps—Quality and reliability (hereinafter the “TS”) to address the scattered EU landscape of assessment frameworks (AFs) for health apps. The adoption of an AF, such as the TS, falls within member state competence and is considered an uncertainty-reduction process. Evaluations by peers as well as ensuring the compatibility of the TS with the needs of health authorities can reduce uncertainty and mediate harmonization. Objective: This study aims to examine the compatibility of the TS with the needs of Catalan and Italian health authorities. Methods: Semistructured interviews were conducted with key informants from a regional (Catalonia in Spain) and national (Italy) health authority, and a thematic analysis was carried out. Main themes were established deductively, following the aspects defined by the value proposition canvas: (1) health authorities’ needs (“gains,” “pains,” and “jobs”) and (2) the TS “products and services” and their distinct characteristics (“gain creators” and “pain relievers”). Subthemes were generated inductively. The compatibility of the needs with the TS was theoretically determined by the researchers. The results were visualized using the value proposition canvas. Two participant validation steps confirmed that the most relevant aspects of the predefined themes had been captured. Results: Despite the diversity of the 2 health authorities, subthemes were common and categorized into 9 gains, 9 pains, and 11 jobs. Key findings include the health authorities’ perceived value of, and need for, integrating quality health apps and using an AF (gains), along with the related policy, implementation, and operational activities (jobs). The lack of enabling EU legislation and standardization, resulting in a need for the multiple authorities involved to consent, made achieving an AF challenging (pains). Nine products and services related to the TS and 17 distinct characteristics (eg, its multistakeholder evidence base) were found to be compatible with 3 gains (eg, stimulating the prescription and use of apps), 7 pains (eg, legislation and harmonization issues), and 6 jobs (eg, assessing apps). Indirect effects, 3 anticipated future services, and 1 anticipated gain creator and pain reliever increase this compatibility. Conclusions: Our results suggest that the health authorities share common fundamental needs, and that the TS is compatible with these needs. The identified needs and compatibility can potentially reduce peer authorities’ uncertainties in adopting an AF in general and the TS in particular. More research is recommended to confirm and translate our results in other contexts and further fine-tune compatibility to achieve wide adoption of the TS and accelerate the uptake of health apps. %M 40258272 %R 10.2196/67855 %U https://formative.jmir.org/2025/1/e67855 %U https://doi.org/10.2196/67855 %U http://www.ncbi.nlm.nih.gov/pubmed/40258272 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58095 %T Digital Health Intervention for Patient Monitoring in Immune-Mediated Inflammatory Diseases: Cocreation and Feasibility Study of the IMIDoc Platform %A Benavent,Diego %A Iniesta-Chamorro,Jose M %A Novella-Navarro,Marta %A Pérez-Martínez,Miguel %A Martínez-Sánchez,Nuria %A Kaffati,Mónica %A Juárez-García,Manuel %A Molinari-Pérez,Marina %A González-Torbay,Andrea %A Gutiérrez,Mariana %A López-Juanes,Natalia %A Navarro-Compán,Victoria %A Monjo-Henry,Irene %A Rodríguez-Rosales,Germán %A Bachiller,Javier %A Calvo-Aranda,Enrique %A Michelena,Xabier %A Berbel-Arcobé,Laura %A Balsa,Alejandro %A , %A Gómez,Enrique J %A Plasencia-Rodríguez,Chamaida %K immune-mediated inflammatory diseases %K cocreation %K health care provider %K digital health solution %K inflammatory %K inflammatory disease %K monitoring %K care model %K patient care %K development %K app %K user centered %K patient monitoring %K decision-making %K user needs %D 2025 %7 21.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Immune-mediated inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis, pose challenges due to recurrent flares and gaps in patient monitoring. Traditional health care models often fail to capture disease progression effectively. Objective: This study aimed to describes the structured cocreation of the IMIDoc platform, an interdisciplinary initiative aimed at improving patient monitoring, education, and health care provider decision-making. Methods: IMIDoc was cocreated through an interdisciplinary team involving clinical experts, biomedical engineers, and technical developers, using user-centered design principles. The development process included the identification of unmet clinical needs, user-centered app design, implementation of medication management features, patient data recording capabilities, and educational content. A 3-month feasibility and functionality testing was performed to evaluate the usability and technical performance of the apption. Results: During the feasibility testing, 111 entries were logged for the patient mobile app, comprising 76 errors identified and corrected, 16 improvements addressing functionality, usability, and performance, and 10 evolutionary suggestions. The professional interface received 45 entries, identifying 40 errors and 5 evolutionary suggestions. Ten iterative updates significantly enhanced the user interface intuitiveness and medication reminder functionality, aligning the solution closely with clinical workflows and user needs. Conclusions: The IMIDoc platform, developed by a multidisciplinary cocreation methodology, shows potential to improve the management of immune-mediated inflammatory diseases ithrough enhanced communication and monitoring. A multicenter clinical study with 360 patients across 5 Spanish hospitals will further evaluate its impact. Trial Registration: ClinicalTrials.gov NCT06273306; https://tinyurl.com/4t6ubcsf %R 10.2196/58095 %U https://humanfactors.jmir.org/2025/1/e58095 %U https://doi.org/10.2196/58095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68891 %T Designing Health Care Provider–Centered Emergency Department Interventions: Participatory Design Study %A Seo,Woosuk %A Li,Jiaqi %A Zhang,Zhan %A Zheng,Chuxuan %A Singh,Hardeep %A Pasupathy,Kalyan %A Mahajan,Prashant %A Park,Sun Young %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48104, United States, 1 2063109264, seow@umich.edu %K emergency departments %K participatory design %K health care providers %K technology %K interventions %K artificial intelligence %D 2025 %7 21.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: In the emergency department (ED), health care providers face extraordinary pressures in delivering accurate diagnoses and care, often working with fragmented or inaccessible patient histories while managing severe time constraints and constant interruptions. These challenges and pressures may lead to potential errors in the ED diagnostic process and risks to patient safety. With advances in technology, interventions have been developed to support ED providers in such pressured settings. However, these interventions may not align with the current practices of ED providers. To better design ED provider–centered interventions, identifying their needs in the diagnostic process is critical. Objective: This study aimed to identify ED providers’ needs in the diagnostic process through participatory design sessions and to propose design guidelines for provider‑centered technological interventions that support decision‑making and reduce errors. Methods: We conducted a participatory design study with ED providers to validate their needs and identify considerations for designing ED provider–centered interventions to improve diagnostic safety. We used 9 technological intervention ideas as storyboards to address the study participants’ needs. We had participants discuss the use cases of each intervention idea to assess their needs during the ED care process and facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. In total, we conducted 6 design sessions with 17 ED frontline providers. Results: Through design sessions with ED providers, we identified 4 key needs in the diagnostic process: information integration, patient prioritization, ED provider-patient communication, and care coordination. We interpreted them as insights for designing technological interventions for ED patients. Hence, we discussed the design implications for technological interventions in four key areas: (1) enhancing ED provider–ED provider communication, (2) enhancing ED provider-patient communication, (3) optimizing the integration of advanced technology, and (4) unleashing the potential of artificial intelligence tools in the ED to improve diagnosis. This work offers evidence-based technology design suggestions for improving diagnostic processes. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED providers into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions that meet ED providers’ needs in the diagnostic process. International Registered Report Identifier (IRRID): RR2-10.2196/55357 %M 40258269 %R 10.2196/68891 %U https://formative.jmir.org/2025/1/e68891 %U https://doi.org/10.2196/68891 %U http://www.ncbi.nlm.nih.gov/pubmed/40258269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66791 %T User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study %A Ristow,Nele %A Wilke,Annika %A Skudlik,Christoph %A John,Swen Malte %A Ludewig,Michaela %+ Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, Osnabrück University, Am Finkenhügel 7a, Osnabrück, 49076, Germany, 49 541 969 7410, neristow@uos.de %K user experience %K mobile health %K mHealth %K app %K smartphone %K complex intervention %K Template for Intervention Description and Replication %K behavior change techniques %K behavior change %K skin diseases %K occupational dermatology %K artificial intelligence %D 2025 %7 18.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone apps are a growing field supporting the prevention of chronic diseases. The user experience (UX) is an important predictor of app use and should be considered in mobile health research. Long-term skin protection behavior is important for those with work-related skin diseases. However, altering health behavior is complex and requires a high level of self-management. We developed a maintenance program consisting of the Mein Hautschutz im Alltag (MiA; “My skin protection in everyday life”) app combined with an individual face-to-face goal-setting interview to support patients in the implementation of skin protection behavior after inpatient rehabilitation. Objective: The objectives of this paper are to (1) describe the intervention in a standardized manner; (2) evaluate the UX, subjective quality, and perceived impact of the MiA app; and (3) evaluate the adherence to the MiA app. Methods: We followed a user-centered and multistage iterative process in 2 steps that combined qualitative and quantitative data. The maintenance program was tested over 12 weeks after discharge from rehabilitation. The UX, subjective quality, and perceived impact were evaluated formatively based on the user version of the Mobile Application Rating Scale after 12 weeks (T2). Adherence was measured using the frequency of interactions with the app. Results: In total, 42 patients took part (with a dropout rate of n=18, 43% at T2). The average age was 49.5 (SD 13.1) years, and 57% (24/42) were male. We found high ratings for the UX, with an average score of 80.18 (SD 8.94) out of a theoretical maximum of 100, but there were a few exceptions in the usability and interaction with the app. The app was most frequently rated with 4 out of 5 stars (15/24, 65%), which indicates a high subjective quality. Furthermore, the app seemed to influence important determinants to implement skin protection behavior. Adherence to skin protection tracking was higher over the study period than adherence to skin documentation and goal assessment. The number of adherent participants to skin protection tracking was higher in the skin care and skin cleansing categories (28/42, 67% each) compared to the skin protection category (13/42, 31%) on day 1 and decreased until day 84 in all dimensions (12/42, 29% each for skin care and skin cleansing; 9/42, 21% for skin protection). Conclusions: The results in terms of adherence met the expectations and were consistent with those of other studies evaluating the use of apps for chronic diseases. Interaction with the app could be increased using artificial intelligence to determine eczema severity via photos. It should be investigated which subgroups have difficulties with usability to individualize the support to a greater degree during onboarding. There is a need for further research regarding the effectiveness of the MiA app on skin protection behavior, quality of life, and eczema severity. %M 40249942 %R 10.2196/66791 %U https://formative.jmir.org/2025/1/e66791 %U https://doi.org/10.2196/66791 %U http://www.ncbi.nlm.nih.gov/pubmed/40249942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65670 %T Development of a GPT-4–Powered Virtual Simulated Patient and Communication Training Platform for Medical Students to Practice Discussing Abnormal Mammogram Results With Patients: Multiphase Study %A Weisman,Dan %A Sugarman,Alanna %A Huang,Yue Ming %A Gelberg,Lillian %A Ganz,Patricia A %A Comulada,Warren Scott %+ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, 37-384C, Los Angeles, CA, 90095, United States, 1 3107948278, wcomulada@mednet.ucla.edu %K standardized patient %K virtual simulated patient %K artificial intelligence %K AI %K large language model %K LLM %K GPT-4 %K agent %K communication skills training %K abnormal mammography results %K biopsy %D 2025 %7 17.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Standardized patients (SPs) prepare medical students for difficult conversations with patients. Despite their value, SP-based simulation training is constrained by available resources and competing clinical demands. Researchers are turning to artificial intelligence and large language models, such as generative pretrained transformers, to create communication training that incorporates virtual simulated patients (VSPs). GPT-4 is a large language model advance allowing developers to design virtual simulation scenarios using text-based prompts instead of relying on branching path simulations with prescripted dialogue. These nascent developmental practices have not taken root in the literature to guide other researchers in developing their own simulations. Objective: This study aims to describe our developmental process and lessons learned for creating a GPT-4–driven VSP. We designed the VSP to help medical student learners rehearse discussing abnormal mammography results with a patient as a primary care physician (PCP). We aimed to assess GPT-4’s ability to generate appropriate VSP responses to learners during spoken conversations and provide appropriate feedback on learner performance. Methods: A research team comprised of physicians, a medical student, an educator, an SP program director, a learning experience designer, and a health care researcher conducted the study. A formative phase with in-depth knowledge user interviews informed development, followed by a development phase to create the virtual training module. The team conducted interviews with 5 medical students, 5 PCPs, and 5 breast cancer survivors. They then developed a VSP using simulation authoring software and provided the GPT-4–enabled VSP with an initial prompt consisting of a scenario description, emotional state, and expectations for learner dialogue. It was iteratively refined through an agile design process involving repeated cycles of testing, documenting issues, and revising the prompt. As an exploratory feature, the simulation used GPT-4 to provide written feedback to learners about their performance communicating with the VSP and their adherence to guidelines for difficult conversations. Results: In-depth interviews helped establish the appropriate timing, mode of communication, and protocol for conversations between PCPs and patients during the breast cancer screening process. The scenario simulated a telephone call between a physician and patient to discuss the abnormal results of a diagnostic mammogram that that indicated a need for a biopsy. Preliminary testing was promising. The VSP asked sensible questions about their mammography results and responded to learner inquiries using a voice replete with appropriate emotional inflections. GPT-4 generated performance feedback that successfully identified strengths and areas for improvement using relevant quotes from the learner-VSP conversation, but it occasionally misidentified learner adherence to communication protocols. Conclusions: GPT-4 streamlined development and facilitated more dynamic, humanlike interactions between learners and the VSP compared to branching path simulations. For the next steps, we will pilot-test the VSP with medical students to evaluate its feasibility and acceptability. %M 40246299 %R 10.2196/65670 %U https://formative.jmir.org/2025/1/e65670 %U https://doi.org/10.2196/65670 %U http://www.ncbi.nlm.nih.gov/pubmed/40246299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65185 %T Creating a Usable and Effective Digital Intervention to Support Men to Test for HIV and Link to Care in A Resource-Constrained Setting: Iterative Design Based on A Person-Based Approach and Human Computer Interaction Methods %A Zeitlin,Anya %A Mathenjwa,Thulile %A Zuma,Thembelihle %A Wyke,Sally %A Matthews,Philippa %A McGrath,Nuala %A Seeley,Janet %A Shahmanesh,Maryam %A Blandford,Ann %+ , Africa Health Research Institute, Krith Building, 3rd floor, 719 Umbilo Rd, Durban, 4001, South Africa, 27 315210455, thulile.mathenjwa@ahri.org %K person-based approach %K HIV %K resource-constrained settings %K digital intervention %K user-centered design %K behavior change techniques %K digital health %D 2025 %7 17.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: It is challenging to design usable and effective digital health interventions (DHIs). The person-based approach (PBA) has been proposed to incorporate users’ perspectives for the design of DHIs. However, it does not explicitly describe the iterative stages of design and evaluation that are essential in moving from early planning to deployment. For this, we draw on methods from human computer interaction (HCI) that have been developed for various situations. Objective: This study aimed to reflect on the adaptation and synthesis of PBA and HCI approaches to developing DHIs. We present a case study applying both approaches to develop Empowering People through Informed Choices for HIV (EPIC-HIV1), a DHI designed for men living in rural KwaZulu-Natal, South Africa, intended to support them in making an informed choice about whether to take an HIV test and, if necessary, engage in care. Methods: We conducted a retrospective analysis of the documentation generated during the development of EPIC-HIV1 including findings about requirements, design representations, and the results of iterative rounds of testing. We developed an account of the process, the outcomes, and the strengths and limitations of the design and evaluation techniques applied. We also present the design of EPIC-HIV1 and summarize considerations when designing for hard-to-reach people in such settings. Results: The PBA was applied to deliver a first prototype. This helped identify key messages to convey and how to manage issues such as user privacy, but the resulting prototype was judged by the team not to be engaging for potential users, and it was unclear whether the design was inclusive of people with low digital or health literacy. We therefore introduced methods from HCI to iteratively test and refine the app. Working with local community representatives, we conducted four refinement cycles with 29 participants, adapting and retesting the app until no further changes were needed. Key changes included making it clearer what the consequences of selecting options in the app were and changing wording to minimize misconceptions (eg, that the app would test for HIV) while addressing common concerns about testing and emphasizing long-term benefits of engaging with care, if needed. Conclusions: Techniques for developing DHIs need to be situationally appropriate. The PBA enabled us to establish both empirical data and theory to design the content of EPIC-HIV1, but it did not directly inform interaction design to make the app usable and effective for the intended users; HCI techniques tailored to the setting enabled us to refine the app to be easy for men with little familiarity with digital technologies to use within the constraints of the setting. Iterative testing ensured the app was easy to use and that the intended clinical messages were communicated effectively. %M 40244652 %R 10.2196/65185 %U https://formative.jmir.org/2025/1/e65185 %U https://doi.org/10.2196/65185 %U http://www.ncbi.nlm.nih.gov/pubmed/40244652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65986 %T Developing an Online Community Advisory Board (CAB) of Parents From Social Media to Co-Design an Human Papillomavirus Vaccine Intervention: Participatory Research Study %A Murray,Regan M %A Chiang,Shawn C %A Klassen,Ann C %A Manganello,Jennifer A %A Leader,Amy E %A Lo,Wen-Juo %A Massey,Philip M %K online community advisory boards %K community engagement %K social media %K digital health %K digital health intervention %K HPV vaccine %K human papillomavirus %K HPV %K parent health %K child health %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media. Objective: This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions. Methods: In May 2020, Twitter was used to recruit parents of children aged 9‐14 years, who were active users of the platform and were interested in serving on a CAB focused on child health and online programs. The recruitment campaign included Twitter (rebranded as X in 2023) advertising tools (eg, “interests” and “audience look-a-likes”). A total of 17 parents completed a screening survey and 6 completed a follow-up phone interview. Following phone interviews, 6 parents were invited to join the CAB, where they committed to a 1-year involvement. The CAB participated in eleven 1-hour online meetings in the first year, contributing to monthly feedback through participatory workbooks. Long-term engagement was sustained through icebreakers and casual online interactions, as well as providing real-time updates to demonstrate CAB feedback integration. An anonymous midterm evaluation was conducted at the end of the project’s first year to assess processes and identify future growth opportunities. Results: A total of 6 parents (5 females and 1 male) with children aged 9-14 years from diverse racial and ethnic backgrounds (African American, South Asian American, and White) across 6 states in the United States, representing urban, suburban, and rural areas, agreed to serve as CAB members. All 6 CAB members committed to 1 year of service beginning in July 2020 with 4 extending their participation into a second year (August 2021-August 2022). The CAB provided expert insights and feedback to co-develop the intervention, including character development, narrative content creation, study recruitment, survey development, and intervention delivery. The midterm evaluation showed 100% (6/6) satisfaction among CAB members, who valued the connections with other parents and their contribution to research. While all members felt confident discussing HPV, 83% (5/6) suggested diversifying the group and increasing informal bonding to enhance engagement and inclusivity, especially for differing vaccination views. Conclusions: This study demonstrates that online CABs are a highly effective model for co-creating and informing online health communication interventions. The engagement of parents from diverse backgrounds and the structured use of online tools (eg, interactive workbooks) creates a constructive and thoughtful environment for incorporating parent contributions to research. This study highlights guiding principles to forming, engaging, and maintaining an online CAB to enhance health research and practice. %R 10.2196/65986 %U https://formative.jmir.org/2025/1/e65986 %U https://doi.org/10.2196/65986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67835 %T Machine Learning Approach to Identifying Empathy Using the Vocals of Mental Health Helpline Counselors: Algorithm Development and Validation %A Sanjeewa,Ruvini %A Iyer,Ravi %A Apputhurai,Pragalathan %A Wickramasinghe,Nilmini %A Meyer,Denny %K vocal features %K voice characteristics %K empathy %K mental health care %K crisis helpline service %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: This research study aimed to detect the vocal features immersed in empathic counselor speech using samples of calls to a mental health helpline service. Objective: This study aimed to produce an algorithm for the identification of empathy from these features, which could act as a training guide for counselors and conversational agents who need to transmit empathy in their vocals. Methods: Two annotators with a psychology background and English heritage provided empathy ratings for 57 calls involving female counselors, as well as multiple short call segments within each of these calls. These ratings were found to be well-correlated between the 2 raters in a sample of 6 common calls. Using vocal feature extraction from call segments and statistical variable selection methods, such as L1 penalized LASSO (Least Absolute Shrinkage and Selection Operator) and forward selection, a total of 14 significant vocal features were associated with empathic speech. Generalized additive mixed models (GAMM), binary logistics regression with splines, and random forest models were used to obtain an algorithm that differentiated between high- and low-empathy call segments. Results: The binary logistics regression model reported higher predictive accuracies of empathy (area under the curve [AUC]=0.617, 95% CI 0.613‐0.622) compared to the GAMM (AUC=0.605, 95% CI 0.601‐0.609) and the random forest model (AUC=0.600, 95% CI 0.595‐0.604). This difference was statistically significant, as evidenced by the nonoverlapping 95% CIs obtained for AUC. The DeLong test further validated these results, showing a significant difference in the binary logistic model compared to the random forest (D=6.443, df=186283, P<.001) and GAMM (Z=5.846, P<.001). These findings confirm that the binary logistic regression model outperforms the other 2 models concerning predictive accuracy for empathy classification. Conclusions: This study suggests that the identification of empathy from vocal features alone is challenging, and further research involving multimodal models (eg, models incorporating facial expression, words used, and vocal features) are encouraged for detecting empathy in the future. This study has several limitations, including a relatively small sample of calls and only 2 empathy raters. Future research should focus on accommodating multiple raters with varied backgrounds to explore these effects on perceptions of empathy. Additionally, considering counselor vocals from larger, more heterogeneous populations, including mixed-gender samples, will allow an exploration of the factors influencing the level of empathy projected in counselor voices more generally. %R 10.2196/67835 %U https://formative.jmir.org/2025/1/e67835 %U https://doi.org/10.2196/67835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65555 %T Acoustic and Natural Language Markers for Bipolar Disorder: A Pilot, mHealth Cross-Sectional Study %A Crocamo,Cristina %A Cioni,Riccardo Matteo %A Canestro,Aurelia %A Nasti,Christian %A Palpella,Dario %A Piacenti,Susanna %A Bartoccetti,Alessandra %A Re,Martina %A Simonetti,Valentina %A Barattieri di San Pietro,Chiara %A Bulgheroni,Maria %A Bartoli,Francesco %A Carrà,Giuseppe %K digital mental health %K remote assessment %K mHealth %K speech %K NLP %K natural language processing %K acoustic %K symptom severity %K machine learning %K markers %K mental health %K bipolar disorders %K app %K applications %K multimodal %K mobile health %K voice %K vocal %K bipolar %K verbal %K emotion %K emotional %K psychiatry %K psychiatric %K mental illness %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Monitoring symptoms of bipolar disorder (BD) is a challenge faced by mental health services. Speech patterns are crucial in assessing the current experiences, emotions, and thought patterns of people with BD. Natural language processing (NLP) and acoustic signal processing may support ongoing BD assessment within a mobile health (mHealth) framework. Objective: Using both acoustic and NLP-based features from the speech of people with BD, we built an app-based tool and tested its feasibility and performance to remotely assess the individual clinical status. Methods: We carried out a pilot, observational study, sampling adults diagnosed with BD from the caseload of the Nord Milano Mental Health Trust (Italy) to explore the relationship between selected speech features and symptom severity and to test their potential to remotely assess mental health status. Symptom severity assessment was based on clinician ratings, using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) for manic and depressive symptoms, respectively. Leveraging a digital health tool embedded in a mobile app, which records and processes speech, participants self-administered verbal performance tasks. Both NLP-based and acoustic features were extracted, testing associations with mood states and exploiting machine learning approaches based on random forest models. Results: We included 32 subjects (mean [SD] age 49.6 [14.3] years; 50% [16/32] females) with a MADRS median (IQR) score of 13 (21) and a YMRS median (IQR) score of 5 (16). Participants freely managed the digital environment of the app, without perceiving it as intrusive and reporting an acceptable system usability level (average score 73.5, SD 19.7). Small-to-moderate correlations between speech features and symptom severity were uncovered, with sex-based differences in predictive capability. Higher latency time (ρ=0.152), increased silences (ρ=0.416), and vocal perturbations correlated with depressive symptomatology. Pressure of speech based on the mean intraword time (ρ=–0.343) and lower voice instability based on jitter-related parameters (ρ ranging from –0.19 to –0.27) were detected for manic symptoms. However, a higher contribution of NLP-based and conversational features, rather than acoustic features, was uncovered, especially for predictive models for depressive symptom severity (NLP-based: R2=0.25, mean squared error [MSE]=110.07, mean absolute error [MAE]=8.17; acoustics: R2=0.11, MSE=133.75, MAE=8.86; combined: R2=0.16; MSE=118.53, MAE=8.68). Conclusions: Remotely collected speech patterns, including both linguistic and acoustic features, are associated with symptom severity levels and may help differentiate clinical conditions in individuals with BD during their mood state assessments. In the future, multimodal, smartphone-integrated digital ecological momentary assessments could serve as a powerful tool for clinical purposes, remotely complementing standard, in-person mental health evaluations. %R 10.2196/65555 %U https://formative.jmir.org/2025/1/e65555 %U https://doi.org/10.2196/65555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67885 %T Using the Healthy Native Youth Implementation Toolbox to Provide Web-Based Adolescent Health Promotion Decision Support to American Indian and Alaska Native Communities: Implementation Study %A Sidhu,Amrita %A Shegog,Ross %A Craig-Rushing,Stephanie %A Trevino,Nicole %A Singer,Michelle %A Jessen,Cornelia %A Gorman,Gwenda %A Simpson,Sean %A Peskin,Melissa %A Hernandez,Belinda %A Markham,Christine %K implementation %K culturally relevant program %K evidence-based health promotion %K user engagement %K reach %K decision support system %K American Indian %K Alaska %K native communities %K youth %K adolescent %K decision support %K Alaska native %K health inequities %K sexual %K reproductive %K mental health %K AI/AN %K Tribal organization %K Google Analytics %K toolbox %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities. Objective: This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY Implementation Toolbox), designed to increase the implementation of evidence-based adolescent health promotion programming in AI/AN communities. Methods: Promotional strategies were designed for optimal geographic reach to Tribal organizations, opinion leaders, federal decision makers, and funders. Promotional channels included grassroots, community, and professional networks. We used Google Analytics to examine the uptake of the HNY website and HNY Implementation Toolbox from January 2022 to January 2024. The Toolbox provides culturally relevant tools and templates to help users navigate through 5 phases of program adoption and implementation: Gather, Choose, Prepare, Implement, and Grow. User reach was estimated by demographic characteristics and geographic location; user engagement was estimated by visit frequency and duration, bounce rates, and frequency of page and tool access. Results: Over the study period, page views of the HNY website and HNY Toolbox increased 10-fold and 27-fold, respectively. Over the 2-year evaluation period since the Toolbox “go live” date, approximately 1 in 8 users of the HNY website visited the Toolbox. The majority of HNY website users were located in Washington (n=1515), California (n=1290), and Oregon (n=1019) and were aged between 18 and 24 (n=1559, 21.7%) and 25‐34 (n=1676, 23.29%) years. Toolbox users were primarily located in California (n=1238), Washington (n=1142), and Oregon (n=986), mostly aged between 35 and 44 years (n=444, 35%). Both website and Toolbox users were primarily female, who accessed the site and Toolbox via desktop computers. The most frequently accessed phase pages within the Implementation Toolbox were Gather, Choose, Implement, and Prepare, as supported by bounce rates and average time on page. The most viewed phase was the “Gather” phase, with 3278 views. The most frequently downloaded tools within the Toolbox were Gather: Community Needs and Resource Assessment, with 136 downloads. The phases and tools accessed may have differed based on the user’s goal or stage of implementation. Conclusions: Findings indicate positive initial reach and engagement of the HNY website and HNY Implementation Toolbox among AI/AN educators that has consistently increased over the 2 years. The provision of web-based decision support that guides AI/AN users through the adoption, implementation, and maintenance of culturally relevant, age-appropriate, evidence-based adolescent health promotion programs in their communities may help increase the implementation of effective adolescent health promotion programs to ultimately increase health equity among AI/AN youth. %R 10.2196/67885 %U https://formative.jmir.org/2025/1/e67885 %U https://doi.org/10.2196/67885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56586 %T A Digital Photo Activity Intervention for Nursing Home Residents With Dementia and Their Carers: Mixed Methods Process Evaluation %A Tan,Josephine Rose Orejana %A Neal,David P %A Vilmen,Maria %A Boersma,Petra %A Ettema,Teake P %A Gobbens,Robbert J J %A Sikkes,Sietske A M %A Dröes,Rose-Marie %+ Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Oldenaller 1, Amsterdam, 1081 HJ, The Netherlands, 31 3316459170, j.r.tan@amsterdamumc.nl %K dementia %K psychosocial interventions %K nursing home %K process evaluation %K social interaction %K photos %K art %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Within the framework of a randomized controlled trial investigating the impact of a digital, psychosocial photo activity intervention for residents living with dementia in nursing homes and their informal and formal carers, a process evaluation was conducted to determine factors that affected the implementation of the intervention and potentially influenced the intervention outcomes. Objective: By tracing facilitators and barriers to implementation, the study also aimed to inform future implementation of the photo activity intervention. Methods: Following Medical Research Council guidance, mixed methods were used to investigate context, implementation, and mechanism-of-impact factors during the photo activity intervention via the Fotoscope web application versus a general conversation activity (control). Google Analytics was set up to gain insight into how the Fotoscope web application was used in practice. For quantitative data, descriptive statistics were calculated and differences between groups tested. For qualitative data, thematic analysis was performed. Results: In total, 163 semistructured interviews were conducted with residents (photo activity group: n=29, 17.8%; control: n=29, 17.8%), formal carers (photo activity group: n=23, 14.1%; control: n=27, 16.6%), and informal carers (photo activity group: n=28, 17.2%; control: n=27, 16.6%). Regarding contextual factors, a minority of formal carers in both groups (photo activity group: 4/18, 22%; control: 9/24, 38%) mentioned time and workload as barriers to implementing the intervention. Regarding implementation, 86% (25/29) of the residents in the intervention group felt that the digital photo activity worked well on a tablet. Informal carers from both groups wanted more intervention updates from formal carers. The majority of formal carers from both groups were satisfied with how the training and activities were implemented. Regarding the mechanisms of impact, residents in the photo activity group (27/29, 93%) felt significantly more positive about the conversations with their carer (U=533.0, z=2.865, r=0.39; P=.004). Formal carers in the photo activity group (20/23, 87%) got to know the resident better (U=390.5, z=2.114, r=0.302; P=.04) compared to the formal carers in the control group (21/27, 78%). Formal carers in the photo activity group (23/50, 46%) gave a significantly higher rating to the digital photo activity as a way of getting to know the resident living with dementia better (median 9.00, IQR 7-9; U=419.0, z=2.169, r=0.307; P=.03) compared to formal carers in the control group (27/50, 54%; median 8.00, IQR 6-8). Finally, the majority of formal carers in the photo activity group (14/18, 78%) agreed that the Fotoscope app can be used as part of care activities in the nursing home. Conclusions: The work invested by formal carers in implementing the photo activity did not seem to differ greatly compared to implementing a general conversation activity, suggesting that the digital photo activity, as an easy-to-implement and enjoyable intervention, could be widely implemented and disseminated in nursing homes. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s12877-021-02632-w %M 40239200 %R 10.2196/56586 %U https://formative.jmir.org/2025/1/e56586 %U https://doi.org/10.2196/56586 %U http://www.ncbi.nlm.nih.gov/pubmed/40239200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69242 %T Evaluation of a Curriculum-Based Nutrition Education Intervention Protocol in Elementary Schools: Nonrandomized Feasibility Study %A Brown,Jacqueline Marie %A Rita,Nicholas %A Franco-Arellano,Beatriz %A LeSage,Ann %A Arcand,Joanne %K nutrition education %K serious games %K children %K food literacy %K school nutrition intervention %K feasibility %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Improving children’s food literacy through school-based interventions can support developing healthy eating habits. However, teachers lack appropriate resources, time, and training to provide nutrition education in schools. Serious games, which are games designed for a purpose other than entertainment, have been demonstrated to improve children’s food literacy and dietary intake and can address the barriers teachers face in providing nutrition education. Foodbot Factory (Arcand Lab) is a nutrition education intervention that is aligned with curricula and uses a serious game to provide nutrition education to students. Further evidence is needed to understand how serious games, including Foodbot Factory, can be researched in schools to support nutrition education. Objective: The objective of this study was to evaluate the feasibility of a research study protocol that implements the curriculum-based nutrition education intervention Foodbot Factory into a real-world classroom setting. The evaluation of the protocol included study processes, resources, and management feasibility outcomes, as well as a preliminary assessment of scientific outcomes relevant to the intervention. Methods: A nonrandomized study determined the feasibility of intervention implementation. Grade 4 and 4/5 classrooms were assigned to have nutrition education lessons for 5 days with either the Foodbot Factory or a control intervention. Outcomes were assessed in 4 feasibility domains of study processes (eg, recruitment and attrition rates), resources (eg, time taken to deliver the intervention), and management (eg, challenges with intervention delivery), and a preliminary assessment of scientific outcomes pertaining to the acceptability and impacts of the interventions. These outcomes were captured in semistructured field notes completed by study staff and a Nutrition Attitudes and Knowledge questionnaire and acceptability questionnaire completed by participants. Data were analyzed descriptively and using a paired t test to assess within-group changes in nutrition knowledge. Results: In total, 4 classrooms participated in the feasibility study, with varying recruitment rates for schools (3/20, 15%), classrooms (4/4, 100%), parents (54/102, 53%), and children (49/54, 91%). The time required to implement the research protocol, including data collection and lesson plans, was sufficient and management of the intervention implementation was overall successful. Some challenges were experienced with classroom management during data collection, specifically with electronic data collection. After the intervention, participants reported a positive affective experience (26/41, 63%) and learning something new about healthy eating (31/41, 76%). Participants in both study groups improved their nutrition knowledge, but the changes were not statistically significant. The Foodbot Factory group had a statistically significant improvement in their knowledge of vegetables and fruit (P=.04) and protein foods (P=.03). Conclusions: These findings indicate that the study protocol is feasible to implement and evaluate Foodbot Factory in a representative sample with select modifications to improve recruitment and data collection procedures. %R 10.2196/69242 %U https://formative.jmir.org/2025/1/e69242 %U https://doi.org/10.2196/69242 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67637 %T Evaluating the Acceptability of a Brief Web-Based Alcohol Misuse Prevention Program Among US Military Cadets: Mixed Methods Formative Evaluation %A Schmied,Emily %A Hurtado,Lauren %A Robinson,W Ken %A Simon-Arndt,Cynthia M %A Moyer III,Richard %A Wilson,Leslie %A Reed,Mark %A Blakey,Shannon M %A Kan,Marni %K alcohol misuse prevention %K digital interventions %K formative research %K military health %K acceptability %K alcohol prevention %K US military %K military %K United States %K formative evaluation %K alcohol use %K evidence-based prevention %K alcohol intervention %K mixed methods study %K survey %K alcohol use disorder %K alcohol misuse %K heavy drinker %K educational web-based intervention %K web-based intervention %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: As alcohol misuse remains pervasive within the military, evidence-based prevention programs that are feasible to implement and appropriately tailored to meet the needs and norms of military personnel are critically needed. Further, programs that target future military leaders, such as trainees, recruits, and cadets, may be especially impactful. eCHECKUP TO GO is a web-based, evidence-based brief alcohol intervention designed to reduce alcohol misuse through education and personalized feedback that may be suitable for military trainees. However, because it was developed for civilian students, efforts to adapt the content for military settings are needed. Objective: This study aimed to evaluate the acceptability of a military version of eCHECKUP TO GO, tailored to include military-specific terminology and alcohol use statistics. Methods: US Air Force Academy cadets were recruited to participate in a single-arm, mixed methods study. Following the completion of eCHECKUP TO GO, participants completed a survey that assessed satisfaction with specific aspects of the user experience, including ease of use, design, and relevance of the information and personalized feedback (range: 1=strongly disagree to 7=strongly agree). A subset of cadets also participated in a focus group to expound on the survey responses. Results: Survey participants included 22 cadets (n=12, 55% male; mean age 19.6, SD 1.8 years). In addition, 6 (27%) cadets participated in the focus group. Participants were satisfied with the program overall (mean 5.8, SD 0.9) and gave the highest ratings to ease of use (mean 6.6, SD 0.7), site design (mean 6.5, SD 0.6), and site interactivity (mean 6.4, SD 1.0). Items pertaining to tailoring, relevance, and amount of content specific to cadets scored lowest (mean 5.8, SD 1.4; mean 5.6, SD 1.4; and mean 5.5, SD 1.5, respectively). Most (n=15, 68%) participants said they would act upon the information they were provided. Focus group participants made suggestions for improved tailoring, such as increasing content on social aspects of drinking and military-specific risks of alcohol misuse (eg, Uniform Code of Military Justice violations). Conclusions: Although the acceptability of eCHECKUP TO GO was high, continued efforts are needed to ensure the content accurately reflects the experiences of cadets. Researchers who design military health promotion interventions need to consider the varied contexts within the force and rigorously evaluate the acceptability of all content before implementation. %R 10.2196/67637 %U https://formative.jmir.org/2025/1/e67637 %U https://doi.org/10.2196/67637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67755 %T Impact of a Virtual Reality Video ("A Walk-Through Dementia") on YouTube Users: Topic Modeling Analysis %A Li,Xiaoli %A Liu,Xiaoyu %A Yin,Cheng %A Collins,Sandra %A Alanazi,Eman %K Alzheimer disease %K Alzheimer disease and related dementias %K ADRD %K dementia %K public awareness %K text mining %K older adult %K health care student %K training %K health care professional %K simulation %K digital world %K virtual environment %K virtual tour %K walk-through dementia %K virtual reality %K VR %K VR video %K VR application %K topic modeling %K YouTube %K Bidirectional Encoder Representations from Transformers %K BERT %K social media comments %K experiential learning tool %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Emerging research has highlighted the potential of virtual reality (VR) as a tool for training health care students and professionals in care skills for individuals with Alzheimer disease and related dementias (ADRD). However, there is limited research on the use of VR to engage the general public in raising awareness about ADRD. Objective: This research aimed to examine the impact of the VR video “A Walk-Through Dementia” on YouTube users by analyzing their posts. Methods: We collected 12,754 comments from the VR video series “A Walk-Through Dementia,” which simulates the everyday challenges faced by individuals with ADRD, providing viewers with an immersive experience of the condition. Topic modeling was conducted to gauge viewer opinions and reactions to the videos. A pretrained Bidirectional Encoder Representations from Transformers (BERT) model was used to transform the YouTube comments into high-dimensional vector embeddings, allowing for systematic identification and detailed analysis of the principal topics and their thematic structures within the dataset. Results: We identified the top 300 most frequent words in the dataset and categorized them into nouns, verbs, and adjectives or adverbs using a part-of-speech tagging model, fine-tuned for accurate tagging tasks. The topic modeling process identified eight8 initial topics based on the most frequent words. After manually reviewing the 8 topics and the content of the comments, we synthesized them into 5 themes. The predominant theme, represented in 2917 comments, centered on users’ personal experiences with the impact of ADRD on patients and caregivers. The remaining themes were categorized into 4 main areas: positive reactions to the VR videos, challenges faced by individuals with ADRD, the role of caregivers, and learning from the VR videos. Conclusions: Using topic modeling, this study demonstrated that VR applications serve as engaging and experiential learning tools, offering the public a deeper understanding of life with ADRD. Future research should explore additional VR applications on social media, as they hold the potential to reach wider audiences and effectively disseminate knowledge about ADRD. %R 10.2196/67755 %U https://formative.jmir.org/2025/1/e67755 %U https://doi.org/10.2196/67755 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68132 %T Acceptability, Usability, and Insights Into Cybersickness Levels of a Novel Virtual Reality Environment for the Evaluation of Depressive Symptoms: Exploratory Observational Study %A Sutori,Sara %A Eliasson,Emma Therése %A Mura,Francesca %A Ortiz,Victor %A Catrambonephd,Vincenzo %A Hadlaczky,Gergö %A Todorov,Ivo %A Alfeo,Antonio Luca %A Cardi,Valentina %A Cimino,Mario G C A %A Mioni,Giovanna %A Raya,Mariano Alcañiz %A Valenza,Gaetano %A Carli,Vladimir %A Gentili,Claudio %+ National Centre for Suicide Research and Prevention, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Granits väg 4, Stockholm, 171 65, Sweden, 46 701407295, emma.eliasson@ki.se %K depression %K virtual reality %K assessment %K acceptability %K usability %K cybersickness %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a clear need for enhanced mental health assessment, depressive symptom (DS) evaluation being no exception. A promising approach to this aim is using virtual reality (VR), which entails the potential of adding a wider set of assessment domains with enhanced ecological validity. However, whilst several studies have used VR for both diagnostic and treatment purposes, its acceptance, in particular how exposure to virtual environments affects populations with psychiatric conditions remains unknown. Objective: This study aims to report on the acceptability, usability, and cybersickness levels of a pilot VR environment designed for the purpose of differentiating between individuals with DSs. Methods: The exploratory study, conducted in Italy, included 50 healthy controls and 50 young adults with mild-to-moderate DSs (without the need for a formal diagnosis). The study used an observational design with approximately 30 minutes of VR exposure followed by a self-report questionnaire battery. The battery included a questionnaire based on the Theoretical Framework of Acceptability, the System Usability Scale as well as the Simulator Sickness Questionnaire. Results: Results indicate that the majority found VR acceptable for the purposes of mental health screening and treatment. However, for diagnostics, there was a clear preference for VR to be used by mental health professionals as a supplementary tool, as opposed to a stand-alone solution. In practice, following exposure to the pilot VR environment, generally, good levels of acceptability and usability were reported, but areas in need of improvement were identified (such as self-efficacy). Self-reported cybersickness levels were comparable to literature averages but were considerably higher among those with DSs. Conclusions: These findings raise questions about the potential interplay between underlying somatic symptoms of depression and VR-induced cybersickness and call for more attention from the scientific community both in terms of methodology as well as potential clinical and theoretical implications. Conclusively, user support indicates a potential for VR to aid mental health assessment, but further research is needed to understand how exposure to virtual environments might affect populations with varying severity and other forms of psychiatric symptoms. International Registered Report Identifier (IRRID): RR2-10.1186/ISRCTN16396369 %M 40238239 %R 10.2196/68132 %U https://formative.jmir.org/2025/1/e68132 %U https://doi.org/10.2196/68132 %U http://www.ncbi.nlm.nih.gov/pubmed/40238239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68855 %T Feasibility, Acceptability, and Effectiveness of a Smartphone App to Increase Pretransplant Vaccine Rates: Usability Study %A Feldman,Amy G %A Beaty,Brenda L %A Moore,Susan L %A Bull,Sheana %A Wilson,Kumanan %A Atkinson,Katherine M %A Bell,Cameron %A Denize,Kathryn M %A Kempe,Allison %K mobile app %K vaccines %K immunizations %K transplantation %K children %K beta test %K mobile health %K mHealth %D 2025 %7 15.4.2025 %9 %J JMIR Form Res %G English %X Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. Despite intensive medical care in the pretransplant period, less than 20% of children are up to date for age-appropriate vaccines at the time of transplant. Mobile health apps have the potential to improve pretransplant vaccine rates. Objective: This paper aimed to perform phase 2 beta testing of the smartphone app, Immunize PediatricTransplant, to determine (1) if it was effective in achieving up-to-date vaccine status by the time of transplant in a cohort of children awaiting transplants and (2) if the app was feasible and acceptable to parent and transplant provider users. Methods: We recruited 25 dyads of parents and providers of a child awaiting a liver, kidney, or heart transplant at Children’s Hospital Colorado, Ann and Robert H. Lurie Children’s Hospital, and the Children’s Hospital of Philadelphia. Parents and providers filled out an entry questionnaire before app use to gather baseline information. A research team member entered the child’s vaccine records into the app. The parent and provider downloaded and used the app until the transplant to view vaccine records, read vaccine education, communicate with team members, and receive overdue vaccine reminders. After the transplant (or on April 1, 2024, the conclusion of the study), the parent and provider filled out an exit questionnaire to explore feasibility and acceptability of the app. The child’s vaccine records were reviewed to determine if the child was up to date on vaccines at the time of transplant. Results: Twenty-five parent and provider dyads were enrolled; 56% (14/25) had a child awaiting a liver transplant, 28% (7/25) had a child awaiting a kidney transplant, and 16% (4/25) had a child awaiting a heart transplant. At the conclusion of the study, 96% (24/25) of the children were up to date on vaccines. Of the 36 parents and providers who filled out an exit questionnaire, 97% (n=35) agreed or strongly agreed that they felt knowledgeable about pretransplant vaccine use and 86% (n=31) agreed or strongly agreed that communication around vaccines was good after using the app. Further, 91% (20/22) of parents and 79% (11/14) of providers recommended the app to future parents and providers of transplant candidates. Parents and providers suggested that in the future the app should connect directly to the electronic medical record or state vaccine registries to obtain vaccine data. Conclusions: The overwhelming majority of children whose parents and providers used the Immunize PediatricTransplant app were up to date on vaccines at the time of transplant. The majority of app users felt the app was feasible and acceptable. In future iterations of the app and subsequent clinical trials, we will explore whether application programming interfaces might be used to extract vaccine data from the electronic medical record. If implemented broadly, this app has the potential to improve pretransplant vaccine rates, resulting in fewer posttransplant infections and improved posttransplant outcomes. %R 10.2196/68855 %U https://formative.jmir.org/2025/1/e68855 %U https://doi.org/10.2196/68855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66301 %T Evaluating User Engagement With a Real-Time, Text-Based Digital Mental Health Support App: Cross-Sectional, Retrospective Study %A Coffield,Edward %A Kausar,Khadeja %+ , Department of Population Health, Hofstra University, 255 Hofstra University, 101 Oak Street Center, Room 100A, Hempstead, NY, 11549, United States, 1 516 463 7019, edward.coffield@hofstra.edu %K mental health support %K text %K app %K utilization %K mobile %K on demand %K scheduled %K mHealth %K mobile health %K app %K student %K university %K college %K mental health %K employee %K job %K work %K occupational health %K counselor %K counseling %K usage %K engagement %K self-reported %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 20% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings. Objective: This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated. Methods: The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types. Results: Most students (178/283, 62.9%) and employees (28/44, 63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions. Conclusions: The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups. %M 40228290 %R 10.2196/66301 %U https://formative.jmir.org/2025/1/e66301 %U https://doi.org/10.2196/66301 %U http://www.ncbi.nlm.nih.gov/pubmed/40228290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65357 %T The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study %A Keinert,Marie %A Schindler-Gmelch,Lena %A Rupp,Lydia Helene %A Sadeghi,Misha %A Richer,Robert %A Capito,Klara %A Eskofier,Bjoern M %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstraße 25a, Erlangen, 91052, Germany, 49 9131 8567563, marie.keinert@fau.de %K depression %K cognitive reappraisal %K facial expression %K kinesthesia %K smartphone-based intervention %K mobile phone %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Harboring dysfunctional depressogenic cognitions contributes to the development and maintenance of depression. A central goal of cognitive behavioral therapy (CBT) for depression is to invalidate such cognitions via cognitive reappraisal (CR). However, relatively low remission rates and high dropout rates in CBT demonstrate the need for further improvement. Potentially, the effects of CBT could be enhanced by addressing not only dysfunctional depressogenic cognitions but also body states associated with depression. This may be done, for example, by systematically pairing the invalidation of depressogenic cognitions with the performance of antidepressive kinesthesia. Objective: This study aimed to examine the feasibility and clinical potential of a smartphone-based cognitive restructuring task that required users to deliberately perform antidepressive kinesthesia in conjunction with the rejection of depressogenic statements and the affirmation of antidepressive statements. This feasibility study was conducted as a precursor to a large-scale randomized controlled trial. Methods: In total, 10 healthy participants engaged in a single 90-120-minute session of smartphone-based CR training. During the training, they completed 2 phases in which they were required to reject 20 depressogenic and affirm 20 antidepressive statements, respectively. Diagnostic assessments were conducted 1 week (T1) before and directly prior (T2) to the training, and again directly posttraining (T3) and at a 2-week follow-up posttraining (T4). Feasibility outcomes assessed at T3 included intervention safety recorded by study therapists, compliance, technical feasibility, usability assessed using the Short Version of the User Experience Questionnaire (UEQ-S), and acceptability assessed using the UEQ-S and self-developed items. Preliminary clinical potential was evaluated via single-item ratings of current depressed and positive mood assessed continuously during the training. Feasibility outcomes were analyzed descriptively, and clinical potential was examined using paired-sample t tests of pre and post ratings of mood at each training phase. Results: Overall, the results indicated that the training was safe, feasible, and usable (UEQ-S pragmatic quality scale: mean 1.45, SD 0.71). However, acceptance was limited (UEQ-S hedonic quality scale: mean 1.05, SD 0.79). While 80% (8/10) of the participants were generally satisfied with the training, 80% (8/10) would recommend it to a friend, 90% (9/10) found it interesting, and 80% (8/10) rated it as “leading edge,” 40% (4/10) to 70% (7/10) did not consider it particularly helpful and 50% (5/10) found it repetitive. Preliminary results regarding clinical potential were promising, with significant increases in positive mood (rejection: Hedges g=0.63; affirmation: Hedges g=0.25), whereas changes in depressed mood were not significant. Conclusions: This study evaluated the feasibility and acceptability of a smartphone-based CR training augmented with validating and invalidating kinesthesia. This provided valuable insights for further optimizing the intervention for the subsequent randomized controlled trial, but also potential similar interventions. If future studies confirm their clinical potential, such interventions offer a promising approach to enhancing CBT for depression. Trial Registration: OSF Registries pw6ma; https://osf.io/pw6ma/ %R 10.2196/65357 %U https://formative.jmir.org/2025/1/e65357 %U https://doi.org/10.2196/65357 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66509 %T Oxidative Stress Markers and Prediction of Severity With a Machine Learning Approach in Hospitalized Patients With COVID-19 and Severe Lung Disease: Observational, Retrospective, Single-Center Feasibility Study %A Raspado,Olivier %A Brack,Michel %A Brack,Olivier %A Vivancos,Mélanie %A Esparcieux,Aurélie %A Cart-Tanneur,Emmanuelle %A Aouifi,Abdellah %K oxidative stress %K COVID-19 %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pulmonary %K respiration disorders %K hospitalization %K machine learning %K ML %K biomarker %K lung %K severity %K prediction %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Serious pulmonary pathologies of infectious, viral, or bacterial origin are accompanied by inflammation and an increase in oxidative stress (OS). In these situations, biological measurements of OS are technically difficult to obtain, and their results are difficult to interpret. OS assays that do not require complex preanalytical methods, as well as machine learning methods for improving interpretation of the results, would be very useful tools for medical and care teams. Objective: We aimed to identify relevant OS biomarkers associated with the severity of hospitalized patients’ condition and identify possible correlations between OS biomarkers and the clinical status of hospitalized patients with COVID-19 and severe lung disease at the time of hospital admission. Methods: All adult patients hospitalized with COVID-19 at the Infirmerie Protestante (Lyon, France) from February 9, 2022, to May 18, 2022, were included, regardless of the care service they used, during the respiratory infectious COVID-19 epidemic. We collected serous biomarkers from the patients (zinc [Zn], copper [Cu], Cu/Zn ratio, selenium, uric acid, high-sensitivity C-reactive protein [hs-CRP], oxidized low-density lipoprotein, glutathione peroxidase, glutathione reductase, and thiols), as well as demographic variables and comorbidities. A support vector machine (SVM) model was used to predict the severity of the patients’ condition based on the collected data as a training set. Results: A total of 28 patients were included: 8 were asymptomatic at admission (grade 0), 14 had mild to moderate symptoms (grade 1) and 6 had severe to critical symptoms (grade 3). As the first outcome, we found that 3 biomarkers of OS were associated with severity (Zn, Cu/Zn ratio, and thiols), especially between grades 0 and 1 and between grades 0 and 2. As a second outcome, we found that the SVM model could predict the level of severity based on a biological analysis of the level of OS, with only 7% misclassification on the training dataset. As an illustrative example, we simulated 3 different biological profiles (named A, B, and C) and submitted them to the SVM model. Profile B had significantly high Zn, low hs-CRP, a low Cu/Zn ratio, and high thiols, corresponding to grade 0. Profile C had low Zn, low selenium, high oxidized low-density lipoprotein, high glutathione peroxidase, a low Cu/Zn ratio, and low glutathione reductase, corresponding to grade 2. Conclusions: The level of severity of pulmonary damage in patients hospitalized with COVID-19 was predicted using an SVM model; moderate to severe symptoms in patients were associated with low Zn, low plasma thiol, increased hs-CRP, and an increased Cu/Zn ratio among a panel of 10 biomarkers of OS. Since this panel does not require a complex preanalytical method, it can be used and studied in other pathologies associated with OS, such as infectious pathologies or chronic diseases. %R 10.2196/66509 %U https://formative.jmir.org/2025/1/e66509 %U https://doi.org/10.2196/66509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65188 %T Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study %A Fleszar-Pavlovic,Sara E %A Noriega Esquives,Blanca %A Lovan,Padideh %A Brito,Arianna E %A Sia,Ann Marie %A Kauffman,Mary Adelyn %A Lopes,Maria %A Moreno,Patricia I %A Koru-Sengul,Tulay %A Gong,Rui %A Wang,Trent %A Wieder,Eric D %A Rueda-Lara,Maria %A Antoni,Michael %A Komanduri,Krishna %A Lesiuk,Teresa %A Penedo,Frank J %K allogeneic stem cell transplantation %K hematologic malignancy %K bone marrow transplant %K mindfulness-based music therapy %K mindfulness %K music therapy %K eHealth %K music therapy intervention %K adult %K adolescence %K allogeneic %K stem cell transplantation %K stem cell %K transplantation %K qualitative study %K treatment %K hematologic cancers %K psychological distress %K side effects %K mindfulness-based stress reduction %K stress reduction %K anxiety %K depression %K diagnosis %K blood sample collection %K eHealth tool %K quality of life %K cancer survivors %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the “think aloud” method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation. Trial Registration: ClinicalTrials.gov NCT05968963; https://clinicaltrials.gov/study/NCT05968963 %R 10.2196/65188 %U https://formative.jmir.org/2025/1/e65188 %U https://doi.org/10.2196/65188 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67275 %T Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study %A Hutchison,Michael G %A Di Battista,Alex P %A Pyndiura,Kyla L %K mild traumatic brain injury %K recovery %K mHealth %K app %K digital health %K smartphone %K eHealth %K digital %K technology %K usability %K concussion rehabilitation %K brain injury %K rehabilitation protocols %K evidence-based exercise %K single-arm pilot study %K home-based rehabilitation %K user-friendly %K questionnaire %K telehealth %K telemedicine %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from “strongly agree” to “strongly disagree”. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100% positive responses, with no single question scoring below 83% positive responses. In the “ease of use and satisfaction” category, 100% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83%-96% (19-22) of users responded positively to the remaining four questions. In the “system information arrangement” category, 100% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87%-96% of users approving action acknowledgment, error recovery, and expected functions. Under the “usefulness” category, 96% (n=22) of users found the app beneficial for health and well-being, and 91% (n=21) users felt it effectively managed their health. For the five custom questions, 100% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app’s potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. %R 10.2196/67275 %U https://formative.jmir.org/2025/1/e67275 %U https://doi.org/10.2196/67275 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63700 %T Cost-Effectiveness Analysis of a Machine Learning–Based eHealth System to Predict and Reduce Emergency Department Visits and Unscheduled Hospitalizations of Older People Living at Home: Retrospective Study %A Havreng-Théry,Charlotte %A Fouchard,Arnaud %A Denis,Fabrice %A Veyron,Jacques-Henri %A Belmin,Joël %+ PRESAGE, 112-114 rue la Boétie, Paris, 75008, France, 33 622152004, jhveyron@presage.care %K monitoring %K older adult %K predictive tool %K home care aide %K emergency department visit %K cost-effectiveness %K artificial intelligence %K electronic health %K eHealth %K emergency department %K unscheduled hospitalization %K aging %K retrospective study %K medico-economic %K living at home %K nursing home %K emergency visit %K Brittany %K France %K machine learning %K remote monitoring %K digital health %K health informatics %D 2025 %7 11.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Dependent older people or those losing their autonomy are at risk of emergency hospitalization. Digital systems that monitor health remotely could be useful in reducing these visits by detecting worsening health conditions earlier. However, few studies have assessed the medico-economic impact of these systems, particularly for older people. Objective: The objective of this study was to compare the clinical and economic impacts of an eHealth device in real life compared with the usual monitoring of older people living at home. Methods: This study was a comparative, retrospective, and controlled trial on data collected between May 31, 2021, and May 31, 2022, in one health care and home nursing center located in Brittany, France. Participants had to be aged >75 years, living at home, and receiving assistance from the home care service for at least 1 month. We implemented among the intervention group an eHealth system that produces an alert for a high risk of emergency department visits or hospitalizations. After each home visit, the home care aides completed a questionnaire on participants’ functional status using a smartphone app, and the information was processed in real time by a previously developed machine learning algorithm that identifies patients at risk of an emergency visit within 7 to 14 days. In the case of predicted risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient’s nurses or general practitioner. Results: A total of 120 patients were included in the study, with 60 in the control group and 60 in the intervention group. Among the 726 visits from the intervention group that were not followed by an alert, only 4 (0.6%) resulted in hospitalizations (P<.001), confirming the relevance of the system’s alerts. Over the course of the study, 37 hospitalizations were recorded for 25 (20.8%) of the 120 patients. Additionally, of the 120 patients, 9 (7.5%) were admitted to a nursing home, and 7 (5.8%) died. Patients in the intervention group (56/60, 93%) remained at home significantly more often than those in the control group (48/60, 80%; P=.03). The total cost of primary care and hospitalization during the study was €167,000 (€1=US $1.09), with €108,000 (64.81%) attributed to the intervention group (P=.20). Conclusions: This study presents encouraging results on the impact of a remote medical monitoring system for older adults, demonstrating a reduction in both emergency department visits and hospitalization costs. Trial Registration: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697 %M 40215100 %R 10.2196/63700 %U https://formative.jmir.org/2025/1/e63700 %U https://doi.org/10.2196/63700 %U http://www.ncbi.nlm.nih.gov/pubmed/40215100 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63928 %T Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study %A Shin,Jinyoung %A Kweon,Hyuk Jung %A Choi,Jaekyung %K gait analysis %K sarcopenia %K wearable electronic devices %K muscle mass %K physical performance %K older adults %K geriatric %K cross-sectional study %K outpatient clinic %K Korea %K mHealth %K mobile health %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications. Objective: This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults. Methods: In a cross-sectional study of 91 participants aged ≥65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities. Results: Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores. Conclusions: This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia. %R 10.2196/63928 %U https://formative.jmir.org/2025/1/e63928 %U https://doi.org/10.2196/63928 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67767 %T Web-Based Explainable Machine Learning-Based Drug Surveillance for Predicting Sunitinib- and Sorafenib-Associated Thyroid Dysfunction: Model Development and Validation Study %A Chan,Fan-Ying %A Ku,Yi-En %A Lie,Wen-Nung %A Chen,Hsiang-Yin %K thyroid dysfunction %K machine learning %K cancer %K sunitinib %K sorafenib %K TKI %K tyrosine kinase inhibitor %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Unlike one-snap data collection methods that only identify high-risk patients, machine learning models using time-series data can predict adverse events and aid in the timely management of cancer. Objective: This study aimed to develop and validate machine learning models for sunitinib- and sorafenib-associated thyroid dysfunction using a time-series data collection approach. Methods: Time series data of patients first prescribed sunitinib or sorafenib were collected from a deidentified clinical research database. Logistic regression, random forest, adaptive Boosting, Light Gradient-Boosting Machine, and Gradient Boosting Decision Tree were used to develop the models. Prediction performances were compared using the accuracy, precision, recall, F1-score, area under the receiver operating characteristic curve, and area under the precision-recall curve. The optimal threshold for the best-performing model was selected based on the maximum F1-score. SHapley Additive exPlanations analysis was conducted to assess feature importance and contributions at both the cohort and patient levels. Results: The training cohort included 609 patients, while the temporal validation cohort had 198 patients. The Gradient Boosting Decision Tree model without resampling outperformed other models, with area under the precision-recall curve of 0.600, area under the receiver operating characteristic curve of 0.876, and F1-score of 0.583 after adjusting the threshold. The SHapley Additive exPlanations analysis identified higher cholesterol levels, longer summed days of medication use, and clear cell adenocarcinoma histology as the most important features. The final model was further integrated into a web-based application. Conclusions: This model can serve as an explainable adverse drug reaction surveillance system for predicting sunitinib- and sorafenib-associated thyroid dysfunction. %R 10.2196/67767 %U https://formative.jmir.org/2025/1/e67767 %U https://doi.org/10.2196/67767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58916 %T Association of Social Media Recruitment and Depression Among Racially and Ethnically Diverse Metabolic and Bariatric Surgery Candidates: Prospective Cohort Study %A Francis,Jackson M %A Neti,Sitapriya S %A Polavarapu,Dhatri %A Atem,Folefac %A Xie,Luyu %A Kapera,Olivia %A Mathew,Matthew S %A Marroquin,Elisa %A McAdams,Carrie %A Schellinger,Jeffrey %A Ngenge,Sophia %A Kukreja,Sachin %A Schneider,Benjamin E %A Almandoz,Jaime P %A Messiah,Sarah E %K social media %K social media recruitment %K depression %K depressed %K major depressive disorder %K MDD %K depressive disorder %K depressive %K race %K racial %K racial differences %K ethnic %K ethnic differences %K ethnicity %K metabolic surgery %K bariatric surgery %K obesity %K obese %K online health %K ethics %K mental health %K eHealth %K internet %K digital health %K digital mental health %K online interventions %K public engagement %K public health %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Due to the widespread use of social media and the internet in today’s connected world, obesity and depression rates are increasing concurrently on a global scale. This study investigated the complex dynamics involving social media recruitment for scientific research, race, ethnicity, and depression among metabolic and bariatric surgery (MBS) candidates. Objective: This study aimed to determine (1) the association between social media recruitment and depression among MBS candidates and (2) racial and ethnic differences in social media recruitment engagement. Methods: The analysis included data from 380 adult MBS candidates enrolled in a prospective cohort study from July 2019 to December 2022. Race and ethnicity, recruitment method (social media: yes or no), and depression status were evaluated using χ2 tests and logistic regression models. Age, sex, and ethnicity were adjusted in multivariable logistic regression models. Results: The mean age of the candidates was 47.35 (SD 11.6) years, ranging from 18 to 78 years. Participants recruited through social media (n=41, 38.32%) were more likely to report past or current episodes of depression compared to nonsocial media–recruited participants (n=74, 27.11%; P=.03), with a 67% increased likelihood of depression (odds ratio [OR] 1.67, 95% CI 1.04‐2.68, P=.03). Further analysis showed that participants with a history of depression who were below the mean sample age were 2.26 times more likely to be recruited via social media (adjusted OR [aOR] 2.26, 95% CI 1.03‐4.95; P=.04) compared to those above the mean age. Hispanic (n=26, 38.81%) and non-Hispanic White (n=53, 35.10%) participants were significantly more likely to be recruited via social media than non-Hispanic Black (n=27, 18.37%) participants (P<.001). After adjusting for covariates, non-Hispanic Black participants were 60% less likely than non-Hispanic White participants to be recruited via social media (aOR 0.40, 95% CI 0.22‐0.71; P=.002). Conclusions: We found that individuals recruited through social media channels, especially younger participants, were more likely to report past or current episodes of depression compared to those recruited through nonsocial media. The study also showed that non-Hispanic Black individuals are less likely to engage in social media recruitment for scientific research versus other racial and ethnic groups. Future mental health–related studies should consider strategies to mitigate potential biases introduced by recruitment methods to ensure the validity and generalizability of research findings. %R 10.2196/58916 %U https://formative.jmir.org/2025/1/e58916 %U https://doi.org/10.2196/58916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63491 %T Encouraging the Voluntary Mobilization of Mental Resources by Manipulating Task Design: Explorative Study %A Louis,Lina-Estelle %A Moussaoui,Saïd %A Ravoux,Sébastien %A Milleville-Pennel,Isabelle %K visual game-like elements %K gamification %K multiplicity of cognitive functions %K cognitive tasks %K perceived playfulness %K mental workload %K performance %K cognitive training %K aging %K mental effort %K cognitive function %K cognitive skills %K cognitive tests %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Cognitive training is increasingly being considered and proposed as a solution for several pathologies, particularly those associated with aging. However, trainees need to be willing to invest enough mental effort to succeed and make progress. Objective: In this study, we explore how gamification in a narrative context (ie, the addition of visual game-like elements [GLEs] embedded in real-world contexts) could contribute increase in perceived playfulness (PP) and voluntary mental effort allocated to a cognitive task. In such context, narrative elements and GLEs can be designed to align with a commonly relatable scenario (like simulating fishing or gardening activity) to ground the task in familiar, real-world contexts. We also consider if the supposed effect of GLEs on PP and voluntary mental effort could endure while manipulating an intrinsic variable of the task (ie, by increasing cognitive solicitation). Methods: In total, 20 participants (average age 33.6, SD 8.6 y) took part in 3 cognitive tasks proposed in a numerical format: a classic version of the Corsi test (Classic Corsi, a spatial memory task), a playful version of the Classic Corsi test (Playful Corsi), with added visual GLEs in a narrative context, and a playful version of the Classic Corsi test with added cognitive solicitation, that is, mental motor inhibition (Playful Corsi Multi). We assessed the impact of visual GLEs and cognitive solicitation on PP (1 question) and mental workload (MWL) using NASA-Task Load Index (NASA-TLX) and workload profile (WP) questionnaires. Results: Results showed that PP was not influenced by interface’s playful characteristics (Classic Corsi [mean 62.4, SD 8.8] vs Playful Corsi [mean 66, SD 8.8]; W=77; P=.30) but decreased the time necessary to complete the task (Classic Corsi [mean 10.7, SD 2.1 s] vs Playful Corsi [mean 6.8, SD 1.6 s]; W=209; P<.001) as well as performance (Classic Corsi [mean 92.4, SD 9.1] vs Playful Corsi [mean 88.2, SD 11.3]; W=140.5; P=.02). So, possibly, visual GLEs could raise the stakes of the task slightly and implicitly encourage people to go a bit faster. Furthermore, visual GLEs increased MWL regarding attentional resources (assessed by WP: Classic Corsi [mean 52.4, SD 10.9] vs Playful Corsi [mean 65.8, SD 10.9]; W=27.5; P=.04), while manipulating cognitive solicitation impacted MWL when linked to task requirements (assessed by NASA-TLX: Playful Corsi [mean 54.2, SD 9.4] vs Playful Corsi Multi [mean 67.5, SD 9.4]; W=35.5; P=.01) without impacting the performance to the task (Playful Corsi [mean 83.8, SD 13.9] vs Playful Corsi Multi [mean 94, SD 5.5]; W=27; P=.007). Thus, working on the way cognitive functions are solicited would be wiser than adding visual GLEs to improve users’ voluntary mental effort while preserving performance. Conclusion: These results offer valuable insights to improve users’ experience during gamified cognitive tasks and serious games. %R 10.2196/63491 %U https://formative.jmir.org/2025/1/e63491 %U https://doi.org/10.2196/63491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65721 %T Support of Home-Based Structured Walking Training and Prediction of the 6-Minute Walk Test Distance in Patients With Peripheral Arterial Disease Based on Telehealth Data: Prospective Cohort Study %A Wiesmüller,Fabian %A Prenner,Andreas %A Ziegl,Andreas %A El-Moazen,Gihan %A Modre-Osprian,Robert %A Baumgartner,Martin %A Brodmann,Marianne %A Seinost,Gerald %A Silbernagel,Günther %A Schreier,Günter %A Hayn,Dieter %K mHealth %K telehealth %K peripheral arterial disease %K home-based structured walking training %K trend estimation %K predictive modeling %K continuous data %K walking %K walking training %K prediction %K prediction model %K cardiovascular disease %K stroke %K heart failure %K physical fitness %K telehealth system %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Telehealth has been effective in managing cardiovascular diseases like stroke and heart failure and has shown promising results in managing patients with peripheral arterial disease. However, more work is needed to fully understand the effect of telehealth-based predictive modeling on the physical fitness of patients with peripheral arterial disease. Objective: For this work, data from the Keep Pace study were analyzed in depth to gain insights on temporal developments of patients’ conditions and to develop models to predict the patients’ total walking distance at the study end. This could help to determine patients who are likely to benefit from the telehealth program and to continuously provide estimations to the patients as a motivating factor. Methods: This work analyzes continuous patient-reported telehealth data, in combination with in-clinic data from 19 Fontaine stage II patients with peripheral arterial disease who underwent a 12-week telehealth-based walking program. This analysis granted insights into the increase of the total walking distance of the 6-minute walk tests (6MWT) as a measure for physical fitness, the steady decrease in the patients’ pain, and the positive correlation between well-being and the total walking distance measured by the 6MWT. Results: This work analyzed trends of and correlations between continuous patient-generated data. Findings of this study include a significant decrease of the patients’ pain sensation over time (P=.006), a low but highly significant correlation between pain sensation and steps taken on the same day (r=−0.11; P<.001) and the walking distance of the independently performed 6MWTs (r=−0.39; P<.001). Despite the reported pain, adherence to the 6MWT measurement protocol was high (85.53%). Additionally, patients significantly improved their timed-up-and-go test times during the study (P=.002). Predicting the total walking distance at the study end measured by the 6MWT worked well at study baseline (root mean squared error of 30 meters; 7.04% of the mean total walking distance at the study end of 425 meters) and continuously improved by adding further telehealth data. Future work should validate these findings in a larger cohort and in a prospective setting based on a clinical outcome. Conclusions: We conclude that the prototypical trend estimation has great potential for an integration in the telehealth system to be used in future work to provide tailored patient-specific advice based on these predictions. Continuous data from the telehealth system grant a deeper insight and a better understanding of the patients’ status concerning well-being and level of pain as well as their current physical fitness level and the progress toward reaching set goals. Trial Registration: ClinicalTrials.gov Identifier: NCT05619835; https://tinyurl.com/mrxt7y9u %R 10.2196/65721 %U https://formative.jmir.org/2025/1/e65721 %U https://doi.org/10.2196/65721 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67624 %T Provider Perspectives on Implementing an Enhanced Digital Screening for Adolescent Depression and Suicidality: Qualitative Study %A Coren,Morgan A %A Lindhiem,Oliver %A Angus,Abby R %A Toevs,Emma K %A Radovic,Ana %K depression %K suicidality %K adolescent mental health screening %K primary care %K digital tools %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: With a growing adolescent mental health crisis, pediatric societies are increasingly recommending that primary care providers (PCPs) engage in mental health screening. While symptom-level screens identify symptoms, novel technology interventions can assist PCPs with providing additional point-of-care guidance to increase uptake for behavioral health services. Objective: In this study, we sought community PCP feedback on a web-based, digitally enhanced mental health screening tool for adolescents in primary care previously only evaluated in research studies to inform implementation in community settings. Methods: A total of 10 adolescent providers were recruited to trial the new screening tool and participate in structured interviews based on the Consolidated Framework for Implementation Research domains. Interviews were audio recorded, transcribed, and coded according to a prespecified codebook using a template analysis approach. Results: Providers identified improving mental health screening and treatment in pediatric primary care as a priority and agreed that a web-based digitally enhanced screening tool could help facilitate identification of and management of adolescent depression. Salient barriers identified were lack of electronic health record integration, time to administer screening, implications on clinic workflow, accessibility, and lack of transparency within health care organizations about the process of approving new technologies for clinical use. Providers made multiple suggestions to enhance implementation in community settings, such as incorporating customization options. Conclusions: Technology interventions can help address the need for improved behavioral health support in primary care settings. However, numerous barriers exist, complicating implementation of new technologies in real-world settings. %R 10.2196/67624 %U https://formative.jmir.org/2025/1/e67624 %U https://doi.org/10.2196/67624 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64174 %T A New Mobile App to Train Attention Processes in People With Traumatic Brain Injury: Logical and Ecological Content Validation Study %A Laverdière,Roxanne %A Jackson,Philip L %A Banville,Frédéric %+ , Department of Health Sciences, Université du Québec à Rimouski, 300, allée des Ursulines, Rimouski, QC, G5L 3A1, Canada, 1 418 723 1986 ext 1931, frederic_banville@uqar.ca %K mobile app %K attention training %K cognitive remediation %K mindfulness %K psychometric properties %K content validation %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention is at the base of more complex cognitive processes, and its deficits can significantly impact safety and health. Attention can be impaired by neurodevelopmental and acquired disorders. One validated theoretical model to explain attention processes and their deficits is the hierarchical model of Sohlberg and Mateer. This model guides intervention development to improve attention following an acquired disorder. Another way to stimulate attention functions is to engage in the daily practice of mindfulness, a multicomponent concept that can be explained by the theoretical model of Baer and colleagues. Mobile apps offer great potential for practicing mindfulness daily as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues have developed such a mobile app called Focusing, which is aimed at attention training using mindfulness-inspired attentional exercises. However, this app has not been scientifically validated. Objective: This research aims to analyze the logical content validity and ecological content validity of the Focusing app. Methods: Logical content validation was performed by 7 experts in neuropsychology and mindfulness. Using an online questionnaire, they determined whether the content of the attention training app exercises is representative of selected constructs, namely the theoretical model of attention by Sohlberg and Mateer and the theoretical model of mindfulness by Baer and colleagues. A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. Ecological content validation was performed with 10 healthy adults. Participants had to explore all sections of the app and assess the usability, relevance, satisfaction, quality, attractiveness, and cognitive load associated with each section of the app, using online questionnaires. Results: Logical content validation results demonstrated a high content validity index (CVI) of the attention training app. Excellent scores (CVI ≥0.78) in both the attention and mindfulness models were obtained for all exercises in the app, except 2 exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding ecological content validation, the results showed that workload, quality, user experience, satisfaction, and relevance of the app were adequate. The Mobile Application Rating Scale questionnaire showed an average quality rating between 3.75/5 (SD 0.41) (objective quality) and 3.65/5 (SD 0.36) (subjective quality), indicating acceptable quality. The mean global attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (SD 0.57), which represents one of the strengths of the app.  Conclusions: Logical and ecological content validation showed that Focusing is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can be tested to train attention processes after a neurological insult such as traumatic brain injury. %M 40202789 %R 10.2196/64174 %U https://formative.jmir.org/2025/1/e64174 %U https://doi.org/10.2196/64174 %U http://www.ncbi.nlm.nih.gov/pubmed/40202789 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69952 %T Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study %A Holmqvist,Sophia %A Kaplan,Marina %A Chaturvedi,Riya %A Shou,Haochang %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, United States, 1 215 204 7000, sophia.holmqvist@temple.edu %K cognitive impairment %K smartwatch %K longitudinal monitoring %K ecological momentary assessment %K aging %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ≥55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33%, SD 6.86% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94% (SD 9.58%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100%) indicated willingness to participate in future smartwatch studies, >80% (37/45) had a positive experience, and >90% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. %M 40198914 %R 10.2196/69952 %U https://humanfactors.jmir.org/2025/1/e69952 %U https://doi.org/10.2196/69952 %U http://www.ncbi.nlm.nih.gov/pubmed/40198914 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59405 %T Development of Digital Strategies for Reducing Sedentary Behavior in a Hybrid Office Environment: Modified Delphi Study %A Parés-Salomón,Iris %A Vaqué-Crusellas,Cristina %A Coffey,Alan %A Loef,Bette %A Proper,Karin I %A Señé-Mir,Anna M %A Puig-Ribera,Anna %A Dowd,Kieran P %A Bort-Roig,Judit %+ Faculty of Health Sciences and Welfare, University of Vic – Central University of Catalonia (UVic-UCC), C Sagrada Família, 7, Vic, 08500, Spain, 34 938 815 50, iris.pares@uvic.cat %K sedentary behavior %K office work %K home office %K hybrid work %K technology %K Delphi %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hybrid work is the new modus operandi for many office workers, leading to more sedentary behavior than office-only working. Given the potential of digital interventions to reduce sedentary behavior and the current lack of studies evaluating these interventions for home office settings, it is crucial to develop digital interventions for such contexts involving all stakeholders. Objective: This study aimed to reach expert consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behavior in the home office context. Methods: A modified Delphi study including 3 survey rounds and focus groups was conducted to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usefulness of digital elements to deliver the strategies. The work strategies were identified and selected from a scoping review, a systematic review, and 2 qualitative studies involving managers and employees. The median and mean absolute deviation from the median for each item are reported. The second round involved 2 ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts’ preferences. The weighted average ranking for each item was calculated to determine the most highly ranked work strategies and digital elements. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. In total, 4 focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analyzed using the principles of reflexive thematic analysis. Results: A total of 27 international experts in the field of occupational health participated in the first round, with response rates of 86% (25/29) and 66% (19/29) in rounds 2 and 3, respectively, and 52% (15/29) in the focus groups. Consensus was achieved on 18 work strategies and 16 digital elements. Feedback on activity progress and goal achievement; creating an action plan; and standing while reading, answering phone calls, or conducting videoconferences were the most feasible work strategies, whereas wrist-based activity trackers, a combination of media, and app interfaces in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies, such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behavior when working from home. Conclusions: This expert consensus provided a foundation for developing digital interventions for sedentary behavior in home office workers. Ongoing interventions should enable the evaluation of feasible strategies delivered via useful digital elements in home office or hybrid contexts. %M 40198908 %R 10.2196/59405 %U https://humanfactors.jmir.org/2025/1/e59405 %U https://doi.org/10.2196/59405 %U http://www.ncbi.nlm.nih.gov/pubmed/40198908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60531 %T Centering Youth Voice in the Adaptation of an mHealth Intervention for Young Adults With HIV in South Texas, United States: Human-Centered Design Approach %A Ho,Nhat Minh %A Johnson,Catherine %A Chidester,Autumn %A Viera Corral,Ruby %A Ramos,Jacundo %A Garcia,Miguel %A Gonuguntla,Rishi %A Cote,Cyrena %A Chandramohan,Divya %A Lin,Hueylie %A Taranova,Anna %A Nijhawan,Ank E %A Kools,Susan %A Ingersoll,Karen %A Dillingham,Rebecca %A Taylor,Barbara S %K HIV %K implementation science %K youth %K mHealth %K adherence %K young %K mobile health %K mobile health intervention %K AIDS %K US %K adult %K self-efficacy %K willingness %K health outcomes %K mHealth intervention %K interview %K human-centered design %K acceptability %K usability %K mobile phone %D 2025 %7 8.4.2025 %9 %J JMIR Form Res %G English %X Background: Young adults living with HIV are less likely to engage in care and achieve viral suppression, compared to other age groups. Young adults living with HIV also have a high degree of self-efficacy and willingness to adopt novel care modalities, including mobile health (mHealth) interventions. Interventions to increase care engagement could aid young adults living with HIV in overcoming structural and social barriers and leveraging youth assets to improve their health outcomes. Objective: The objective of the paper was to use an assets-based framework, positive youth development, and human-centered design principles to adapt an existing mHealth intervention, PositiveLinks (PL), to support care engagement for 18‐ to 29-year-olds with HIV. Methods: We conducted a formative evaluation including semistructured interviews with 14 young adults with HIV and focus groups with 26 stakeholders (providers, nurses, case managers, and clinic staff). Interviews covered barriers to care, provider communication, and concerns or suggestions about mHealth interventions. The research team used thematic analysis to review interview transcripts. In the second phase, human-centered design processes informed adaptation of the existing PL platform using data from real-time use suggestions of 3 young adults with HIV. Throughout the formative evaluation and adaptation, a Youth Advisory Board (YAB) provided input. Results: Young adults with HIV and stakeholders identified common elements of an mHealth intervention that would support care engagement including: the convenience of addressing needs through the app, online support groups to support interconnection, short videos or live chats with other young adults with HIV or providers, appointment and medication reminders, and medical information from a trustworthy source. Stakeholders also mentioned the need for youth empowerment. Concerns included worries about confidentiality, unintentional disclosures of status, urgent content in an unmoderated forum, and the impersonality of online platforms. Design suggestions from young adults with HIV included suggestions on appearance, new formatting for usability of the online support group, and prioritization of local content. Based on the feedback received, iterative changes were made to transform PL into Positive Links for Youth (PL4Y). Final votes on adaptations were made by the YAB. The overall appearance of the platform was changed, including logo, color, and font. The online support group was divided into 3 channels which support hashtags and content searches. The “Resources” and “Frequently Asked Questions” sections were condensed and revised to prioritize South Texas–specific content. Conclusions: Our assets-based framework supported young adults with HIV and stakeholder input in the transformation of an mHealth intervention to meet the needs of 18- to 29-year-olds in South Texas. The human-centered design approach allowed young adults with HIV to suggest specific changes to the intervention’s design to support usability and acceptability. This adapted version, PL4Y, is now ready for pilot testing in the final phase of this implementation science project. %R 10.2196/60531 %U https://formative.jmir.org/2025/1/e60531 %U https://doi.org/10.2196/60531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e72469 %T Chatbot to Support the Mental Health Needs of Pregnant and Postpartum Women (Moment for Parents): Design and Pilot Study %A McAlister,Kelsey %A Baez,Lara %A Huberty,Jennifer %A Kerppola,Marianna %K perinatal support %K human-centered design %K digital health %K maternal health %K chatbot %K digital tool %D 2025 %7 8.4.2025 %9 %J JMIR Form Res %G English %X Background: Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. Objective: This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. Methods: This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Results: Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6%) re-engaged 3 or more times. Overall, 28/30 (93.3%) found the chatbot relevant for them, though some noted repetitive content and limited response options. Conclusions: The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness. %R 10.2196/72469 %U https://formative.jmir.org/2025/1/e72469 %U https://doi.org/10.2196/72469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60484 %T Opportunities and Challenges Surrounding the Use of Wearable Sensor Bracelets for Infectious Disease Detection During Hajj: Qualitative Interview Study %A Maddah,Noha %A Verma,Arpana %A Ainsworth,John %+ Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Vaughn House, Manchester, M13 9GB, United Kingdom, 44 1612757675, noha.maddah@postgrad.manchester.ac.uk %K wearable sensor %K unified theory of acceptance and use of technology %K task-technology fit %K hajj %K presymptomatic detection %K infectious diseases %K artificial intelligence %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable sensor bracelets have gained interest for their ability to detect symptomatic and presymptomatic infections through alterations in physiological indicators. Nevertheless, the use of these devices for public health surveillance among attendees of large-scale events such as hajj, the Islamic religious mass gathering held in Saudi Arabia, is currently in a nascent phase. Objective: This study aimed to explore hajj stakeholders’ perspectives on the use of wearable sensor bracelets for disease detection. Methods: We conducted a qualitative, theoretically informed, interview-based study from March 2022 to October 2023 involving a diverse sample of hajj stakeholders, including technology experts, health care providers, and hajj service providers. The study was guided by the task-technology fit model and the unified theory of acceptance and use of technology to provide a comprehensive understanding of the factors influencing the acceptance and use of the technology. Semistructured in-depth interviews were used to capture perspectives on using wearable sensor bracelets for infectious disease detection during hajj. Thematic analysis of interview transcripts was conducted. Results: A total of 14 individuals were interviewed. In total, 4 main themes and 13 subthemes emerged from the study, highlighting crucial challenges, considerations, recommendations, and opportunities in the use of wearable sensor bracelets for the presymptomatic detection of infectious diseases during hajj. Implementing wearable sensor bracelets for disease detection during hajj faces obstacles from multiple perspectives, encompassing users, implementing stakeholders, and technological factors. Hajj stakeholders were concerned about the substantial financial and operational barriers. The motivation of implementing stakeholders and users is essential for the acceptance and uptake of devices during hajj. Successful integration of wearables into the hajj surveillance system depends on several factors, including infrastructure, device features, suitable use cases, training, and a smooth organizational integration process. Conclusions: This study provides valuable insights into the potential opportunities and challenges of adopting wearable sensor bracelets for disease detection during hajj. It offers essential factors to consider and important suggestions to enhance comprehension and ensure the effective implementation of this technology. %M 40198912 %R 10.2196/60484 %U https://formative.jmir.org/2025/1/e60484 %U https://doi.org/10.2196/60484 %U http://www.ncbi.nlm.nih.gov/pubmed/40198912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66966 %T Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention %A Sørensen,Nikita Marie %A Skaarnes,Helene %A Mathiasen,Kim %A Thastum,Mikael %A Lomholt,Johanne Jeppesen %+ , Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 11, Aarhus C, 8000, Denmark, 45 87159439, nikita@psy.au.dk %K user-centered design %K digital treatment %K digital mental health %K internet-based %K cognitive behavioral therapy %K anxiety %K adolescents %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. Objective: This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. Methods: The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. Results: In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled “humans” received more votes as adolescents could better “identify” themselves with them. Communication should preferably be “supportive” and feel “like a friend” talking to them. Statements including praise—such as “You’re well on your way. How are you today?”—received the most votes (12 votes), whereas directive statements such as “Tell us how your day has been?” and “How is practicing your steps going?” received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Conclusions: Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice. %M 40198911 %R 10.2196/66966 %U https://formative.jmir.org/2025/1/e66966 %U https://doi.org/10.2196/66966 %U http://www.ncbi.nlm.nih.gov/pubmed/40198911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65788 %T The Use of Mobile Apps in Adolescent Psychotherapy: Assessment of Psychotherapists’ Perspectives %A Wüllner,Sarah %A Hermenau,Katharin %A Hecker,Tobias %A Siniatchkin,Michael %+ University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Medical School EWL, Protestant Hospital Bethel, Bielefeld University, Remterweg 13a, Bielefeld, 33617, Germany, 49 5211063166, sarah.wuellner@uni-bielefeld.de %K mental health app %K psychotherapy %K adolescent %K mHealth %K youth %K feasibility %K implementation %K app features %K barriers %K drivers %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Therapy-accompanying mental health apps can play an important role in the psychotherapeutic treatment of adolescents. They can enhance adolescents’ engagement and autonomy, provide immediate support in critical situations, and positively influence the therapeutic working alliance. Nevertheless, mental health apps are rarely used by psychotherapists. Furthermore, due to the limited or nonexistent use of apps in psychotherapy, little is known about the actual barriers and drivers affecting their integration into psychotherapists’ daily routines. To better understand how mental health apps should be designed for practical use, it is essential to explore psychotherapists’ perspectives on key app features and characteristics, as well as the factors influencing their integration into clinical practice. Objective: This study aims to analyze which app features and characteristics are essential for psychotherapists to use a mobile app in psychotherapy with adolescents and to identify the key drivers and barriers influencing the integration of a psychotherapeutic app from the psychotherapists’ perspectives. Methods: We conducted 3 feasibility studies using Steps, a transdiagnostic, therapy-accompanying app for adolescents, across 3 different psychotherapeutic treatment contexts: inpatient treatment, treatment in psychiatric outpatient clinics, and outpatient treatment with psychotherapists in private practice. All studies followed a qualitative quasi-experimental design. Participants provided information on their age, occupation, years of work experience, media affinity, attitudes toward psychotherapeutic apps, perceived app quality and feasibility, and the implementation process of the therapy-accompanying app. Qualitative data were analyzed using deductive qualitative content analysis. A total of 40 mental health professionals participated across the 3 studies (study 1: n=18; study 2: n=13; study 3: n=9). Results: Study participation and app usage rates were low across all studies. Six core features for a transdiagnostic, therapy-accompanying app were identified: mood checks, library, reminders, goals and tasks, emergency kit, and questionnaires. Additionally, the integration of mental health apps into daily routines was influenced by various drivers and barriers. The most significant barriers included technological issues and practical constraints, such as limited time and resources. The most important driver was the perceived improvement in treatment quality. Conclusions: Overall, psychotherapists were generally open to using a therapy-accompanying mental health app. However, study participation and app usage remained low. As psychotherapists act as gatekeepers for patients’ use of mental health apps, their needs should be prioritized in the development and implementation of such apps. Trial Registration: German Clinical Trials Register DRKS00031258; https://drks.de/search/en/trial/DRKS00031258/details %M 40198916 %R 10.2196/65788 %U https://formative.jmir.org/2025/1/e65788 %U https://doi.org/10.2196/65788 %U http://www.ncbi.nlm.nih.gov/pubmed/40198916 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68179 %T A Reminder App to Optimize Bladder Filling During Radiotherapy for Patients With Prostate Cancer (REFILL-PAC): Protocol for a Prospective Trial %A Rades,Dirk %A Küter,Jan-Dirk %A von Staden,Michael %A Al-Salool,Ahmed %A Janssen,Stefan %A Timke,Carmen %A Duma,Marciana Nona %A Bartscht,Tobias %A Vestergård Madsen,Christine %A Kristiansen,Charlotte %A Cremers,Florian %+ Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus A, Lubeck, 23538, Germany, 49 451 500 ext 45400, dirk.rades@uksh.de %K prostate cancer %K external beam radiation therapy %K radiation toxicity %K bladder filling %K mobile app %D 2025 %7 8.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many patients with nonmetastatic prostate cancer receive radiotherapy, which may be associated with acute cystitis, particularly if the volume of the urinary bladder is small. Three studies showed bladder volumes <200 ml or <180 ml to be associated with increased urinary toxicity. Therefore, it is important to maintain bladder volumes greater than 200 ml during as many radiation fractions as possible. Several studies investigated drinking protocols, where patients were asked to drink a certain amount of water prior to radiotherapy sessions. This may require considerable discipline from the patients, who are predominantly older adults. Adherence to a drinking protocol may be facilitated by a mobile app that reminds patients to drink water prior to each radiation session. This study investigates the effect of such an app on bladder filling status in patients with prostate cancer undergoing external beam radiotherapy (EBRT) alone. Objective: The primary goal of this study is to evaluate the impact of an app that reminds patients irradiated for prostate cancer to drink 300 ml of water prior to each radiotherapy session on the number of fractions with bladder volumes <200 ml during the radiotherapy course. Methods: This ongoing phase 2 aims to recruit 28 patients treated with EBRT alone for nonmetastatic prostate cancer. Radiotherapy will be administered using normo-fractionation, with doses ranging from 70 to 80 Gy in 35 to 40 fractions of 2 Gy, preferably with volumetric-modulated arc therapy (VMAT). Treatment volumes include the prostate with or without the seminal vesicles. Results: Recruitment for this trial will start in March 2025 and is planned to be completed in October 2026. The study is scheduled to conclude in December 2026. Conclusions: This trial is the first to evaluate the impact of a reminder app on the number of radiotherapy fractions with bladder volumes <200 ml in patients undergoing irradiation for localized prostate cancer. Trial Registration: Clinicaltrials.gov NCT06653751; https://clinicaltrials.gov/show/NCT06653751 International Registered Report Identifier (IRRID): PRR1-10.2196/68179 %M 40198906 %R 10.2196/68179 %U https://www.researchprotocols.org/2025/1/e68179 %U https://doi.org/10.2196/68179 %U http://www.ncbi.nlm.nih.gov/pubmed/40198906 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e59942 %T Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool %A Biernetzky,Olga A %A Thyrian,Jochen René %A Boekholt,Melanie %A Berndt,Matthias %A Hoffmann,Wolfgang %A Teipel,Stefan J %A Kilimann,Ingo %K unmet needs %K assessment development %K family caregivers of people with dementia %K dementia %K need %K Alzheimer %K self-guided %K self-reported %K caregiver %K informal care %K spousal care %K interview %K qualitative %K thematic %K usability %K mHealth %K tablet %K self-completed %K aging %K patient care %K health interventions %K care giver %K digital health %K ehealth %K digital assessment %K memory %D 2025 %7 7.4.2025 %9 %J JMIR Aging %G English %X Background: Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective. Objective: Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting. Methods: The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angehörige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers’ biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically. Results: Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings. Conclusions: The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial. Trial Registration: ClinicalTrials.gov NCT04037501; https://clinicaltrials.gov/study/NCT04037501 %R 10.2196/59942 %U https://aging.jmir.org/2025/1/e59942 %U https://doi.org/10.2196/59942 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67294 %T Detecting Sleep/Wake Rhythm Disruption Related to Cognition in Older Adults With and Without Mild Cognitive Impairment Using the myRhythmWatch Platform: Feasibility and Correlation Study %A Jones,Caleb D %A Wasilko,Rachel %A Zhang,Gehui %A Stone,Katie L %A Gujral,Swathi %A Rodakowski,Juleen %A Smagula,Stephen F %K sleep %K sleep/wake %K circadian %K activity pattern %K dementia %K cognition %K mobile sensing %K actigraphy %K accelerometer %D 2025 %7 7.4.2025 %9 %J JMIR Aging %G English %X Background: Consumer wearable devices could, in theory, provide sufficient accelerometer data for measuring the 24-hour sleep/wake risk factors for dementia that have been identified in prior research. To our knowledge, no prior study in older adults has demonstrated the feasibility and acceptability of accessing sufficient consumer wearable accelerometer data to compute 24-hour sleep/wake rhythm measures. Objective: We aimed to establish the feasibility of characterizing 24-hour sleep/wake rhythm measures using accelerometer data gathered from the Apple Watch in older adults with and without mild cognitive impairment (MCI), and to examine correlations of these sleep/wake rhythm measures with neuropsychological test performance. Methods: Of the 40 adults enrolled (mean [SD] age 67.2 [8.4] years; 72.5% female), 19 had MCI and 21 had no cognitive disorder (NCD). Participants were provided devices, oriented to the study software (myRhythmWatch or myRW), and asked to use the system for a week. The primary feasibility outcome was whether participants collected enough data to assess 24-hour sleep/wake rhythm measures (ie, ≥3 valid continuous days). We extracted standard nonparametric and extended-cosine based sleep/wake rhythm metrics. Neuropsychological tests gauged immediate and delayed memory (Hopkins Verbal Learning Test) as well as processing speed and set-shifting (Oral Trails Parts A and B). Results: All participants meet the primary feasibility outcome of providing sufficient data (≥3 valid days) for sleep/wake rhythm measures. The mean (SD) recording length was somewhat shorter in the MCI group at 6.6 (1.2) days compared with the NCD group at 7.2 (0.6) days. Later activity onset times were associated with worse delayed memory performance (β=−.28). More fragmented rhythms were associated with worse processing speed (β=.40). Conclusions: Using the Apple Watch-based myRW system to gather raw accelerometer data is feasible in older adults with and without MCI. Sleep/wake rhythms variables generated from this system correlated with cognitive function, suggesting future studies can use this approach to evaluate novel, scalable, risk factor characterization and targeted therapy approaches. %R 10.2196/67294 %U https://aging.jmir.org/2025/1/e67294 %U https://doi.org/10.2196/67294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62741 %T Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model %A Mbeya-Munkhondya,Tiwonge E %A Meek,Caroline J %A Mphande,Mtisunge %A Tembo,Tapiwa A %A Chitani,Mike J %A Jean-Baptiste,Milenka %A Kumbuyo,Caroline %A Vansia,Dhrutika %A Simon,Katherine R %A Rutstein,Sarah E %A Mwapasa,Victor %A Go,Vivian %A Kim,Maria H %A Rosenberg,Nora E %K blended learning %K technology acceptance model %K index case testing %K acceptability %K partner notification %K contact tracing %D 2025 %7 7.4.2025 %9 %J JMIR Form Res %G English %X Background: HIV index case testing (ICT) aims to identify people living with HIV and their contacts, engage them in HIV testing services, and link them to care. ICT implementation has faced challenges in Malawi due to limited counseling capacity among lay health care workers (HCWs). Enhancing capacity through centralized face-to-face training is logistically complex and expensive. A decentralized blended learning approach to HCW capacity-building, combining synchronous face-to-face and asynchronous digital modalities, may be an acceptable way to address this challenge. Objective: The objective of this analysis is to describe factors influencing HCW anticipated acceptability of blended learning using the Technology Acceptance Model (TAM). Methods: This formative qualitative study involved conducting 26 in-depth interviews with HCWs involved in the ICT program across 14 facilities in Machinga and Balaka, Malawi (November-December 2021). Results were analyzed thematically using TAM. Themes were grouped into factors affecting the 2 sets of TAM constructs: perceived usefulness and perceived ease of use. Results: A total of 2 factors influenced perceived usefulness. First, HCWs found the idea of self-guided digital learning appealing, as they believed it would allow for reinforcement, which would facilitate competence. They also articulated the need for opportunities to practice and receive feedback through face-to-face interactions in order to apply the digital components. In total, 5 factors influenced perceived ease of use. First, HCWs expressed a need for orientation to the digital technology given limited digital literacy. Second, they requested accessibility of devices provided by their employer, as many lacked personal devices. Third, they wished for adequate communication surrounding their training schedules, especially if they were going to be asynchronous. Fourth, they wished for support for logistical arrangements to avoid work interruptions. Finally, they wanted monetary compensation to motivate learning, a practice comparable with offsite trainings. Conclusions: A decentralized blended learning approach may be an acceptable method of enhancing ICT knowledge and skills among lay HCWs in Malawi, although a broad range of external factors need to be considered. Our next step is to integrate these findings into a blended learning package and examine perceived acceptability of the package in the context of a cluster randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-077706 %R 10.2196/62741 %U https://formative.jmir.org/2025/1/e62741 %U https://doi.org/10.2196/62741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70149 %T Digital Health Platform for Maternal Health: Design, Recruitment Strategies, and Lessons Learned From the PowerMom Observational Cohort Study %A Ajayi,Toluwalase %A Kueper,Jacqueline %A Ariniello,Lauren %A Ho,Diana %A Delgado,Felipe %A Beal,Matthew %A Waalen,Jill %A Baca Motes,Katie %A Ramos,Edward %+ Jacobs Center for Health Innovation, Department of Medicine and Pediatrics, University of California, San Diego, 9300 Campus Point Drive, MC 7196, La Jolla, CA, 92037, United States, 1 785 218 1643, tajayi@health.ucsd.edu %K maternal health research %K digital health platforms %K pregnancy monitoring %K decentralized clinical trials %K participant engagement %K health disparities %D 2025 %7 7.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal health research faces challenges in participant recruitment, retention, and data collection, particularly among underrepresented populations. Digital health platforms like PowerMom (Scripps Research) offer scalable solutions, enabling decentralized, real-world data collection. Using innovative recruitment and multimodal techniques, PowerMom engages diverse cohorts to gather longitudinal and episodic data during pregnancy and post partum. Objective: This study aimed to evaluate the design, implementation, and outcomes of the PowerMom research platform, with a focus on participant recruitment, engagement, and data collection across diverse populations. Secondary objectives included identifying challenges encountered during implementation and deriving lessons to inform future digital maternal health studies. Methods: Participants were recruited via digital advertisements, pregnancy apps, and the PowerMom Consortium of more than 15 local and national organizations. Data collection included self-reported surveys, wearable devices, and electronic health records. Anomaly detection measures were implemented to address fraudulent enrollment activity. Recruitment trends and descriptive statistics from survey data were analyzed to summarize participant characteristics, assess engagement metrics, and quantify missing data to identify gaps. Results: Overall, 5617 participants were enrolled from 2021 to 2024, with 69.8% (n=3922) providing demographic data. Of these, 48.5% (2723/5617) were younger than 35 years, 14% (788/5617) identified as Hispanic or Latina, and 13.7% (770/5617) identified as Black or African American. Geographic representation spanned all 50 US states, Puerto Rico, and Guam, with 58.3% (3276/5617) residing in areas with moderate access to maternity care and 16.4% (919/5617) in highly disadvantaged neighborhoods based on the Area Deprivation Index. Enrollment rates increased substantially over the study period, from 55 participants in late 2021 to 3310 in 2024, averaging 99.4 enrollments per week in 2024. Participants completed a total of 17,123 surveys, with 71.8% (4033/5617) completing the Intake Survey and 12.4% (697/5617) completing the Postpartum Survey. Wearable device data were shared by 1168 participants, providing more than 378,000 daily biometric measurements, including activity levels, sleep, and heart rate. Additionally, 96 participants connected their electronic health records, contributing 276 data points such as diagnoses, medications, and laboratory results. Among pregnancy-related characteristics, 28.1% (1578/5617) enrolled during the first trimester, while 15.1% (849/5617) reported information about the completion of their pregnancies during the study period. Among the 913 participants who shared delivery information, 56.1% (n=512) had spontaneous vaginal deliveries and 17.9% (n=163) underwent unplanned cesarean sections. Conclusions: The PowerMom platform demonstrates the feasibility of using digital tools to recruit and engage diverse populations in maternal health research. Its ability to integrate multimodal data sources showcases its potential to provide comprehensive maternal-fetal health insights. Challenges with data completeness and survey attrition underscore the need for sustained participant engagement strategies. These findings offer valuable lessons for scaling digital health platforms and addressing disparities in maternal health research. Trial Registration: ClinicalTrials.gov NCT03085875; https://clinicaltrials.gov/study/NCT03085875 %M 40194282 %R 10.2196/70149 %U https://formative.jmir.org/2025/1/e70149 %U https://doi.org/10.2196/70149 %U http://www.ncbi.nlm.nih.gov/pubmed/40194282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70594 %T Are Dating App Algorithms Making Men Lonely and Does This Present a Public Health Concern? %A Balki,Eric %+ Faculty of Health and Medicine, Department of Health, Lancaster University, Innovation One, Sir John Fisher Dr, Bailrigg, Lancaster, LA1 4AT, United Kingdom, 44 1524 593763, e.balkhi@lancaster.ac.uk %K dating apps %K mental health %K men %K algorithm %K anxiety %K depression %K loneliness %D 2025 %7 7.4.2025 %9 Viewpoint %J JMIR Form Res %G English %X During the pandemic, dating apps emerged as essential platforms connecting users amid social isolation, experiencing rapid growth in engagement and profile creation. This paper examines the evolution of these apps, highlighting their shift from facilitating offline encounters to promoting match accumulation for revenue. In particular, the study investigates gender disparities, addictive behaviors, and algorithmic match throttling that disproportionately impact men’s psychological well-being. Drawing on evidence linking dating app use to increased depression and anxiety, the analysis calls for regulatory intervention to eliminate pay-for-advantage models and ensure fair, healthy user experiences, thereby mitigating adverse public health outcomes. %M 40193188 %R 10.2196/70594 %U https://formative.jmir.org/2025/1/e70594 %U https://doi.org/10.2196/70594 %U http://www.ncbi.nlm.nih.gov/pubmed/40193188 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64449 %T Comparison of Smart Display Versus Laptop Platforms for an eHealth Intervention to Improve Functional Health for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Clinical Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Curtin,John J %A Pe-Romashko,Klaren %A Landucci,Gina %+ , Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 1440, gina.landucci@wisc.edu %K eHealth %K aged %K geriatrics %K functional health %K multiple chronic conditions %K smart display %K smart speaker %K primary care %K quality of life %D 2025 %7 3.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance on appropriate exercise can help. However, older adults with multiple morbidities may be unable to use a laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform—comprising a smart speaker plus a small visual screen—has the potential to remove these barriers because it is voice-activated. Objective: The study aims to compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects. Methods: A minimum of 356 adults aged 60 years and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a postintervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in the subscales of functional health (eg, physical function and depression), as well as measures of health distress, loneliness, unscheduled health care, and falls. We will also examine mediators and moderators of the effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed-effect models to evaluate outcomes over time, with treatment condition and time point as between-subjects factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end in May 2025; data collection will end in November 2025. Findings will be disseminated via peer-reviewed publications. Conclusions: Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life. Trial Registration: ClinicalTrials.gov NCT05240534; https://clinicaltrials.gov/study/NCT05240534 International Registered Report Identifier (IRRID): DERR1-10.2196/64449 %M 40080672 %R 10.2196/64449 %U https://www.researchprotocols.org/2025/1/e64449 %U https://doi.org/10.2196/64449 %U http://www.ncbi.nlm.nih.gov/pubmed/40080672 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65412 %T Assessing the Cultural Fit of a Digital Sleep Intervention for Refugees in Germany: Qualitative Study %A Blomenkamp,Maja %A Kiesel,Andrea %A Baumeister,Harald %A Lehr,Dirk %A Unterrainer,Josef %A Sander,Lasse B %A Spanhel,Kerstin %+ Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstr. 29, Freiburg, D-79104, Germany, 49 761 203 5530, kerstin.spanhel@mps.uni-freiburg.de %K Ukraine %K eHealth %K sleep disturbances %K low-threshold treatment %K culturally sensitive treatment %K refugee %K digital sleep %K Germany %K digital intervention %K interview %K content analysis %K qualitative study %K mental burden %K mental health care %K electronic health %K digital health %D 2025 %7 3.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions have been suggested to facilitate access to mental health care for refugees, who experience structural, linguistic, and cultural barriers to mental health care. Sleep-e, a digital sleep intervention originally developed for German teachers, has been culturally adapted for refugees in Germany mainly coming from African and Middle East countries. With the increasing number of refugees from Ukraine and the associated diversity of cultural backgrounds among refugees in Germany, it is essential to assess whether existing digital interventions are culturally appropriate for this target group as well. Objective: The study aimed to investigate the perceived cultural appropriateness of Sleep-e in both its original and culturally adapted versions among refugees in Germany, hereby exploring and possibly contrasting the needs of refugees coming from Ukraine and other countries of origin. Methods: Overall, 13 refugees (6 from Ukraine, 23-66 years old; and 7 from other countries, 26-41 years old) participated in the study. Each participant went through parts of the original or culturally adapted version of the digital sleep intervention, with 5 participants going through both versions. A total of 17 semistructured interviews (11 for the adapted, 6 for the nonadapted intervention version) and 9 think-aloud sessions (6 for the adapted, 3 for the nonadapted intervention version) were conducted to assess cultural appropriateness, suggestions for adaptations, and perceived relevance. Data were transcribed, categorized, and analyzed using structured qualitative content analysis. Results: The findings showed key differences in the perceived appropriateness and identification between the 2 refugee groups and the 2 intervention versions. Ukrainian participants expressed positive (n=70) and negative (n=56) feedback on the adapted intervention version, which revealed identity conflicts, as the adapted intervention version was targeted at a refugee population with whom they could not fully identify (18 negative feedback quotes concerning the refugee example characters). Whereas they identified with the European context in the original version, they found the problems described less relevant to their experiences. In contrast, participating refugees from other countries found the culturally adapted version more comprehensible and culturally appropriate (55 positive and 5 negative feedback quotes). No significant usability issues were reported, but several participants highlighted the need for an individualization of the intervention content. Conclusions: Neither the original nor culturally adapted version of the digital sleep intervention fully met the needs of all refugee groups, highlighting the complexity of culturally adapting digital interventions for this population. Particularly, the identity conflict of participating Ukrainian refugees regarding the refugee context suggests that adaptation should go beyond regional considerations and consider the dynamics of social identity. These findings emphasize the relevance of including co-design processes with different refugee populations to ensure broad identification and, herewith, cultural appropriateness of digital interventions. Trial Registration: German Clinical Trials Register DRKS00036484; https://drks.de/search/de/trial/DRKS00036484 %M 40179371 %R 10.2196/65412 %U https://formative.jmir.org/2025/1/e65412 %U https://doi.org/10.2196/65412 %U http://www.ncbi.nlm.nih.gov/pubmed/40179371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67997 %T A Remote Intervention Based on mHealth and Community Health Workers for Antiretroviral Therapy Adherence in People With HIV: Pilot Randomized Controlled Trial %A Shourya,Shivesh %A Liu,Jianfang %A McInerney,Sophia %A Casimir,Trinity %A Kenniff,James %A Kershaw,Trace %A Batey,David %A Schnall,Rebecca %+ Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 6503346176, shivesh.shourya@yale.edu %K HIV %K antiretroviral therapy adherence %K ART %K ART adherence %K mobile health technology %K mHealth technology %K community health workers %K CHWs %K smart pill bottle %K feasibility evaluation %K mobile health technology acceptance model %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the United States achieve viral suppression, largely due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence rates, which must be maintained at ≥95% to prevent viral load rebound. Combination interventions leveraging community health worker (CHW) support and mobile health (mHealth) technologies have the potential to overcome previously identified barriers and provide cost-effective support for improving adherence and viral suppression outcomes in people with HIV. Objective: This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of remote delivery of the Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, combining the WiseApp, CHW support, and the CleverCap smart pill bottle. A secondary aim was to gather participants’ feedback on the usability of the app and pill bottle as well as to better understand their experiences with remote study procedures. Methods: This mixed methods pilot study involved 40 participants with HIV, who were randomly assigned to a control group (n=20, 50%) or the CHAMPS intervention (n=20, 50%) over 3 months. The intervention group participated in up to 12 sessions with CHWs and used the WiseApp, paired with a CleverCap smart pill bottle, to support ART adherence. Remote baseline and follow-up visits were conducted via Zoom and included surveys measuring adherence, self-efficacy, and usability (measured by Health Information Technology Usability Evaluation Scale [Health-ITUES] and Poststudy System Usability Questionnaire [PSSUQ]). Semistructured interviews explored participants’ experiences with the intervention. Thematic analysis was used to identify key facilitators and barriers based on the Mobile Health Technology Acceptance Model. Results: Remote delivery of the CHAMPS intervention was feasible, with high usability ratings for both the WiseApp and CleverCap (overall scores on Health-ITUES: mean 4.35, SD 0.58 and PSSUQ: mean 2.04, SD 1.03). In the intervention group, there were nonsignificant improvements in self-reported adherence scores (P=.29) and in self-efficacy scores (P=.07). The adjusted odds ratio for achieving undetectable viral load in the intervention group compared to the control group was 3.01 (95% CI –1.59 to 4.12), indicating a medium effect size in favor of the intervention. Overall study retention was 75% (30/40), with higher retention in the control group. Participants valued the flexibility of remote study procedures, particularly Zoom-based study visits and mailed blood sample kits. Qualitative feedback highlighted the intervention’s acceptability and ability to overcome logistical barriers. Conclusions: The remote CHAMPS pilot study demonstrated the feasibility and acceptability of combining mHealth tools with CHW support to promote medication adherence among people with HIV. While further optimization is needed to enhance its impact, this intervention shows potential for improving health outcomes in diverse underserved populations. Trial Registration: ClinicalTrials.gov NCT05938413; https://clinicaltrials.gov/study/NCT05938413 %M 40173448 %R 10.2196/67997 %U https://formative.jmir.org/2025/1/e67997 %U https://doi.org/10.2196/67997 %U http://www.ncbi.nlm.nih.gov/pubmed/40173448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e68242 %T Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study %A Pereira,Ana P %A Janela,Dora %A Areias,Anabela C %A Molinos,Maria %A Tong,Xin %A Bento,Virgílio %A Yanamadala,Vijay %A Atherton,Jennesa %A Dias Correia,Fernando %A Costa,Fabíola %K women's health %K pelvic floor muscle training %K physical therapy %K menopause %K digital therapeutics %K biofeedback %K mobile phone %D 2025 %7 2.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ∼40%‐50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire–short form 7, Urinary Impact Questionnaire–short form 7, Colorectal-Anal Impact Questionnaire–short form 7, and Pelvic Organ Prolapse Impact Questionnaire–short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants’ daily lives decreased significantly (−19.55 points, 95% CI −22.22 to −16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (−18.09, 95% CI −19.99 to −16.20 and −15.08, 95% CI −17.52 to −12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms’ burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 %R 10.2196/68242 %U https://mhealth.jmir.org/2025/1/e68242 %U https://doi.org/10.2196/68242 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69609 %T The Impact of a Human Papillomavirus Facebook-Based Intervention (#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy %A Adegboyega,Adebola %A Wiggins,Amanda %A Wuni,Abubakari %A Ickes,Melinda %K human papillomavirus vaccination %K HPV vaccination %K Facebook-based intervention %K young Black adults %K social media %D 2025 %7 2.4.2025 %9 %J JMIR Form Res %G English %X Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults. Objective: This study aimed to assess the impact of a Facebook-based intervention (#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years. Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (#HPVVaxTalks). #HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants’ satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis Results: Overall, 32 of the 43 (74%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants’ satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness. Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities. %R 10.2196/69609 %U https://formative.jmir.org/2025/1/e69609 %U https://doi.org/10.2196/69609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68249 %T Examining the Client Experience of Digital Tools in Blended Care Therapy: Qualitative Interview Study %A Lattie,Emily G %A Beltzer,Miranda %A Varra,Alethea %A Chen,Connie E %A Lungu,Anita %+ , Lyra Health, 270 East Lane, Burlingame, CA, 94010, United States, 1 (877) 505 7147, elattie@lyrahealth.com %K anxiety %K depression %K blended care therapy %K mental health care %K digital mental health %K digital tools %K qualitative interviews %K Lyra Care Therapy %K video lesson %K symptom assessment %K written exercise %K thematic analysis %K LCT model %K therapeutic value %K client experience %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Lyra Health’s short-term blended care therapy model, Lyra Care Therapy (LCT), has demonstrated effectiveness at scale. In LCT, clients participate in synchronous telehealth sessions and asynchronous guided practice sessions, in which they are provided with digital tools to reinforce key concepts and skills. These digital tools include animated video lessons that use storytelling to show characters learning and implementing new skills from therapy, written psychoeducational materials, interactive exercises that prompt reflection and skills practice, symptom assessments, and messaging with therapists. Past research on LCT found that time spent in therapy sessions and viewing digital video lessons predicts improvements in depression and anxiety symptoms. Objective: This study aims to explore the client experience of LCT digital tools and to understand clients’ perceived benefits and challenges of using digital tools while in LCT. Methods: In total, 12 ethnically and racially diverse adults (5 male, 6 female, and 1 pangender) who had graduated from LCT in the previous 4 months participated in semistructured interviews. Interviews focused on experiences with the digital components of LCT (ie, video lessons, symptom assessments, and written exercises). Transcripts were analyzed using thematic analytic methods to determine the benefits and challenges associated with components of the LCT model. Results: In total, 3 primary themes were generated through thematic analysis. These themes centered around supporting knowledge and skill development, the benefits and challenges associated with the range of digital tools, and the combination of flexibility and accountability promoting positive change. First, we summarize the ways in which guided practice sessions allow clients to develop additional knowledge and learn skills related to their mental health and well-being. Then, we describe how the range of digital tools included in LCT presents different benefits and challenges for clients. Finally, we discuss how flexibility inherent in having both synchronous and asynchronous sessions, along with the accountability from a provider, encourages clients to continue to practice skills related to their mental health and well-being. Conclusions: Results provide insights into the unique contributions of different components of the LCT model on therapeutic gains. While perceived time constraints and content preferences can impact engagement with digital tools, overall the digital tools were perceived as carrying significant value for participants in the LCT program. %M 40173439 %R 10.2196/68249 %U https://formative.jmir.org/2025/1/e68249 %U https://doi.org/10.2196/68249 %U http://www.ncbi.nlm.nih.gov/pubmed/40173439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68149 %T Medical Device Based on a Virtual Reality–Based Upper Limb Rehabilitation Software: Usability Evaluation Through Cognitive Walkthrough %A Hong,Seojin %A Choi,Hyun %A Kweon,Hyosun %K usability %K cognitive walkthrough %K virtual reality-based upper limb rehabilitation software %K upper limb %K limb rehabilitation %K rehabilitation %K therapist %K virtual reality %K VR %K medical device %K formative evaluation %K quantitative %K qualitative %K occupational therapy %K user safety %K usability testing %K software %K risk factor %D 2025 %7 1.4.2025 %9 %J JMIR Form Res %G English %X Background: The use of virtual reality (VR) technology in rehabilitation therapy has been growing, leading to the development of VR-based upper-limb rehabilitation softwares. To ensure the effective use of such software, usability evaluations are critical to enhance user satisfaction and identify potential usability issues. Objective: This study aims to evaluate the usability of a VR-based upper-limb rehabilitation software from the perspective of occupational therapists. Specifically, the study seeks to identify usability challenges and provide insights to improve user satisfaction. Methods: The VR-based upper-limb rehabilitation software was tailored for therapists to operate while delivering therapy to patients. Usability testing was conducted with occupational therapists from the Korean National Rehabilitation Center using cognitive walkthroughs and surveys. Participants performed tasks that simulated real clinical scenarios, including turning the device on, assisting patients with wearing the device, and shutting it down. Observers recorded user reactions during task performance, and participants completed surveys to assess the ease of use of the user interface. This mixed-methods approach provided qualitative insights into user difficulties and their root causes. Results: Usability evaluations were conducted with 6 participants. Cognitive walkthroughs revealed potential areas for improvement in the software, including (1) enhancements to the graphical user interface for ease of use, (2) refinements in the natural user interface, and (3) better user manuals for clearer product instructions. The ease-of-use score for the user interface averaged 1.58 on a 5-point scale (1=very easy to 5=very difficult). Conclusions: This study provides valuable insights into improving user satisfaction by focusing on the needs of occupational therapists who operate a VR-based rehabilitation software. Future research should explore software refinement and clinical efficacy to maximize the therapeutic potential of such technologies. %R 10.2196/68149 %U https://formative.jmir.org/2025/1/e68149 %U https://doi.org/10.2196/68149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65000 %T Personalized Physician-Assisted Sleep Advice for Shift Workers: Algorithm Development and Validation Study %A Shen,Yufei %A Choto Olivier,Alicia %A Yu,Han %A Ito-Masui,Asami %A Sakamoto,Ryota %A Shimaoka,Motomu %A Sano,Akane %+ Rice University, 6100 Main St., Houston, TX, 77005, United States, 1 7133483821, akane.sano@rice.edu %K cognitive behavioral therapy %K CBT %K health care workers %K machine learning %K medical safety %K web-based intervention %K app-based intervention %K shift work %K shift work sleep disorders %K shift workers %K sleep disorder %K wearable sensors %K well-being %D 2025 %7 1.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: In the modern economy, shift work is prevalent in numerous occupations. However, it often disrupts workers’ circadian rhythms and can result in shift work sleep disorder. Proper management of shift work sleep disorder involves comprehensive and patient-specific strategies, some of which are similar to cognitive behavioral therapy for insomnia. Objective: Our goal was to develop and evaluate machine learning algorithms that predict physicians’ sleep advice using wearable and survey data. We developed a web- and app-based system to provide individualized sleep and behavior advice based on cognitive behavioral therapy for insomnia for shift workers. Methods: Data were collected for 5 weeks from shift workers (N=61) in the intensive care unit at 2 hospitals in Japan. The data comprised 3 modalities: Fitbit data, survey data, and sleep advice. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice and selected 1 to 5 messages from a list of 23 options. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. We explored 3 models (random forest, light gradient-boosting machine, and CatBoost) and 3 data-balancing approaches (no balancing, random oversampling, and synthetic minority oversampling technique) to predict selections for the 7 most frequent advice messages related to bedroom brightness, smartphone use, and nap and sleep duration. We tested our predictions under participant-dependent and participant-independent settings and analyzed the most important features for prediction using permutation importance and Shapley additive explanations. Results: We found that the clusters were distinguished by work shifts and behavioral patterns. For example, one cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved a higher area under the precision-recall curve than the baseline in all settings. The performance differences were statistically significant (P<.001 for 13 tests and P=.003 for 1 test). Sensitivity ranged from 0.50 to 1.00, and specificity varied between 0.44 and 0.93 across all advice messages and dataset split settings. Feature importance analysis of our models found several important features that matched the corresponding advice messages sent. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions. Conclusions: Although our current system requires physician input, an accurate machine learning algorithm shows promise for automatic advice without compromising the trustworthiness of the selected recommendations. Despite its decent performance, the algorithm is currently limited to the 7 most popular messages. Further studies are needed to enable predictions for less frequent advice labels. %M 40168666 %R 10.2196/65000 %U https://formative.jmir.org/2025/1/e65000 %U https://doi.org/10.2196/65000 %U http://www.ncbi.nlm.nih.gov/pubmed/40168666 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63405 %T Integrating Virtual Reality, Neurofeedback, and Cognitive Behavioral Therapy for Auditory Verbal Hallucinations (Hybrid): Protocol of a Pilot, Unblinded, Single-Arm Interventional Study %A Spark,Jessica %A Rowe,Elise %A Alvarez-Jimenez,Mario %A Bell,Imogen %A Byrne,Linda %A Dzafic,Ilvana %A Ellinghaus,Carli %A Lavoie,Suzie %A Lum,Jarrad %A McLean,Brooke %A Thomas,Neil %A Thompson,Andrew %A Wadley,Greg %A Whitford,Thomas %A Wood,Stephen %A Yuen,Hok Pan %A Nelson,Barnaby %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 399669100, elise.rowe@unimelb.edu.au %K psychosis %K first episode psychosis %K schizophrenia %K virtual reality %K neurofeedback %K EEG %K auditory verbal hallucinations %K voices %K cognitive behavior therapy %K youth mental health %K pilot study %K paracusias %K paracusis %K treatment %K medication %K psychotic disorder %K efficacy %K neuroscience %K psychology %K hybrid %K adolescent %K Australia %D 2025 %7 1.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Current treatments for schizophrenia and other psychotic disorders have limited efficacy, with high rates of nonresponse to “gold standard” treatments. New approaches are therefore urgently required. Objective: The aims of this pilot study are to investigate the feasibility, acceptability, safety, and usability of Hybrid treatment (primary aim); and to explore Hybrid’s treatment efficacy and engagement of treatment targets (secondary aim). The primary aim will be assessed via face-to-face user experience surveys on a (self-assessed) 5-point Likert scale (and qualitative open-ended questions) examining: (1) acceptability, (2) helpfulness, (3) engagement, and (4) perceived safety. We will also examine consent and completion rates, and the number of sessions attended. Our threshold for moving on to efficacy trials will be at least 70% of our participants to rate 3 and above (which corresponds to agree or strongly agree) that the intervention package was acceptable, feasible, and safe. The secondary aims will be assessed by observing whether individuals achieve self-directed modulation of high-β neurophysiological activity (neural target) and progression upwards through the VR-based exposure hierarchy (psychological target), and by assessing symptom change scores. This study developed a new treatment approach for auditory verbal hallucinations, a major symptom of psychotic disorders, that integrates advances in psychological therapy (cognitive behavioral therapy for psychosis), technology (virtual reality, VR), and neuroscience (electroencephalography-based neurofeedback). Methods: Hybrid takes a “symptom capture” approach using individually tailored VR-based exposure exercises. Participants (N=10) will receive the intervention package weekly over 12 face-to-face sessions. Here, participants will be progressively exposed to symptom triggers and develop methods of downregulating neural activity associated with these symptoms (neurofeedback component) while concurrently receiving clinician-delivered cognitive behavioral therapy for psychosis. Results: As of February 2025, Hybrid has commenced (unblinded) recruitment activities from Orygen clinical services in Northwestern Melbourne, Australia. A total of 75 individuals have been approached and 64 individuals have been prescreened (41 individuals were deemed eligible, 15 individuals were ineligible, and 8 individuals declined or did not respond to contact attempts) and 5 individuals have been included in the study. Of the 5 individuals who have commenced the Hybrid treatment, 4 are actively engaged in the program and 1 individual has withdrawn. We expect recruitment to conclude in July 2025 and for the results to be published in 2026. Conclusions: The Hybrid study is piloting a novel approach that has the potential to address the shortcomings of current treatments for psychotic symptoms. If there is favorable evidence for the acceptability, feasibility, safety and usability of Hybrid, the study team will move on to efficacy trials. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000357550; https://tinyurl.com/24ey8hpy International Registered Report Identifier (IRRID): PRR1-10.2196/63405 %M 40168662 %R 10.2196/63405 %U https://www.researchprotocols.org/2025/1/e63405 %U https://doi.org/10.2196/63405 %U http://www.ncbi.nlm.nih.gov/pubmed/40168662 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63098 %T Cooperative Virtual Reality Gaming for Anxiety and Pain Reduction in Pediatric Patients and Their Caregivers During Painful Medical Procedures: Protocol for a Randomized Controlled Trial %A Liszio,Stefan %A Bäuerlein,Franziska %A Hildebrand,Jens %A van Nahl,Carolin %A Masuch,Maic %A Basu,Oliver %+ , Center for Virtual and Extended Reality in Medicine, University Hospital Essen, Hufelandstraße 55, Essen, 45147, Germany, 49 201723 ext 1907, stefan.liszio@uk-essen.de %K virtual reality %K extended reality %K mixed reality %K serious game %K video game %K pain %K anxiety %K stress %K child %K caregiver %K patient experience %K well-being %K medical procedures %K punctures %K distraction %K intervention %D 2025 %7 31.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The hospital experience is often marked by fear and pain, particularly for children undergoing medical procedures. Sedation is commonly used to alleviate patient anxiety, but it poses additional health risks. Caregivers, usually the parents, also experience emotional distress during the child’s hospital stay, which can further exacerbate the child’s anxiety and pain. While various interventions exist to ease patient distress, few consider the emotional well-being of caregivers. Objective: This study aims to explore the effectiveness of a cooperative virtual reality (VR) game as a novel nonpharmacological solution to reduce anxiety and pain for both pediatric patients and their caregivers during medical procedures. Specifically, we aim to investigate whether the VR game “Sweet Dive VR” (SDVR), designed for children aged between 6 and 12 years to play with 1 caregiver, can alleviate anxiety and pain during different types of needle punctures and Kirschner-wire removal. Methods: A prospective multicenter randomized clinical trial will be conducted. Eligible participants will be identified by scanning the hospital information system, and group allocation will follow stratified randomization. During the medical procedure, patients in the VR condition will play SDVR with a caregiver present, while patients in the control group will listen to a recording of gently crashing waves. Data collection will be carried out through self-reports of patients and caregivers using visual analog scales and questionnaires at 2 measurement time points: before and after the intervention. In addition, observation by the interviewers will occur during the intervention to capture emotional and pain reactions as well as interaction quality between patients and caregivers and smoothness of the procedure flow using a structured observation protocol. The measured variables will encompass patient affect and pain, caregiver affect, player experience, patient experience, and the flow of the procedure. Results: As of November 2024, we enrolled 39 patients and caregivers, 28 of whom completed the study. Data collection is still ongoing. Conclusions: Cooperative VR gaming, as exemplified by SDVR, emerges as a promising intervention to address anxiety and pain in pediatric patients while involving caregivers to support the emotional well-being of both parties. Our approach strives to foster positive shared experiences and to maintain trust between children and caregivers during emotionally challenging medical situations. Trial Registration: German Clinical Trial Register (DRKS) DRKS00033544; https://drks.de/search/en/trial/DRKS00033544 International Registered Report Identifier (IRRID): DERR1-10.2196/63098 %M 40164171 %R 10.2196/63098 %U https://www.researchprotocols.org/2025/1/e63098 %U https://doi.org/10.2196/63098 %U http://www.ncbi.nlm.nih.gov/pubmed/40164171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62749 %T Development of a Comprehensive Decision Support Tool for Chemotherapy-Cycle Prescribing: Initial Usability Study %A Iivanainen,Sanna %A Arokoski,Reetta %A Mentu,Santeri %A Lang,Laura %A Ekström,Jussi %A Virtanen,Henri %A Kataja,Vesa %A Koivunen,Jussi Pekka %K cancer %K chemotherapy %K ePRO %K electronic patient-reported outcome %K decision support system %D 2025 %7 31.3.2025 %9 %J JMIR Form Res %G English %X Background: Chemotherapy cycle prescription is generally carried out through a multistep manual process that is prone to human error. Clinical decision support tools can provide patient-specific assessments that support clinical decisions, improve prescribing practices, and reduce medication errors. Objective: We hypothesized that a knowledge-based, patient-derived, evidence-directed decision support tool consisting of multiple modules focusing on the core duties preceding chemotherapy-cycle prescription could result in a more cost-effective and error-free approach and streamline the workflow. Methods: A 1-arm, multicenter, prospective clinical trial (“Follow-up of Cancer Patients Receiving Chemotherapy or Targeted Therapy by Electronic Patient Reported Outcomes-tool” [ECHO] 7/2019-1/2021; NCT04081558) was initiated to investigate the tool. The most important inclusion criteria were the presence of colorectal cancer (CRC) treated with oxaliplatin-based chemotherapy, age ≥18 years, Eastern Cooperative Oncology Group [ECOG] performance score of 0 to 2, and internet access. A decision support tool that included digital symptom monitoring, a laboratory value interface, and treatment schedule integration for semiautomated chemotherapy cycle prescribing was integrated into the care pathway. Performance was assessed by the percentage of chemotherapy cycles with sent and completed symptom questionnaires, while perceptions of health care professionals (HCPs) on the feasibility of the approach were collected through a 1-time semistructured interview. Results: The ECHO trial included 43 patients with CRC treated with doublet or triplet chemotherapy in an adjuvant or metastatic setting. Altogether, 843 electronic patient-reported outcome (ePRO) symptom questionnaires were completed. Of the 15 recorded symptoms, fatigue (n=446, 52.9%) and peripheral neuropathy (n=429, 50.9%) were reported most often, while 137 grade 3 to 4 symptoms were recorded, of which diarrhea (n=5, 4%) and peripheral neuropathy (n=4, 3%) were the most common. During the study, 339 chemotherapy cycles were prescribed, and for the 77% (n=262) of new chemotherapy cycles, ePRO questionnaire data were available within preset limits (completed within 3 days prior to chemotherapy scheduling) while 65% of the cycles (n=221) had symptom questionnaire grading at ≤1%, and 67% of the cycles (n=228) had laboratory values in a preset range. The recommendations by the tool for a new chemotherapy cycle were tier 1 (green; meaning “go”) in 145 (42.8%) of the cycles, tier 2 (yellow; “evaluate”) in 83 (25%), and tier 3 (red; “hold”) in 111 (32.7%). HCPs (n=3) were interviewed with a questionnaire (comprising 8 questions), revealing that they most valued the improved workflow, faster patient evaluation, and direct messaging option. Conclusions: In this study, we investigated the feasibility of a decision support system for chemotherapy-cycle pre-evaluation and prescription that was developed for the prospective ECHO trial. The study showed that the functionalities of the investigated tool were feasible and that an automated approach to chemotherapy-cycle prescription was possible for nearly half of the cycles. Trial Registration: ClinicalTrials.gov NCT04081558; https://clinicaltrials.gov/study/NCT04081558 %R 10.2196/62749 %U https://formative.jmir.org/2025/1/e62749 %U https://doi.org/10.2196/62749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67545 %T Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial %A Han,Areum %A Oster,Robert %A Yuen,Hon %A Jenkins,Jeremy %A Hawkins,Jessica %A Edwards,Lauren %+ , Department of Occupational Therapy, University of Alabama at Birmingham, SHPB 339, 1720 2nd Avenue South, Birmingham, AL, 35294, United States, 1 2059752882, ahan@uab.edu %K acceptance and commitment therapy %K Alzheimer disease %K caregivers %K dementia %K depression %K web-based intervention %K quality of life %K randomized controlled trial %K stress %K videoconferencing %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers’ mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population. Objective: This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only. Methods: This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes. Results: The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of –6.09 (1.16) points (95% CI –8.42 to –3.76; P<.001) in the posttest and –6.71 (1.45) points (95% CI –9.63 to –3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032). Conclusions: The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among family caregivers with depression who give care to individuals with dementia. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs. Trial Registration: ClinicalTrials.gov NCT05043441; https://clinicaltrials.gov/study/NCT05043441 %M 40163859 %R 10.2196/67545 %U https://formative.jmir.org/2025/1/e67545 %U https://doi.org/10.2196/67545 %U http://www.ncbi.nlm.nih.gov/pubmed/40163859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67047 %T Barriers and Determinants of Referral Adherence in AI-Enabled Diabetic Retinopathy Screening for Older Adults in Northern India During the COVID-19 Pandemic: Mixed Methods Pilot Study %A Chauhan,Anshul %A Goyal,Anju %A Masih,Ritika %A Kaur,Gagandeep %A Kumar,Lakshay %A Neha,­ %A Rastogi,Harsh %A Kumar,Sonam %A Singh,Bidhi Lord %A Syal,Preeti %A Gupta,Vishali %A Vale,Luke %A Duggal,Mona %K diabetic retinopathy %K diabetes %K gerontology %K geriatric %K old %K aging %K aged %K artificial intelligence %K retinopathy %K retinal %K referral %K screening %K optometry %K ophthalmology %K adherence %K barriers %D 2025 %7 31.3.2025 %9 %J JMIR Form Res %G English %X Background: Diabetic retinopathy (DR) is a leading cause of blindness globally. DR has increasingly affected both individuals and health care systems as the population ages. Objective: This study aims to explore factors and identify barriers associated with nonadherence to referral recommendations among older adult participants after DR screening (DRS) during the COVID-19 pandemic. Method: This paper presents findings from a pilot study on artificial intelligence–enabled DRS conducted in two districts in Punjab, India (Moga and Mohali) during the COVID-19 pandemic. The screenings were conducted from March to June 2022 at community health center Badhani Kalan in Moga and from March to June 2021 in community settings (homes) in Block Boothgarh, Mohali. Participants were referred to the district hospital for an ophthalmological review based on artificial intelligence–enabled screening. After 1 month, the participants were contacted by telephone to assess adherence to the referral recommendations. Participants who did not adhere to the referral were then interviewed alongside health care providers to understand the barriers explaining their nonadherence. Results: We aimed to recruit 346 and 600 older adult participants from 2 sites but enrolled 390. Key challenges included health facility closures due to COVID-19, low motivation among health personnel for recruitment, incomplete nonparticipation data, and high participant workloads. Approximately 45% of the participants were male and 55% female. Most participants (62.6%) were between 60 and 69 years old, while 37.4% were 70 or older, with a mean age of 67.2 (SD 6.2) years. In total, 159 participants (40.8%) were referred, while 231 participants (59.2%) were not. Only 23 (14.5%) of those referred followed through and visited a health facility for ophthalmological review, while 136 (85.5%) did not pursue further evaluation. Our analysis revealed no significant differences in the characteristics between adherent and nonadherent participants, suggesting that demographic and health factors alone do not predict adherence behavior in patients with DR. Interviews identified limited knowledge about DR, logistical challenges, financial constraints, and attitudinal barriers as the primary challenges. Conclusions: This study, conducted during the COVID-19 pandemic, showed suboptimal adherence to referral recommendations among older adult patients due to knowledge gaps, logistical challenges, and health system issues. Quantifying and understanding adherence factors are crucial for targeted interventions addressing barriers to referral recommendations after DRS. Integrating teleophthalmology into and strengthening infrastructure for artificial intelligence–enabled diabetic retinopathy screening to enhance access and outcomes. %R 10.2196/67047 %U https://formative.jmir.org/2025/1/e67047 %U https://doi.org/10.2196/67047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58542 %T Ambulance Commanders’ Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial %A Hylander,Johan %A Gyllencreutz,Lina %A Haney,Michael %A Westman,Anton %+ Department of Diagnostics and Intervention, Surgery, Umeå University, Linnaeus väg 6, Umeå, 90736, Sweden, 46 90 786 50 00, johan.hylander@umu.se %K e-learning %K major incident %K incident management %K disaster medicine %K road tunnels %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness. Objective: We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context. Methods: We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50%) received a lecture on general incident management, while the intervention group (n=10, 50%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25%), and collected data were analyzed using qualitative content analysis. Results: All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20, 0%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: –0.58 points, 95% CI –1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-mémoire). Conclusions: Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders’ decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings. %M 40153786 %R 10.2196/58542 %U https://formative.jmir.org/2025/1/e58542 %U https://doi.org/10.2196/58542 %U http://www.ncbi.nlm.nih.gov/pubmed/40153786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69001 %T Convergent and Known-Groups Validity and Sensitivity to Change of the Virtual Performance Measure in Patients With Hip and Knee Osteoarthritis: Longitudinal Study %A Razmjou,Helen %A Denis,Suzanne %A Robarts,Susan %A Wainwright,Amy %A Dickson,Patricia %A Murnaghan,John %+ Sunnybrook Health Science Centre, University of Toronto, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada, helen.razmjou@sunnybrook.ca %K virtual %K video-based outcome %K longitudinal validity %K sensitivity to change %K osteoarthritis %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Subsequent to the COVID-19 pandemic in 2020, a different approach to health care utilization was required to improve safety and efficiency. In the postpandemic era, virtual care and remote assessment of musculoskeletal conditions has become more common, and examining the accuracy of these remote encounters remains vital. In 2023, an innovative, video-based tool—the Virtual Performance Measure (VPM)—was introduced to assess the functional difficulties of patients with osteoarthritis of the knee joint. Further validation of this tool is warranted to expand its application longitudinally and in more diverse populations. Objective: This study examined the longitudinal validity of the VPM, a digitally based outcome tool, in patients with osteoarthritis of the hip and knee joints who had undergone arthroplasty. Methods: Patients completed a web-based survey after watching 40 videos that demonstrated 10 functional tasks with increasing difficulty, prior to and at approximately 3-5 months following surgery. The Lower Extremity Functional Scale (LEFS) was used as the reference measure. Longitudinal convergent and known-groups validity as well as sensitivity to change were assessed. Results: The data of 120 patients (n=80, 67% female; mean age 67, SD 9 years; n=58, 48% with hip osteoarthritis and n=62, 52% with knee osteoarthritis) were examined. There was a statistically significant improvement in both LEFS (t119=16.04, P<.001) and VPM total scores (t119=13.92, P<.001) over time. The correlation between the postoperative LEFS and VPM scores was higher (r=0.66; P<.001) than the correlation between the change scores of these measures (r=0.51; P<.001). The area under the curve value for the VPM’s ability to differentiate between urgent and nonurgent candidates for surgery was 0.71 (95% CI 0.57-0.84). Sensitivity to change as measured by the standardized response mean was 1.27 (95% CI 1.09-1.45), indicating good ability to detect change over time. Conclusions: The VPM demonstrated sufficient longitudinal convergent and known-groups validity as well as sensitivity to change in patients with hip and knee osteoarthritis following arthroplasty. This tool has a potential to improve the delivery of care by increasing access, reducing the frequency of in-person visits, and improving the overall efficiency of the health care system following a major surgery. %M 40153784 %R 10.2196/69001 %U https://formative.jmir.org/2025/1/e69001 %U https://doi.org/10.2196/69001 %U http://www.ncbi.nlm.nih.gov/pubmed/40153784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60221 %T Personalized mHealth Intervention (StepAdd) for Increasing Physical Activity in Japanese Patients With Type 2 Diabetes: Secondary Analysis of Social Cognitive Theory Measurements of a Single-Arm Pilot Study %A Waki,Kayo %A Enomoto,Syunpei %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %K social cognitive theory %K mHealth %K mobile health %K behavior change %K diabetes %K diabetic %K type 2 diabetes %K walk %K step %K exercise %K physical activity %K walking %K digital therapeutics %K secondary analysis %K personalization %K coping %K self-efficacy %D 2025 %7 28.3.2025 %9 %J JMIR Form Res %G English %X Background: A 12-week pilot of the StepAdd mobile health (mHealth) behavior change intervention based on social cognitive theory (SCT) saw an 86.7% increase in mean daily step counts among patients with type 2 diabetes. Due to the lack of exploration of theoretical implications in mHealth intervention studies, there is a need to understand the mechanism underlying the behavioral change to inform the future design of digital therapeutics. Objective: This study aimed to examine the SCT drivers underlying the mean increase in exercise among Japanese patients with type 2 diabetes who participated in the StepAdd intervention. Methods: This is a post hoc analysis of data collected in the single-arm pilot study of the 32 patients who completed the StepAdd intervention. The StepAdd app uses self-mastery and coping strategies to increase self-efficacy and thus increase walking. Self-mastery was measured by the goal completion (GC) rate, which is the percentage of days in which patients met these adapting goals. The use of coping strategies was measured by the strategy implementation (SI) rate, which is the percentage of days in which patients applied their selected coping strategies. We assessed correlations between GC, SI, and self-efficacy to increase walking via linear regression and analyzed relationships via structural equation modeling. Results: We found statistically significant support for the SCT approach, including a correlation coefficient (ρ) of 0.649 between step increase and GC rate (P<.001); a ρ of 0.497 between the coping SI rate and self-efficacy increase (P=.004); a ρ of 0.446 between GC rate and self-mastery increase (P=.01); and a ρ of 0.355 between self-regulation increase and step increase (P=.046), giving us insight into why the behavior intervention succeeded. We also found significant correlations between self-efficacy for barriers and self-efficacy for task-specific behavior (ρ=0.358; P=.04), as well as self-regulation and self-efficacy for task-specific behavior (ρ=0.583; P<.001). However, a cross-lagged panel modeling analysis found no significant evidence that changes in self-efficacy preceded behavior changes in line with SCT. Conclusions: Self-mastery and coping strategies contributed to the walking behavior change in StepAdd, supporting the SCT model of behavior change. Future research is needed to better understand the causal pathways proposed by SCT. %R 10.2196/60221 %U https://formative.jmir.org/2025/1/e60221 %U https://doi.org/10.2196/60221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67861 %T Accuracy of Smartphone-Mediated Snore Detection in a Simulated Real-World Setting: Algorithm Development and Validation %A Brown,Jeffrey %A Mitchell,Zachary %A Jiang,Yu Albert %A Archdeacon,Ryan %K snore detection %K snore tracking %K machine learning %K SleepWatch %K Bodymatter %K neural net %K mobile device %K smartphone %K smartphone application %K mobile health %K sleep monitoring %K sleep tracking %K sleep apnea %D 2025 %7 28.3.2025 %9 %J JMIR Form Res %G English %X Background: High-quality sleep is essential for both physical and mental well-being. Insufficient or poor-quality sleep is linked to numerous health issues, including cardiometabolic diseases, mental health disorders, and increased mortality. Snoring—a prevalent condition—can disrupt sleep and is associated with disease states, including coronary artery disease and obstructive sleep apnea. Objective: The SleepWatch smartphone app (Bodymatter, Inc) aims to monitor and improve sleep quality and has snore detection capabilities that were built through a machine-learning process trained on over 60,000 acoustic events. This study evaluated the accuracy of the SleepWatch snore detection algorithm in a simulated real-world setting. Methods: The snore detection algorithm was tested by using 36 simulated snoring audio files derived from 18 participants. Each file simulated a snoring index between 30 and 600 snores per hour. Additionally, 9 files with nonsnoring sounds were tested to evaluate the algorithm’s capacity to avoid false positives. Sensitivity, specificity, and accuracy were calculated for each test, and results were compared by using Bland-Altman plots and Spearman correlation to assess the statistical association between detected and actual snores. Results: The SleepWatch algorithm showed an average sensitivity of 86.3% (SD 16.6%), an average specificity of 99.5% (SD 10.8%), and an average accuracy of 95.2% (SD 5.6%) across the snoring tests. The positive predictive value and negative predictive value were 98.9% (SD 2.6%) and 93.8% (SD 14.4%) respectively. The algorithm performed exceptionally well in avoiding false positives, with a specificity of 97.1% (SD 3.5%) for nonsnoring files. Inclusive of all snoring and nonsnore tests, the aggregated accuracy for all trials in this bench study was 95.6% (SD 5.3%). The Bland-Altman analysis indicated a mean bias of −29.8 (SD 41.7) snores per hour, and the Spearman correlation analysis revealed a strong positive correlation (rs=0.974; P<.001) between detected and actual snore rates. Conclusions: The SleepWatch snore detection algorithm demonstrates high accuracy and compares favorably with other snore detection apps. Aside from its broader use in sleep monitoring, SleepWatch demonstrates potential as a tool for identifying individuals at risk for sleep-disordered breathing, including obstructive sleep apnea, on the basis of the snoring index. %R 10.2196/67861 %U https://formative.jmir.org/2025/1/e67861 %U https://doi.org/10.2196/67861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64384 %T User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study %A Wittmar,Silke %A Frankenstein,Tom %A Timm,Vincent %A Frei,Peter %A Kurpiers,Nicolas %A Wölwer,Stefan %A Schäfer,Axel Georg Meender %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Goschentor 1, Hildesheim, 31134, Germany, 49 5121881369, silke.wittmar@hawk.de %K usability testing %K health promotion %K exercise %K smartphone app %K mHealth %K physical activity %K user experience %K user %K university student %K undergraduate %K college %K student %K mixed methods %K physical fitness %K digital intervention %K mobile health %K promote %K engagement %K mobile phone %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences. Objective: This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA. Methods: A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data. Results: The UX received positive ratings across 4 User Experience Questionnaire scales (range –3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students’ appreciation for the personalized, diverse content and social networking features of futur.move. Conclusions: futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features “your condition” and “goal setting.” While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advanced prototype and conducting a longitudinal study to assess its impact on PA behavior and sustained engagement. %M 40153787 %R 10.2196/64384 %U https://formative.jmir.org/2025/1/e64384 %U https://doi.org/10.2196/64384 %U http://www.ncbi.nlm.nih.gov/pubmed/40153787 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65847 %T Theory-Based Social Media Intervention for Nonmedical Use of Prescription Opioids in Young Adults: Protocol for a Randomized Controlled Trial %A Tam,Cheuk Chi %A Young,Sean D %A Harrison,Sayward %A Li,Xiaoming %A Litwin,Alain H %+ Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States, 1 8037776883, ctam@mailbox.sc.edu %K nonmedical use of prescription opioids %K opioid misuse %K young adults %K social media %K psychosocial intervention %K randomized controlled trial %K mixed methods %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonmedical use of prescription opioids (NMUPO) in young adults in the United States is concerning and is robustly influenced by many psychosocial factors. Given the advantages of flexibility, wide coverage, and real-time responses and assessment, using social media appears to be a promising and innovative approach to delivering psychosocial intervention to young adults. However, few theory-based social media interventions are available for NMUPO targeting this at-risk population. Objective: Guided by the information-motivation-behavioral skills model, the proposed research aims to address critical gaps by theoretically exploring psychosocial content associated with NMUPO among young adults via formative assessment. These findings will then be used to develop and evaluate the feasibility and preliminary efficacy of a peer-led social media intervention to reduce NMUPO among young adults. Methods: The proposed study will comprise serial research activities. First, formative research will be conducted through semistructured interviews among 30 young adults engaged in NMUPO. Qualitative data will be synthesized using a pragmatic approach for identifying psychosocial content associated with NMUPO. Second, qualitative findings will be used for developing a peer-led social media intervention to reduce NMUPO among young adults by integrating promising psychotherapy principles and incorporating them with well-trained recovery coaches. Third, the social media intervention will be evaluated through a 12-week randomized controlled trial among 70 young adults (n=35, 50% in the intervention group and control group) engaged in NMUPO via mixed methods, including pre- and postintervention surveys, social media paradata (eg, time-series reactions to posts) collection, and ecological momentary assessment during the intervention. The control group will not receive an intervention but will complete the pre- and postintervention surveys. The primary outcomes will be feasibility, usability, and acceptability, while the secondary outcomes will be psychosocial and behavioral measures, such as past–3-month NMUPO, intention, psychological distress, self-efficacy, resilience, and coping strategies. Results: The proposed study was funded in May 2024. Social media campaigns have received responses from a total of 379 individuals, with 24 (6.3%) identified as eligible. As of February 10, 2025, we have completed formative interviews with 8 eligible participants. Conclusions: The proposed study will be one of the first efforts to develop and deliver a theory-based peer-led intervention on social media, incorporating empirical findings on the psychosocial mechanism of NMUPO. The findings of the proposed study will provide valuable insights into opioid risk reduction for young adults through an innovative approach. If the tested trial is found to be feasible, the proposed study will contribute to future scaled-up and fully powered psychosocial interventions among young adults and other key populations at risk for NMUPO. Trial Registration: ClincialTrials.gov NCT06469749; https://clinicaltrials.gov/study/NCT06469749 International Registered Report Identifier (IRRID): DERR1-10.2196/65847 %M 40139213 %R 10.2196/65847 %U https://www.researchprotocols.org/2025/1/e65847 %U https://doi.org/10.2196/65847 %U http://www.ncbi.nlm.nih.gov/pubmed/40139213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59953 %T Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People Who Use Drugs: Pilot Feasibility Study %A Gicquelais,Rachel E %A Conway,Caitlin %A Vjorn,Olivia %A Genz,Andrew %A Kirk,Gregory %A Westergaard,Ryan %K HIV %K drug use %K social determinants of health %K mobile health %K mHealth %K smartphone %D 2025 %7 26.3.2025 %9 %J JMIR Form Res %G English %X Background: Active substance use, food or housing insecurity, and criminal legal system involvement can disrupt HIV care for people living with HIV and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings. Objective: We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral nonsuppression and missed care visits to inform future mobile health interventions. Methods: We enrolled 59 participants from the AIDS Linked to the Intravenous Experience (ALIVE) Study in Baltimore, Maryland, into a 12-month substudy between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA ≥1000 copies/mL or a ≥1-month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis, through a survey on a mobile health app. We described weekly survey completion and investigated which factors were associated with viral nonsuppression (HIV RNA ≥200 copies/mL) or a missed care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use. Results: Participants were predominantly male (36/59, 61%), Black (53/59, 90%), and had a median of 53 years old. At baseline, 16% (6/38) were virally unsuppressed. Participants completed an average of 23.3 (SD 16.3) total surveys and reported missing a dose of antiretroviral therapy, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD 9.8) weekly surveys over 1 year. Reporting use of any drugs (adjusted odds ratio [aOR] 2.3, 95% CI 1.4‐3.7), injecting drugs (aOR 2.3, 95% CI 1.3‐3.9), and noncompletion of all surveys (aOR 1.6, 95% CI 1.1‐2.2) were associated with missing a scheduled care visit over the subsequent 30 days. Missing ≥2 antiretroviral medication doses within 1 week was associated with HIV viral nonsuppression (aOR 3.7, 95% CI: 1.2‐11.1) in the subsequent 30 days. Conclusions: Mobile health apps can capture risk factors that predict viral nonsuppression and missed care visits among people living with HIV who have OUD. Using mobile health tools to detect sociobehavioral factors that occur prior to treatment disengagement may facilitate early intervention by health care teams. %R 10.2196/59953 %U https://formative.jmir.org/2025/1/e59953 %U https://doi.org/10.2196/59953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66763 %T Mobile App-Based Interactive Care Plan for Migraine: Survey Study of Usability and Improvement Opportunities %A Young,Nathan P %A Stern,Jennifer I %A Steel,Stephanie J %A Ebbert,Jon O %K migraine %K remote monitoring %K mobile app %K mHealth %K patient-reported outcomes %K care plan %K digital health %K app %K smartphone %K eHealth %K technology %K survey study %K headache %K electronic health record %K remote assessment %K older adult %K adult %K electronic survey %K pain %K mobile phone %K telehealth %K telemedicine %D 2025 %7 26.3.2025 %9 %J JMIR Form Res %G English %X Background: We implemented a novel mobile app-based Migraine Interactive Care Plan (MICP) integrated with our electronic health records (EHRs). The MICP facilitates remote assessment of adult patients with migraine, educational content delivery, and care team communication. Feasibility of the MICP was demonstrated in a pilot implementation study. Objective: We aimed to assess the preferences and satisfaction of patients with migraine users of a mobile app-based care plan integrated with the EHR. Methods: An electronic survey was administered to a single cohort of MICP users between December 6, 2021, and December 30, 2021. The survey assessed patient preferences for which data to track, frequency of tracking, and satisfaction with the MICP. Survey responses were compared between subsets determined by patient-reported headache frequency and treatment with and without botulinum toxin and calcitonin gene-related peptide (CGRP) antagonist therapy. The Wilcoxon rank-sum test was used for continuous variables and the χ2 test or Fisher exact test for categorical variables. Results: The total sample size was 184 and the survey response rate was 30.4% (56/184). No significant differences in age (P=.26) or sex (P=.19) between respondents and nonrespondents were observed. Respondent median age was 42 (range 20‐72) years and 94.6% (53/56) were female. Headache frequency was (1) 0 to 8 days (26/56, 46.4%), (2) 9 to 14 days (12/56, 21.4%), and (3) 15 or more days (18/56, 32.1%). No difference was observed in any survey responses based on headache frequency or treatment. The majority of respondents preferred to track headache days weekly (30/56, 53.6%) or daily (15/56, 26.8%) and preferred to change the frequency of headache tracking reminders (42/56, 75%). Respondents were somewhat or very interested in daily tracking personal observations in free text (41/52, 78.8%), medication treatment (43/52, 82.7%) and treatment response (39/56, 69.6%), class of medication treatment (36/52, 69.2%), severity of functional impairment (39/56, 69.6%), type of functional impairment (35/53, 66%), headache day (40/54, 74.1%), and headache pain level on a scale of 1 to 10 (38/53, 71.7%). Respondents agreed or strongly agreed that the education content was useful (31/51, 60.8%) but lacked personalization (25/51, 49%). Most respondents agreed or strongly agreed that they were satisfied with the MICP (38/50, 76%) and that it helped them communicate with their care team (38/53, 71.7%). Conclusions: Most MICP users were motivated to track headache frequency, medication treatment with response, functional impairment, and pain intensity. Opportunities to improve the MICP include (1) allowing patients to change the frequency of assessments and notifications; (2) recording personal observations or comments through free text, which may include headache triggers; (3) assessment of headache severity using a 1 to 10 pain scale; and (4) tailoring headache education based on frequency and severity (episodic vs chronic migraine). These observations may be useful to improve the usability of the MICP and similar EHR-integrated migraine care platforms that others may develop. %R 10.2196/66763 %U https://formative.jmir.org/2025/1/e66763 %U https://doi.org/10.2196/66763 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 10 %N %P e64096 %T School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners %A March,Christine A %A Naame,Elissa %A Libman,Ingrid %A Proulx,Chelsea N %A Siminerio,Linda %A Miller,Elizabeth %A Lyon,Aaron R %+ , Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, United States, 1 4126929156, christine.eklund@chp.edu %K type 1 diabetes %K user-centered design %K school health %K collaborative care model %K implementation research %K pediatric %K usability testing %K virtual intervention %K multisystem community partners %K children %K youth %K diabetes management support %K health system partners %K psychosocial interventions %K quantitative assessments %K qualitative assessments %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Diabetes %G English %X Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10%-60% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue (ρ=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing. %M 40138695 %R 10.2196/64096 %U https://diabetes.jmir.org/2025/1/e64096 %U https://doi.org/10.2196/64096 %U http://www.ncbi.nlm.nih.gov/pubmed/40138695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57468 %T Stigma and Behavior Change Techniques in Substance Use Recovery: Qualitative Study of Social Media Narratives %A Chen,Annie T %A Wang,Lexie C %A Johnny,Shana %A Wong,Sharon H %A Chaliparambil,Rahul K %A Conway,Mike %A Glass,Joseph E %+ , Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Box 358047, Seattle, WA, 98109, United States, 1 206 221 3369, atchen@uw.edu %K stigma %K substance use %K transtheoretical model %K behavior change techniques %K social media %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing literature shows that persons with substance use disorder (SUD) experience different stages of readiness to reduce or abstain from substance use, and tailoring intervention change strategies to these stages may facilitate recovery. Moreover, stigma may serve as a barrier to recovery by preventing persons with SUDs from seeking treatment. In recent years, the behavior change technique (BCT) taxonomy has increasingly become useful for identifying potential efficacious intervention components; however, prior literature has not addressed the extent to which these techniques may naturally be used to recover from substance use, and knowledge of this may be useful in the design of future interventions. Objective: We take a three-step approach to identifying strategies to facilitate substance use recovery: (1) characterizing the extent to which stages of change are expressed in social media data, (2) identifying BCTs used by persons at different stages of change, and (3) exploring the role that stigma plays in recovery journeys. Methods: We collected discussion posts from Reddit, a popular social networking site, and identified subreddits or discussion forums about 3 substances (alcohol, cannabis, and opioids). We then performed qualitative data analysis using a hybrid inductive-deductive method to identify the stages of change in social media authors’ recovery journeys, the techniques that social media content authors used as they sought to quit substance use, and the role that stigma played in social media authors’ recovery journeys. Results: We examined 748 posts pertaining to 3 substances: alcohol (n=316, 42.2%), cannabis (n=335, 44.8%), and opioids (n=135, 18%). Social media content representing the different stages of change was observed, with the majority (472/748, 63.1%) of narratives representing the action stage. In total, 11 categories of BCTs were identified. There were similarities in BCT use across precontemplation, contemplation, and preparation stages, with social support seeking and awareness of natural consequences being the most common. As people sought to quit or reduce their use of substances (action stage), we observed a variety of BCTs, such as the repetition and substitution of healthful behaviors and monitoring and receiving feedback on their own behavior. In the maintenance stage, reports of diverse BCTs continue to be frequent, but offers of social support also become more common than in previous stages. Stigma was present throughout all stages. We present 5 major themes pertaining to the manifestation of stigma. Conclusions: Patterns of BCT use and stigmatizing experiences are frequently discussed in social media, which can be leveraged to better understand the natural course of recovery from SUD and how interventions might facilitate recovery from substance use. It may be important to incorporate stigma reduction across all stages of the recovery journey. %M 40138682 %R 10.2196/57468 %U https://formative.jmir.org/2025/1/e57468 %U https://doi.org/10.2196/57468 %U http://www.ncbi.nlm.nih.gov/pubmed/40138682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64266 %T Perceived Trust and Professional Identity Threat in AI-Based Clinical Decision Support Systems: Scenario-Based Experimental Study on AI Process Design Features %A Ackerhans,Sophia %A Wehkamp,Kai %A Petzina,Rainer %A Dumitrescu,Daniel %A Schultz,Carsten %+ , Kiel Institute of Responsible Innovation, University of Kiel, Westring 425, Kiel, 24118, Germany, 49 431880479, ackerhans@bwl.uni-kiel.de %K artificial intelligence %K clinical decision support systems %K explainable artificial intelligence %K professional identity threat %K health care %K physicians %K perceptions %K professional identity %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI)–based systems in medicine like clinical decision support systems (CDSSs) have shown promising results in health care, sometimes outperforming human specialists. However, the integration of AI may challenge medical professionals’ identities and lead to limited trust in technology, resulting in health care professionals rejecting AI-based systems. Objective: This study aims to explore the impact of AI process design features on physicians’ trust in the AI solution and on perceived threats to their professional identity. These design features involve the explainability of AI-based CDSS decision outcomes, the integration depth of the AI-generated advice into the clinical workflow, and the physician’s accountability for the AI system-induced medical decisions. Methods: We conducted a 3-factorial web-based between-subject scenario-based experiment with 292 medical students in their medical training and experienced physicians across different specialties. The participants were presented with an AI-based CDSS for sepsis prediction and prevention for use in a hospital. Each participant was given a scenario in which the 3 design features of the AI-based CDSS were manipulated in a 2×2×2 factorial design. SPSS PROCESS (IBM Corp) macro was used for hypothesis testing. Results: The results suggest that the explainability of the AI-based CDSS was positively associated with both trust in the AI system (β=.508; P<.001) and professional identity threat perceptions (β=.351; P=.02). Trust in the AI system was found to be negatively related to professional identity threat perceptions (β=–.138; P=.047), indicating a partially mediated effect on professional identity threat through trust. Deep integration of AI-generated advice into the clinical workflow was positively associated with trust in the system (β=.262; P=.009). The accountability of the AI-based decisions, that is, the system required a signature, was found to be positively associated with professional identity threat perceptions among the respondents (β=.339; P=.004). Conclusions: Our research highlights the role of process design features of AI systems used in medicine in shaping professional identity perceptions, mediated through increased trust in AI. An explainable AI-based CDSS and an AI-generated system advice, which is deeply integrated into the clinical workflow, reinforce trust, thereby mitigating perceived professional identity threats. However, explainable AI and individual accountability of the system directly exacerbate threat perceptions. Our findings illustrate the complex nature of the behavioral patterns of AI in health care and have broader implications for supporting the implementation of AI-based CDSSs in a context where AI systems may impact professional identity. %M 40138691 %R 10.2196/64266 %U https://formative.jmir.org/2025/1/e64266 %U https://doi.org/10.2196/64266 %U http://www.ncbi.nlm.nih.gov/pubmed/40138691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65114 %T Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study %A Seel,Mariella %A Mihalic,Julian Alexander %A Froschauer,Stefan Mathias %A Holzner,Bernhard %A Meier,Jens %A Gotterbarm,Tobias %A Holzbauer,Matthias %K carpal tunnel release surgery %K patient education %K structured web-based education %K online information %K health education literacy %K web-based %K health education %K information seeking %K carpal tunnel release %K carpal tunnel surgery %K non-randomized %K controlled study %K self-management %K perioperative %K online health information %K health literacy %K day surgery %K online search %K carpal tunnel %K carpal %D 2025 %7 25.3.2025 %9 %J JMIR Form Res %G English %X Background: With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management. Objective: This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy’s impact on patients’ health education literacy (HEL) compared with self-directed online information seeking. Methods: A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients’ preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients’s comprehension of medical information (COMPR), patients’s ability to apply health-related information in an everyday life (APPLY), and patient’s ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)–related parameters. Results: In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92% (66/72) versus 90% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89%) and over self-directed searches (15/18, 84%). No significant differences were found in CTS-related symptoms between groups. Conclusions: The CTS Academy effectively enhanced patients’ HEL, especially in applying and communicating medical information. The platform’s usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process. %R 10.2196/65114 %U https://formative.jmir.org/2025/1/e65114 %U https://doi.org/10.2196/65114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67293 %T Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study %A Whittemore,Robin %A Jeon,Sangchoon %A Akyirem,Samuel %A Chen,Helen N C %A Lipson,Joanna %A Minchala,Maritza %A Wagner,Julie %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 860 420 9623, robin.whittemore@yale.edu %K patient portal %K mobile phone %K diabetes %K community health center %K adults %K diabetic %K DM %K diabetes mellitus %K Type 2 diabetes %K T2D %K community health centers %K CHCs %K pilot study %K feasibility %K self-management %K glycemic control %K patient portals %K social determinants of health %K primary outcome %K digital health %K digital health literacy %K health technology %K health technologies %K psychosocial %K efficacy %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% 1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0% (no savings) to 50%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US $. Results: The total cost of iCAN was US $2865 PPPY, which was made up of US $265 in startup (9%) and US $2600 (91%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8%. This means that if average health care costs (US $36,917) among people experiencing homelessness were reduced by more than 7.8% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25% ($9229/$36,917; equal to 56% [$9229/$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US $2.22 in health care savings per US $1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US $28.7 million, which could be reduced to US $2.2 million if at least 8% ($2880/$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention. Conclusions: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8% ($2880/$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio. Trial Registration: ClinicalTrials NCT05365867; https://clinicaltrials.gov/study/NCT05365867 %R 10.2196/64973 %U https://formative.jmir.org/2025/1/e64973 %U https://doi.org/10.2196/64973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65794 %T Development of a Clinical Decision Support Tool to Implement Asthma Management Guidelines in Pediatric Primary Care: Qualitative Study %A Fedele,David A %A Ray,Jessica M %A Mallela,Jaya L %A Bian,Jiang %A Chen,Aokun %A Qin,Xiao %A Salloum,Ramzi G %A Kelly,Maria %A Gurka,Matthew J %A Hollenbach,Jessica %+ Center for Healthcare Delivery Science, Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32610, United States, 1 904 697 3600, david.fedele@nemours.org %K clinical decision support %K asthma %K primary care %K guidelines %K pediatric %K asthma care %K morbidity %K health information technology %K electronic health record %K EHR %K user-centered design %K inductive approach %K digital health %K health technology %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a longstanding gap between national asthma guidelines and their implementation in primary care. Primary care providers (PCPs) endorse numerous provider and practice or clinic-related barriers to providing guidelines-based asthma care. To reduce asthma morbidity in primary care, PCPs need access to tools that facilitate adherence to national guidelines, which can be delivered at the point of care, are minimally burdensome, and fit within the clinic workflow. Clinical decision support (CDS) tools are health IT systems that can be housed in the electronic health record (EHR) system. Objective: This study aimed to follow user-centered design principles and describe the formative qualitative work with target stakeholders (ie, PCPs and IT professionals) to inform our design of an EHR-embedded CDS tool that adheres to recent, significant changes in asthma management guidelines. Methods: Purposive sampling was used to recruit three separate subgroups of professionals (n=15) between (1) PCPs with previous experience using a paper-based CDS tool for asthma management, (2) PCPs without previous experience using CDS tools for asthma management, and (3) health care IT professionals. The PCP interview guide focused on their practice, familiarity with national asthma guidelines, and how a CDS tool embedded in the EHR might help them provide guideline-based care. The health care IT professional guide included questions on the design and implementation processes of CDS tools into the EHR. Qualitative data were audio-recorded, transcribed, and then analyzed using an inductive approach to develop themes. Results: Themes were organized into 2 domains, current practice and CDS tool development. The themes that emerged from PCPs included descriptions of assessments conducted to make an asthma diagnosis, previous attempts or opportunities to implement updated national asthma guidelines, and how a CDS tool could be implemented using the EHR and fit into the current asthma management workflow. The themes that emerged from health care IT professionals included processes used to design CDS tools and strategies to collect evidence that indicated a tool’s value to a practice and the broader health system. Conclusions: In this study, user-centered design principles were used to guide a qualitative study on perceived barriers and facilitators to a primary care–based, EHR-integrated asthma CDS tool. PCPs expressed their interest in adopting an asthma CDS tool that was low burden and efficient but could help them adhere to national asthma guidelines and improve clinic workflow. Similarly, health care IT professionals perceived an asthma CDS tool to be useful, if it adhered to EHR design standards. Implementation of a CDS tool to improve adherence of PCPs to recently updated national asthma guidelines could be beneficial in reducing pediatric asthma morbidity. %M 40100268 %R 10.2196/65794 %U https://formative.jmir.org/2025/1/e65794 %U https://doi.org/10.2196/65794 %U http://www.ncbi.nlm.nih.gov/pubmed/40100268 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64664 %T Use of Wearable Transdermal Alcohol Sensors for Monitoring Alcohol Consumption After Detoxification With Contingency Management: Pilot Randomized Feasibility Trial %A Brobbin,Eileen %A Drummond,Colin %A Parkin,Stephen %A Deluca,Paolo %+ King's College London, 4 Windswor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K alcohol %K alcohol dependence %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensor %K transdermal technology %K wearable %K wearable alcohol biosensor %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable transdermal alcohol sensor (TAS) devices generate continuous data on alcohol consumption through the indiscernible sweat vapors on the skin. This continuous alcohol monitoring capability could provide a new method for alcohol services to monitor service users at various stages of their alcohol treatment. Objective: We aimed to assess the feasibility of using a TAS as part of alcohol treatment with alcohol service users using the device with or without contingency management (CM). Methods: A feasibility study was conducted of a convenience sample of 29 current service users from 3 South London alcohol services. Participants were randomized into either a control (treatment as usual) or CM group (treatment as usual+CM). We assessed the feasibility of enrollment, participation, device tampering and return, and device wearability and the accuracy of data capture. These data were reported descriptively where appropriate, the groups were compared, and alcohol self-report data were compared to the transdermal alcohol concentration to assess accuracy. Results: A total of 34 individuals were approached, and 32 (94%) were enrolled and randomized (n=17, 53% to the control group and n=15, 47% to the CM group) over 5 months. In total, 3 participants withdrew (n=2, 67% from the control group and n=1, 33% from the CM group). There was a total of 203 meetings arranged (29 participants × 7 meetings), and 185 (91.1%) were attended. Only 1 of the 29 participants (3%) admitted to turning the TAS off to avoid monitoring. There were some issues with the TAS not functioning properly and not being able to be cleaned. Removals were recorded, but the definition of TAS removal may need to be improved for future trials. There was a high TAS return rate (28/29, 97% of the participants returned the TAS). Secondary outcomes suggest that the BACtrack Skyn remains an accurate tool to monitor alcohol consumption compared to self-report data and that it is acceptable to wearers over 2 weeks, with many participants (27/28, 96%) answering that they would wear it again and for longer but that the CM procedure could be made clearer. Conclusions: The delivery of CM via a TAS was feasible in this study, but recommendations for a future larger trial include that the study design should be changed to provide an operationalized rather than manual method of checking whether TAS data meet CM criteria. This would reduce researcher burden and researcher and participant time. Current recruitment and research meeting design seem suitable for a future larger trial. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 %M 40085839 %R 10.2196/64664 %U https://humanfactors.jmir.org/2025/1/e64664 %U https://doi.org/10.2196/64664 %U http://www.ncbi.nlm.nih.gov/pubmed/40085839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60170 %T Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data %A Hüer,Theresa %A Walendzik,Anke %A Kleinschmidt,Lara %A Höfer,Klemens %A Nauendorf,Beatrice %A Malsch,Juliane %A Brittner,Matthias %A Brandenburg,Paul %A Aeustergerling,André %A Schneider,Udo %A Wadeck,Anja %A Liersch,Sebastian %A Sehlen,Stephanie %A Schwarze,Katharina %A Wasem,Jürgen %+ Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 201 183 2592, theresa.hueer@medman.uni-due.de %K video consultation %K outpatient medical care %K user groups %K claims data analysis %K Germany %K physician %K psychotherapist %K sociodemographic %K healthcare %K digital health %K digital consultation %K telehealth %K telemonitoring %K telemedicine %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Supplementing outpatient medical care with the use of video consultations could, among other benefits, improve access, especially in structurally disadvantaged areas. Objective: This claims data analysis, carried out as part of the German research project “Preference-based use of video consultation in urban and rural regions,” aimed to analyze the use of video consultations and the characteristics of its user groups. Methods: Claims data from 3 Statutory Health Insurance Funds (SHIFs) and 4 Associations of Statutory Health Insurance Physicians (ASHIPs) from the period April 2017 to the end of 2020 were used. Data from a sample of about 6.1 million insured and 33,100 physicians and psychotherapists were analyzed. In addition to data on the use of video consultations, patient data on sociodemographic characteristics, diagnoses, and place of residence were included. To analyze the physicians’ perspectives, specialty groups, demographic characteristics, and the type of practice location were also included. In consideration of the principles of data economy and the fact that data analysis represents merely a preliminary phase within the broader project, the SHIFs and ASHIPs transmitted aggregated data (cross-tabulations per subgroup analysis) to the evaluator. For this reason, the analyses were constrained to a comparison of video consultation users versus nonusers, differentiated according to the aforementioned subgroups. Furthermore, the association between place of residence or type of region of the practice location and the use of video consultation was examined. A significance level of P<.05 was set for chi-square tests. Results: From 2017 to 2019, almost no video consultations were used in outpatient care in the German health care system. Although this changed considerably in relative terms with the start of the COVID-19 pandemic (but still at a very low absolute level), there was also a clear decline in the use of video consultations as the number of infections flattened out. Physicians working in psychotherapy and psychological psychotherapists used video consultations with around 16% (44,808/282,530) of their treatment cases in the second quarter of 2020, followed by psychotherapists using video consultations for children (10,828/113,293, 10%). Although the absolute number of treatment cases with video consultations among general practitioners was very high compared with other specialist groups, their share of video consultations in all treatment cases was very low at 0.3% (29,600/9,837,118). Younger age groups and those located in urban areas used video consultations more frequently; this applies to both patients (age groups: χ27=9903.2, P<.001; region types: χ22=3746.2, P<.001) and service providers (age groups: χ23=11,338.2, P<.001; region types: χ22=8474.1, P<.001). Conclusions: The current use of video consultations is below its potential in terms of scope and user groups. The widespread and lasting use of video consultations will only succeed if the potential user groups accept this form of service provision and recognize its advantages. Further analyses (both qualitative, such as focus group discussions, and quantitative, such as preference surveys) should therefore investigate the preferences of user groups for the use of video consultations. International Registered Report Identifier (IRRID): RR2-10.2196/50932 %M 40085136 %R 10.2196/60170 %U https://formative.jmir.org/2025/1/e60170 %U https://doi.org/10.2196/60170 %U http://www.ncbi.nlm.nih.gov/pubmed/40085136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67454 %T Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries (“I Was Always at the Library”): Qualitative Interview Study %A Knapp,Ashley A %A Cohen,Katherine %A Kruzan,Kaylee P %A Kornfield,Rachel %A Herrera,Miguel %A Pederson,Aderonke B %A Lee,Sydney %A Macapagal,Kathryn %A Roulston,Chantelle A %A Clarke,Kaleigh %A Wijaya,Clarisa %A Simmons,Robert %A Jackson,Latonia %A Kour,Simrandeep %A Franco,Sandra %A Mohr,David C %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125033751, ashley.knapp@northwestern.edu %K public libraries %K digital mental health %K teens %K youth %K adolescents %K anxiety %K mental health %K implementation %K safe spaces %K mobile phone %K smartphone %D 2025 %7 13.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens. Objective: This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs. Methods: We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56% (9/16) identified as female, 31% (5/16) identified as male, and 12% (2/16) identified as nonbinary. Most (11/16, 69%) identified as either White or Black or African American individuals, with the remainder (5/16, 31%) identifying as Hispanic or Latino or Chinese American individuals or with ≥2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes. Results: Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline. Conclusions: Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries. %M 40080819 %R 10.2196/67454 %U https://formative.jmir.org/2025/1/e67454 %U https://doi.org/10.2196/67454 %U http://www.ncbi.nlm.nih.gov/pubmed/40080819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67999 %T Interprofessional Discussion for Knowledge Transfer in a Digital “Community of Practice” for Managing Pneumoconiosis: Mixed Methods Study %A Sood,Varinn Avi %A Rishel Brakey,Heidi %A Myers,Orrin %A Shore,Xin %A Sood,Akshay %K digital community of practice %K knowledge transfer %K pneumoconiosis %K telementoring %K rural health care %K rural professionals %K multidisciplinary management %K interprofessional discussion %K miner health %K health equity %K mixed methods %K digital health %K public health %K digital community %K self-efficacy %K quantitative analyses %K quantitative %K technology %K multidisciplinary care %K patient outcome %D 2025 %7 13.3.2025 %9 %J JMIR Form Res %G English %X Background: Pneumoconiosis prevalence is increasing in the United States, especially among coal miners. Contemporaneously with an increased need for specialized multidisciplinary care for miners, there is a shortage of experts to fulfill this need. Miners’ Wellness ECHO (Extension for Community Health Outcomes) is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants’ self-efficacy for clinical, medicolegal, and “soft” skills related to miners’ health. Objective: We aimed to examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer. Methods: This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and analyzed content to examine participant discussions. We focused on participants’ statements of expertise followed by other participants’ acceptance or eschewal of these statements (utterances). We conducted quantitative analyses to examine the associations of active participation in discussion (primary outcome variable, defined as any utterance). We analyzed the association of the outcome on the following predictors: (1) participant group status, (2) study time frame, (3) participant ECHO experience status, (4) concordance of participant group identity between presenter and participant, (5) video usage, and (6) attendance frequency. We used the generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSMEANS to examine least squares means of fixed effects. Results: We studied 23 sessions with 158 unique participants and 539 total participants, averaging 23.4 (SD 5.6) participants per session. Clinical providers, the largest participant group, constituting 36.7% (n=58) of unique participants, were the most vocal group (mean 21.74, SD 2.11 average utterances per person-session). Benefits counselors were the least vocal group, with an average utterance rate of 0.57 (SD 0.29) per person-session and constituting 8.2% (n=13) of unique participants. Thus, various participant groups exhibited different utterance rates across sessions (P=.003). Experienced participants may have dominated active participation in discussion compared to those with less or intermediate experience, but this difference was not statistically significant (P=.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction P=.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (P=.11). Conclusions: Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes. %R 10.2196/67999 %U https://formative.jmir.org/2025/1/e67999 %U https://doi.org/10.2196/67999 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e57470 %T Effect of SMS Ward Round Notifications on Inpatient Experience in Acute Medical Settings: Retrospective Cohort Study %A Lee,Jongchan %A Ahn,Soyeon %A Ohn,Jung Hun %A Kim,Eun Sun %A Lim,Yejee %A Kim,Hye Won %A Park,Hee-Sun %A Cho,Jae Ho %A Kim,Sun-wook %A Ryu,Jiwon %A Kim,Jihye %A Jang,Hak Chul %A Kim,Nak-Hyun %K rounds %K round-time notification %K text messaging %K patient experience assessment %K patient experiences %K patient-centeredness %K patient participation %D 2025 %7 12.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Ward rounds are an essential component of inpatient care. Patient participation in rounds is increasingly encouraged, despite the occasional complicated circumstances, especially in acute care settings. Objective: This study aimed to evaluate the effect of real-time ward round notifications using SMS text messaging on the satisfaction of inpatients in an acute medical ward. Methods: Since January 2021, a service implementing real-time ward round notifications via text messaging (WR-SMS) has been operational at a tertiary-care medical center in Korea. To assess its impact, we conducted a retrospective cohort study of patients admitted to the acute medical unit who participated in a patient experience survey. Patient satisfaction was compared between patients admitted in 2020 (pre–WR-SMS group) and 2021 (post–WR-SMS group). Results: From January 2020 to December 2021, a total of 100 patients were enrolled (53 patients in the pre–WR-SMS group and 47 patients in the post–WR-SMS group). Compared with the pre–WR-SMS group, the post–WR-SMS group showed significantly greater satisfaction about being informed about round schedules (mean 3.43, SD 0.910 vs mean 3.89, SD 0.375; P<.001) and felt more emotionally supported during admission (mean 3.49, SD 0.800 vs mean 3.87, SD 0.397; P<.001). Regarding other questionnaire scores, the post–WR-SMS group showed an overall, although statistically insignificant, improvement compared with the pre–WR-SMS group. Conclusions: Real-time round notifications using a user-friendly SMS may improve inpatient satisfaction effectively. %R 10.2196/57470 %U https://humanfactors.jmir.org/2025/1/e57470 %U https://doi.org/10.2196/57470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66695 %T Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study %A Doerr,Adam J %A Orwig,Taylor A %A McNulty,Matthew %A Sison,Stephanie Denise M %A Paquette,David R %A Leung,Robert %A Ding,Huitong %A Erban,Stephen B %A Weinstein,Bruce R %A Guilarte-Walker,Yurima %A Zai,Adrian H %A Walkey,Allan J %A Soni,Apurv %A McManus,David D %A Lin,Honghuang %+ Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, S6-755, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K cognitive assessment %K primary care %K digital %K cognitive impairment %K digital assessment %K assessment %K cognitive health %K cognition %K primary care %K cognitive evaluation %K Core Cognitive Evaluation %K CCE %K cohort %K impairment %K cognitive %K outpatient %D 2025 %7 12.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health’s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied. Objective: This study aimed to explore the integration of CCE implementation in a primary care setting. Methods: A cohort of participants was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included individuals aged ≥65 years; ability to read, write, and speak in English or Spanish; no previous diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators collected consent from participants and facilitated the screening process. PCPs reviewed reports in real time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant’s REDCap (Research Electronic Data Capture; Vanderbilt University) record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. Results: The screened cohort included 150 patients with a mean age of 74 (SD 7) years, of whom 65% (97/150) were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. A total of 84 orders were placed for select laboratory tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Before the assessment, 95% (143/150) of patients and all 15 caregivers expressed a desire to know if their or their loved one’s brain health was declining. All except one patient also completed the postassessment survey. Among them, 96% (143/149) of patients reported finding the CCE easy to complete, and 70% (105/149) felt that the experience was beneficial. In addition, 87% (130/149) of patients agreed or strongly agreed that they wanted to know their CCE results. Among the 7 participating PCPs, 6 stated that the CCE results influenced their patient care management, and all 7 indicated they would continue using the CCE if it were made available after the study. Conclusions: We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world. %M 40073397 %R 10.2196/66695 %U https://formative.jmir.org/2025/1/e66695 %U https://doi.org/10.2196/66695 %U http://www.ncbi.nlm.nih.gov/pubmed/40073397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63251 %T Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey %A Cummins,Mollie R %A Ivanova,Julia %A Soni,Hiral %A Robbins,Zoe %A Bunnell,Brian E %A López,Esteban %A Welch,Brandon M %K telemedicine %K telehealth %K telemental %K provider %K professional %K experience %K attitude %K opinion %K perception %K perspective %K prescribing %K prescription %K drug %K pharmacology %K pharmacotherapy %K pharmaceutic %K pharmaceutical %K medication %K mental health %K digital health %K informatics %K buprenorphine %K ketamine %K cross sectional %K survey %K questionnaire %D 2025 %7 11.3.2025 %9 %J JMIR Form Res %G English %X Background: In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective: Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods: We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results: A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8% (17/115) to 19.1% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions: These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States. %R 10.2196/63251 %U https://formative.jmir.org/2025/1/e63251 %U https://doi.org/10.2196/63251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68292 %T Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids %A Edwards,Karlyn A %A Dildine,Troy C %A You,Dokyoung S %A Herrick,Ashley M %A Darnall,Beth D %A Mackey,Sean C %A Ziadni,Maisa S %+ Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Rd, Suite 200, Stanford, CA, 94304, United States, 1 650 497 7671, mziadni@stanford.edu %K Empowered Relief %K single session %K chronic pain %K prescription opioids %K telehealth %K daily data %K pain intensity %K pain catastrophizing %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually. Objective: This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment. Methods: During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76% female participants; n=52, 88% White participants) experiencing chronic pain who were receiving daily prescribed opioids (≥10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class. Results: Of the 60 participants enrolled, 41 (68%) attended the class and 24 (59% of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months (β=–3.49, P=.01; Cohen d=0.35) and 6 months after treatment (β=–3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months (β=–0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain (β=.42, P<.001) and higher self-reported opioid use (β=3.14, P<.001); daily pain intensity significantly reduced after the class (β=–.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class (β=–9.31, P=.02), although this result did not survive correction for multiplicity. Conclusions: Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way. %M 40068160 %R 10.2196/68292 %U https://formative.jmir.org/2025/1/e68292 %U https://doi.org/10.2196/68292 %U http://www.ncbi.nlm.nih.gov/pubmed/40068160 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64869 %T Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study %A Groninger,Hunter %A Arem,Hannah %A Ayangma,Lylian %A Gong,Lisa %A Zhou,Eric %A Greenberg,Daniel %+ , MedStar Health Research Institute, c/o 110 Irving Street NW, Room 2A68, Washington, DC, 20010, United States, 1 202 877 7445, hunter.groninger@medstar.net %K cancer %K survivor %K insomnia %K cognitive behavioral therapy %K technology %K app %K oncology %K mobile health %K artificial intelligence %K young adults %K sleep %K mHealth %K mobile health %K CBT %K voice-activated virtual assistant %K virtual assistants %K focus group %K qualitative research %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold-standard intervention to address insomnia. To improve CBT-I access and treatment adherence, screen-based digital CBT-I platforms have been developed. However, even with these digital products, widespread uptake of CBT-I remains limited, and new strategies for CBT-I delivery are warranted. Objective: The objective of this study is to understand how YACS experience insomnia and how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel screen-free voice-activated virtual assistant–delivered CBT-I prototype. Methods: Eligible participants—ages 18-39, living with a history of cancer (any type, any stage), self-reporting on average less sleep than National Sleep Foundation recommendations, and English-speaking—were recruited from a major urban cancer center, 2 regional oncology clinics, and 2 cancer survivorship support groups. We conducted 4 focus groups to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: In total, 26 YACS (6-7 participants per group) experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. In total, 12 participants completed device prototype testing, engaging with the prototype 94% of the assigned times (twice daily for 14 days; meeting predetermined feasibility cutoff of engagement ≥70% of assigned times) and rating the prototype with an overall mean score of 5.43 on the Satisfaction subscale of the Usability, Satisfaction, and Ease of Use scale (range 4.42-7; exceeding the predetermined cutoff score for acceptability of 5.0). All participants completing the study reported they would be interested in using the prototype again and would recommend it to someone else with insomnia. Conclusions: YACS were highly engaged with our voice-activated virtual assistant–delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate the efficacy of this intervention among YACS. Trial Registration: ClinicalTrials.gov NCT05875129; https://clinicaltrials.gov/study/NCT05875129 %M 40063947 %R 10.2196/64869 %U https://formative.jmir.org/2025/1/e64869 %U https://doi.org/10.2196/64869 %U http://www.ncbi.nlm.nih.gov/pubmed/40063947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66207 %T Medical Misinformation in AI-Assisted Self-Diagnosis: Development of a Method (EvalPrompt) for Analyzing Large Language Models %A Zada,Troy %A Tam,Natalie %A Barnard,Francois %A Van Sittert,Marlize %A Bhat,Venkat %A Rambhatla,Sirisha %K ChatGPT %K health care %K LLM %K misinformation %K self-diagnosis %K large language model %D 2025 %7 10.3.2025 %9 %J JMIR Form Res %G English %X Background: Rapid integration of large language models (LLMs) in health care is sparking global discussion about their potential to revolutionize health care quality and accessibility. At a time when improving health care quality and access remains a critical concern for countries worldwide, the ability of these models to pass medical examinations is often cited as a reason to use them for medical training and diagnosis. However, the impact of their inevitable use as a self-diagnostic tool and their role in spreading health care misinformation has not been evaluated. Objective: This study aims to assess the effectiveness of LLMs, particularly ChatGPT, from the perspective of an individual self-diagnosing to better understand the clarity, correctness, and robustness of the models. Methods: We propose the comprehensive testing methodology evaluation of LLM prompts (EvalPrompt). This evaluation methodology uses multiple-choice medical licensing examination questions to evaluate LLM responses. Experiment 1 prompts ChatGPT with open-ended questions to mimic real-world self-diagnosis use cases, and experiment 2 performs sentence dropout on the correct responses from experiment 1 to mimic self-diagnosis with missing information. Humans then assess the responses returned by ChatGPT for both experiments to evaluate the clarity, correctness, and robustness of ChatGPT. Results: In experiment 1, we found that ChatGPT-4.0 was deemed correct for 31% (29/94) of the questions by both nonexperts and experts, with only 34% (32/94) agreement between the 2 groups. Similarly, in experiment 2, which assessed robustness, 61% (92/152) of the responses continued to be categorized as correct by all assessors. As a result, in comparison to a passing threshold of 60%, ChatGPT-4.0 is considered incorrect and unclear, though robust. This indicates that sole reliance on ChatGPT-4.0 for self-diagnosis could increase the risk of individuals being misinformed. Conclusions: The results highlight the modest capabilities of LLMs, as their responses are often unclear and inaccurate. Any medical advice provided by LLMs should be cautiously approached due to the significant risk of misinformation. However, evidence suggests that LLMs are steadily improving and could potentially play a role in health care systems in the future. To address the issue of medical misinformation, there is a pressing need for the development of a comprehensive self-diagnosis dataset. This dataset could enhance the reliability of LLMs in medical applications by featuring more realistic prompt styles with minimal information across a broader range of medical fields. %R 10.2196/66207 %U https://formative.jmir.org/2025/1/e66207 %U https://doi.org/10.2196/66207 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e56978 %T Gamified Adaptive Approach Bias Modification in Individuals With Methamphetamine Use History From Communities in Sichuan: Pilot Randomized Controlled Trial %A Shen,Danlin %A Jiao,Jianping %A Zhang,Liqun %A Liu,Yanru %A Liu,Xiang %A Li,Yuanhui %A Zhang,Tianjiao %A Li,Dai %A Hao,Wei %K digital therapeutics %K substance use disorder %K game %K pilot RCT %K randomized controlled trial %K methamphetamine %K psychiatric %K gamified design %K engagement %K effectiveness %K smartphone app %K cognitive bias modification %D 2025 %7 10.3.2025 %9 %J JMIR Serious Games %G English %X Background: Cognitive bias modification (CBM) programs have shown promise in treating psychiatric conditions, but they can be perceived as boring and repetitive. Incorporating gamified designs and adaptive algorithms in CBM training may address this issue and enhance engagement and effectiveness. Objectives: This study aims to gather preliminary data and assess the preliminary efficacy of an adaptive approach bias modification (A-ApBM) paradigm in reducing cue-induced craving in individuals with methamphetamine use history. Methods: A randomized controlled trial with 3 arms was conducted. Individuals aged 18‐60 years with methamphetamine dependence and at least 1 year of methamphetamine use were recruited from 12 community-based rehabilitation centers in Sichuan, China. Individuals with the inability to fluently operate a smartphone and the presence of mental health conditions other than methamphetamine use disorder were excluded. The A-ApBM group engaged in ApBM training using a smartphone app for 4 weeks. The A-ApBM used an adaptive algorithm to dynamically adjust the difficulty level based on individual performance. Cue-induced craving scores and relapses were assessed using a visual analogue scale at baseline, postintervention, and at week-16 follow-up. Results: A total of 136 participants were recruited and randomized: 48 were randomized to the A-ApBM group, 48 were randomized to the static approach bias modification (S-ApBM) group, and 40 were randomized to the no-intervention control group. The A-ApBM group showed a significant reduction in cue-induced craving scores at postintervention compared with baseline (Cohen d=0.34; P<.01; 95% CI 0.03-0.54). The reduction remained significant at the week-16 follow-up (Cohen d=0.40; P=.01; 95% CI 0.18-0.57). No significant changes were observed in the S-ApBM and control groups. Conclusions: The A-ApBM paradigm with gamified designs and dynamic difficulty adjustments may be an effective intervention for reducing cue-induced craving in individuals with methamphetamine use history. This approach improves engagement and personalization, potentially enhancing the effectiveness of CBM programs. Further research is needed to validate these findings and explore the application of A-ApBM in other psychiatric conditions. Trial Registration: ClinicalTrials.gov NCT05794438; https://clinicaltrials.gov/study/NCT05794438 %R 10.2196/56978 %U https://games.jmir.org/2025/1/e56978 %U https://doi.org/10.2196/56978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64239 %T Evaluation of the MyFertiCoach Lifestyle App for Subfertile Couples: Single-Center Evaluation of Augmented Standard Care %A Smeenk,Jesper %A Smit,Ellen %A Jacobs,Marc %A van Rooij,Ilse %+ Elisabeth TweeSteden Ziekenhuis, Doctor Deelenlaan 5, Tilburg, 5042 AD, The Netherlands, 31 (013) 221 00 00, j.smeenk@etz.nl %K fertility %K mHealth %K pregnancy %K lifestyle %K app %K smartphone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Many couples undergoing fertility treatment face multiple lifestyle risk factors that lower their chances of achieving pregnancy. The MyFertiCoach (MFC) app was designed as an integrated lifestyle program featuring modules on healthy weight management, nutrition, exercise, quitting smoking, reducing alcohol and drug use, and managing stress. We hypothesized that supplementing standard care with the MFC app would improve lifestyle outcomes. Objective: This study aims to assess the impact of the MFC app on changing multiple lifestyle habits in women seeking fertility treatment. The primary outcome is the change in the total risk score (TRS) at 3- and six-month follow-ups. The TRS is calculated for each individual as the sum of all risk scores per behavior (eg, vegetable/fruit/folic acid intake, smoking, and alcohol use) at 3 and 6 months. A higher TRS indicates unhealthier nutrition and lifestyle habits and a lower likelihood of achieving pregnancy. The secondary endpoints include changes in BMI, activity score, preconception dietary risk score, distress score (eg, perceived burden), smoking habits, alcohol intake, and program adherence. Methods: This retrospective, observational, single-center evaluation included patients between January 1, 2022, and December 31, 2023. Subfertile female patients aged 18-43 years and their partners, who were referred to a gynecologist, were invited to participate in online lifestyle coaching via the MFC app. The gynecologist selected relevant lifestyle modules based on the results of integrated screening questionnaires. We used (hierarchical) linear mixed models (LMMs) to estimate changes in outcomes. For missing data patterns deemed missing not at random, joint modeling was applied. Statistical significance was set at P≤.05, with methods in place to maintain the same false-positive rate. Results: A total of 1805 patients were invited to participate in the evaluation, with an average of 737 (40.83%) completing the screening questionnaire at baseline. For the TRS, 798 (44.21%) patients were included at baseline, of whom 517 (64.8%) involved their partner. On average, 282 of 744 (37.9%) patients submitted at least one follow-up questionnaire. Patients rated the app above average (n=137, median score of 7 on a 1-10 scale) on days 7 and 14. The TRS decreased by an average of 1.5 points (P<.001) at T3 and T6 compared with baseline, a clinically meaningful improvement. All secondary outcomes showed statistically significant positive changes for patients who used a relevant lifestyle module (P<.001). Most improvements were achieved by 3 months and remained significant at 6 months (P<.001), except for alcohol intake (P<.53). These findings were consistent across both LMMs and joint models. Conclusions: Our evaluation of a mobile health app integrated into standard care demonstrates immediate and clinically meaningful improvements in key lifestyle parameters among women seeking to become pregnant. Additional scientific research is needed to identify the causal pathways leading to sustained effectiveness. To maintain and enhance these outcomes, further tailoring of patient-specific programs is essential. %M 40063944 %R 10.2196/64239 %U https://formative.jmir.org/2025/1/e64239 %U https://doi.org/10.2196/64239 %U http://www.ncbi.nlm.nih.gov/pubmed/40063944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72477 %T Authors’ Reply: Advancing Digital Health Integration in Oncology %A Lee,Yura %A Park,Ye-Eun %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 1498, haepary@amc.seoul.kr %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2025 %7 7.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40053760 %R 10.2196/72477 %U https://www.jmir.org/2025/1/e72477 %U https://doi.org/10.2196/72477 %U http://www.ncbi.nlm.nih.gov/pubmed/40053760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70316 %T Advancing Digital Health Integration in Oncology %A Khan,Rai Muhammad Umar %A Tariq,Hassan %+ Punjab Medical College, Faisalabad Medical University, Sargodha Road, Faisalabad, 38800, Pakistan, 92 41 9210080, raimumerkhan@gmail.com %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2025 %7 7.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40053796 %R 10.2196/70316 %U https://www.jmir.org/2025/1/e70316 %U https://doi.org/10.2196/70316 %U http://www.ncbi.nlm.nih.gov/pubmed/40053796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e51975 %T FRAILSURVEY—an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study %A Midao,Luis %A Duarte,Mafalda %A Sampaio,Rute %A Almada,Marta %A Dias,Cláudia Camila %A Paúl,Constança %A Costa,Elísio %+ RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, R. Jorge de Viterbo Ferreira 228, Porto, 4050-313, Portugal, 351 22 042 8500, luismidao@gmail.com %K frailty %K mHealth %K assessment %K validation %K GFI %K reliability %K self-assessment %K Groningen Frailty Indicator %K FRAILSURVEY %K mobile phone %D 2025 %7 7.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. Objective: This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. Methods: To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app’s validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. Results: The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). Conclusions: Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals. %M 40053720 %R 10.2196/51975 %U https://formative.jmir.org/2025/1/e51975 %U https://doi.org/10.2196/51975 %U http://www.ncbi.nlm.nih.gov/pubmed/40053720 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e67993 %T Exploring Health Care Professionals’ Perspectives on Education, Awareness, and Preferences for Digital Educational Resources to Support Transgender, Nonbinary, and Intersex Care: Interview Study %A Katta,Sravya %A Davoody,Nadia %+ Health Informatics Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, S-17177, Stockholm, Sweden, 46 (0)8 524 864, nadia.davoody@ki.se %K health care professionals %K transgender, nonbinary, and intersex %K communication challenges %K systematic barriers %K information and communication technology %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: Health care professionals often face challenges in providing affirming and culturally competent care to transgender, nonbinary, and intersex (TNBI) patients due to a lack of understanding and training in TNBI health care. This gap highlights the opportunity for tailored educational resources to enhance health care professionals’ interactions with TNBI individuals. Objective: This study aimed to explore health care professionals’ perspectives on education and awareness of health issues related to TNBI individuals. Specifically, it aimed to identify their needs, challenges, and preferences in accessing and using digital educational resources to enhance their knowledge and competence in providing inclusive and effective care for this population. Methods: A qualitative research approach was used in this study. In total, 15 health care professionals were recruited via convenience sampling to participate in semistructured interviews. Thematic analysis was applied to identify recurring codes and themes. Results: The study identified several themes and subthemes related to gender diversity awareness, inclusive communication and understanding the needs of TNBI individuals, societal and structural challenges, regulatory gaps in training and support infrastructure, education and training needs for health care professionals on TNBI care, educational resources and training tools for TNBI care, challenges and design considerations for eHealth tools integrations, and evaluating eHealth impact. Participants identified communication barriers, the need for health care providers to use inclusive language, and gaps in both health care system infrastructure and specialized training for gender-affirming care. In addition, participants expressed a need for comprehensive education on transgender and nonbinary health issues, resources for mental health professionals, user-friendly design, and accessibility features in eHealth tools. Conclusions: The study revealed substantial deficiencies in health care professionals’ knowledge of gender diversity, cultural competency, and the importance of inclusive communication. Addressing the identified barriers and challenges through targeted interventions, such as providing training and support for health care professionals, investing in user-friendly design and data security, and promoting cultural competence in TNBI health care, is essential. Despite integration challenges, eHealth tools have the potential to improve patient–health care professional relationships and access to care. %M 40053815 %R 10.2196/67993 %U https://mededu.jmir.org/2025/1/e67993 %U https://doi.org/10.2196/67993 %U http://www.ncbi.nlm.nih.gov/pubmed/40053815 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59215 %T Novel Profiles of Family Media Use: Latent Profile Analysis %A Hamp,Nicole %A Radesky,Jenny %A Weeks,Heidi M %A Miller,Alison L %A Kaciroti,Niko %K preschool %K child %K digital media %K mobile media %K media use %K latent profile analysis %K computer use %K LPA %K technology use %K survey %K questionnaire %K pediatrics %D 2025 %7 6.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information. Objective: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media. Methods: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership. Results: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership. Conclusions: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes. %R 10.2196/59215 %U https://pediatrics.jmir.org/2025/1/e59215 %U https://doi.org/10.2196/59215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60486 %T Feasibility and Links Between Emotions, Physical States, and Eating Behavior in Patients After Metabolic Bariatric Surgery: Experience Sampling Study %A Kuipers,Ellen A M %A Timmerman,Josien G %A van Det,Marc J %A Vollenbroek-Hutten,Miriam M R %+ Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, Almelo, 7609 PP, The Netherlands, 31 620024496, el.kuipers@zgt.nl %K feasibility %K experience sampling methodology %K metabolic bariatric surgery %K eating behavior %K positive and negative affect %K physical states %K contextual factors %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Lifestyle modification is essential to achieve and maintain successful outcomes after metabolic bariatric surgery (MBS). Emotions, physical states, and contextual factors are considered important determinants of maladaptive eating behavior, emphasizing their significance in understanding and addressing weight management. In this context, experience sampling methodology (ESM) offers promise for measuring lifestyle and behavior in the patient’s natural environment. Nevertheless, there is limited research on its feasibility and association among emotions and problematic eating behavior within the population after MBS. Objective: This study aimed to examine the feasibility of ESM in the population after MBS regarding emotions, physical states, contextual factors, and problematic eating behavior, and to explore the temporal association among these variables. Methods: An experience sampling study was conducted in which participants rated their current affect (positive and negative), physical states (disgust, boredom, fatigue, and hunger), contextual factors (where, with whom, and doing what), and problematic eating behavior (ie, grazing, dietary relapse, craving, and binge eating) via smartphone-based ESM questionnaires at 6 semirandom times daily for 14 consecutive days. Feasibility was operationalized as the study’s participation rate and completion rate, compliance in answering ESM questionnaires, and response rates per day. At the end of the study period, patients reflected on the feasibility of ESM in semistructured interviews. Generalized estimation equations were conducted to examine the temporal association between emotions, physical states, contextual factors, and problematic eating behavior. Results: In total, 25 out of 242 participants consented to participate, resulting in a study participation rate of 10.3%. The completion rate was 83%. Overall compliance was 57.4% (1072/1868), varying from 13% (11/84) to 89% (75/84) per participant. Total response rates per day decreased from 65% (90/138) to 52% (67/130) over the 14-day study period. According to the interviews, ESM was considered feasible and of added value. Temporal associations were found for hunger and craving (odds ratio 1.04, 95% CI 1.00-1.07; P=.03), and for positive affect and grazing (odds ratio 1.61, 95% CI 1.03-2.51; P=.04). Conclusions: In this exploratory study, patients after MBS were not amenable to participate. Only a small number of patients were willing to participate. However, those who participated found it feasible and expressed satisfaction with it. Temporal associations were identified between hunger and craving, as well as between positive affect and grazing. However, no clear patterns were observed among emotions, physical states, context, and problematic eating behaviors. %M 40053719 %R 10.2196/60486 %U https://formative.jmir.org/2025/1/e60486 %U https://doi.org/10.2196/60486 %U http://www.ncbi.nlm.nih.gov/pubmed/40053719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58867 %T Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study %A Beerbaum,Julian %A Robens,Sibylle %A Fehring,Leonard %A Mortsiefer,Achim %A Meister,Sven %+ Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstr. 11, Witten, 58448, Germany, 49 230292678629, sven.meister@uni-wh.de %K technology acceptance %K UTAUT %K family doctor %K digital health %K eHealth %K video consultation %K electronic health records %K digital anamnesis %K online appointment scheduling %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients’ overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine. Objective: To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach. Methods: Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case. Results: Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; β=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; β=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; β=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; β=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; β=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; β=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; β=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; β=.053; P=.10). Conclusions: In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice. %M 40053731 %R 10.2196/58867 %U https://formative.jmir.org/2025/1/e58867 %U https://doi.org/10.2196/58867 %U http://www.ncbi.nlm.nih.gov/pubmed/40053731 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56862 %T Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study %A Nonaka,Sayuri %A Fujii,Susumu %A Yamada,Kosuke Chris %K health care %K disaster medicine %K mobile app %K survey %K disaster situations %K self-reliance %K Japan %K disaster response %K mobile phone %D 2025 %7 5.3.2025 %9 %J JMIR Form Res %G English %X Background: Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster. Objective: This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization. Methods: We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios. Results: Among the 70 free apps, the predominant functions included “recording” (n=60 cases, 86%) and “measurement” (n=47 cases, 67%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but “content provision” (n=54 cases, 70%) was the most prevalent. Furthermore, the “content provision” function was particularly common in the “purposes of use” categories “sleep” (χ211=29; P<.001), “relaxation” (χ211=14.6; P<.001), and “exercise” (χ211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster. Conclusions: The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps. %R 10.2196/56862 %U https://formative.jmir.org/2025/1/e56862 %U https://doi.org/10.2196/56862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64492 %T An Integrated Platform Combining Immersive Virtual Reality and Physiological Sensors for Systematic and Individualized Assessment of Stress Response (bWell): Design and Implementation Study %A Khundrakpam,Budhachandra %A Segado,Melanie %A Pazdera,Jesse %A Gagnon Shaigetz,Vincent %A Granek,Joshua A %A Choudhury,Nusrat %+ National Research Council Canada, 75 de Mortagne, Boucherville, QC, J4B 6Y4, Canada, 1 450 978 6198, nusrat.choudhury@nrc-cnrc.gc.ca %K virtual reality %K stress %K physiological response %K NASA-Task Load Index %K cognitive demand %K physical demand %K vagal tone %K heart rate variability %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress is a pervasive issue in modern society, manifesting in various forms such as emotional, physical, and work-related stress, each with distinct impacts on individuals and society. Traditional stress studies often rely on psychological, performance, or social tests; however, recently, immersive virtual reality (VR), which provides a sense of presence and natural interaction, offers the opportunity to simulate real-world tasks and stressors in controlled environments. Despite its potential, the use of VR to investigate the multifaceted manifestations of stress has not been thoroughly explored. Objective: This study aimed to explore the feasibility of using a VR-based platform, bWell, to elicit multifaceted stress responses and measure the resulting behavioral and physiological changes. Specifically, we aimed to design various VR stress exercises based on neurocardiac models to systematically test cardiac functioning within specific contexts of self-regulation (executive functioning, physical efforts, and emotional regulation). Methods: The development process adhered to guidelines for VR clinical trials and complex health interventions, encompassing 3 phases: preparation, development, and verification. The preparation phase involved a comprehensive literature review to establish links between stress, the heart, and the brain, leading to the formulation of a conceptual model based on the Neurovisceral Integration Model (NVIM) and Vagal Tank Theory (VTT). The development phase involved designing VR exercises targeting specific stressors and integrating physiological sensors such as photoplethysmography (PPG) and electromyography (EMG) to capture heart rate variability (HRV) and facial expressions. The verification phase, conducted with a small number of trials, aimed to design a study and implement a workflow for testing the feasibility, acceptability, and tolerability of the VR exercises. In addition, the potential for capturing physiological measures along with subjective ratings of stress for specific dimensions was assessed. Results: Verification trials demonstrated that the VR exercises were well tolerated, with negligible cybersickness and high user engagement. The different VR exercises successfully elicited the intended stress demands, along with the physiological responses. Conclusions: The study presents a novel VR-based experimental setup that allows a systematic and individualized assessment of stress responses, paving the way for future research to identify features that confer stress resilience and help individuals manage stress effectively. While our conceptual model highlights the role of HRV in providing valuable insights into stress responses, future research will involve multivariate and machine learning analyses to predict individual stress responses based on comprehensive sensor data, including EMG and the VR-based behavioral data, ultimately guiding personalized stress management interventions. %M 40053709 %R 10.2196/64492 %U https://formative.jmir.org/2025/1/e64492 %U https://doi.org/10.2196/64492 %U http://www.ncbi.nlm.nih.gov/pubmed/40053709 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 2 %N %P e58784 %T At-Home Virtual Reality Intervention for Patients With Chronic Musculoskeletal Pain: Single-Case Experimental Design Study %A Slatman,Syl %A Heesink,Lieke %A Achterkamp,Reinoud %A Broeks,José %A Monteiro de Oliveira,Nelson %A ter Riet,Remko %A Stegeman,Marjolein %A Tabak,Monique %K virtual reality %K VR %K chronic musculoskeletal pain %K CMP %K single-case experimental design %K SCED %K user experience %K self-management %K musculoskeletal pain %D 2025 %7 4.3.2025 %9 %J JMIR XR Spatial Comput %G English %X Background: Virtual reality (VR) could possibly alleviate complaints related to chronic musculoskeletal pain (CMP); however, little is known about how it affects pain-related variables on an individual level and how patients experience this intervention. Objective: This study aimed to gain detailed insight into the influence of an at-home VR intervention for pain education and management on pain-related variables, and to explore its feasibility and general experience. Methods: The study applied a single-case experimental design in which an at-home VR intervention was used for 4 weeks by patients with CMP who were on a waiting list for regular pain treatment. Outcome measures included pain-related variables, functioning, and objectively measured outcomes (ie, stress, sleep, and steps). Outcomes were analyzed using data visualization (based on line plots) and statistical methods (ie, Tau-U and reliable change index) on an individual and group level. In addition, a focus group was conducted to assess feasibility and general experience to substantiate findings from the single-case experimental design study. This focus group was analyzed using inductive thematic analysis. Results: A total of 7 participants (female: n=6, 86%) with a median age of 45 (range 31‐61) years participated in this study. A dataset with 42 measurement moments was collected with a median of 280 (range 241‐315) data points per participant. No statistically significant or clinically relevant differences between the intervention and no-intervention phases were found. Results of the visual analysis of the diary data showed that patients responded differently to the intervention. Results of the focus group with 3 participants showed that the VR intervention was perceived as a feasible and valued additional intervention. Conclusions: Although patients expressed a positive perspective on this VR intervention, it did not seem to influence pain-related outcomes. Individual patients responded differently to the intervention, which implies that this intervention might not be suitable for all patients. Future studies should examine which CMP patients VR is effective for and explore its working mechanisms. In addition, future larger trials should be conducted to complement this study’s findings on the effectiveness of this intervention for patients with CMP and whether VR prevents deterioration on the waiting list compared with a control group. %R 10.2196/58784 %U https://xr.jmir.org/2025/1/e58784 %U https://doi.org/10.2196/58784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65859 %T A Digital Pornography Education Prototype Co-Designed With Young People: Formative Evaluation %A Turvey,Jake %A Raggatt,Michelle %A Wright,Cassandra J C %A Davis,Angela C %A Temple-Smith,Meredith J %A Lim,Megan S C %K pornography %K education %K website %K prototyping %K evaluation %K sexual health %K sexual wellbeing %K pornography literacy %K young people %K youth %K adolescents %K The Gist %K sexual education %K Australia %K efficacy %K digital health %K co-design %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: Interventions to help young people make sense of sex and relationships in the context of widely available pornography are becoming increasingly supported in school settings. However, young people who experience disruptions to their education often have less access to such programs. Digital platforms may offer a more accessible method to deliver tailored sexual health and pornography literacy to young people who are disengaged from mainstream schooling, or who experience other types of structural disadvantage. Objective: This study aimed to describe the formative evaluation of “The Gist” a co-designed online sexual health education and pornography literacy prototype designed to meet the sexual health information needs of structurally marginalized young people in Australia. Methods: We conducted iterative workshops with 33 young people aged between 15 and 24 years recruited from an alternative education school in Melbourne, Australia. Through interactive activities, participants evaluated the overall prototype design, including its usability, desirability, inclusiveness, and potential for impact. Results: Participants reported The Gist to be easy to use (17/20, 85%) and safe (19/23, 83%), with “hot” branding (25/30, 83%). However, perceived content relevance was dependent on the participants’ existing level of sexual health knowledge and experience, with only 31% (7/23) agreeing that “The Gist feels like it was made for me.” The interactive learning activities such as the debunked (myth-busting) and quiz features were among the most used and well-liked on The Gist platform. Low unprompted engagement with the prototype outside of facilitated workshop settings also confirmed previous researcher postulations that The Gist as a standalone digital platform is unlikely to meet the needs of this population group. Further design refinements are needed to improve user experience, including more interactive activities and visual information in place of heavily text-based features. Conclusions: This study provides important insights into the design and sexual health information needs of structurally marginalized young people. Further research is needed to assess the overall efficacy of The Gist prototype, as well as its ability to positively influence young people’s sexual attitudes, beliefs, and behaviors. Future iterations should consider hybrid or face-to-face delivery models to better capture student engagement. %R 10.2196/65859 %U https://formative.jmir.org/2025/1/e65859 %U https://doi.org/10.2196/65859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59954 %T Supplementing Consent for a Prospective Longitudinal Cohort Study of Infants With Antenatal Opioid Exposure: Development and Assessment of a Digital Tool %A Newman,Jamie E %A Clarke,Leslie %A Athimuthu,Pranav %A Dhawan,Megan %A Owen,Sharon %A Beiersdorfer,Traci %A Parlberg,Lindsay M %A Bangdiwala,Ananta %A McMillan,Taya %A DeMauro,Sara B %A Lorch,Scott %A Peralta-Carcelen,Myriam %A Wilson-Costello,Deanne %A Ambalavanan,Namasivayam %A Merhar,Stephanie L %A Poindexter,Brenda %A Limperopoulos,Catherine %A Davis,Jonathan M %A Walsh,Michele %A Bann,Carla M %K informed consent digital tool %K avatars %K video-assisted consent %K MRI %K antenatal opioid exposure %K infant %K antenatal %K opioid exposure %K caregiver %K survey %K magnetic resonance imaging %K Outcomes of Babies With Opioid Exposure %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: The Outcomes of Babies With Opioid Exposure (OBOE) study is an observational cohort study examining the impact of antenatal opioid exposure on outcomes from birth to 2 years of age. COVID-19 social distancing measures presented challenges to research coordinators discussing the study at length with potential participants during the birth hospitalization, which impacted recruitment, particularly among caregivers of unexposed (control) infants. In response, the OBOE study developed a digital tool (consenter video) to supplement the informed consent process, make it more engaging, and foster greater identification with the research procedures among potential participants. Objective: We aim to examine knowledge of the study, experiences with the consent process, and perceptions of the consenter video among potential participants of the OBOE study. Methods: Analyses included 129 caregivers who were given the option to view the consenter video as a supplement to the consent process. Participants selected from 3 racially and ethnically diverse avatars to guide them through the 11-minute video with recorded voice-overs. After viewing the consenter video, participants completed a short survey to assess their knowledge of the study, experiences with the consent process, and perceptions of the tool, regardless of their decision to enroll in the main study. Chi-square tests were used to assess differences between caregivers of opioid-exposed and unexposed infants in survey responses and whether caregivers who selected avatars consistent with their racial or ethnic background were more likely to enroll in the study than those who selected avatars that were not consistent with their background. Results: Participants demonstrated good understanding of the information presented, with 95% (n=123) correctly identifying the study purpose and 88% (n=112) correctly indicating that their infant would not be exposed to radiation during the magnetic resonance imaging. Nearly all indicated they were provided “just the right amount of information” (n=123, 98%) and that they understood the consent information well enough to decide whether to enroll (n=125, 97%). Survey responses were similar between caregivers of opioid-exposed infants and unexposed infants on all items except the decision to enroll. Those in the opioid-exposed group were more likely to enroll in the main study compared to the unexposed group (n=49, 89% vs n=38, 51%; P<.001). Of 81 caregivers with known race or ethnicity, 35 (43%) chose avatars to guide them through the video that matched their background. Caregivers selecting avatars consistent with their racial or ethnic background were more likely to enroll in the main study (n=29, 83% vs n=43, 57%; P=.01). Conclusions: This interactive digital tool was helpful in informing prospective participants about the study. The consenter tool enhanced the informed consent process, reinforced why caregivers of unexposed infants were being approached, and was particularly helpful as a resource for families to understand magnetic resonance imaging procedures. Trial Registration: ClinicalTrials.gov NCT04149509; https://clinicaltrials.gov/study/NCT04149509 %R 10.2196/59954 %U https://formative.jmir.org/2025/1/e59954 %U https://doi.org/10.2196/59954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63572 %T Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study %A Walzer,Stefan %A Schön,Isabel %A Pfeil,Johanna %A Merz,Nicola %A Marx,Helga %A Ziegler,Sven %A Kunze,Christophe %+ , Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723920295, stefan.walzer@hs-furtwangen.de %K nurses %K geriatric patients %K cognitive impairment %K technology %K fall prevention %K hospital %K mixed methods %K patient %K learning process %K assessment %K autonomy %K impairment %K real-time motion %K university %K geriatric ward %K survey %K anxiety %K willingness %K patient privacy %K effectiveness %K monitoring system %K health care practice %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults now make up about two-thirds of hospital admissions, with up to 50% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices. Objective: This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses’ perceptions of physical and mental stress, (2) evaluate the IRMS’s effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS. Methods: The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses’ experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting. Results: Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48%). Survey results showed that 80% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it. Conclusions: Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses’ fear of falls and enhances their responsiveness. The study highlights the broader impact of the IRMS beyond fall prevention and stresses the importance of thoughtful integration into health care practice. %M 40053780 %R 10.2196/63572 %U https://formative.jmir.org/2025/1/e63572 %U https://doi.org/10.2196/63572 %U http://www.ncbi.nlm.nih.gov/pubmed/40053780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56254 %T Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study %A Wu,Jia %A Zeng,Youjia %A Yang,Jun %A Yao,Yutong %A Xu,Xiuling %A Song,Gaofeng %A Yi,Wuyong %A Wang,Taifen %A Zheng,Yihou %A Jia,Zhongwei %A Yan,Xiangyu %+ , School of Disaster and Emergency Medicine, Tianjin University, No 92 Weijin Road, Tianjin, 300072, China, 86 02287370177 ext 307, yanxiangyu1123@163.com %K peritoneal dialysis %K mHealth %K patient management %K heart failure %K prediction model %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment. Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system’s daily treatment monitoring data. Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model. Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor’s data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results. Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis. %M 40053710 %R 10.2196/56254 %U https://formative.jmir.org/2025/1/e56254 %U https://doi.org/10.2196/56254 %U http://www.ncbi.nlm.nih.gov/pubmed/40053710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66744 %T Patients’ Experience With Evaluation by Both a Musculoskeletal Physician and Physical Therapist in the Same Digital Visit: Survey Study %A O'Connor,Mary I %A Chudy,Carolyn %A Peters,Kaitlyn C %A Ribaudo,Megan %A McCulloch,Carrie %A Aguilar,Jared %A Taylor,Trista %A Grant,Ryan A %K telemedicine %K musculoskeletal care %K patient satisfaction %K multidisciplinary care %K digital visit %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Patients undergoing evaluation for musculoskeletal concerns are often seen by a physician and physical therapist in the in-person setting in a sequential manner. This process typically delays the onset of nonoperative care, inclusive of physical therapy, and creates the risk of inadequate clinical collaboration between physician and physical therapist. To address these issues, we designed a novel initial patient evaluation to a group visit in which both a specialty-trained musculoskeletal physician and physical therapist simultaneously evaluate a patient together in the digital encounter. Objective: The aim of the study is to gain insights from patients on their experience with this innovative digital simultaneous musculoskeletal medical doctor and physical therapist (MD+PT) visit format for the initial evaluation of musculoskeletal concerns. Methods: An electronic 7-question survey was sent to 750 patients who completed an MD+PT visit asking them to comment on prior musculoskeletal evaluations and their experience with the MD+PT format. Results: In total, 195 (26%) patients responded to the survey with the frequent body regions of diagnosis being lumbar spine (n=65), knee (n=32), shoulder (n=21), cervical spine (n=20), hip (n=14), and hand (n=11). Most patients had prior musculoskeletal experience with a physician or nurse practitioner (171/195, 87.7%) or physical therapist (148/195, 75.9%) with nearly all such encounters in the in-person setting (161/171,94.2% for physician or nurse practitioner and 144/148, 97.3% for physical therapy). Only 3.1% (6/193) of patients reported seeing both a physician and physical therapist during the same in-person visit. Patients rated the simultaneous MD+PT visit very favorably: this type of digital evaluation saved them time (179/192, 93.2%) and permitted them to promptly start their treatment plan (174/192, 90.6%). Overall, 87.5% (168/192) rated the MD+PT visit as enjoyable, and 92.2% (177/192) responded that it increased their confidence with understanding their medical condition and how to start treating it. Conclusions: Our early experience with the evaluation of patients with musculoskeletal conditions by both a specialty-trained musculoskeletal physician and physical therapist simultaneously in the same digital visit resulted in patients reporting a very positive experience with high satisfaction, engagement, and confidence in understanding their diagnosis and how to start treating it. %R 10.2196/66744 %U https://formative.jmir.org/2025/1/e66744 %U https://doi.org/10.2196/66744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58266 %T App- and Wearable-Based Remote Monitoring for Patients With Myasthenia Gravis and Its Specialists: Feasibility and Usability Study %A Stein,Maike %A Stegherr,Regina %A Narayanaswami,Pushpa %A Legg,David %A Herdick,Meret %A Meisel,Andreas %A Gerischer,Lea %A Lehnerer,Sophie %K myasthenia gravis %K myasthenia %K remote monitoring %K PROMs %K digital platform %K wearables %K telemedicine %K spirometry %K app %K usability %K feasibility %K autoimmune disorder %K web-based portal %K activity tracker %K communication %K wearable data %K digital tool %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Myasthenia gravis (MG) is rare, chronic autoimmune disorder of the neuromuscular junction that requires specialized care and often lifelong treatment, facing challenges due to its rarity and the limited availability of specialists. Telemedical solutions in specialized centers hold considerable promise in bridging this gap by increasing access to this care to a broader patient population in a timely manner. However, there is no research regarding interventional remote care solutions in the field of MG to date. Objective: This study aimed to assess the feasibility and usability among patients with MG and specialists of a telemedicine platform, tailored to patients with MG and designed to facilitate remote monitoring, treated in a specialized center. Methods: The telemedicine platform consisted of an app for patients and a web-based portal for physicians. Over a period of 3 months, 30 patients continuously monitored their vital parameters through external devices, including a digital spirometer and a wearable (activity tracker). Furthermore, patients completed 7 different patient-reported outcome measures (PROMs) through the app at predefined intervals. Specialists could review this monitoring data and adjust therapy as necessary. In addition, communication between patients and physicians was facilitated through a chat module. Feasibility was evaluated by total adherence rates for completing PROMs within the app, alongside the collection of spirometry and wearable data. Furthermore, user satisfaction was assessed among both patients with MG and physicians at the end of study. Results: Total adherence rates ranged from 74.3% (1830/2464) to 97.9% (327/334) across all data types, with the highest adherence observed for PROMs (1139/1179, 96.6%), followed by spirometry (293/334, 87.7%) and wearables (1830/2261, 80.9%). Notably, patients wore the wearable longer than required by protocol and conducted a higher number of spirometry measurements during the study than required per protocol (median 20 h/d [IQR 15-24] vs 14 h/d and median 49 [IQR 15-59] measurements vs 11 measurements, respectively). Technical issues and discomfort with wearables were factors affecting lower adherence in some patients. The System Usability Scale yielded a median score of 85 indicating “excellent usability.” In addition, results from a more detailed user evaluation questionnaire showed high levels of user satisfaction among both patients and health care professionals across diverse categories, including their experience of the care program, communication, and evaluation of the program. Conclusions: Remote monitoring of patients with MG through the telemedical platform demonstrated good feasibility and acceptability, as evidenced by above-average adherence rates and user satisfaction for both patients and physicians. The majority of patients wanted to continue using the app. These findings highlight the potential for user-friendly digital tools to enhance care for patients with MG, although addressing technical challenges and ensuring patient comfort with wearables are essential for optimal implementation. Further research involving larger cohorts and longer study duration is warranted to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029907; https://drks.de/search/en/trial/DRKS00029907 %R 10.2196/58266 %U https://formative.jmir.org/2025/1/e58266 %U https://doi.org/10.2196/58266 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65187 %T Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators %A O'Grady,Megan %A Harrison,Laura %A Suleiman,Adekemi %A Hutchison,Morica %A Kwon,Nancy %A Muench,Frederick %A Kapoor,Sandeep %K unhealthy alcohol use %K text messaging intervention %K emergency department %K barriers and facilitators %K implementation %K alcohol use %K unhealthy %K mixed methods assessment %K mixed methods %K assessment %K facilitators %K alcohol %K health care %K scalable supports %K text messaging %K patient outcomes %K health system %K electronic health record %K EHR %K alcohol screening %K acceptability %K feasibility %K survey %K health-related goals %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings. Objective: This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient’s characteristics, the innovation’s degree of fit within the existing practice, and the unique nature of the inner and outer context. Methods: This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context. Results: Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%‐93%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals. Conclusions: ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also generally viewed the SMS text messaging intervention positively, with limited drawbacks (eg, slight concerns about having time to read messages). The results provide information that can be used to develop implementation strategies that can be tested in future studies. Trial Registration: ClinicalTrials.gov NCT05350878; http://clinicaltrials.gov/ct2/show/NCT05350878 %R 10.2196/65187 %U https://formative.jmir.org/2025/1/e65187 %U https://doi.org/10.2196/65187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60465 %T Assessment of the Sensitivity of a Smartphone App to Assist Patients in the Identification of Stroke and Myocardial Infarction: Cross-Sectional Study %A Dhand,Amar %A Mangipudi,Rama %A Varshney,Anubodh S %A Crowe,Jonathan R %A Ford,Andria L %A Sweitzer,Nancy K %A Shin,Min %A Tate,Samuel %A Haddad,Haissam %A Kelly,Michael E %A Muller,James %A Shavadia,Jay S %K time-to-treatment %K digital health %K patient-centered care %K eHealth apps %K smartphones %K apps %K cross-sectional study %K stroke %K myocardial infarction %K heart attack %K neurology %K neurological assessment %K accuracy %K emergency department %K finger-tapping test %K hospital admission %K physicians %K medical records %K mobile health %K mhealth %K symptom recognition %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Most people do not recognize symptoms of neurological and cardiac emergencies in a timely manner. This leads to delays in hospital arrival and reduced access to therapies that can open arteries. We created a smartphone app to help patients and families evaluate if symptoms may be high risk for stroke or heart attack (myocardial infarction, MI). The ECHAS (Emergency Call for Heart Attack and Stroke) app guides users to assess their risk through evidence-based questions and a test of weakness in one arm by evaluating finger-tapping on the smartphone. Objective: This study is an initial step in the accuracy evaluation of the app focused on sensitivity. We evaluated whether the app provides appropriate triage advice for patients with known stroke or MI symptoms in the Emergency Department. We designed this study to evaluate the sensitivity of the app, since the most dangerous output of the app would be failure to recognize the need for emergency evaluation. Specificity is also important, but the consequences of low specificity are less dangerous than those of low sensitivity. Methods: In this single-center cross-sectional study, we enrolled patients presenting with symptoms of possible stroke or MI. The ECHAS app assessment consisted of a series of evidence-based questions regarding symptoms and a test of finger-tapping speed and accuracy on the phone’s screen to detect unilateral arm weakness. The primary outcome was the sensitivity of the ECHAS app in detecting the need for ED evaluation. The secondary outcome was the sensitivity of the ECHAS app in detecting the need for hospital admission. Two independent and blinded board-certified physicians reviewed the medical record and adjudicated the appropriateness of the ED visit based on a 5-point score (ground truth). Finally, we asked patients semistructured questions about the app’s ease of use, drawbacks, and benefits. Results: We enrolled 202 patients (57 with stroke and 145 with MI). The ECHAS score was strongly correlated with the ground truth appropriateness score (Spearman correlation 0.41, P<.001). The ECHAS app had a sensitivity of 0.98 for identifying patients in whom ED evaluation was appropriate. The app had a sensitivity of 1.0 for identifying patients who were admitted to the hospital because of their ED evaluation. Patients completed an app session in an average of 111 (SD 60) seconds for the stroke pathway and 60 (SD 33) seconds for the MI pathway. Patients reported that the app was easy to use and valuable for personal emergency situations at home. Conclusions: The ECHAS app demonstrated a high sensitivity for the detection of patients who required emergency evaluation for symptoms of stroke or MI. This study supports the need for a study of specificity of the app, and then a prospective trial of the app in patients at increased risk of MI and stroke. %R 10.2196/60465 %U https://formative.jmir.org/2025/1/e60465 %U https://doi.org/10.2196/60465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58262 %T A Digital Program for Daily Life Management With Endometriosis: Pilot Cohort Study on Symptoms and Quality of Life Among Participants %A Breton,Zélia %A Stern,Emilie %A Pinault,Mathilde %A Lhuillery,Delphine %A Petit,Erick %A Panel,Pierre %A Alexaline,Maïa %+ Lyv Healthcare, 6 rue Edouard Nignon, Nantes, 44300, France, 33 650208680, maia@lyv.app %K digital program %K endometriosis %K integrative therapies %K quality of life %K nonpharmacological intervention %K daily life %K adenomyosis %K lesions %K women %K digital %K France %K case control %K digital health %K pilot study %K control group %K global symptom %K burden %K depression %K neuropathic pain %K chronic %K multidisciplinary %K web based %K mobile health %K mHealth %K intervention %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: After experiencing symptoms for an average of 7 years before diagnosis, patients with endometriosis are usually left with more questions than answers about managing their symptoms in the absence of a cure. To help women with endometriosis after their diagnosis, we developed a digital program combining user research, evidence-based medicine, and clinical expertise. Structured around cognitive behavioral therapy and the quality of life metrics from the Endometriosis Health Profile score, the program was designed to guide participants for 3 months. Objective: This cohort study was designed to measure the impact of a digital health program on the symptoms and quality of life levels of women with endometriosis. Methods: In total, 63% (92/146) of the participants were included in the pilot study, recruited either free of charge through employer health insurance or via individual direct access. A control group of 404 women with endometriosis who did not follow the program, recruited through social media and mailing campaigns, was sampled (n=149, 36.9%) according to initial pain levels to ensure a similar pain profile to participants. Questionnaires assessing quality of life and symptom levels were emailed to both groups at baseline and 3 months. Descriptive statistics and statistical tests were used to analyze intragroup and intergroup differences, with Cohen d measuring effect sizes for significant results. Results: Over 3 months, participants showed substantial improvements in global symptom burden, general pain level, anxiety, depression, dysmenorrhea, dysuria, chronic fatigue, neuropathic pain, and endo belly. These improvements were significantly different from the control group for global symptom burden (participants: mean –0.7, SD 1.6; controls: mean –0.3, SD 1.3; P=.048; small effect size), anxiety (participants: mean –1.1, SD 2.8; controls: mean 0.2, SD 2.5; P<.001; medium effect size), depression (participants: mean –0.9, SD 2.5; controls: mean 0.0, SD 3.1; P=.04; small effect size), neuropathic pain (participants: mean –1.0, SD 2.7; controls: mean –0.1, SD 2.6; P=.004; small effect size), and endo belly (participants: mean –0.9, SD 2.5; controls: mean –0.3, SD 2.4; P=.03; small effect size). Participants’ quality of life improved between baseline and 3 months and significantly differed from that of the control group for the core part of the Endometriosis Health Profile-5 (participants: mean –5.9, SD 21.0; controls: mean 1.0, SD 14.8; P=.03; small effect size) and the EQ-5D (participants: mean 0.1, SD 0.1; controls: mean –0.0, SD 0.1; P=.001; medium effect size). Perceived knowledge of endometriosis was significantly greater at 3 months among participants compared to the control group (P<.001). Conclusions: This study’s results suggest that a digital health program providing medical and scientific information about endometriosis and multidisciplinary self-management tools may be useful to reduce global symptom burden, anxiety, depression, neuropathic pain, and endo belly while improving knowledge on endometriosis and quality of life among participants. %M 39791286 %R 10.2196/58262 %U https://formative.jmir.org/2025/1/e58262 %U https://doi.org/10.2196/58262 %U http://www.ncbi.nlm.nih.gov/pubmed/39791286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70278 %T Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study %A Miranda,Christina %A Matheson,Brittany %A Datta,Nandini %A Whyte,Aileen %A Yang,Hyun-Joon %A Schmiedmayer,Paul %A Ravi,Vishnu %A Aalami,Oliver %A Lock,James %K mHealth %K mobile health %K mobile application %K emotion regulation %K eating disorders %K family-based treatment %K distress tolerance %K mealtimes %D 2025 %7 28.2.2025 %9 %J JMIR Form Res %G English %X Background: Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)–based distress tolerance skills to support adolescents and families during mealtimes. Objective: Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT. Methods: BALANCE was developed collaboratively with Stanford University’s Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app’s usability, perceived effectiveness, and its impact on their distress tolerance. Results: The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app’s broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa. Conclusions: BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE’s application to broader adolescent populations. %R 10.2196/70278 %U https://formative.jmir.org/2025/1/e70278 %U https://doi.org/10.2196/70278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55603 %T Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre– and Post–Follow-Up Study %A Samele,Chiara %A Urquia,Norman %A Edwards,Rachel %A Donnell,Katie %A Krause,Nihara %+ , stem4, Connect House, 133-137 Alexandra Road, Wimbledon, London, SW19 7JY, United Kingdom, 44 7956396375, dr.nihara.krause@stem4.org.uk %K mental health %K anxiety %K depression %K emotional and behavioral difficulties %K mobile phone app %K cognitive behavioral therapy %K digital tool %K young people %K mobile phone %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people. Objective: We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy. Methods: The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre– and post–follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post–app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis. Results: A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of “very high” on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes. Conclusions: The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties. %M 40053764 %R 10.2196/55603 %U https://formative.jmir.org/2025/1/e55603 %U https://doi.org/10.2196/55603 %U http://www.ncbi.nlm.nih.gov/pubmed/40053764 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58992 %T Mobilizing Health Promotion Through Canada’s Student Mental Health Network: Concurrent, Mixed Methods Process Evaluation %A Ecclestone,Amy %A Linden,Brooke %A Rose,Jessica %A Kullar,Kiran %K mental health %K health promotion %K program evaluation %K postsecondary %K knowledge translation %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: Mental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgment of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access support due to barriers including lack of awareness, geographical and financial barriers, and lack of relevance in offerings. Canada’s Student Mental Health Network is a web-based knowledge mobilization initiative designed to fill these gaps. With content created and curated “for-students, by-students” and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students. Objective: The goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately 1 year of operations, with the goal of assessing acceptability and feasibility. Methods: Using a concurrent mixed methods study design, quantitative and qualitative data were simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data were automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included the number of users accessing the website, user engagement, and user “stickiness.” Quantitative data were used to evaluate both accessibility and feasibility. Qualitative data were collected via individual, digital interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility. Results: A total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90% of total website traffic. An overall 66% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website use statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the esthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified. Conclusions: The results of this study provide evidence in support of the feasibility and acceptability of the Network as a web-based knowledge mobilization initiative in support of postsecondary students’ mental health and well-being. Future research will pursue a summative, impact assessment to evaluate utility. %R 10.2196/58992 %U https://formative.jmir.org/2025/1/e58992 %U https://doi.org/10.2196/58992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66807 %T Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study %A Pickard,Abigail %A Edwards,Katie %A Farrow,Claire %A Haycraft,Emma %A Blissett,Jacqueline %K pediatric %K paediatric %K child %K child eating %K parent feeding %K parent %K ecological momentary assessment %K mHealth %K mobile health %K mobile app %K application %K smartphone %K digital %K digital health %K digital technology %K digital intervention %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 “full” days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 %R 10.2196/66807 %U https://formative.jmir.org/2025/1/e66807 %U https://doi.org/10.2196/66807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66478 %T Novel Evaluation Metric and Quantified Performance of ChatGPT-4 Patient Management Simulations for Early Clinical Education: Experimental Study %A Scherr,Riley %A Spina,Aidin %A Dao,Allen %A Andalib,Saman %A Halaseh,Faris F %A Blair,Sarah %A Wiechmann,Warren %A Rivera,Ronald %K medical school simulations %K AI in medical education %K preclinical curriculum %K ChatGPT %K ChatGPT-4 %K medical simulation %K simulation %K multimedia %K feedback %K medical education %K medical student %K clinical education %K pilot study %K patient management %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: Case studies have shown ChatGPT can run clinical simulations at the medical student level. However, no data have assessed ChatGPT’s reliability in meeting desired simulation criteria such as medical accuracy, simulation formatting, and robust feedback mechanisms. Objective: This study aims to quantify ChatGPT’s ability to consistently follow formatting instructions and create simulations for preclinical medical student learners according to principles of medical simulation and multimedia educational technology. Methods: Using ChatGPT-4 and a prevalidated starting prompt, the authors ran 360 separate simulations of an acute asthma exacerbation. A total of 180 simulations were given correct answers and 180 simulations were given incorrect answers. ChatGPT was evaluated for its ability to adhere to basic simulation parameters (stepwise progression, free response, interactivity), advanced simulation parameters (autonomous conclusion, delayed feedback, comprehensive feedback), and medical accuracy (vignette, treatment updates, feedback). Significance was determined with χ² analyses using 95% CIs for odds ratios. Results: In total, 100% (n=360) of simulations met basic simulation parameters and were medically accurate. For advanced parameters, 55% (200/360) of all simulations delayed feedback, while the Correct arm (157/180, 87%) delayed feedback was significantly more than the Incorrect arm (43/180, 24%; P<.001). A total of 79% (285/360) of simulations concluded autonomously, and there was no difference between the Correct and Incorrect arms in autonomous conclusion (146/180, 81% and 139/180, 77%; P=.36). Overall, 78% (282/360) of simulations gave comprehensive feedback, and there was no difference between the Correct and Incorrect arms in comprehensive feedback (137/180, 76% and 145/180, 81%; P=.31). ChatGPT-4 was not significantly more likely to conclude simulations autonomously (P=.34) and provide comprehensive feedback (P=.27) when feedback was delayed compared to when feedback was not delayed. Conclusions: These simulations have the potential to be a reliable educational tool for simple simulations and can be evaluated by a novel 9-part metric. Per this metric, ChatGPT simulations performed perfectly on medical accuracy and basic simulation parameters. It performed well on comprehensive feedback and autonomous conclusion. Delayed feedback depended on the accuracy of user inputs. A simulation meeting one advanced parameter was not more likely to meet all advanced parameters. Further work must be done to ensure consistent performance across a broader range of simulation scenarios. %R 10.2196/66478 %U https://formative.jmir.org/2025/1/e66478 %U https://doi.org/10.2196/66478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62680 %T Probing Public Perceptions of Antidepressants on Social Media: Mixed Methods Study %A Zhu,Jianfeng %A Zhang,Xinyu %A Jin,Ruoming %A Jiang,Hailong %A Kenne,Deric R %K antidepressant %K AskaPatient %K natural language processing %K BERTopic %K large language models %K Reddit %D 2025 %7 26.2.2025 %9 %J JMIR Form Res %G English %X Background: Antidepressants are crucial for managing major depressive disorders; however, nonadherence remains a widespread challenge, driven by concerns over side effects, fear of dependency, and doubts about efficacy. Understanding patients’ experiences is essential for improving patient-centered care and enhancing adherence, which prioritizes individual needs in treatment. Objective: This study aims to gain a deeper understanding of patient experiences with antidepressants, providing insights that health care providers, families, and communities can develop into personalized treatment strategies. By integrating patient-centered care, these processes may improve satisfaction and adherence with antidepressants. Methods: Data were collected from AskaPatient and Reddit, analyzed using natural language processing and large language models. Analytical techniques included sentiment analysis, emotion detection, personality profiling, and topic modeling. Furthermore, demographic variations in patient experiences were also examined to offer a comprehensive understanding of discussions around antidepressants. Results: Sentiment and emotion analysis revealed that the majority of discussions (21,499/36,253, 59.3%) expressed neutral sentiments, with negative sentiments following closely (13,922/36,253, 38.4%). The most common emotions were fear (16,196/36,253, 44.66%) and sadness (12,507/36,253, 34.49%). The largest topic, “Mental Health and Relationships,” accounted for 11.69% (3755/36,253) of the discussions, which indicated a significant focus on managing mental health conditions. Discussions around nonadherence were marked by fear, followed by sadness, while self-care discussions showed a notable trend of sadness. Conclusions: These psychological insights into public perceptions of antidepressants provide a foundation for developing tailored, patient-centered treatment approaches that align with individual needs, enhancing both effectiveness and empathy of care. %R 10.2196/62680 %U https://formative.jmir.org/2025/1/e62680 %U https://doi.org/10.2196/62680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69602 %T Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods %A Meyerhoff,Jonah %A Popowski,Sarah A %A Lakhtakia,Tanvi %A Tack,Emily %A Kornfield,Rachel %A Kruzan,Kaylee P %A Krause,Charles J %A Nguyen,Theresa %A Rushton,Kevin %A Pisani,Anthony R %A Reddy,Madhu %A Van Orden,Kimberly A %A Mohr,David C %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125031232, jonah.meyerhoff@northwestern.edu %K mental health services %K technology %K therapy %K computer assisted %K SMS text messaging %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging–based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants—creating a threaded digital conversation. Researcher-posted prompts centered on participants’ experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging–based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message–based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults’ existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices—data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants—this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy. %M 40009840 %R 10.2196/69602 %U https://formative.jmir.org/2025/1/e69602 %U https://doi.org/10.2196/69602 %U http://www.ncbi.nlm.nih.gov/pubmed/40009840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59829 %T Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers %A Reifegerste,Doreen %A Wagner,Anna J M %A Huber,Lisa %A Fastuca,Manuel %+ School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, 33615, Germany, 49 521 10667 ext 807, doreen.reifegerste@uni-bielefeld.de %K mental health %K suicide prevention %K men’s health %K evaluation %K website %K gatekeeper %K suicide %K male %K suicide risk %K digital communication %K intervention %K suicidal behavior %K digital intervention %K digital media %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention’s applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. %M 40009838 %R 10.2196/59829 %U https://formative.jmir.org/2025/1/e59829 %U https://doi.org/10.2196/59829 %U http://www.ncbi.nlm.nih.gov/pubmed/40009838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57511 %T Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study %A Fathalla,Ahmed M %A Chiang,Cherie %A Audehm,Ralph %A Gorelik,Alexandra %A Chang,Shanton %A Yates,Christopher J %A Snow,Steve %A Barmanray,Rahul %A Price,Sarah %A Collins,Lucy %A Wark,John D %+ Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, 300 Grattan Street, Parkville, Melbourne, 3050, Australia, 61 03 8344 5892, ahmed.elsayed@unimelb.edu.au %K community-based fracture capture bone hub %K osteoporosis %K virtual communities of practice %K continuing professional development %K primary care physicians %K web-based learning platform %K case-based education %D 2025 %7 25.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program’s design and content, showing promising potential. Objective: We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants’ interactions, satisfaction levels, and overall experience. Methods: Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs’ knowledge and confidence after engagement with the CFC Learning Hub. Results: Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. Conclusions: The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs’ needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. International Registered Report Identifier (IRRID): DERR1-10.2196/57511 %M 39999431 %R 10.2196/57511 %U https://www.researchprotocols.org/2025/1/e57511 %U https://doi.org/10.2196/57511 %U http://www.ncbi.nlm.nih.gov/pubmed/39999431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65169 %T A Classroom-Based Intervention for Reducing Sedentary Behavior and Improving Spinal Health: Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial %A Fisher,Dominic %A Maart,Rentia %A Thabane,Lehana %A Louw,Quinette %+ School of Health Professions, Faculty of Health, University of Plymouth, North Road East, InterCity Place, Plymouth, PL4 6AB, United Kingdom, 44 01752587580, dominic.fisher@plymouth.ac.uk %K sedentary behavior %K spinal health %K classroom-based intervention %K sit-stand desks %K spinal %K African %K Africa %K primary school %K child %K youth %K randomized controlled trial %K RCT %K infectious disease %K acceptability %K data collection %K teacher %K classroom-based interventions %K primary school learners %K physical activity %K closed-cohort %K interview %K quantitative data %K wearable %K wearable sensor %K spine %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers’ practices, and the logistical and pragmatic considerations of data collection. Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors. Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers’ interviews and learners’ focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel. Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR2-10.2196/18522 %M 39993285 %R 10.2196/65169 %U https://formative.jmir.org/2025/1/e65169 %U https://doi.org/10.2196/65169 %U http://www.ncbi.nlm.nih.gov/pubmed/39993285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59032 %T Evaluation of Financial Support Workshops for Patients Under State Pension Age With Degenerative Cervical Myelopathy: Survey Study %A Rujeedawa,Tanzil %A Karimi,Zahabiya %A Wood,Helen %A Sangeorzan,Irina %A Smith,Roy %A Sadler,Iwan %A Martin-Moore,Esther %A Gardner,Adrian %A K Demetriades,Andreas %A Sinha,Rohitashwa %A Grahovac,Gordan %A Bateman,Antony %A Deakin,Naomi %A Davies,Benjamin %K myelopathy %K degenerative %K spine %K spinal %K benefits %K aid %K financial %K money %K income %K poverty %K disability %K disabled %K finance %K workshop %K education %K service %K access %K accessibility %K navigate %K confidence %K government %D 2025 %7 24.2.2025 %9 %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Myelopathy.org is the first global scientific and clinical charity for DCM, providing an accessible platform freely disseminating information relevant to the DCM diagnosis and its treatment. Significant transient and long-term change to earnings do occur and can thrust individuals into poverty. People with DCM face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Financial support available to patients under pension age include Universal Credit (UC), a payment that helps with living costs, and Personal Independence Payment (PIP), which helps with extra living costs if someone has both a long-term health condition or disability and difficulty doing certain everyday tasks. Objective: This study aimed to assess if delivering workshops centered around access to financial support could assist people with DCM living in the United Kingdom. Methods: A series of 2 internet-based workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymized survey delivered to participants after each session. The first session was on UC and the second on PIP. The survey consisted of a mixture of Likert scales, free text and yes or no answers. Survey responses were analyzed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the use of UC was 9.00/10. Presession self-rated confidence levels were 5.11/10 rising to 8.00/10. The mean score of wanting further similar sessions was 8.67/10 with 56% (5/9) of participants wanting one-to-one sessions. For PIP, the average session use rating was 10/10. Presession self-rated confidence levels were 4.43/10 rising to 9.57/10. The mean score of wanting further similar sessions was 8.71/10, with 43% (3/7) of participants wanting one-to-one sessions . Following inductive thematic analysis, themes regarding the usefulness of such sessions and the challenges to accessing financial support emerged. One participant gave negative feedback, which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organizations. %R 10.2196/59032 %U https://formative.jmir.org/2025/1/e59032 %U https://doi.org/10.2196/59032 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68667 %T Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study %A Prochnow,Tyler %A Dunton,Genevieve F %A de la Haye,Kayla %A Pollack Porter,Keshia M %A Lee,Chanam %+ Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab, College Station, TX, 77843, United States, 1 2629450275, tprochnow@tamu.edu %K physical activity %K youth %K social environment %K built environment %K ecological momentary assessment %K social network analysis %K phenotypes %K accelerometry %K GPS %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study’s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 %M 39984166 %R 10.2196/68667 %U https://www.researchprotocols.org/2025/1/e68667 %U https://doi.org/10.2196/68667 %U http://www.ncbi.nlm.nih.gov/pubmed/39984166 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64465 %T Tablet- and Group-Based Multicomponent Cognitive Stimulation for Older Adults With Mild Cognitive Impairment: Single-Group Pilot Study and Protocol for Randomized Controlled Trial %A Jornkokgoud,Khanitin %A Makmee,Pattrawadee %A Wongupparaj,Peera %A Grecucci,Alessandro %+ Department of Psychology, Faculty of Humanities and Social Sciences, Burapha University, 169 Long-Haad Bang Saen Road, Saen-Sook Sub-district, Mueang District, Chon Buri, 20131, Thailand, 66 38 102622, peera.wo@go.buu.ac.th %K computerized cognitive stimulation %K multisensory integration %K cognitive decline %K aging %K electroencephalography %K randomized controlled trial %K RCT %K protocol %K cognitive stimulation %K mild cognitive impairment %K cognitive %K cognition %K cognitive simulation therapy %K CST %K MCI %K tablet %K effectiveness %K pilot study %K neuropsychological tests %K behavioral %K emotional %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive stimulation therapy is a group-based psychological treatment for people with dementia as well as those with mild cognitive impairment (MCI) and is shown to improve both cognition and quality of life. Previous studies have indicated the potential to benefit from the use of technological devices in group interventions. Objective: The pilot study aimed to assess the effectiveness of a tablet- and group-based multicomponent cognitive stimulation therapy (MCST) for enhancing cognitive functions among older adults with MCI. The following study aims to report the protocol for a trial evaluating whether the MCST program is affecting individuals with MCI. Methods: In the first study, 30 individuals with MCI participated in 10 sessions of the tablet- and group-based MCST group. A subsequent protocol study will compare tablet-based MCST, tablet-based cognitive stimulation therapy, and control groups among 93 individuals with MCI. All participants will be recruited from older adults living in semiurban communities. Intervention groups will be facilitated by trained therapists, nurses, or psychologists. The study will be assessed by a pre- and posttest evaluation, including computer-based neuropsychological tests and electroencephalography assessment. The effects of several indicators, such as cognitive functions, behavioral, and emotional, will be analyzed as being indexed by their neurophysiological data. Results: The pilot study showed significant cognitive improvement (P<.001), reduced depression (P=.002), and decreased state anxiety (P=.001) post intervention. Quality of life remained unchanged (P=.18). The randomized controlled trial study was funded in March 2023. Enrolling began in August 2023 and was completed in December 2023. The data analysis was started, and the results are expected to be published by mid- to late-2025. Conclusions: The study is the first tablet-group–based MCST for older adults with MCI in middle-income countries. It will provide deeper insight into participants’ neuropsychological data, thus identifying specific processes underlying physiologically measured positive outcomes. Furthermore, the project will deliver solid and integrative results to mental health professionals in terms of knowledge and guidance for implementing the tablet- and group-based MCST in people with MCI. Trial Registration: Thai Clinical Trials Registry TCTR20230829004; https://tinyurl.com/3wuaue3e International Registered Report Identifier (IRRID): DERR1-10.2196/64465 %M 39983114 %R 10.2196/64465 %U https://www.researchprotocols.org/2025/1/e64465 %U https://doi.org/10.2196/64465 %U http://www.ncbi.nlm.nih.gov/pubmed/39983114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68419 %T Designing Values Elicitation Technologies for Mental Health and Chronic Care Integration: User-Centered Design Approach %A Rooper,Isabel R %A Liem,William W %A Burla,Martha %A Gordon,Jacob %A Baez,Lara M %A Kornfield,Rachel %A Berry,Andrew B L %+ , Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Ste 2100, Chicago, IL, 60611, United States, 1 312 503 4910, andrew.berry@northwestern.edu %K chronic care management %K anxiety %K depression %K values elicitation %K eHealth %K patient-centered care %K technology-enabled services %K human-centered design %K multimorbidity %K user-centered design %K multiple chronic conditions %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with multiple chronic conditions (MCCs) and mental health challenges such as depression or anxiety have complex health needs and experience significant challenges with care coordination. Approaches to enhance care for patients with MCCs typically focus on eliciting patients’ values to identify and align treatment priorities across patients and providers. However, these efforts are often hindered by both systems- and patient-level barriers, which are exacerbated for patients with co-occurring mental health symptoms. Technology-enabled services (TES) offer a promising avenue to facilitate values elicitation and promote patient-centered care for these patients, though TES have not yet been tailored to their unique needs. Objective: This study aimed to identify design and implementation considerations for TES that facilitate values elicitation among patients with MCCs and depression or anxiety. We sought to understand the preferences of both clinicians and patients for TES that could bridge the gap between mental and physical health care. Methods: Using human-centered design methods, we conducted 7 co-design workshops with 18 participants, including primary care clinicians, mental health clinicians, and patients with MCCs and depression or anxiety. Participants were introduced to TES prototypes that used various formats (eg, worksheets and artificial intelligence chatbots) to elicit and communicate patients’ values. Prototypes were iteratively refined based on participant feedback. Data from these sessions were analyzed using reflexive thematic analysis to uncover themes related to service, technology, and implementation considerations. Results: Three primary themes were identified. (1) Service considerations: TES should help patients translate elicited values into actionable treatment plans and include low-burden, flexible activities to accommodate fluctuations in their mental health symptoms. Both patients and clinicians indicated that TES could be valuable for improving appointment preparation and patient-provider communication through interpersonal skill-building. (2) Technology considerations: Patients expressed openness to TES prototypes that used artificial intelligence, particularly those that provided concise summaries of appointment priorities. Visual aids and simplified language were highlighted as essential features to support accessibility for neurodiverse patients. (3) Implementation considerations: Clinicians and patients favored situating values elicitation in mental health care settings over primary care and preferred self-guided TES that patients could complete independently before appointments. Conclusions: Findings indicate that TES can address the unique needs of patients with MCCs and mental health challenges by facilitating values-based care. Key design considerations include ensuring TES flexibility to account for fluctuating mental health symptoms, facilitating skill-building for effective communication, and creating user-friendly technology interfaces. Future research should explore how TES can be integrated into health care settings to enhance care coordination and support patient-centered treatment planning. By aligning TES design with patient and clinician preferences, there is potential to bridge gaps in care for this complex patient population. %M 39970432 %R 10.2196/68419 %U https://formative.jmir.org/2025/1/e68419 %U https://doi.org/10.2196/68419 %U http://www.ncbi.nlm.nih.gov/pubmed/39970432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66706 %T Adapting the Germ Defence Web-Based Intervention to Improve Infection Prevention and Control in Care Homes: Interview Study Among Care Home Staff %A Hall,Alex %A Aguilera-Muñoz,Johanna %A McGarrigle,Lisa %A Eost-Telling,Charlotte %A Denison-Day,James %A Cabral,Christie %A Willcox,Merlin %A Todd,Chris %+ , School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613068705, alex.hall@manchester.ac.uk %K care homes %K long-term care %K nursing homes %K infection prevention and control %K behavioral intervention development %K person-based approach %K qualitative %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. Objective: This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. Methods: This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. Results: There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Conclusions: Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation. %M 39970434 %R 10.2196/66706 %U https://formative.jmir.org/2025/1/e66706 %U https://doi.org/10.2196/66706 %U http://www.ncbi.nlm.nih.gov/pubmed/39970434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65302 %T Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial %A Dang,Thu Ha %A Wickramasinghe,Nilmini %A Jayaraman,Prem Prakash %A Burbury,Kate %A Alexander,Marliese %A Whitechurch,Ashley %A Dyer,Mitchell %A Quinn,Stephen %A Forkan,Abdur Rahim Mohammad %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K home-based cancer treatment %K smartphone app %K oral chemotherapy %K patient safety %K SAMSON %K mobile phone %K digital solution %K medication adherence %K self-management %K cancer %K randomized controlled trial %K RCT %K pilot study %K oncology %K mobile health %K mHealth %K quality of life %K eHealth %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication nonadherence is a serious problem in cancer, potentially impacts patients’ health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited. Objective: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer. Methods: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients’ adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion. Results: A total of 33 patients (79% of those who were approached) consented to participate in the trial. Of those, 31/33 (94%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87% app usage; 14/15, 93% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83%) and helpful in improving their MA (6/12, 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (71% of scheduled tasks). Most patients (10/12, 83%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders. Conclusions: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants’ feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079122 %M 39969972 %R 10.2196/65302 %U https://formative.jmir.org/2025/1/e65302 %U https://doi.org/10.2196/65302 %U http://www.ncbi.nlm.nih.gov/pubmed/39969972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57512 %T Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study %A Zhang,Tianyi %A Camargo,Andres %A Schmaal,Lianne %A Kostakos,Vassilis %A D'Alfonso,Simon %+ School of Computing and Information Systems, University of Melbourne, Level 4, Melbourne Connect (Building 290), Melbourne, 3010, Australia, 61 449930128, tianyiz4@student.unimelb.edu.au %K mobile sensing %K nomophobia %K digital phenotyping %K depression %K mental health %K smartphone use %K personal sensing %K behavior analysis %K machine learning %K mobile health %K mobile phone %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones have become an indispensable part of people’s lives, and the fear of being without them, what has been termed “no mobile phone phobia” (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. Objective: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. Methods: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. Results: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual’s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. Conclusions: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies. %M 39969982 %R 10.2196/57512 %U https://formative.jmir.org/2025/1/e57512 %U https://doi.org/10.2196/57512 %U http://www.ncbi.nlm.nih.gov/pubmed/39969982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65026 %T Exploring the Acceptance of Just-in-Time Adaptive Lifestyle Support for People With Type 2 Diabetes: Qualitative Acceptability Study %A Hietbrink,Eclaire A G %A Middelweerd,Anouk %A d’Hollosy,Wendy %A Schrijver,Laura K %A Laverman,Gozewijn D %A Vollenbroek-Hutten,Miriam M R %+ Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, The Netherlands, 31 53 4892760, e.a.g.hietbrink@utwente.nl %K eHealth %K just-in-time adaptive intervention %K ecological momentary assessment %K type 2 diabetes %K behavior change %K physical activity %K nutrition %K acceptability %K formative evaluation %K mobile phone %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of type 2 diabetes (T2D) requires individuals to adopt and maintain a healthy lifestyle. Personalized eHealth interventions can help individuals change their lifestyle behavior. Specifically, just-in-time adaptive interventions (JITAIs) offer a promising approach to provide tailored support to encourage healthy behaviors. Low-effort self-reporting via ecological momentary assessment (EMA) can provide insights into individuals’ experiences and environmental factors and thus improve JITAI support, particularly for conditions that cannot be measured by sensors. We developed an EMA-driven JITAI to offer tailored support for various personal and environmental factors influencing healthy behavior in individuals with T2D. Objective: This study aimed to assess the acceptability of EMA-driven, just-in-time adaptive lifestyle support in individuals with T2D. Methods: In total, 8 individuals with T2D used the JITAI for 2 weeks. Participants completed daily EMAs about their activity, location, mood, overall condition, weather, and cravings and received tailored support via SMS text messaging. The acceptability of the JITAI was assessed through telephone-conducted, semistructured interviews. Interview topics included the acceptability of the EMA content and prompts, the intervention options, and the overall use of the JITAI. Data were analyzed using a hybrid approach of thematic analysis. Results: Participants with a mean age of 70.5 (SD 9) years, BMI of 32.1 (SD 5.3) kg/m², and T2D duration of 15.6 (SD 7.7) years had high self-efficacy scores in physical activity (ie, 32) and nutrition (ie, 29) and were mainly initiating or maintaining behavior changes. The identified themes were related to the intervention design, decision points, tailoring variables, intervention options, and mechanisms underlying adherence and retention. Participants provided positive feedback on several aspects of the JITAI, such as the motivating and enjoyable messages that appeared well tailored to some individuals. However, there were notable differences in individual experiences with the JITAI, particularly regarding intervention intensity and the perceived personalization of the EMA and messages. The EMA was perceived as easy to use and low in burden, but participants felt it provided too much of a snapshot and too little context, reducing the perceived tailoring of the intervention options. Challenges with the timing and frequency of prompts and the relevance of some tailoring variables were also observed. While some participants found the support relevant and motivating, others were less inclined to follow the advice. Participants expressed the need for even more personalized support tailored to their specific characteristics and circumstances. Conclusions: This study showed that an EMA-driven JITAI can provide motivating and tailored support, but more personalization is needed to ensure that the lifestyle support more closely fits each individual’s unique needs. Key areas for improvement include developing more individually tailored interventions, improving assessment methods to balance active and passive data collection, and integrating JITAIs within comprehensive lifestyle interventions. %M 39969969 %R 10.2196/65026 %U https://formative.jmir.org/2025/1/e65026 %U https://doi.org/10.2196/65026 %U http://www.ncbi.nlm.nih.gov/pubmed/39969969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57826 %T Exploring the Effect of an 8-Week AI-Composed Exercise Program on Pain Intensity and Well-Being in Patients With Spinal Pain: Retrospective Cohort Analysis %A Griefahn,Annika %A Avermann,Florian %A Zalpour,Christoff %A Marshall,Robert Percy %A Cordon Morillas,Inés %A Luedtke,Kerstin %K exercise %K mHealth %K app engagement %K spinal pain %K artificial intelligence %K AI %K intensity %K well-being %K mobile health %K apps %K applications %K retrospective analysis %K physical activity %K adults %K questionnaire %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X Background: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives. Objective: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement. Methods: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3‐5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis. Results: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2% (n=27.6 days) of the 56 available days. Conclusions: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users. Trial Registration: OSF Registries osf.io/kjhef; https://osf.io/kjhef %R 10.2196/57826 %U https://formative.jmir.org/2025/1/e57826 %U https://doi.org/10.2196/57826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55316 %T Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study %A Dauber-Decker,Katherine L %A Feldstein,David %A Hess,Rachel %A Mann,Devin %A Kim,Eun Ji %A Gautam-Goyal,Pranisha %A Solomon,Jeffrey %A Khan,Sundas %A Malik,Fatima %A Xu,Lynn %A Huffman,Ainsley %A Smith,Paul D %A Halm,Wendy %A Yuroff,Alice %A Richardson,Safiya %K clinical decision support %K CDS %K decision aid %K clinical aid %K cough %K sore throat %K strep pharyngitis %K snowball group usability testing %K snowball group %K usability testing %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X Background: Usability testing is valuable for assessing a new tool or system’s usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Objective: Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. Methods: We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. Results: The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites’ sessions prior to conducting their own testing. Conclusions: Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized. Trial Registration: Clinicaltrials.gov NCT04255303; https://clinicaltrials.gov/study/NCT04255303 %R 10.2196/55316 %U https://formative.jmir.org/2025/1/e55316 %U https://doi.org/10.2196/55316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68436 %T Machine Learning Approach to Identifying Wrong-Site Surgeries Using Centers for Medicare and Medicaid Services Dataset: Development and Validation Study %A Chen,Yuan-Hsin %A Lin,Ching-Hsuan %A Fan,Chiao-Hsin %A Long,An Jim %A Scholl,Jeremiah %A Kao,Yen-Pin %A Iqbal,Usman %A Li,Yu-Chuan Jack %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 301, Yuantong Rd. Zhonghe Dist, New Taipei City, 235, Taiwan, 886 266382736, jack@tmu.edu.tw %K patient safety %K wrong site surgery %K medical errors %K machine learning %K claim data %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Wrong-site surgery (WSS) is a critical but preventable medical error, often resulting in severe patient harm and substantial financial costs. While protocols exist to reduce wrong-site surgery, underreporting and inconsistent documentation continue to contribute to its persistence. Machine learning (ML) models, which have shown success in detecting medication errors, may offer a solution by identifying unusual procedure-diagnosis combinations. This study investigated whether an ML approach can effectively adapt to detect surgical errors. Objective: This study aimed to evaluate the transferability and effectiveness of an ML-based model for detecting inconsistencies within surgical documentation, particularly focusing on laterality discrepancies. Methods: We used claims data from the Centers for Medicare and Medicaid Services Limited Data Set (CMS-LDS) from 2017 to 2020, focusing on surgical procedures with documented laterality. We developed an adapted Association Outlier Pattern (AOP) ML model to identify uncommon procedure-diagnosis combinations, specifically targeting discrepancies in laterality. The model was trained on data from 2017 to 2019 and tested on 2020 orthopedic procedures, using ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) codes to distinguish body part and laterality. Test cases were classified based on alignment between procedural and diagnostic laterality, with 2 key subgroups (right-left and left-right mismatches) identified for evaluation. Model performance was assessed by comparing precision-recall curves and accuracy against rule-based methods. Results: The findings here included 346,382 claims, of which 2170 claims demonstrated with significant laterality discrepancies between procedures and diagnoses. Among patients with left-side procedures and right-side diagnoses (603/1106), 54.5% were confirmed as errors after clinical review. For right-side procedures with left-side diagnoses (541/1064), 50.8% were classified as errors. The AOP model identified 697 and 655 potentially unusual combinations in the left-right and right-left subgroups, respectively, with over 80% of these cases confirmed as errors following clinical review. Most confirmed errors involved discrepancies in laterality for the same body part, while nonerror cases typically involved general diagnoses without specified laterality. Conclusions: This investigation showed that the AOP model effectively detects inconsistencies between surgical procedures and diagnoses using CMS-LDS data. The AOP model outperformed traditional rule-based methods, offering higher accuracy in identifying errors. Moreover, the model’s transferability from medication-disease associations to procedure-diagnosis verification highlights its broad applicability. By improving the precision of identifying laterality discrepancies, the AOP model can reduce surgical errors, particularly in orthopedic care. These findings suggest that the model enhances patient safety and has the potential to improve clinical decision-making and outcomes. %M 39946709 %R 10.2196/68436 %U https://formative.jmir.org/2025/1/e68436 %U https://doi.org/10.2196/68436 %U http://www.ncbi.nlm.nih.gov/pubmed/39946709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67452 %T Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study %A Shamebo,Dessalegn %A Derseh Mebratie,Anagaw %A Arsenault,Catherine %+ Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 2029941011, catherine.arsenault@gwu.edu %K mobile phone surveys %K patient satisfaction %K interactive voice response %K global health %K surveys %K Ethiopia %K IVR %K Africa %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys. Objective: In this study, we tested the feasibility of using an IVR system to assess patient satisfaction with primary care services in Addis Ababa, Ethiopia. We described the methodology, response rates, and survey costs and identified factors associated with survey participation, completion, and duration. Methods: Patients were recruited in person from 18 public and private health facilities in Addis Ababa. Patients’ sex, age, education, reasons for seeking care, and mobile phone numbers were collected. The survey included 15 questions that respondents answered using their phone keypad. We used a Heckman probit regression model to identify factors influencing the likelihood of IVR survey participation (picking up and answering at least 1 question) and completion (answering all survey questions) and a Weibull regression model to identify factors influencing the survey completion time. Results: A total of 3403 individuals were approached across 18 health facilities. Nearly all eligible patients approached (2985/3167, 94.3%) had a functioning mobile phone, and 89.9% (2415/2685) of those eligible agreed to be enrolled in the study. Overall, 92.6% (2236/2415) picked up the call, 65.6% (1584/2415) answered at least 1 survey question, and 42.9% (1037/2415) completed the full survey. The average survey completion time was 8.1 (SD 1.7) minutes for 15 Likert-scale questions. We found that those aged 40-49 years and those aged 50+ years were substantially less likely to participate in (odds ratio 0.63, 95% CI 0.53-0.74) and complete the IVR survey (odds ratio 0.77, 95% CI 0.65-0.90) compared to those aged 18-30 years. Higher education levels were also strongly associated with survey participation and completion. In adjusted models, those enrolled in private facilities were less likely to participate and complete the survey compared to those in public health centers. Being male, younger, speaking Amharic, using a private hospital, and being called after 8 PM were associated with a shorter survey duration. The average survey costs were US $7.90 per completed survey. Conclusions: Our findings reveal that an IVR survey is a feasible, low-cost, and rapid solution to assess patient satisfaction in an urban context in Ethiopia. However, survey implementation must be carefully planned and tailored to local challenges. Governments and health facilities should consider IVR to routinely collect patient satisfaction data to inform quality improvement strategies. %R 10.2196/67452 %U https://formative.jmir.org/2025/1/e67452 %U https://doi.org/10.2196/67452 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e66852 %T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study %A Asadollahi,Fateme %A Ebrahimzadeh Zagami,Samira %A Eslami,Saeid %A Latifnejad Roudsari,Robab %+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com %K pregnancy %K prenatal care %K mobile health apps %K mHealth %K women’s health %K health care providers %K quality assessment %K content evaluation %K suitability assessment %K digital health %K smartphones %K eHealth %K telehealth %K telemedicine %K health promotion %K technology %K functionality %K systematic search %D 2025 %7 13.2.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 %M 39946714 %R 10.2196/66852 %U https://apinj.jmir.org/2025/1/e66852 %U https://doi.org/10.2196/66852 %U http://www.ncbi.nlm.nih.gov/pubmed/39946714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62663 %T Designing a Smartphone-Based Virtual Reality App for Relaxation: Qualitative Crossover Study %A Verstegen,Amandine %A Van Daele,Tom %A Bonroy,Bert %A Debard,Glen %A Sels,Romy %A van Loo,Marlon %A Bernaerts,Sylvie %+ Psychology and technology, Centre of Expertise - Care and Well-being, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, 2018, Belgium, 32 34324050, sylvie.bernaerts@thomasmore.be %K smartphone-based virtual reality %K virtual reality %K relaxation %K stress %K user experience %K mobile phone %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Accumulating evidence supports the use of virtual reality (VR) in mental health care, with one potential application being its use to assist individuals with relaxation exercises. Despite studies finding support for the potential of VR to effectively aid in relaxation, its implementation remains limited outside of specialized clinics. Known barriers are insufficient knowledge regarding VR operation, lack of availability of VR relaxation apps tailored to local health care systems, and cost concerns. Unfortunately, many VR relaxation apps are designed exclusively for stand-alone headsets, limiting accessibility for a broad audience. Objective: We aimed to design an accessible, smartphone-based VR relaxation app based on user preferences. This paper describes the assessment of 2 stand-alone VR relaxation apps and the resulting smartphone-based VR relaxation app design. Methods: Overall, 30 participants (n=23, 77% women; n=7, 23% men) took part in 2 separate VR sessions, assessing 1 of the 2 VR relaxation apps (Flowborne and Calm Place) in each session. After each session, participants were presented with open-ended questions to assess their experiences via a web-based survey tool. These questions explored positive and negative features, shortcomings, and suggestions for improvements while also allowing space for additional remarks concerning the 2 VR relaxation apps. Three of the authors analyzed the responses using inductive thematic analysis, a process comprising 6 phases. Results: Across both the apps, 5 recurring themes and 13 recurring subthemes were identified in the participants’ answers: audio (music and sounds, guidance), visuals (content, realism, variation and dynamics in the environment), features (language, options, feedback and instructions, duration, exercise), implementation (technical aspects, cybersickness, acceptability and usability), and experience. We analyzed the participants’ findings and conducted a literature review, which served as the basis for developing the app. The resulting app is a Dutch-language, smartphone-based VR relaxation app, with customization options including 3 types of relaxation exercises, 2 guiding voices, and 3 different environments. Efforts have been made to ensure maximum variation and dynamism in the environments. Calming music and nature sounds accompany the exercises. The efficacy and effectiveness of the resulting app design were not assessed. Conclusions: This study provides insights into key features of VR relaxation apps, which were subsequently used for the development of a novel smartphone-based VR relaxation app. Further research concerning the effectiveness of this app, along with a broader evaluation of the efficacy and user feedback for smartphone-based VR relaxation apps, is needed. More generally, there is a clear need for more research on the impact of interactivity, biofeedback, and type of environment in VR relaxation. %M 39946693 %R 10.2196/62663 %U https://formative.jmir.org/2025/1/e62663 %U https://doi.org/10.2196/62663 %U http://www.ncbi.nlm.nih.gov/pubmed/39946693 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 8 %N %P e58998 %T Enhancing Quadruple Health Outcomes After Thoracic Surgery: Feasibility Pilot Randomized Controlled Trial Using Digital Home Monitoring %A Nagappa,Mahesh %A Subramani,Yamini %A Yang,Homer %A Wood,Natasha %A Querney,Jill %A Fochesato,Lee-Anne %A Nguyen,Derek %A Fatima,Nida %A Martin,Janet %A John-Baptiste,Ava %A Nayak,Rahul %A Qiabi,Mehdi %A Inculet,Richard %A Fortin,Dalilah %A Malthaner,Richard %+ Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Lawson Health Research Institute, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Road, London, ON, N6A 5A5, Canada, 1 5196858500 ext 34436, Mahesh.Nagappa@lhsc.on.ca %K remote monitor %K digital home monitoring %K continuity of care %K quadruple health outcomes %K patient satisfaction %K caregivers satisfaction %K healthcare provider satisfaction %K feasibility %K RCT %K thoracic surgery %K postoperative monitoring %K surgical recovery %K perioperative medicine %K patient care %K questionnaire %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department (ED) and readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods. Objective: We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care. Methods: We conducted a 2-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into 2 groups: the DHM group and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day ED visit rates, 30-day readmission rates, postoperative complications, length of stay, postdischarge 30-day opioid consumption, 30-day quality of recovery, patient-program satisfaction, caregiver satisfaction, health care provider satisfaction, and cost per case. Results: All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI 79.4%-93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI 89.4%-99.2%) and 98.7% (95% CI 92.9%-99.9%), respectively. In total, 80 patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the 2 groups. The DHM group had fewer unplanned ED visits (2.7% vs 20.5%; P=.02), fewer unplanned admission rates (0% vs 7.6%; P=.24), lower rates of postoperative complications (20% vs 47.5%, P=.01) shorter hospital stays (4.0 vs 6.9 days; P=.05), but more opioid consumption (111.6, SD 110.9) vs 74.3, SD 71.9 mg morphine equivalents; P=.08) compared to the control group. DHM also resulted in shorter ED visit times (130, SD 0 vs 1048, SD 1093 minutes; P=.48) and lower cost per case (CAD $12,145 [US $ 8436.34], SD CAD $8779 [US $ 6098.20] vs CAD $17,247 [US $11,980.37], SD CAD $15,313 [US $10,636.95]; P=.07). The quality of recovery scores was clinically significantly better than the controls (185.4, SD 2.6 vs 178.3, SD 3.3; P<.001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI 90.5%-100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the fourth week post hospital discharge (47.7%; 95% CI 35.7%-59.1%). Health care providers reported a 100% satisfaction rate. Conclusions: This pilot RCT demonstrates the feasibility of conducting a full-scale trial to assess DHM's efficacy in improving postoperative care following thoracic surgery. DHM shows promise for enhancing continuity of care and warrants further investigation. Trial Registration: ClinicalTrials.gov NCT04340960; https://clinicaltrials.gov/study/NCT04340960 %M 39938882 %R 10.2196/58998 %U https://periop.jmir.org/2025/1/e58998 %U https://doi.org/10.2196/58998 %U http://www.ncbi.nlm.nih.gov/pubmed/39938882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65206 %T The Effect of the Virtual Reality–Based Biofeedback Intervention DEEP on Stress, Emotional Tension, and Anger in Forensic Psychiatric Inpatients: Mixed Methods Single-Case Experimental Design %A Klein Haneveld,Lisa %A Dekkers,Tessa %A Bouman,Yvonne H A %A Scholten,Hanneke %A Weerdmeester,Joanneke %A Kelders,Saskia M %A Kip,Hanneke %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands, 31 619210156, l.kleinhaneveld@transfore.nl %K virtual reality %K VR %K diaphragmatic breathing %K biofeedback %K DEEP %K forensic psychiatry %K mental health %K stress %K single-case experimental design %K experience sampling method %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Decreasing aggression through stress reduction is an important part of forensic psychiatric treatment. DEEP is an experience-based virtual reality intervention that uses biofeedback to train diaphragmatic breathing and increase relaxation. Although DEEP has shown promising results in reducing stress and anxiety in students and adolescents in special education, it has not been examined in forensic psychiatric populations. Objective: This study aimed to evaluate DEEP’s potential to reduce stress, emotional tension, and anger in forensic psychiatric inpatients. Methods: A mixed methods, alternating treatment, single-case experimental design was conducted with 6 Dutch forensic inpatients. For 20 days, participants engaged in 4 DEEP sessions. Experience sampling was used for continuous monitoring of stress, emotional tension, and anger twice daily. A repeated linear mixed model was used as a primary statistical approach for analyzing the experience sampling data as well as visual analyses. Finally, semistructured interviews were conducted with participants and health care professionals to compare quantitative with qualitative results. Results: Of the 6 participants, 3 (50%) completed all 4 DEEP sessions, while the other 3 (50%) missed one session due to technical difficulties or absence from the inpatient clinic. P1 showed a significant reduction of stress after session 2 (β=–.865; P=.005). No significant changes over time were found, although an experienced effect was reported during the interviews. P2 showed no significant results. They reported the sessions as being repetitive, with no experienced effect. P3 showed a momentary increase of emotional tension after the first session (β=–.053; P=.002), but no changes were observed over time. No experienced effects were reported in the interview. P4 did not show significant results over time, and was hesitant to report clear experienced effects. P5 showed a significant decline of emotional tension (β=–.012; P=.006), stress (β=–.014; P=.007), and anger (β=–.007; P=.02) over time. They also reported short-term experienced effects in the interview. P6 showed a significant decline of stress over time (β=–.029; P<.001) and reported experiencing substantial effects. Finally, health care professionals reported a relaxing effect of DEEP in their patients but did not expect many long-term effects because no clear behavioral changes were observed. Conclusions: DEEP shows promise in teaching deep breathing techniques to forensic psychiatric inpatients, potentially decreasing stress, emotional tension, and anger in some patients. However, DEEP is not a one-size-fits-all intervention that supports every patient because the effectiveness on the outcome measures varied among participants. To increase effectiveness, emphasis should be put on supporting patients to transfer deep breathing skills into their daily lives. This highlights the importance for the structural integration of DEEP into current treatment protocols. %M 39938081 %R 10.2196/65206 %U https://formative.jmir.org/2025/1/e65206 %U https://doi.org/10.2196/65206 %U http://www.ncbi.nlm.nih.gov/pubmed/39938081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63610 %T Designing Patient-Centered Interventions for Emergency Care: Participatory Design Study %A Seo,Woosuk %A Jain,Shruti %A Le,Vivian %A Li,Jiaqi %A Zhang,Zhan %A Singh,Hardeep %A Pasupathy,Kalyan %A Mahajan,Prashant %A Park,Sun Young %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, United States, 1 2063109264, seow@umich.edu %K emergency department %K participatory design %K patient %K technology %K intervention %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are high-pressure environments where clinicians diagnose patients under significant constraints, including limited medical histories, severe time pressures, and frequent interruptions. Current ED care practices often inadequately support meaningful patient participation. Most interventions prioritize clinical workflow and health care provider communication, inadvertently overlooking patients’ needs. Additionally, patient-facing technologies in EDs are typically developed without meaningful patient input, leading to solutions that may not effectively address patients’ specific challenges. To enhance both patient-centered care practices and the diagnosis process in EDs, patient involvement in technology design is essential to ensure their needs during emergency care are understood and addressed. Objective: This study aimed to invite ED patients to participatory design sessions, identify their needs during ED visits, and present potential design guidelines for technological interventions to address these needs. Methods: We conducted 8 design sessions with 36 ED patients and caregivers to validate their needs and identify considerations for designing patient-centered interventions to improve diagnostic safety. We used 10 technological intervention ideas as probes for a needs evaluation of the study participants. Participants discussed the use cases of each intervention idea to assess their needs during the ED care process. We facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. Results: On the basis of ED patients’ feedback and evaluation of our intervention designs, we found the 3 most preferred intervention ideas that addressed the common challenges ED patients experience. We also identified 4 themes of ED patients’ needs: a feeling of inclusion in the ED care process, access to sources of medical information to enhance patient comprehension, addressing patient anxiety related to information overload and privacy concerns, and ensuring continuity in care and information. We interpreted these as insights for designing technological interventions for ED patients. Therefore, on the basis of the findings, we present five considerations for designing better patient-centered interventions in the ED care process: technology-based interventions should (1) address patients’ dynamic needs to promote continuity in care; (2) consider the amount and timing of information that patients receive; (3) empower patients to be more active for better patient safety and care quality; (4) optimize human resources, depending on patients’ needs; and (5) be designed with the consideration of patients’ perspectives on implementation. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED patients into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions to enhance patient safety. International Registered Report Identifier (IRRID): RR2-10.2196/55357 %M 39938082 %R 10.2196/63610 %U https://formative.jmir.org/2025/1/e63610 %U https://doi.org/10.2196/63610 %U http://www.ncbi.nlm.nih.gov/pubmed/39938082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59533 %T Activity Trackers in Physical Therapy for People With Chronic Obstructive Pulmonary Disease in the Netherlands: Cross-Sectional Study on Current Use and Implementation Determinants %A Ummels,Darcy %A Bols,Esther %A Frantzen,Roel Johannes Anna %A Frantzen,Tim %A Robeerts,Levy %A Beekman,Emmylou %K physical therapy %K activity tracker %K implementation %K technology %K COPD %K chronic obstructive pulmonary disease %K eHealth %K meaningful use %K health measurement %K active lifestyle %K Netherlands %K physical activity %K barriers %K therapy %D 2025 %7 12.2.2025 %9 %J JMIR Form Res %G English %X Background: In the Netherlands, 545,900 people experienced chronic obstructive pulmonary disease (COPD) in 2022. Physical therapy following the Royal Dutch Society for Physiotherapy (Koninklijk Nederlands Genootschap voor Fysiotherapie) guidelines for COPD treatment is a proven effective treatment for people with COPD. The revised guidelines include a new recommendation: a patient’s physical activity level should be assessed with an activity tracker (AT). Literature shows that the implementation of eHealth in clinical practice, in this case, ATs, is challenging. Objective: This study aims (1) to assess how and why ATs are currently used in physical therapy in patients with COPD and (2) to determine which barriers and facilitators are of relevance for optimal implementation of ATs during the clinical reasoning process of physical therapists in patients with COPD. Methods: A cross-sectional study was used to evaluate the implementation of ATs in physical therapy. Included participants were physical therapists who were affiliated with Chronisch ZorgNet and had a specialization in COPD treatment. The survey content was based on the Consolidated Framework for Implementation Research, the theory of planned behavior, the framework “experiences of patients with commercially available ATs,” and the Koninklijk Nederlands Genootschap voor Fysiotherapie guidelines for COPD. Physical therapists were questioned via a digital survey. Results: In total, 211 completed surveys were analyzed. Of the 211 participating physical therapists, 108 (51.2%) used ATs, whereas most of them (n=82, 75.9%) already used ATs before it was advised in the guidelines. Physical therapists indicated that the most important reason to use ATs is that they experience it as an added health care value. Both users and nonusers indicated that the most important reason why they do not use ATs is because their patients do not want to use an AT. The second reason was a lack of knowledge in the nonuser group. Moreover, both users and nonusers indicated that the implementation of ATs was not prepared and planned for within their center. Conclusions: Overall, these results show that ATs are not yet fully implemented in the Dutch general physical therapy practice in patients with COPD, as recommended by current evidence-based guidelines. Physical therapists need guidance for the successful implementation of ATs. This could be accomplished by providing training for physical therapists, integrating ATs into the education of (future) physical therapists, and providing support during the implementation process of ATs for both the physical therapists and management. %R 10.2196/59533 %U https://formative.jmir.org/2025/1/e59533 %U https://doi.org/10.2196/59533 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67043 %T Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study %A Jacob,Christine %A Müller,Roman %A Schüler,Sonja %A Rey,Alix %A Rey,Guillaume %A Armenian,Berj %A Vonlaufen,Alain %A Drepper,Michael %A Zimmerli,Marius %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %K usability study %K colonoscopy %K app %K application %K examinations %K smartphone %K usability %D 2025 %7 12.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app’s usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants’ task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app’s usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. %R 10.2196/67043 %U https://humanfactors.jmir.org/2025/1/e67043 %U https://doi.org/10.2196/67043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66692 %T Use of a Technology-Based Fall Prevention Program With Visual Feedback in the Setting of Early Geriatric Rehabilitation: Controlled and Nonrandomized Study %A Steinmetz,Carolin %A Stenzel,Christina %A Sylvester,Maj %A Glage,Denis %A Linke,Anne %A Sadlonova,Monika %A von Arnim,Christine A F %A Schnieder,Marlena %A Valentová,Miroslava %A Heinemann,Stephanie %K fall prevention %K fall prevention program %K early geriatric rehabilitation %K gerontology %K older adult %K elder %K aging %K digital exercise intervention %K digital activity %K physical exercise %K functional capacity %K new technology %K technology-based %K digital intervention %K feasibility %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear. Objective: This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR. Methods: We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called “Pixformance.” The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients’ and facilitators’ perspective; ≥75%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes. Results: A cohort of 60 patients (mean 80.2, SD 6.1 y; 58% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%), or fatigue (17%). EGR patients rated FPP usability at 84% and facilitators at 65% out of 100%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved. Conclusions: While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility. %R 10.2196/66692 %U https://formative.jmir.org/2025/1/e66692 %U https://doi.org/10.2196/66692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59386 %T Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study %A Grieve,Natalie %A Braaten,Kyra %A MacPherson,Megan %A Liu,Sam %A Jung,Mary E %K usability evaluation %K mHealth %K usability testing %K app %K end-user %K focus group %K participant %K survey %K diabetes %K user-centered %K cognitive walkthrough %K cognitive walkthroughs %K questionnaire %K mobile phone %K digital health %K prediabetes %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app’s usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client’s preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes’ program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. %R 10.2196/59386 %U https://formative.jmir.org/2025/1/e59386 %U https://doi.org/10.2196/59386 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53913 %T Understanding Experiences of Telehealth in Palliative Care: Photo Interview Study %A Kalla,Mahima %A O'Brien,Teresa %A Metcalf,Olivia %A Hoda,Rashina %A Chen,Xiao %A Li,Andy %A Parker,Catriona %A Franco,Michael Edward %A Georgy,Sam %A Huckvale,Kit %A Bain,Christopher %A Poon,Peter %K consultation summary %K digital scribe %K qualitative research %K telehealth %K digital health %K photo-elicitation %K palliative care %K photo interview %K qualitative research %K photographs %K intertextual analysis %D 2025 %7 11.2.2025 %9 %J JMIR Hum Factors %G English %X Background: It is widely accepted that the COVID-19 pandemic has accelerated the era of online health care delivery, including within community palliative care. This study was part of a larger project involving a collaboration between universities, health care services, government agencies, and software developers that sought to enhance an existing telehealth (video call) platform with additional features to improve both patient and health care professional (HCP) experience in a palliative care context. Objective: The aim of this study was to understand palliative care patients’ and HCPs’ experiences of telehealth delivery in a palliative care context in Victoria, Australia. For the purposes of this study, telehealth included consultations by both video and telephone calls. By better understanding users’ experiences and perceptions of telehealth, we hoped to determine users’ preferences for new telehealth enhancement features. Methods: A total of 6 health care professionals and 6 patients were recruited from a major tertiary hospital network’s palliative care unit in Victoria, Australia. Participants were asked to generate 3‐5 photographs depicting their telehealth experiences. These photographs were used as visual aids to prompt discussion during subsequent one-on-one interviews. Intertextual analysis was conducted to identify key themes. Results: A total of 3 overarching themes emerged: comfort (or lack thereof) afforded by telehealth, connection considerations in telehealth, and care quality impacts of telehealth. Patients (n=6) described telehealth as supporting their physical and psychological comfort and maintaining connection with HCPs, yet there were specific situations where it failed to meet their needs or impacted care quality and delayed treatment. HCPs (n=6) recognized the benefit of telehealth for patients but reported several limitations of telehealth, in particular due to lack of physical examination opportunities. Participants indicated that 2 types of connection were imperative for effective telehealth delivery: technical connection (eg, good internet connectivity or clear phone line) and interpersonal connection (ie, good rapport and therapeutic alliance between the HCPs and patients). Often technical connection issues impeded the development of interpersonal connection between the HCPs and patients in telehealth. Conclusions: The findings presented in this study combined with other co-design activities, which are outside the scope of this paper, indicated the potential value of a telehealth enhancement feature that generates patient-facing clinical consultation summaries. Our team has developed a video telehealth enhancement feature (or “add-on”), which will enable clinicians to distill key actionable advice and self-management guidance discussed during teleconsultations for a take-home summary document for patients. The add-on’s prototype has also been subjected to an initial simulation study, which will be reported in a future publication. %R 10.2196/53913 %U https://humanfactors.jmir.org/2025/1/e53913 %U https://doi.org/10.2196/53913 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e49610 %T Social Acceptance of Smart Glasses in Health Care: Model Evaluation Study of Anticipated Adoption and Social Interaction %A Zuidhof,Niek %A Peters,Oscar %A Verbeek,Peter-Paul %A Ben Allouch,Somaya %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, M.H. Tromplaan 28, Enschede, 7513 AB, The Netherlands, 31 682381157, e.n.zuidhof@saxion.nl %K smart glasses %K technology adoption %K social interaction %K instrument development %K structural equation modeling %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the growing interest in smart glasses, it is striking that they are not widespread among health care professionals. Previous research has identified issues related to social interactions involving the use of smart glasses in public settings, which may differ from those associated with their application in health care contexts. Objective: Assuming that smart glasses mediate contact between the health care provider and patient, the objectives of this research are two-fold: (1) to develop an instrument that combines the adoption and mediation perspectives, and (2) to gain insights into how the intention to use is influenced through aspects of adoption and social interaction. Methods: A questionnaire was administered to a target audience of health care professionals (N=450), with recruitment via MTurk. The sample primarily included male participants from the United States, with the majority aged 42 years or younger. Although a large portion of respondents were medical doctors, the sample also included nurses and other health care professionals. Data were analyzed by structural equation modeling. Results: Regarding the aim of developing an instrument combining adoption and social interaction, the internal consistency was above the aspirational level (α>.70) for the instrument. Furthermore, regarding the second objective involving gaining insights into the influential constructs of the anticipated intention to use, the following results were highlighted: in testing the conceptual model, the measurement model generated a good fit and the respecified structural model also generated a good fit. The tested hypotheses confirmed that social interaction constructs could explain a higher variance of users’ anticipated intention to use. Perceived social isolation and decreased attentional allocation did not have a significant effect on attitude. Furthermore, the intention to use smart glasses despite nonacceptance of smart glasses by the patient significantly influenced the anticipated intention to use. In summary, constructs that focus on social interaction could contribute to better explanation and prediction of the expected adoption of smart glasses in health care. Conclusions: The empirical findings of this study provide new insights into how the mediation perspective can increase the explained variance compared to existing knowledge about adoption. Against expectations based on previous literature and despite the social issues raised earlier, these social aspects do play important roles for health care professionals but are ultimately not decisive for the intention to use. As a result, there are fewer threats to the adoption of smart glasses from the perspective of health care professionals than might be expected based on the previous literature. Therefore, the use of smart glasses can still be considered as an innovative way of working in health care. %M 39933169 %R 10.2196/49610 %U https://formative.jmir.org/2025/1/e49610 %U https://doi.org/10.2196/49610 %U http://www.ncbi.nlm.nih.gov/pubmed/39933169 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e60755 %T Evaluating the Efficacy of a Serious Game to Deliver Health Education About Invasive Meningococcal Disease: Clustered Randomized Controlled Equivalence Trial %A Bloomfield,Lauren %A Boston,Julie %A Masek,Martin %A Andrew,Lesley %A Barwood,Donna %A Devine,Amanda %+ Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 0863045702, julie.boston@ecu.edu.au %K serious games %K meningococcal disease %K immersive digital applications %K health promotion %K gaming %K meningitis %K infection %K bacteria %K contagious %K infectious %K immersive %K education %K mHealth %K mobile health %K applications %K youth %K adolescents %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Invasive meningococcal disease (IMD) is a serious, vaccine-preventable infectious disease that can be life-threatening. Teaching adolescents about the early detection and prevention of IMD can be challenging in a school environment, with educators reporting they lack confidence or expertise to cover this in the classroom environment. Professional guest educators are an alternative to cover specialist topics such as IMD; however, time and resourcing constraints can mean that these educators are not always available. Serious games may be an alternative to face-to-face education, where complex health information may be delivered via self-directed gameplay. Objective: This study aims to develop a serious game that can replace a face-to-face educator in a classroom setting to educate adolescents aged 12 years to 15 years. This study evaluates the efficacy of the Meningococcal Immunisation Awareness, Prevention and Protection app (MIApp), a serious game designed to replicate the information provided in a 30-minute face-to-face presentation provided by a trained educator. Methods: This clustered, randomized controlled equivalence trial involved students (Years 7-10) from 6 secondary schools across metropolitan Western Australia who completed pre- and postintervention questionnaires with a follow-up at 3 months postintervention to measure the primary outcome of IMD knowledge acquisition following this self-guided intervention. The findings were compared with changes in an active control (comparison) group who received an in-class educational presentation about IMD transmission and protection. A questionnaire was developed to assess 9 key areas of knowledge. Median scores for knowledge pre- and postintervention were collected from a self-administered assessment of this questionnaire and, at 3 months postintervention, were compared between groups. A knowledge score of +/–2/16 was determined a priori to meet the criteria for equivalence. Participants who used MIApp were also asked a series of questions to assess the enjoyment of and engagement with the game. Results: Of the 788 participating students, the median postintervention correct score in both the MIApp and control cohorts was 14/16 (87.5% correct responses), compared with the median pre-intervention correct score of 6/16 (37.5% correct responses), representing a significant (P<.001) increase in IMD knowledge in both groups. Improvements were retained in both groups 3 months after the initial intervention (median correct score: 11/16 in the intervention group; 12/16 in the control group; P=.86), demonstrating the efficacy of MIApp to deliver health education about IMD transmission and protection, although response rates in the follow-up cohort were low (255/788, 32.4%). Conclusions: MIApp met the predetermined threshold for equivalence, demonstrating similar improvements in knowledge posttrial and at the 3-month follow-up. Participating adolescents considered the MIApp game more enjoyable than a presentation, with equivalent improvements in knowledge. Serious games could represent a constructive tool to help teachers impart specialized health education. %M 39932769 %R 10.2196/60755 %U https://games.jmir.org/2025/1/e60755 %U https://doi.org/10.2196/60755 %U http://www.ncbi.nlm.nih.gov/pubmed/39932769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60495 %T mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study %A Perez Ramirez,Alejandra %A Ortega,Adrian %A Stephenson,Natalie %A Muñoz Osorio,Angel %A Kazak,Anne %A Phan,Thao-Ly %+ Center For Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 302 358 5968, alejandra.perezramirez@nemours.org %K obesity %K user testing %K mHealth %K mobile health %K Spanish %K child %K rural population %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform—the Healthy Lifestyle (Nemours Children’s Health) dashboard—was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100%) selected the same dashboard icon and 71% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. %M 39932772 %R 10.2196/60495 %U https://formative.jmir.org/2025/1/e60495 %U https://doi.org/10.2196/60495 %U http://www.ncbi.nlm.nih.gov/pubmed/39932772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e55741 %T Novel Procedures for Evaluating Autism Online in a Culturally Diverse Population of Children: Protocol for a Mixed Methods Pathway Development Study %A Mirzaei,Venus %A Wolstencroft,Jeanne %A Lockwood Estrin,Georgia %A Buckley,Eleanor %A Sayani,Shermina %A Katakis,Panos %A Anand,Reena %A Squire,Tessa %A Short,Eleanor %A Frankson,Paige %A Skuse,David %A Heys,Michelle %+ Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom, 44 07964630290, j.wolstencroft@ucl.ac.uk %K autism %K child %K telehealth %K co-development %K feasibility %K acceptability %K assessment %K diagnosis %K online %K evaluation %K diagnostic %K intervention %K pilot implementation evaluation study %D 2025 %7 11.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Current autism assessment procedures are costly and resource-intensive. The COVID-19 pandemic accelerated the adoption of telemedicine, highlighting the benefits of innovative diagnostic tools. Telemedicine-based pathways could enhance accessibility and equity in autism diagnostics. Objective: The Children with Autism Technology Enabled Assessment (CHATA) project aims to develop and pilot an open-source autism diagnostic pathway for children up to 5 years old, delivered through telemedicine. The pathway is designed to be culturally and linguistically adaptable, increasing its applicability to diverse populations and integrating with existing National Health Service digital systems. Methods: Initial pathway development was informed by systematic evidence reviews, coproduction, and mixed methods usability. CHATA comprises 2 key elements: online self-completed standardized autism questionnaires and a structured online interview and observation by a trained clinician. Out of 60 families near the top of the local waiting list will be invited to participate in the pilot evaluation, assessed using both the CHATA and usual assessment pathways. Sensitivity and specificity will be calculated by comparing the diagnosis of autism through CHATA with usual care. Quantitative usability assessment will be gathered from all families using the System Usability Scale (where a mean above 68 indicates above-average usability). A subset of CHATA assessments will be reviewed for interrater reliability (measured by the Cohen κ for categorical data [diagnosis present or absent], with values indicating the level of agreement; eg, <0 indicating no agreement, 0.61-0.80 indicating substantial agreement). Qualitative data on acceptability, feasibility, and usability will be gathered from semistructured interviews with a subset of families and health care providers. We will recruit 60 families for the main pilot study (including the usability testing) and 10-15 participants for the qualitative substudy. Data will estimate CHATA’s diagnostic accuracy, validity, reliability, usability, and acceptability. Patient and public involvement will be integral throughout. The study will take place in a socio-economically deprived, ethnically diverse inner-London Borough within a community-based child health National health service responsible for the Autism assessment of children and young people up to the age of 13 years. Results: Ethics approval was received in June 2023 (Research Ethics Committee reference 22/LO/0751; IRAS project ID 320499). Data collection commenced in April 2023 and completed in October 2024. Project end date is March 2025. As of November 2024, we had enrolled 57 participants to the pilot study and 12 to the qualitative substudy. Conclusions: The CHATA project aims to establish a novel, culturally sensitive, equitable, and accurate online autism assessment pathway. By addressing geographical and linguistic barriers, this pathway seeks to reduce service costs, shorten waiting times, and promote equity in autism diagnosis. The procedures developed are expected to be generalized to other populations nationwide. International Registered Report Identifier (IRRID): DERR1-10.2196/55741 %M 39932780 %R 10.2196/55741 %U https://www.researchprotocols.org/2025/1/e55741 %U https://doi.org/10.2196/55741 %U http://www.ncbi.nlm.nih.gov/pubmed/39932780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60095 %T Developing an ICD-10 Coding Assistant: Pilot Study Using RoBERTa and GPT-4 for Term Extraction and Description-Based Code Selection %A Puts,Sander %A Zegers,Catharina M L %A Dekker,Andre %A Bermejo,Iñigo %K International Classification of Diseases %K ICD-10 %K computer-assisted-coding %K GPT-4 %K coding %K term extraction %K code analysis %K computer assisted coding %K transformer model %K artificial intelligence %K AI automation %K retrieval-augmented generation %K RAG %K large language model %K LLM %K Bidirectional Encoder Representations from Transformers %K Robustly Optimized BERT Pretraining Approach %K RoBERTa %K named entity recognition %K NER %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: The International Classification of Diseases (ICD), developed by the World Health Organization, standardizes health condition coding to support health care policy, research, and billing, but artificial intelligence automation, while promising, still underperforms compared with human accuracy and lacks the explainability needed for adoption in medical settings. Objective: The potential of large language models for assisting medical coders in the ICD-10 coding was explored through the development of a computer-assisted coding system. This study aimed to augment human coding by initially identifying lead terms and using retrieval-augmented generation (RAG)–based methods for computer-assisted coding enhancement. Methods: The explainability dataset from the CodiEsp challenge (CodiEsp-X) was used, featuring 1000 Spanish clinical cases annotated with ICD-10 codes. A new dataset, CodiEsp-X-lead, was generated using GPT-4 to replace full-textual evidence annotations with lead term annotations. A Robustly Optimized BERT (Bidirectional Encoder Representations from Transformers) Pretraining Approach transformer model was fine-tuned for named entity recognition to extract lead terms. GPT-4 was subsequently employed to generate code descriptions from the extracted textual evidence. Using a RAG approach, ICD codes were assigned to the lead terms by querying a vector database of ICD code descriptions with OpenAI’s text-embedding-ada-002 model. Results: The fine-tuned Robustly Optimized BERT Pretraining Approach achieved an overall F1-score of 0.80 for ICD lead term extraction on the new CodiEsp-X-lead dataset. GPT-4-generated code descriptions reduced retrieval failures in the RAG approach by approximately 5% for both diagnoses and procedures. However, the overall explainability F1-score for the CodiEsp-X task was limited to 0.305, significantly lower than the state-of-the-art F1-score of 0.633. The diminished performance was partly due to the reliance on code descriptions, as some ICD codes lacked descriptions, and the approach did not fully align with the medical coder’s workflow. Conclusions: While lead term extraction showed promising results, the subsequent RAG-based code assignment using GPT-4 and code descriptions was less effective. Future research should focus on refining the approach to more closely mimic the medical coder’s workflow, potentially integrating the alphabetic index and official coding guidelines, rather than relying solely on code descriptions. This alignment may enhance system accuracy and better support medical coders in practice. %R 10.2196/60095 %U https://formative.jmir.org/2025/1/e60095 %U https://doi.org/10.2196/60095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60275 %T Assessing Dynamic Cognitive Function in the Daily Lives of Youths With and Without Type 1 Diabetes: Usability Study %A Ray,Mary Katherine %A Fleming,Jorie %A Aschenbrenner,Andrew %A Hassenstab,Jason %A Redwine,Brooke %A Burns,Carissa %A Arbelaez,Ana Maria %A Vajravelu,Mary Ellen %A Hershey,Tamara %K ecological momentary assessment %K EMA %K ambulatory %K smartphone %K continuous glucose monitoring %K CGM %K assessment %K daily lives %K youth %K type 1 diabetes %K diabetes %K feasibility study %K pilot study %K glycemic control %K environmental factor %K phone %K acceptability %K young %K cognitive test %K app %K application %K mobile phone %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: Studies have shown a relationship between worse glycemic control and lower cognitive scores in youths with type 1 diabetes (T1D). However, most studies assess long-term glucose control (eg, years-decades) and cognition at a single time point. Understanding this relationship at a higher temporal resolution (eg, minutes-hours) and in naturalistic settings has potential clinical implications. Newer technology (eg, continuous glucose monitoring [CGM] and ecological momentary assessment) provides a unique opportunity to explore the glucose dynamics that influence dynamic cognition; that is, cognitive functions that fluctuate short-term and are influenced by environmental factors. Objective: Before we can assess this relationship, we need to determine the feasibility of measuring cognition in youths in daily life and determine the plausibility of obtaining glucose variation with CGM to be integrated with real-time cognition measures. This study’s purpose was to assess the acceptability of measuring dynamic cognition using a smartphone app and adherence to cognitive testing in daily life in youths with and without T1D. Further, we assessed CGM-derived glucose measures at temporally related timeframes to cognitive testing in naturalistic settings. Methods: Data were obtained from 3 studies including one in-laboratory study and 2 remote studies. For all studies, youths were asked to complete cognitive tests on the Ambulatory Research in Cognition (ARC) smartphone app that measured processing speed, associative memory, and working memory. For the in-laboratory study, youths completed testing 4 times during 1 session. For the remote studies, youths were asked to complete cognitive tests 5 times per day for either 10 or 14 consecutive days in daily life. Youths were asked to rate their impressions of the app. Youths with T1D wore a CGM. Results: 74 youths (n=53 control; n=21 T1D) aged 4‐16 years participated. Youths generally reported liking or understanding the ARC app tasks in a laboratory and remote setting. Youths had high testing adherence in daily life (2350/3080 to 721/900, 76.3%‐80.2%) and none dropped out. The percentage of measurements within each glycemic range taken immediately before the app’s cognitive testing was 3% (28/942) low glucose, 51% (484/942) euglycemia, 23% (221/942) high glucose, and 22% (210/942) very high glucose. In the 2-hour window before each cognitive task, mean glucose was 182.5 (SD 76.2) mg/dL, SD in glucose was 27.1 mg/dL (SD 18.7), and the mean maximum difference between the highest and lowest glucose was 85.5 (SD 53.7) mg/dL. Conclusions: The results suggest that using the ARC smartphone app to assess dynamic cognitive functions in youths with and without T1D is feasible. Further, we showed CGM-derived glycemic variability at temporally associated timeframes of dynamic cognitive assessments. The next steps include using ecological momentary assessment in a fully powered study to determine the relationship between short-term glycemic control and cognition in youths with T1D. %R 10.2196/60275 %U https://formative.jmir.org/2025/1/e60275 %U https://doi.org/10.2196/60275 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54156 %T Understanding Providers’ Attitude Toward AI in India’s Informal Health Care Sector: Survey Study %A Kumar,Sumeet %A Rayal,Snehil %A Bommaraju,Raghuram %A Varasala,Navya Pratyusha %A Papineni,Sirisha %A Deo,Sarang %K artificial intelligence %K tuberculosis %K health care providers %K cross-sectional studies %K trust %K x-rays %K India %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Tuberculosis (TB) is a major global health concern, causing 1.5 million deaths in 2020. Diagnostic tests for TB are often inaccurate, expensive, and inaccessible, making chest x-rays augmented with artificial intelligence (AI) a promising solution. However, whether providers are willing to adopt AI is not apparent. Objective: The study seeks to understand the attitude of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) and informal health care providers, who we jointly call AIPs, toward adopting AI for TB diagnosis. We chose to study these providers as they are the first point of contact for a majority of TB patients in India. Methods: We conducted a cross-sectional survey of 406 AIPs across the states of Jharkhand (162 participants) and Gujarat (244 participants) in India. We designed the survey questionnaire to assess the AIPs’ confidence in treating presumptive TB patients, their trust in local radiologists’ reading of the chest x-ray images, their beliefs regarding the diagnostic capabilities of AI, and their willingness to adopt AI for TB diagnosis. Results: We found that 93.7% (270/288) of AIPs believed that AI could improve the accuracy of TB diagnosis, and for those who believed in AI, 71.9% (194/270) were willing to try AI. Among all AIPs, 69.4% (200/288) were willing to try AI. However, we found significant differences in AIPs’ willingness to try AI across the 2 states. Specifically, in Gujarat, a state with better and more accessible health care infrastructure, 73.4% (155/211) were willing to try AI, and in Jharkhand, 58.4% (45/77) were willing to try AI. Moreover, AIPs in Gujarat who showed higher trust in the local radiologists were less likely to try AI (odds ratio [OR] 0.15, 95% CI 0.03‐0.69; P=.02). In contrast, in Jharkhand, those who showed higher trust in the local radiologists were more likely to try AI (OR 2.11, 95% CI 0.9‐4.93; P=.09). Conclusions: While most AIPs believed in the potential benefits of AI-based TB diagnoses, many did not intend to try AI, indicating that the expected benefits of AI measured in terms of technological superiority may not directly translate to impact on the ground. Improving beliefs among AIPs with poor access to radiology services or those who are less confident of diagnosing TB is likely to result in a greater impact of AI on the ground. Additionally, tailored interventions addressing regional and infrastructural differences may facilitate AI adoption in India’s informal health care sector. %R 10.2196/54156 %U https://formative.jmir.org/2025/1/e54156 %U https://doi.org/10.2196/54156 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62776 %T NutriDiary, a Smartphone-Based Dietary Record App: Description and Usability Evaluation %A Klasen,Linda %A Koch,Stefanie Anna Julia %A Benz,Maike Elena %A Conrad,Johanna %A Alexy,Ute %A Blaszkiewicz,Konrad %A Andone,Ionut %A Nöthlings,Ute %K dietary assessment %K food record %K barcode scanning %K app %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Repeated applications of short-term dietary assessment instruments are recommended for estimating usual dietary intake. For this purpose, NutriDiary, a smartphone app for collecting weighed dietary records (WDRs) in the German population, was developed. Objective: We aim to describe NutriDiary and evaluate its usability and acceptability. Methods: NutriDiary was developed as a WDR, allowing users to enter food items via text search, barcode scanning, or free text entry. The sample for the evaluation study included 74 participants (n=51, 69% female, aged 18‐64 years), including 27 (37.5%) experts and 47 (63.5%) laypersons (including n=22, 30%, nutrition students). Participants completed a 1-day WDR and entered a predefined sample meal (n=17 foods) the following day by using NutriDiary. An evaluation questionnaire was answered from which the system usability scale (SUS) score (0‐100) was calculated. A backward selection procedure (PROC REG in SAS; SAS Institute) was used to identify potential predictors for the SUS score (age, sex, status [expert or laypersons], and operating system [iOS or Android]). Results: The median SUS score of 75 (IQR 63‐88) indicated good usability. Age was the only characteristic identified as a potential predictor for a lower SUS score (P<.001). The median completion time for an individual WDR was 35 (IQR 19‐52) minutes. Older participants took longer to enter the data than younger ones (18‐30 y: median 1.5, IQR 1.1‐2.0 min/item vs 45‐64 y: median 1.8, IQR 1.3‐2.3 min/item). Most participants expressed a preference for NutriDiary over the traditional paper-based method. Conclusions: Good usability and acceptability make NutriDiary promising for use in epidemiological studies. %R 10.2196/62776 %U https://humanfactors.jmir.org/2025/1/e62776 %U https://doi.org/10.2196/62776 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e55298 %T Validity, Accuracy, and Safety Assessment of an Aerobic Interval Training Using an App-Based Prehabilitation Program (PROTEGO MAXIMA Trial) Before Major Surgery: Prospective, Interventional Pilot Study %A Faqar Uz Zaman,Sara Fatima %A Sliwinski,Svenja %A Mohr-Wetzel,Lisa %A Dreilich,Julia %A Filmann,Natalie %A Detemble,Charlotte %A Zmuc,Dora %A Chun,Felix %A Derwich,Wojciech %A Schreiner,Waldemar %A Bechstein,Wolf %A Fleckenstein,Johannes %A Schnitzbauer,Andreas A %+ Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany, 49 69 6301, andreas.schnitzbauer@rub.de %K digital health %K prehab %K major surgery %K surgical oncology %K smartwatches %K safety and quality %K surgery %K surgical %K oncology %K validity %K accuracy %K safety management %K management %K aerobic %K aerobic training %K app %K prehabilitation %K pilot study %K quality of life %K medical device %K wearable %K wearables %K heart rate %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients’ preoperative status; however, little remains known regarding their safety and accuracy as medical devices. Objective: This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement. Methods: The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures. Results: A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ≤5 bpm (beats per minute) with a mean absolute percentage error of ≤5%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39%) patients experienced adverse events: pain (5/12, 42%), ECG electrode–related skin irritations (2/42, 17%), dizziness (2/42, 17%), shortness of breath (2/42, 17%), and fatigue (1/42, 8%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range –3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range –7 to 43; P<.001); and sodium (mmol/l), mean –2 (range –11 to 12; P<.001). Conclusions: The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implementation in the future. Trial Registration: German Clinical Trials Register DRKS00026985; https://drks.de/search/en/trial/DRKS00026985 and European Database on Medical Devices (EUDAMED) CIV-21-07-0307311. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069394 %M 39928941 %R 10.2196/55298 %U https://mhealth.jmir.org/2025/1/e55298 %U https://doi.org/10.2196/55298 %U http://www.ncbi.nlm.nih.gov/pubmed/39928941 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64747 %T An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study %A Kennedy,Fiona %A Smith,Susan %A Beeken,Rebecca J %A Buck,Caroline %A Williams,Sarah %A Martin,Charlene %A Lally,Phillippa %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E7HB, United Kingdom, 44 2076791722, abigail.fisher@ucl.ac.uk %K cancer %K physical activity %K process evaluation %K randomized controlled trial %K intervention %K app %K habit %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer. Objective: Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement. Methods: Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews. Results: The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support. Conclusions: The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-022-01028-w %M 39928926 %R 10.2196/64747 %U https://cancer.jmir.org/2025/1/e64747 %U https://doi.org/10.2196/64747 %U http://www.ncbi.nlm.nih.gov/pubmed/39928926 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70071 %T Social Media Use and Oral Health–Related Misconceptions in Saudi Arabia: Cross-Sectional Study %A BinHamdan,Rahaf Hamdan %A Alsadhan,Salwa Abdulrahman %A Gazzaz,Arwa Zohair %A AlJameel,AlBandary Hassan %+ Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Diriyah 12372, Riyadh, 11545, Saudi Arabia, 966 0114677743, rahafbinhamdan@gmail.com %K social media %K oral health %K health misinformation %K digital health %K Saudi Arabia %K public health %K Instagram %K Snapchat %K TikTok %K Twitter %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals’ behaviors and oral health outcomes. Objective: This study aimed to describe the patterns of social media use and estimate the prevalence of oral health–related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions. Methods: A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health–related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions. Results: WhatsApp (n=344, 89.8%) and Instagram (n=304, 78.9%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that “Pregnancy causes calcium loss in teeth” (n=337, 87%) and “Dental treatment should be avoided during pregnancy” (n=245, 63.3%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95% CI 1.02-1.31). Conclusions: Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health–related misconceptions. %M 39928937 %R 10.2196/70071 %U https://formative.jmir.org/2025/1/e70071 %U https://doi.org/10.2196/70071 %U http://www.ncbi.nlm.nih.gov/pubmed/39928937 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64445 %T Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report %A Abdulazeem,Hebatullah %A Borges do Nascimento,Israel Júnior %A Weerasekara,Ishanka %A Sharifan,Amin %A Grandi Bianco,Victor %A Cunningham,Ciara %A Kularathne,Indunil %A Deeken,Genevieve %A de Barros,Jerome %A Sathian,Brijesh %A Østengaard,Lasse %A Lamontagne-Godwin,Frederique %A van Hoof,Joost %A Lazeri,Ledia %A Redlich,Cassie %A Marston,Hannah R %A Dos Santos,Ryan Alistair %A Azzopardi-Muscat,Natasha %A Yon,Yongjie %A Novillo-Ortiz,David %+ Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Marmorvej, 51, Copenhagen, 2100, Denmark, 45 45 33 7198, dnovillo@who.int %K people living with dementia %K digital health technologies %K bibliometric analysis %K evidence-based medicine %D 2025 %7 10.2.2025 %9 Review %J JMIR Ment Health %G English %X Background: Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members. Objective: This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers. Methods: A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends. Results: A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions. Conclusions: Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally. Trial Registration: PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=511241 %M 39928936 %R 10.2196/64445 %U https://mental.jmir.org/2025/1/e64445 %U https://doi.org/10.2196/64445 %U http://www.ncbi.nlm.nih.gov/pubmed/39928936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58964 %T Step Count Accuracy of the Life Plus Connected Watch at Different Localizations and Speeds in Healthy Adults, Patients With Cardiovascular Disease, and Patients With Peripheral Artery Disease: Step Count Validation Study in Laboratory Settings %A Heizmann,Anne-Noëlle %A Ollier,Edouard %A Labeix,Pierre %A Goujon,Ivan %A Roche,Frédéric %A Le Hello,Claire %K physical activity assessment %K accuracy %K validation %K steps %K smartwatches %K wearables %K cardiovascular disease %K cardiovascular %K cardiology %K heart %K artery %K peripheral artery disease %K wearable physical activity monitoring device %K physical activity %K exercise %K walking %K monitoring %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly used to monitor and motivate physical activity. Patients with cardiovascular disease (CVD) and peripheral artery disease (PAD) often do not meet national physical activity recommendations. They may, thus, benefit from a physical activity program using smartwatches. The Life Plus smartwatch is designed to facilitate activity monitoring by counting steps, but its validity needs to be determined, particularly in patients who may not have a normal gait, such as those with cardiovascular pathology. Objective: This study evaluates the accuracy of the Life Plus smartwatch (versions 2 and 3) in healthy adults, patients with CVD, and patients with PAD at different walking speeds (1.8, 2.5, 3.2, and 4 km/h) and different localizations (wrists, hips, and ankles) to determine best accuracy. Methods: In total, 34 participants, comprising healthy individuals (n=10), patients with CVD (n=14), and patients with PAD (n=10), wore 6 Life Plus watches simultaneously (3 of version 2 and 3 of version 3), located on wrists, hips, and ankles. Participants walked on a treadmill for 3-minute sessions at speeds of 1.8, 2.5, 3.2, and 4 km/h; they then performed a 10-minute free walking on the ground and again walked for 3-minute sessions on a treadmill at the same speeds. Actual step counts were recorded through video footage. Results: When worn at the wrist, no significant difference between the actual number of steps and step count by version 2 watches was found in each group independently (healthy group: P=.25; CVD group: P=.50; and PAD group: P=.37). Significant differences were found with the version 2 watches at the wrist in the healthy group at 3.2 (−5.26%; P=.01) and 4 km/h (−6.13%; P=.008) and in the CVD group at 2.5 (−5.94%; P=.008), 3.2(−13.1%; P=.008), and 4 km/h (−13.96%; P=.004). When worn at the wrist, no significant difference between actual number of steps and step count by version 3 watches was found in the healthy group (P=.02) and the PAD group (P=.90). Significant differences were found with the version 3 watches at the wrist in the CVD group at 3.2 (−6.43%; P=.001) and 4 km/h (−7.3%; P=.01) and in the PAD group at 4 km/h (−5.77%; P=.04). Conclusions: For optimized counting when worn at the wrist, healthy individuals should prefer version 2 watches for slow walking (1.8 and 2.5 km/h) and version 3 for higher speeds (3.2 and 4 km/h). Patients (CVD and PAD) should prefer version 2 watches at 1.8 km/h and version 3 watches for higher speeds (2.5, 3.2, and 4 km/h). %R 10.2196/58964 %U https://formative.jmir.org/2025/1/e58964 %U https://doi.org/10.2196/58964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63819 %T A Web-Based Resource Informed by Cognitive Behavioral Therapy and Positive Psychology to Address Stress, Negative Affect, and Problematic Alcohol Use: A Usability and Descriptive Study %A Serck-Hanssen,Ingrid %A Solheim-Witt,Marit %A Anker,Justin J %A Sugarman,Dawn E %K alcohol misuse %K stress %K drinking to cope %K DTC %K negative affect %K positive psychology intervention %K PPI %K cognitive behavior therapy %K CBT %K alcohol use %K drinking %K usability %K descriptive study %K behavior %K emotion %K coping skill %K positive psychology %K psychology %K online resource %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Research documents that drinking to cope behavior can be disrupted by enhancing emotion regulation and coping skills related to the experience of stress and negative affect. The Alpha Element Self-Coaching Plan incorporates principles of positive psychology and cognitive behavioral therapy to redirect negative thinking and emotions and, therefore, has the potential to benefit individuals who use alcohol to cope with stress. Objective: This study aimed to evaluate satisfaction and usability of the web-based Alpha Element Self-Coaching Plan in order to inform the development of an expanded digital platform based on the Alpha Element framework. Methods: Participants enrolled in the web-based program as part of their clinical care were eligible to participate. A total of 20 individuals (14 women and 6 men) between ages 30 and 79 (mean 54.5, SD 14.14) years completed web-based questionnaires to assess product performance in areas such as ease of technology use, quality of videos and handouts, and the value of the activities. Participants also completed the System Usability Scale (SUS) and provided background and demographic information, including alcohol use. Results: Only 1 participant reported no alcohol use in the past year; 55% (11/20) of participants drank alcohol 2‐4 times per month or less and 45% (9/20) reported drinking alcohol 2‐3 times per week or more. The average SUS score of 76.38 (SD 17.85) was well above the commonly accepted threshold of 68, indicating high system usability. A majority of the sample (16/19, 84%) agreed or strongly agreed that the activities in the program inspired behavioral changes; and most agreed or strongly agreed that the program was engaging (16/20, 80%), well-organized (18/20, 90%), and easy to follow (17/20, 85%). Only 2 participants endorsed experiencing difficulty using the program on a smartphone. Suggestions for program improvements included expanding the platform, updating the web format, adding user interactivity, and enhancing navigation. Conclusions: These data suggest that participants were generally satisfied with the web-based Alpha Element Self-Coaching Plan, and rated usability of the program as favorable. Importantly, a significant portion of participants reported that the program inspired behavioral changes. More research is needed with a larger sample to obtain specific data about alcohol consumption and investigate associations between alcohol use and program components, as well as examine gender differences. Data collected from this study will be used to expand the platform and improve user experience. %R 10.2196/63819 %U https://formative.jmir.org/2025/1/e63819 %U https://doi.org/10.2196/63819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57768 %T Evaluating the Knowledge Level, Practice, and Behavioral Change Potential of Care Managers in Pressure Injury Prevention Using a Mobile App Prototyping Model in the Home-Care Setting: Single-Arm, Pre-Post Pilot Study %A Kohta,Masushi %A Takahashi,Mayumi %A Koyanagi,Hiroe %A Sugama,Junko %K behavioral change %K home care %K knowledge %K mobile application %K pressure injury %K mHealth %K mobile health %K apps %K practice %K injury %K prevention %K prototype %K effectiveness %K care manager %K Japan %K Pips-Map %K questionnaire %K wound care %K pilot study %K women %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. Objective: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. Methods: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants’ knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70% (adequate knowledge level) increased from 2 (11%) to 7 (36.8%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. Conclusions: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs. Trial Registration: UMIN Clinical Trial Registry UMIN000048904; https://tinyurl.com/5bt6zv7t %R 10.2196/57768 %U https://formative.jmir.org/2025/1/e57768 %U https://doi.org/10.2196/57768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59161 %T Exploring the Relationship Between Smartphone GPS Patterns and Quality of Life in Patients With Advanced Cancer and Their Family Caregivers: Longitudinal Study %A Lee,Kyungmi %A Azuero,Andres %A Engler,Sally %A Kumar,Sidharth %A Puga,Frank %A Wright,Alexi A %A Kamal,Arif %A Ritchie,Christine S %A Demiris,George %A Bakitas,Marie A %A Odom,J Nicholas %K cancer %K digital phenotyping %K global positioning system %K quality of life %K smartphone %K mobile phone %K family caregiver %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: Patients with advanced cancer and their family caregivers often experience poor quality of life (QOL). Self-report measures are commonly used to quantify QOL of family caregivers but may have limitations such as recall bias and social desirability bias. Variables derived from passively obtained smartphone GPS data are a novel approach to measuring QOL that may overcome these limitations and enable detection of early signs of mental and physical health (PH) deterioration. Objective: This study explored the feasibility of a digital phenotyping approach by assessing participant adherence and examining correlations between smartphone GPS data and QOL levels among family caregivers and patients with advanced cancer. Methods: This was a secondary analysis involving 7 family caregivers and 4 patients with advanced cancer that assessed correlations between GPS sensor data captured by a personally owned smartphone and QOL self-report measures over 12 weeks through linear correlation coefficients. QOL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 was collected at baseline, 6, and 12 weeks. Using a Beiwe smartphone app, GPS data were collected and processed into variables including total distance, time spent at home, transition time, and number of significant locations. Results: The study identified relevant temporal correlations between QOL and smartphone GPS data across specific time periods. For instance, in terms of PH, associations were observed with the total distance traveled (12 and 13 wk, with r ranging 0.37 to 0.38), time spent at home (−4 to −2 wk, with r ranging from −0.41 to −0.49), and transition time (−4 to −2 wk, with r ranging −0.38 to −0.47). Conclusions: This research offers insights into using passively obtained smartphone GPS data as a novel approach for assessing and monitoring QOL among family caregivers and patients with advanced cancer, presenting potential advantages over traditional self-report measures. The observed correlations underscore the potential of this method to detect early signs of deteriorating mental health and PH, providing opportunities for timely intervention and support. %R 10.2196/59161 %U https://formative.jmir.org/2025/1/e59161 %U https://doi.org/10.2196/59161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68914 %T Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study %A Thiagarajan,Nishanth %A Tan,Hong Chang %A Rama Chandran,Suresh %A Lee,Phong Ching %A Chin,Yun Ann %A Zeng,Wanling %A Ho,Emily Tse Lin %A Carmody,David %A Goh,Su-Yen %A Bee,Yong Mong %K diabetes %K insulin %K monitoring %K technology %K mobile %K app %K intervention %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: Self-monitoring of blood glucose (SMBG) using web-based diabetes management platforms has demonstrated promise in managing type 2 diabetes (T2D). However, the effectiveness of such systems incorporating algorithm-guided insulin titration has not been extensively studied in Asian populations. Objective: This study evaluates the efficacy and safety of the ALRT telehealth solution—a US Food and Drug Administration–cleared, web-based platform that integrates SMBG with algorithm-driven insulin dose adjustments—in improving glycemia in insulin-treated T2D. Methods: This 24-week, pre-post intervention study enrolled 25 adults with T2D (mean age 58.9, SD 7.0 y; n=14, 56% male) on twice-daily premixed insulin. Inclusion criteria included a baseline hemoglobin A1c (HbA1c) level between 7.5% to 9.9% (58‐86 mmol/mol), a BMI ≤40 kg/m², and experience with SMBG. Participants uploaded twice-daily SMBG data weekly via a mobile app, which generated insulin titration recommendations based on a predefined algorithm. Physicians reviewed and approved the recommendations, which were then communicated back to participants via the app. The primary outcome was the change in HbA1c level from baseline to 24 weeks. Secondary outcomes included changes in fasting plasma glucose, insulin dose, hypoglycemia incidence, and SMBG adherence. Results: Participants achieved significant reductions in HbA1c level from 8.6% (70 mmol/mol) at baseline to 7.4% (57 mmol/mol) at 24 weeks (P<.001), with reductions of 0.8% and 0.4% in the first and second 12 weeks, respectively. Fasting plasma glucose decreased from 8.7 (SD 2.0) mmol/L to 7.1 (SD 1.4) mmol/L (P<.001). Mean total daily insulin dose increased modestly from 0.73 (SD 0.31) units/kg/day to 0.79 (SD 0.34) units/kg/day (P=.007). Participants demonstrated high adherence, completing 97.3% (327/336) of prescribed SMBG measurements. During the study, 48% (12/25) of participants experienced at least 1 hypoglycemia episode, predominantly mild hypoglycemia (85/96, 88.5%; glucose 3.0‐3.9 mmol/L). Hypoglycemia episodes increased from 24 during weeks 0‐12 to 72 during weeks 13‐24. There were no episodes of severe hypoglycemia requiring external assistance. BMI increased slightly from 29.0 (SD 3.6) kg/m² to 29.5 (SD 3.6) kg/m² (P=.03), reflecting a modest weight gain associated with improved glycemia. Conclusions: In conclusion, patients with insulin-treated T2D initiated on a web-based glucose monitoring system with algorithm-guided dosing recommendations showed significant improvement in glycemic control compared to baseline. High adherence rates underscore the feasibility of integrating algorithm-guided insulin titration into routine care. While hypoglycemia incidence rose slightly, episodes were predominantly mild, and no severe events occurred. This intervention shows promise for broader adoption in T2D management, particularly in resource-constrained settings. %R 10.2196/68914 %U https://formative.jmir.org/2025/1/e68914 %U https://doi.org/10.2196/68914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62935 %T Assessment of Digital Capabilities by 9 Countries in the Alliance for Healthy Cities Using AI: Cross-Sectional Analysis %A Lee, Hocheol %K digital capabilities %K digital health cities %K digital transformation %K Asian Forum of Healthy Cities %K assessment %K digital health %K artificial intelligence %K AI %K World Health Organization %K WHO %K healthy city %K data %K health management %K digital era %K qualitative analysis %K cross-sectional survey %K database %K digital health database %K effectiveness %K digital literacy %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: The Alma-Ata Declaration of 1978 initiated a global focus on universal health, supported by the World Health Organization (WHO) through healthy cities policies. The concept emerged at the 1984 Toronto “Beyond Health Care” conference, leading to WHO’s first pilot project in Lisbon in 1986. The WHO continues to support regional healthy city networks, emphasizing digital transformation and data-driven health management in the digital era. Objective: This study explored the capabilities of digital healthy cities within the framework of digital transformation, focusing on member countries of the Asian Forum of Healthy Cities. It examined the cities’ preparedness and policy needs for transitioning to digital health. Methods: A cross-sectional survey was conducted of 9 countries—Australia, Cambodia, China, Japan, South Korea, Malaysia, Mongolia, the Philippines, and Vietnam—from August 1 to September 21, 2023. The 6-section SPIRIT (setting approach and sustainability; political commitment, policy, and community participation; information and innovation; resources and research; infrastructure and intersectoral; and training) checklist was modified to assess healthy cities’ digital capabilities. With input from 3 healthy city experts, the checklist was revised for digital capabilities, renaming “healthy city” to “digital healthy city.” The revised tool comprises 8 sections with 33 items. The survey leveraged ChatGPT (version 4.0; OpenAI, Microsoft), accessed via Python (Python Software Foundation) application programming interface. The openai library was installed, and an application programming interface key was entered to use ChatGPT (version 4.0). The “GPT-4 Turbo” model command was applied. A qualitative analysis of the collected data was conducted by 5 healthy city experts through group deep-discussions. Results: The results indicate that these countries should establish networks and committees for sustainable digital healthy cities. Cambodia showed the lowest access to electricity (70%) and significant digital infrastructure disparities. Efforts to sustain digital health initiatives varied, with countries such as Korea focusing on telemedicine, while China aimed to build a comprehensive digital health database, highlighting the need for tailored strategies in promoting digital healthy cities. Life expectancy was the highest in the Republic of Korea and Japan (both 84 y). Access to electricity was the lowest in Cambodia (70%) with the remaining countries having had 95% or higher access. The internet use rate was the highest in Malaysia (97.4%), followed by the Republic of Korea (97.2%), Australia (96.2%), and Japan (82.9%). Conclusions: This study highlights the importance of big data-driven policies and personal information protection systems. Collaborative efforts across sectors for effective implementation of digital healthy cities. The findings suggest that the effectiveness of digital healthy cities is diminished without adequate digital literacy among managers and users, suggesting the need for policies to improve digital literacy. %R 10.2196/62935 %U https://formative.jmir.org/2025/1/e62935 %U https://doi.org/10.2196/62935 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65140 %T Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study %A Astill Wright,Laurence %A Moore,Matthew %A Reeves,Stuart %A Vallejos,Elvira Perez %A Morriss,Richard %+ Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 823 1294, laurence.astillwright@nottingham.ac.uk %K mood monitoring %K ecological momentary assessment %K EMA %K passive ecological momentary assessment %K passive EMA %K bipolar disorder %K implementation %K qualitative %K mobile phone %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired. %M 39918865 %R 10.2196/65140 %U https://formative.jmir.org/2025/1/e65140 %U https://doi.org/10.2196/65140 %U http://www.ncbi.nlm.nih.gov/pubmed/39918865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53566 %T Adapting a Mobile Health App for Smoking Cessation in Black Adults With Anxiety Through an Analysis of the Mobile Anxiety Sensitivity Program Proof-of-Concept Trial: Qualitative Study %A Cheney,Marshall K %A Alexander,Adam C %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka A %A Kezbers,Krista M %A Matoska,Cameron T %A Zvolensky,Michael J %A Businelle,Michael S %+ Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States, 1 4053255211, marshall@ou.edu %K cultural tailoring %K tailoring %K African American %K black %K smoking cessation %K mHealth %K smartphone application %K just in time adaptive intervention %K qualitative %K formative evaluation %K app %K application %K anxiety %K adult %K qualitative analysis %K smoking %K mobile phone %K tobacco %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: At least half of smokers make a serious quit attempt each year, but Black adults who smoke are less likely than White adults who smoke to quit smoking successfully. Black adults who smoke and have high anxiety sensitivity (an individual difference factor implicated in smoking relapse and culturally relevant to Black adults) are even less successful. The Mobile Anxiety Sensitivity Program for Smoking (MASP) is a smoking cessation smartphone app culturally tailored to Black adults who smoke to increase smoking cessation rates by targeting anxiety sensitivity. Objective: This study examined the acceptability and feasibility of the MASP smartphone app following a 6-week pilot test through postintervention qualitative interviews. Methods: The MASP smoking cessation app was adapted from an evidence-based app by adding culturally tailored narration and images specific to the Black community, educational content on tobacco use in the Black community and the role of menthol, culturally tailored messages, and addressing tobacco use and racial discrimination. The MASP app was piloted with 24 adults with high anxiety sensitivity who identified as Black, smoked daily, and were not currently using medications or psychotherapy for smoking cessation. At the end of the 6-week pilot test, 21/24 participants (67% female; 95.2% non-Hispanic; mean age=47.3 years; 43% college educated; 86% single or separated) completed an audio-recorded semistructured interview assessing the acceptability and utility of the app, individual experiences, barriers to use, the cultural fit for Black adults who wanted to quit smoking, and identified areas for improvement. Transcribed interviews were coded using NVivo (Lumivero), and then analyzed for themes using an inductive, use-focused process. Results: Most participants (17/21, 81%) had smoked for more than 20 years and 29% (6/21) of them smoked more than 20 cigarettes daily. Participants felt the MASP app was helpful in quitting smoking (20/21, 95%) and made them more aware of smoking thoughts, feelings, and behaviors (16/19, 84%). Half of the participants (11/21, 52%) thought the combination of medication and smartphone app gave them the best chance of quitting smoking. Themes related to participant experiences using the app included establishing trust and credibility through the recruitment experience, providing personally tailored content linked to evidence-based stress reduction techniques, and self-reflection through daily surveys. The culturally tailored material increased app relevance, engagement, and acceptability. Suggested improvements included opportunities to engage with other participants, more control over app functions, and additional self-monitoring functions. Conclusions: Adding culturally tailored material to an evidence-based mobile health (mHealth) intervention could increase the use of smoking cessation interventions among Black adults who want to quit smoking. Qualitative interviews provide mHealth app developers important insights into how apps can be improved before full study implementation and emphasize the importance of getting feedback from the target population throughout the development process of mHealth interventions. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 %M 39918847 %R 10.2196/53566 %U https://formative.jmir.org/2025/1/e53566 %U https://doi.org/10.2196/53566 %U http://www.ncbi.nlm.nih.gov/pubmed/39918847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53483 %T Status of Digital Health Technology Adoption in 5 Vietnamese Hospitals: Cross-Sectional Assessment %A Tran,Duc Minh %A Thanh Dung,Nguyen %A Minh Duc,Chau %A Ngoc Hon,Huynh %A Minh Khoi,Le %A Phuc Hau,Nguyen %A Thi Thu Huyen,Duong %A Thi Le Thu,Huynh %A Van Duc,Tran %A , %A Minh Yen,Lam %A Thwaites,C Louise %A Paton,Chris %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam, 84 2839237954, ductm@oucru.org %K electronic health record %K electronic medical record %K digital maturity %K clinical decision support %K digital infrastructure %K Vietnam %K health information technology %K digital health technology %K low- and middle-income country %D 2025 %7 6.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies (DHTs) have been recognized as a key solution to help countries, especially those in the low- and middle-income group, to achieve the Sustainable Development Goals (SDGs) and the World Health Organization’s (WHO) Triple Billion Targets. In hospital settings, DHTs need to be designed and implemented, considering the local context, to achieve usability and sustainability. As projects such as the Vietnam ICU Translational Applications Laboratory are seeking to integrate new digital technologies in the Vietnamese critical care settings, it is important to understand the current status of DHT adoption in Vietnamese hospitals. Objective: We aimed to explore the current digital maturity in 5 Vietnamese public hospitals to understand their readiness in implementing new DHTs. Methods: We assessed the adoption of some key DHTs and infrastructure in 5 top-tier public hospitals in Vietnam using a questionnaire adapted from the Vietnam Health Information Technology (HIT) Maturity Model. The questionnaire was answered by the heads of the hospitals’ IT departments, with follow-up for clarifications and verifications on some answers. Descriptive statistics demonstrated on radar plots and tile graphs were used to visualize the data collected. Results: Hospital information systems (HIS), laboratory information systems (LIS), and radiology information systems–picture archiving and communication systems (RIS-PACS) were implemented in all 5 hospitals, albeit at varied digital maturity levels. At least 50% of the criteria for LIS in the Vietnam HIT Maturity Model were satisfied by the hospitals in the assessment. However, this threshold was only met by 80% and 60% of the hospitals with regard to HIS and RIS-PACS, respectively. Two hospitals were not using any electronic medical record (EMR) system or fulfilling any extra digital capability, such as implementing clinical data repositories (CDRs) and clinical decision support systems (CDSS). No hospital reported sharing clinical data with other organizations using Health Level Seven (HL7) standards, such as Continuity of Care Document (CCD) and Clinical Document Architecture (CDA), although 2 (40%) reported their systems adopted these standards. Of the 5 hospitals, 4 (80%) reported their RIS-PACS adopted the Digital Imaging and Communications in Medicine (DICOM) standard. Conclusions: The 5 major Vietnamese public hospitals in this assessment have widely adopted information systems, such as HIS, LIS, and RIS-PACS, to support administrative and clinical tasks. Although the adoption of EMR systems is less common, their implementation revolves around data collection, management, and access to clinical data. Secondary use of clinical data for decision support through the implementation of CDRs and CDSS is limited, posing a potential barrier to the integration of external DHTs into the existing systems. However, the wide adoption of international standards, such as HL7 and DICOM, is a facilitator for the adoption of new DHTs in these hospitals. %M 39913927 %R 10.2196/53483 %U https://formative.jmir.org/2025/1/e53483 %U https://doi.org/10.2196/53483 %U http://www.ncbi.nlm.nih.gov/pubmed/39913927 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68163 %T Mediating Effect of Social Capital on the Association Between Digital Literacy and Life Satisfaction Among Older Adults in South Korea: Cross-Sectional Study %A Jung,Hyein %A Lee,Hocheol %A Nam,Eun Woo %K digital literacy %K digital access %K digital competency %K digital utilization %K life satisfaction %K older adults %K social capital %K mediating effect %K aging %D 2025 %7 6.2.2025 %9 %J JMIR Form Res %G English %X Background: As Korea rapidly transforms into a super-aged society, research indicates that digital literacy among older adults enhances their life satisfaction. Digital literacy refers to the ability to efficiently use digital technologies, encompassing access, competency, and utilization. It reflects the capacity to navigate and benefit from digital environments effectively. Furthermore, social capital positively influences the quality of life, and digital literacy facilitates social capital formation. However, since most studies have only focused on the direct relationship between digital literacy and life satisfaction, research on the mediating role of social capital remains limited. Objective: To analyze the effect of digital literacy on the life satisfaction of older adults in South Korea and to verify whether social capital acts as a mediating factor in this process. Methods: This descriptive cross-sectional study used data from the 2023 Report on the Digital Divide—an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. The study targeted individuals aged 65 years or older. Descriptive statistics, the Pearson correlation analyses, and the 3-step multiple regression analysis proposed by Baron and Kenny were performed. The bootstrap method was employed, and all analyses were conducted using R, version 4.4.1. Results: The study included 869 participants. Digital literacy had a significant positive effect on their life satisfaction (β=0.103; P=.008). Social capital was also positively associated with life satisfaction (β=0.337; P<.001). Mediation analysis showed that digital literacy influenced life satisfaction both directly (β=0.103; P=.006) and indirectly through social capital (β=0.037; P=.03). Bootstrapping confirmed the significance of the indirect effect (β=0.037, 95% CI 0.005‐0.070; P=.03). The total effect of digital literacy on life satisfaction was also significant (β=0.140, 95% CI 0.058‐0.230; P=.002). Conclusions: This study analyzed the association between digital literacy, social capital, and life satisfaction among older adults in Korea. We identified that social capital mediates the association between digital literacy and life satisfaction among older adults. These findings indicate that tailored digital literacy programs and support policies that promote social capital formation could help bridge the digital divide and foster social inclusion. These measures would enable older adults to access essential services, reduce social isolation, and enhance health and well-being, ultimately improving the overall quality of life. %R 10.2196/68163 %U https://formative.jmir.org/2025/1/e68163 %U https://doi.org/10.2196/68163 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e57443 %T Comparing In-Person, Standard Telehealth, and Remote Musculoskeletal Examination With a Novel Augmented Reality Exercise Game System: Pilot Cross-Sectional Comparison Study %A Wu,Richard %A Chakka,Keerthana %A Belko,Sara %A Khargonkar,Ninad %A Desai,Kevin %A Prabhakaran,Balakrishnan %A Annaswamy,Thiru %K physical examination %K telemedicine %K tele-health %K virtual care %K virtual health %K telerehabilitation %K augmented reality %K AR %K game %K simulation %K digital world %K virtual environment %K motion %K strength %K force %K musculoskeletal %K remote examination %K exercise %K physical examinations %K telehealth %K cross-sectional %K VIRTEPEX %K patient %K exergame %D 2025 %7 5.2.2025 %9 %J JMIR Serious Games %G English %X Background: Current telemedicine technologies are not fully optimized for conducting physical examinations. The Virtual Remote Tele-Physical Examination (VIRTEPEX) system, a novel proprietary technology platform using a Microsoft Kinect-based augmented reality game system to track motion and estimate force, has the potential to assist with conducting asynchronous, remote musculoskeletal examinations. Objective: This pilot study evaluated the feasibility of the VIRTEPEX system as a supplement to telehealth musculoskeletal strength assessments. Methods: In this cross-sectional pilot study, 12 study participants with upper extremity pain and/or weakness underwent strength evaluations for four upper extremity movements using in-person, telehealth, VIRTEPEX, and composite (telehealth plus VIRTEPEX) assessments. The evaluators were blinded to each other’s assessments. The primary outcome was feasibility, as determined by participant recruitment, study completion, and safety. The secondary outcome was preliminary evaluation of inter-rater agreement between in-person, telehealth, and VIRTEPEX strength assessments, including κ statistics. Results: This pilot study had an 80% recruitment rate, a 100% completion rate, and reported no adverse events. In-person and telehealth evaluations achieved highest overall agreement (85.71%), followed by agreements between in-person and composite (75%), in-person and VIRTEPEX (62.5%), and telehealth and VIRTEPEX (62.5%) evaluations. However, for shoulder flexion, agreement between in-person and VIRTEPEX evaluations (78.57%; κ=0.571, 95% CI 0.183 to 0.960) and in-person and composite evaluations (78.57%; κ=0.571, 95% CI 0.183 to 0.960) was higher than that between in-person and telehealth evaluations (71.43%; κ=0.429, 95% CI −0.025 to 0.882). Conclusions: This study demonstrates the feasibility of asynchronous VIRTEPEX examinations and supports the potential for VIRTEPEX to supplement and add value to standard telehealth platforms. Further studies with an additional development of VIRTEPEX and larger sample sizes for adequate power are warranted. %R 10.2196/57443 %U https://games.jmir.org/2025/1/e57443 %U https://doi.org/10.2196/57443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64444 %T Nurses’ Perspectives and Experiences of Using a Bed-Exit Information System in an Acute Hospital Setting: Mixed Methods Study %A Walzer,Stefan %A Schön,Isabel %A Pfeil,Johanna %A Klemm,Sam %A Ziegler,Sven %A Schmoor,Claudia %A Kunze,Christophe %+ Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723 920 2957, stefan.walzer@hs-furtwangen.de %K cognitive impairment %K bed-exit %K technology %K fall prevention %K inpatient %K hospital %K mixed methods %K nurse %K information system %K acute hospital %K support %K online questionnaire %K cognitively impaired %K workload %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals. Objective: To develop a better understanding of nurses’ perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting. Methods: BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist. Results: A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system. Conclusions: While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses’ workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses. Trial Registration: German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720 %M 39908092 %R 10.2196/64444 %U https://formative.jmir.org/2025/1/e64444 %U https://doi.org/10.2196/64444 %U http://www.ncbi.nlm.nih.gov/pubmed/39908092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66666 %T Addressing the “Black Hole” of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study %A Rudin,Robert S %A Herman,Patricia M %A Vining,Robert %K low back pain %K clinical decision support %K user-centered design %K usability %K back pain %K low back pain care %K pain %K clinical decision %K societal burden %K substantial %K burden %K evidence-based %K treatment %K diagnosis %K support tool %K clinicians %K chiropractic %K chiropractor %K reviews %K scenario-based interviews %K interviews %D 2025 %7 4.2.2025 %9 %J JMIR Form Res %G English %X Background: Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. Objectives: We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Methods: Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. Results: The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5‐95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the “black hole” of LBP diagnosis and treatment. Conclusions: Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care. %R 10.2196/66666 %U https://formative.jmir.org/2025/1/e66666 %U https://doi.org/10.2196/66666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62738 %T Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %K chatbot %K conversational agents %K tele-dentistry %K oral health behavior %K in-person toothbrushing %K hands-on %K children %K covid-19 %K oral health education %K development. %D 2025 %7 3.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3‐5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot’s content quality, empathetic communication, and multimedia design, but noted the intervention’s lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers’ perceptions of oral health care and improved tooth-brushing practices for children aged 6‐36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 %R 10.2196/62738 %U https://pediatrics.jmir.org/2025/1/e62738 %U https://doi.org/10.2196/62738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54147 %T Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control %A Manski-Nankervis,Jo-Anne %A Hunter,Barbara %A Lumsden,Natalie %A Laughlin,Adrian %A McMorrow,Rita %A Boyle,Douglas %A Chondros,Patty %A Jesudason,Shilpanjali %A Radford,Jan %A Prictor,Megan %A Emery,Jon %A Amores,Paul %A Tran-Duy,An %A Nelson,Craig %+ Primary Care and Family Medicine, Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore, 65 65138572, joanne.mn@ntu.edu.sg %K primary care %K general practice %K clinical decision support %K chronic kidney disease %K cardiovascular disease %K cardiovascular %K clinical decision %K decision support %K support %K kidney %K kidney disease %K electronic medical record %K risk %K risk reduction %K pharmacological %K pharmacological therapy %K medical records %K logistic model %D 2025 %7 3.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). Objective: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). Methods: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Results: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. Conclusions: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial Registration: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119 %M 39899838 %R 10.2196/54147 %U https://formative.jmir.org/2025/1/e54147 %U https://doi.org/10.2196/54147 %U http://www.ncbi.nlm.nih.gov/pubmed/39899838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54167 %T Summer Research Internship Curriculum to Promote Self-Efficacy, Researcher Identity, and Peer-to-Peer Learning: Retrospective Cohort Study %A Levites Strekalova,Yulia A %A Liu-Galvin,Rachel %A Border,Samuel %A Midence,Sara %A Khan,Mishal %A VanZanten,Maya %A Tomaszewski,John %A Jain,Sanjay %A Sarder,Pinaki %K artificial intelligence %K biomedical research %K curriculum %K training programs %K workforce %D 2025 %7 3.2.2025 %9 %J JMIR Form Res %G English %X Background: Common barriers to students’ persistence in research include experiencing feelings of exclusion and a lack of belonging, difficulties developing a robust researcher identity, perceptions of racial and social stigma directed toward them, and perceived gaps in research skills, which are particularly pronounced among trainees from groups traditionally underrepresented in research. To address these known barriers, summer research programs have been shown to increase the participation and retention of undergraduate students in research. However, previous programs have focused predominantly on technical knowledge and skills, without integrating an academic enrichment curriculum that promotes professional development by improving students’ academic and research communication skills. Objective: This retrospective pre-then-post study aimed to evaluate changes in self-reported ratings of research abilities among a cohort of undergraduate students who participated in a summer research program. Methods: The Human BioMolecular Atlas Program (HuBMAP) piloted the implementation of a web-based academic enrichment curriculum for the Summer 2023 Research Internship cohort, which was comprised of students from groups underrepresented in biomedical artificial intelligence research. HuBMAP, a 400-member research consortium funded by the Common Fund at the National Institutes of Health, offered a 10-week summer research internship that included an academic enrichment curriculum delivered synchronously via the web to all students across multiple sites. The curriculum is intended to support intern self-efficacy, researcher identity development, and peer-to-peer learning. At the end of the internship, students were invited to participate in a web-based survey in which they were asked to rate their academic and research abilities before the internship and as a result of the internship using a modified Entering Research Learning Assessment instrument. Wilcoxon matched-pairs signed rank test was performed to assess the difference in the mean scores per respondent before and after participating in the internship. Results: A total of 14 of the 22 undergraduate students who participated in the internship responded to the survey. The results of the retrospective pre-then-post survey indicated that there was a significant increase in students’ self-rated research abilities, evidenced by a significant improvement in the mean scores of the respondents when comparing reported skills self-assessment before and after the internship (improvement: median 1.09, IQR 0.88-1.65; W=52.5, P<.001). After participating in the HuBMAP web-based academic enrichment curriculum, students’ self-reported research abilities, including their confidence, their communication and collaboration skills, their self-efficacy in research, and their abilities to set research career goals, increased. Conclusions: Summer internship programs can incorporate an academic enrichment curriculum with small-group peer learning in addition to a laboratory-based experience to facilitate increased student engagement, self-efficacy, and a sense of belonging in the research community. Future research should investigate the impact of academic enrichment curricula and peer mentoring on the long-term retention of students in biomedical research careers, particularly retention of students underrepresented in biomedical fields. %R 10.2196/54167 %U https://formative.jmir.org/2025/1/e54167 %U https://doi.org/10.2196/54167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63139 %T Effectiveness of Cognitive Behavioral Therapy Provided Through a Web Application for Subthreshold Depression, Subthreshold Insomnia, and Subthreshold Panic: Open-Labeled 6-Arm Randomized Clinical Trial Pilot Study %A Taguchi,Kayoko %A Miyoshi,Mirai %A Seki,Yoichi %A Baba,Shiori %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, chuo-ku, Inohana 1-8-1, Chiba, 260-8670, Japan, 81 43 226 2027, k.taguchi@chiba-u.jp %K minimally important change %K nonguided cognitive behavioral therapy %K subthreshold depression %K subthreshold insomnia %K subthreshold panic %K cognitive behavioral therapy %K CBT %K psychiatric disease %K primary care %K interventions %K depression %K anxiety %K insomnia %K psychological therapy %D 2025 %7 3.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: A common definition of “subthreshold” is that the diagnostic threshold is not met but the individuals are not asymptomatic. Some symptoms are present, causing significant difficulty in functioning and negatively impacting quality of life. Despite the attention given to subthreshold symptoms and the interventions for subthreshold symptoms being efficient in preventing the transition to psychiatric disease in primary care, reports on specific interventions are insufficient. Objective: This study aimed to verify the effectiveness of internet-delivered cognitive behavioral therapy (ICBT) for subthreshold depression (SD), subthreshold insomnia (SI), and subthreshold panic (SP). Additionally, this study aimed to explore the minimally important change (MIC) of each subthreshold group’s effectiveness outcome. Methods: Participants aged 18-70 years from internet research monitors were categorized into SD, SI, and SP groups based on screening assessment. They were randomly assigned to intervention or control groups within each subthreshold symptom. The intervention groups worked on 4 weeks of nonguided ICBT (“Mentre”), while the control groups worked on a sham app. The primary outcome was the score change from screening (T1) to 4-week follow-up (T4) using the Center for Epidemiologic Studies Depression Scale (CESD) in the SD group, the Pittsburgh Sleep Quality Index (PSQI) in the SI group, and the Panic and Agoraphobia Scale (PAS) in the SP group. Secondary outcomes were score changes in the Generalized Anxiety Disorder-7 (GAD-7) scale, the Patient Health Questionnaire 9 (PHQ-9), the CESD, the PSQI, and the PAS, except the primary outcome in each group. Secondary outcomes were analyzed using complete-case analysis and repeated-measures ANOVA. Additionally, the MIC in the primary endpoint for each group was also calculated as an exploratory outcome. Results: The SD, SP, and SI groups contained 846, 597, and 1106 participants, respectively. In the SD group, the difference in the CESD score change from baseline to follow-up between the intervention and control groups was significant (difference=0.52, 95% CI 1.29-4.66, P<.001). In the SI group, the difference in the PSQI score change was also significant (difference=0.53, 95% CI 0.11-0.94, P=.01). However, in the SP group, the difference in the PAS score change was not significant (difference=0.07, 95% CI –2.00 to 2.15, P=.94). Conclusions: Our ICBT program Mentre contributes to the improvement of SI and SD. This suggests that nonguided ICBT may be effective in preventing SI and SD from progressing to the full threshold. However, appropriate definitions of subthreshold symptoms are necessary. In particular, it is difficult to define SP, and further research that considers the specific factors of each subthreshold symptom is necessary to accumulate evidence. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000051280; https://tinyurl.com/2wyahhe3 %M 39899369 %R 10.2196/63139 %U https://formative.jmir.org/2025/1/e63139 %U https://doi.org/10.2196/63139 %U http://www.ncbi.nlm.nih.gov/pubmed/39899369 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69311 %T Evaluating the Impact of Pharmacotherapy in Augmenting Quit Rates Among Hispanic Adults in an App-Delivered Smoking Cessation Intervention: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Cupertino,Ana Paula %A Salloum,Ramzi G %A Triplette,Matthew %A Zvolensky,Michael J %A Bricker,Jonathan B %+ Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 206 667 4780, msantiag@fredhutch.org %K acceptance and commitment therapy %K Hispanic or Latino %K iCanQuit %K QuitGuide %K smartphone apps %K smoking cessation %K mobile phone %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic adults receive less advice to quit smoking and use fewer evidence-based smoking cessation treatments compared to their non-Hispanic counterparts. Digital smoking cessation interventions, such as those delivered via smartphone apps, provide a feasible and within-reach treatment option for Hispanic adults who smoke and want to quit smoking. While the combination of pharmacotherapy and behavioral interventions are considered best practices for smoking cessation, its efficacy among Hispanic adults, especially alongside smartphone app–based interventions, is uncertain. Objective: This secondary analysis used data from a randomized controlled trial that compared the efficacy of 2 smoking cessation apps, iCanQuit (based on acceptance and commitment therapy) and QuitGuide (following US clinical practice guidelines), to explore the association between pharmacotherapy use and smoking cessation outcomes among the subsample of 173 Hispanic participants who reported on pharmacotherapy use. Given the randomized design, we first tested the potential interaction of pharmacotherapy use and intervention arm on 12-month cigarette smoking abstinence. We then examined whether the use of any pharmacotherapy (ie, nicotine replacement therapy [NRT], varenicline, or bupropion) and NRT alone augmented each app-based intervention efficacy. Methods: Participants reported using pharmacotherapy on their own during the 3-month follow-up and cigarette smoking abstinence at the 12-month follow-up via web-based surveys. These data were used (1) to test the interaction effect of using pharmacotherapy to aid smoking cessation and intervention arm (iCanQuit vs QuitGuide) on smoking cessation at 12 months and (2) to test whether the use of pharmacotherapy to aid smoking cessation augmented the efficacy of each intervention arm to help participants successfully quit smoking. Results: The subsample of Hispanic participants was recruited from 30 US states. They were on average 34.5 (SD 9.3) years of age, 50.9% (88/173) were female, and 56.1% (97/173) reported smoking at least 10 cigarettes daily. Approximately 22% (38/173) of participants reported using pharmacotherapy to aid smoking cessation at the 3-month follow-up, including NRT, varenicline, or bupropion, with no difference between intervention arms. There was an interaction between pharmacotherapy use and intervention arm that marginally influenced 12-month quit rates at 12 months (P for interaction=.053). In the iCanQuit arm, 12-month missing-as-smoking quit rates were 43.8% (7/16) for pharmacotherapy users versus 28.8% (19/16) for nonusers (odds ratio 2.21, 95% CI 0.66-7.48; P=.20). In the QuitGuide arm, quit rates were 9.1% (2/22) for pharmacotherapy users versus 21.7% (15/69) for nonusers (odds ratio 0.36, 95% CI 0.07-1.72; P=.20). Results were similar for the use of NRT only. Conclusions: Combining pharmacotherapy to aid smoking cessation with a smartphone app–based behavioral intervention that teaches acceptance of cravings to smoke (iCanQuit) shows promise in improving quit rates among Hispanic adults. However, this combined approach was not effective with the US clinical guideline–based app (QuitGuide). Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 International Registered Report Identifier (IRRID): RR2-10.1001/jamainternmed.2020.4055 %R 10.2196/69311 %U https://formative.jmir.org/2025/1/e69311 %U https://doi.org/10.2196/69311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69771 %T An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial %A Alexander,Adam %A Businelle,Michael %A Cheney,Marshall %A Cohn,Amy %A McNeill,Lorna %A Short,Kevin %A Frank-Pearce,Summer %A Bradley,David %A Estrada,Kimberly %A Flores,Iván %A Fronheiser,Jack %A Kendzor,Darla %+ University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 (405) 965 05, Adam-Alexander@ouhsc.edu %K African American %K Black %K mobile health %K mHealth %K smartphone app %K smoking cessation %K physical activity, mobile phone %D 2025 %7 31.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults in the United States experience disproportionately high rates of tobacco- and obesity-related diseases, driven in part by disparities in smoking cessation and physical activity. Smartphone-based interventions with financial incentives offer a scalable solution to address these health disparities. Objective: This study aims to assess the feasibility and preliminary efficacy of a mobile health intervention that provides financial incentives for smoking cessation and physical activity among Black adults. Methods: A total of 60 Black adults who smoke (≥5 cigarettes/d) and are insufficiently physically active (engaging in <150 min of weekly moderate-intensity physical activity) will be randomly assigned to either HealthyCells intervention (incentives for smoking abstinence only) or HealthyCells+ intervention (incentives for both smoking abstinence and daily step counts). Participants will use study-provided smartphones, smartwatches, and carbon monoxide monitors for 9 weeks (1 wk prequit date through 8 wk postquit date). Feasibility will be evaluated based on recruitment rates, retention, and engagement. The primary outcomes include carbon monoxide–verified, 7-day smoking abstinence at 8 weeks postquit date and changes in average daily step count. Feasibility benchmarks include a recruitment rate of ≥5 participants per month, a retention rate of ≥75%, and a smoking abstinence rate of ≥20% at 8 weeks postquit date. Expected increases in physical activity include a net gain of 500 to 1500 steps per day compared to baseline. Results: Recruitment is expected to begin in February 2025 and conclude by September 2025, with data analysis completed by October 2025. Conclusions: This study will evaluate the feasibility of a culturally tailored mobile health intervention combining financial incentives for smoking cessation and physical activity promotion. Findings will inform the design of larger-scale trials to address health disparities through scalable, technology-based approaches. Trial Registration: ClinicalTrials.gov NCT05188287; https://clinicaltrials.gov/ct2/show/NCT05188287 International Registered Report Identifier (IRRID): PRR1-10.2196/69771 %M 39888657 %R 10.2196/69771 %U https://www.researchprotocols.org/2025/1/e69771 %U https://doi.org/10.2196/69771 %U http://www.ncbi.nlm.nih.gov/pubmed/39888657 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66132 %T Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study %A Puttkammer,Nancy %A Dunbar,Elizabeth %A Germanovych,Myroslava %A Rosol,Mariia %A Golden,Matthew %A Hubashova,Anna %A Fedorchenko,Vladyslav %A Hetman,Larisa %A Legkostup,Liudmyla %A Flowers,Jan %A Nesterova,Olena %+ Digital Initiatives Group at I-TECH, Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, United States, 1 206 898 5892, nputt@uw.edu %K human-centered design %K mobile health %K mHealth %K Ukraine %K HIV testing %K war and humanitarian settings %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)–Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking. Objective: The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability. Methods: This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study’s formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients. Results: The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine’s wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload. Conclusions: It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing. %M 39883930 %R 10.2196/66132 %U https://formative.jmir.org/2025/1/e66132 %U https://doi.org/10.2196/66132 %U http://www.ncbi.nlm.nih.gov/pubmed/39883930 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57208 %T Co-Designing a Digital Brief Intervention to Reduce the Risk of Prescription Opioid–Related Harm Among People With Chronic Noncancer Pain: Qualitative Analysis of Patient Lived Experiences %A Elphinston,Rachel A %A Pager,Sue %A Brown,Kelly %A Sterling,Michele %A Fatehi,Farhad %A Gray,Paul %A Hipper,Linda %A Cahill,Lauren %A Connor,Jason P. %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, 296 Herston Road, Herston, 4006, Australia, 61 412662084, rachelel@uq.edu.au %K chronic noncancer pain %K prescription opioid use %K brief intervention %K co-design %K patient partners %K lived experience %K qualitative %K digital health %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid medications are important for pain management, but many patients progress to unsafe medication use. With few personalized and accessible behavioral treatment options to reduce potential opioid-related harm, new and innovative patient-centered approaches are urgently needed to fill this gap. Objective: This study involved the first phase of co-designing a digital brief intervention to reduce the risk of opioid-related harm by investigating the lived experience of chronic noncancer pain (CNCP) in treatment-seeking patients, with a particular focus on opioid therapy experiences. Methods: Eligible patients were those aged between 18 and 70 years with CNCP at a clinically significant level of intensity (a score of ≥4 of 10). Purposive sampling was used to engage patients on public hospital waitlists via mail or through the treating medical specialist. Participants (N=18; n=10 women; mean age 49.5 years, SD 11.50) completed semistructured telephone interviews. Interviews were transcribed verbatim, thematically analyzed using grounded theory, and member checked by patients. Results: Eight overarching themes were found, listed in the order of their prominence from most to least prominent: limited treatment collaboration and partnership; limited biopsychosocial understanding of pain; continued opioid use when benefits do not outweigh harms; a trial-and-error approach to opioid use; cycles of hopefulness and hopelessness; diagnostic uncertainty; significant negative impacts tied to loss; and complexity of pain and opioid use journeys. Conclusions: The findings of this study advance progress in co-designing digital brief interventions by actively engaging patient partners in their lived experiences of chronic pain and use of prescription opioid medications. The key recommendations proposed should guide the development of personalized solutions to address the complex care needs of patients with CNCP. %M 39883931 %R 10.2196/57208 %U https://formative.jmir.org/2025/1/e57208 %U https://doi.org/10.2196/57208 %U http://www.ncbi.nlm.nih.gov/pubmed/39883931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54216 %T Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study %A Steyn,Sherrie %A Slabbert,Meggan %+ Vimbo Health SA (Pty) Ltd, 20 Riverclub Mews, 7 Sycamore Avenue, Riverclub, Sandton, 2191, South Africa, 27 63 861 6780, sherrie@vimbohealth.com %K treatment gap %K mental health %K health %K depression %K anxiety %K South Africa %K CBT %K cognitive behavioral therapy %K app-based intervention %K mobile health %K mental health app %K smartphone %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy–based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as “unemployed but seeking employment” (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. %M 39883938 %R 10.2196/54216 %U https://formative.jmir.org/2025/1/e54216 %U https://doi.org/10.2196/54216 %U http://www.ncbi.nlm.nih.gov/pubmed/39883938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54392 %T Web-Based Exercise and Nutrition Intervention to Improve Leg Muscle Strength and Physical Functioning in Older Adults: Pre-Post Pilot Study %A Dorhout,Berber Gijsbertha %A Wezenbeek,Nick %A de Groot,Lisette C P G M %A Grootswagers,Pol %K web-based lifestyle intervention %K resistance exercise %K protein intake %K muscle strength %K muscle mass %K older adults %K web-based exercise %K nutrition %K exercise %K resistance training %K sarcopenia %D 2025 %7 30.1.2025 %9 %J JMIR Form Res %G English %X Background: The lifestyle intervention ProMuscle, which combines resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass, and physical functioning in older adults. However, due to a growing shortage of health care professionals, the rapidly growing aging population cannot be personally guided in the future. Therefore, Uni2Move, a scalable web-based variant of ProMuscle, was designed to reach larger groups of older adults without putting additional burden on health care professionals. Objective: The current study investigated the effects of a web-based lifestyle intervention on muscle strength, protein intake, and physical functioning in healthy older adults. In addition, we conducted a qualitative study to gather key insights of the participants involved, as little is known about older adults’ perceptions of web-based lifestyle interventions. Methods: A pre-post pilot study was conducted in the Netherlands. In the 24-week intervention, 19 healthy adults aged >55 years were included. They performed resistance training at home twice a week for 24 weeks via web-based workout videos. Videos (45‐60 minutes) were recorded by the fitness trainer and mainly focused on training leg muscles. In addition, older adults were advised on increasing protein intake via two web-based consultations by a dietitian in the first 12 weeks and via an e-learning course in the second 12 weeks. Intervention adherence and acceptance was measured in week 25. The 1 repetition maximum knee extension strength, repeated chair rise test, and protein intake were measured at baseline, week 13, and week 25. Linear mixed models were used to test differences over time. Semistructured interviews were used to gather experiences of participants. Atlas.ti version 22 was used to analyze the interviews. Results: The mean age of participants (n=19) at baseline was 69 (SD 7) years. The 1 repetition maximum knee extension strength and repeated chair rise test improved significantly during the 24-week intervention with a mean difference of 7.0 kg (95% CI 4.8-9.3; P<.001) and −1.2 seconds (95% CI −1.7 to −0.6; P<.001), respectively. Total protein intake per day did not change, whereas protein intake during breakfast had increased significantly after 13 weeks with a mean difference of 6.9 g (95% CI 1.1-12.7; P=.01). Qualitative research revealed that advantages of the program included no need to travel and exercising in their own environment. Disadvantages were the lack of physical interaction and no corrections by the trainer. Conclusions: The results of the web-based exercise and nutrition intervention Uni2Move indicate potential improvements of muscle strength and physical functioning in healthy middle-aged and older adults. Providing such lifestyle interventions on the internet could reach an increased number of older adults, providing the opportunity to contribute to the health and independence of the rapidly growing aging population. %R 10.2196/54392 %U https://formative.jmir.org/2025/1/e54392 %U https://doi.org/10.2196/54392 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54531 %T Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study %A Sankesara,Heet %A Denyer,Hayley %A Sun,Shaoxiong %A Deng,Qigang %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Asherson,Philip %A Bilbow,Andrea %A Groom,Madeleine J %A Hollis,Chris %A Dobson,Richard J B %A Folarin,Amos %A Kuntsi,Jonna %K ADHD %K smartphones %K wearable devices %K mobile health %K mHealth %K remote monitoring %K surveillance %K digital markers %K attention-deficit/hyperactivity disorder %K behavioral data %K real world %K adult %K adolescent %K participants %K digital signals %K restlessness %K severity %K predicting outcomes %D 2025 %7 29.1.2025 %9 %J JMIR Form Res %G English %X Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)–base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. %R 10.2196/54531 %U https://formative.jmir.org/2025/1/e54531 %U https://doi.org/10.2196/54531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67814 %T Experiences of Peer Mentoring Sexual and Gender Minority Emerging Adults Who Are at Risk for Suicide: Mixed Methods Study %A Tran,Jennifer T %A Webster,Jessica %A Wolfe,James R %A Ben Nathan,Jennifer %A Mayinja,Lindiwe %A Kautz,Marin %A Oquendo,Maria A %A Brown,Gregory K %A Mandell,David %A Mowery,Danielle %A Bauermeister,José A %A Brown,Lily A %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2158983616, jtgtran@nursing.upenn.edu %K suicide prevention %K peer mentorship %K LGBTQIA health %K mental health %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and Gender Diverse Youth (SGDY) are at increased risk for suicide due to unique experiences including discrimination, family or friend rejection, and low positive affect. Peer mentors (PMs) may offer a unique opportunity for intervention but are underutilized for suicide prevention among SGDY. Objective: Little is known about the training needed for PMs when working with SGDY at risk for suicide. We developed an intervention, Supporting Transitions to Adulthood and Reducing Suicide (STARS), to improve suicide prevention among SGDY and increase social support, coping, and positive effects. PMs were trained by a licensed clinical therapist and provided a manual. PMs meet virtually for 6 weeks, providing social support, strategies to diminish the impact of discrimination, connection to safe spaces, and reinforcement of intentions to use Safety Plans with mentees. Methods: To understand PMs’ experiences in their role, including distress, fidelity to the manual, and perceptions of feasibility and acceptability of STARS and mentees’ Safety Plan, we collected survey data from mentees and PMs as well as in-depth interviews with PMs after the completion of the intervention. Results: As of September 2024, all peer mentees (N=64) have completed the study and all PMs have finished providing sessions for peer mentees. PMs (n=5) reported overall high comfort (8.52) and low distress (1.93) during sessions. All 5 PMs had high fidelity (>90%) to the PM intervention training. All 5 PMs reported high feasibility (17.50), acceptability (20), and appropriateness (20) of the STARS intervention. Mentees (n=27) reported high confidence ratings (3.54) in speaking with their PMs. Conclusions: Peer mentorship for SGDY who are at risk for suicide was feasible and acceptable by PMs and mentees alike. PMs reported that they felt comfortable and confident during the sessions. Mentees also reported confidence in working with their PMs. Future research should explore the optimal strategies to support PMs and mentees as they engage in suicide prevention work as well as incorporate feedback from the PMs in this study to ensure optimal outcomes. Trial Registration: ClinicalTrials.gov NCT05018143; https://clinicaltrials.gov/study/NCT05018143 International Registered Report Identifier (IRRID): RR2-10.2196/48177 %M 39879591 %R 10.2196/67814 %U https://formative.jmir.org/2025/1/e67814 %U https://doi.org/10.2196/67814 %U http://www.ncbi.nlm.nih.gov/pubmed/39879591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65658 %T Understanding Individual Differences in Happiness Sources and Implications for Health Technology Design: Exploratory Analysis of an Open Dataset %A Ennis,Edel %A Bond,Raymond %A Mulvenna,Maurice %A Sweeney,Colm %+ School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom, 44 2870123892, e.ennis@ulster.ac.uk %K happiness %K sexes %K age %K marital status %K parents %K affections %K achievements %K datasets %K digital health %K well-being %K mental health %K digital mental health interventions %K regression analyses %K evidence based %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychologists have developed frameworks to understand many constructs, which have subsequently informed the design of digital mental health interventions (DMHIs) aimed at improving mental health outcomes. The science of happiness is one such domain that holds significant applied importance due to its links to well-being and evidence that happiness can be cultivated through interventions. However, as with many constructs, the unique ways in which individuals experience happiness present major challenges for designing personalized DMHIs. Objective: This paper aims to (1) present an analysis of how sex may interact with age, marital status, and parental status to predict individual differences in sources of happiness, and (2) to present a preliminary discussion of how open datasets may contribute to the process of designing health-related technology innovations. Methods: The HappyDB is an open database of 100,535 statements of what people consider to have made them happy, with some people asking to consider the past 24 hours (49,831 statements) and some considering the last 3 months (50,704 statements). Demographic information is also provided. Binary logistic regression analyses are used to determine whether various groups differed in their likelihood of selecting or not selecting a category as a source of their happiness. Results: Sex and age interacted to influence what was selected as sources of happiness, with patterns being less consistent among female individuals in comparison with male individuals. For marital status, differences in sources of happiness were predominantly between married individuals and those who are divorced or separated, but these were the same for both sexes. Married, single, and widowed individuals were all largely similar in their likelihood of selecting each of the categories as a source of their happiness. However, there were some anomalies, and sex appeared to be important in these anomalies. Sex and parental status also interacted to influence what was selected as sources of happiness. Conclusions: Sex interacts with age, marital status, and parental status in the likelihood of reporting affection, bonding, leisure, achievement, or enjoying the moment as sources of happiness. The contribution of an open dataset to understanding individual differences in sources of happiness is discussed in terms of its potential role in addressing the challenges of designing DMHIs that are ethical, responsible, evidence based, acceptable, engaging, inclusive, and effective for users. The discussion considers how the content design of DMHIs in general may benefit from exploring new methods informed by diverse data sources. It is proposed that examining the extent to which insights from nondigital settings can inform requirements gathering for DMHIs is warranted. %M 39879609 %R 10.2196/65658 %U https://formative.jmir.org/2025/1/e65658 %U https://doi.org/10.2196/65658 %U http://www.ncbi.nlm.nih.gov/pubmed/39879609 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65222 %T Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic %A Macrynikola,Natalia %A Chen,Kelly %A Lane,Erlend %A Nguyen,Nic %A Pinto,Jennifer %A Yen,Shirley %A Torous,John %+ Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States, 1 617 667 4735, jtorous@bidmc.harvard.edu %K digital interventions %K transdiagnostic treatment %K evidence-based treatment %K digital navigator %K access to care %K mobile phone %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. Objective: To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Methods: Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants’ app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Results: Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Conclusions: Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care. %M 39879612 %R 10.2196/65222 %U https://mental.jmir.org/2025/1/e65222 %U https://doi.org/10.2196/65222 %U http://www.ncbi.nlm.nih.gov/pubmed/39879612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58628 %T Technological Adjuncts to Streamline Patient Recruitment, Informed Consent, and Data Management Processes in Clinical Research: Observational Study %A Koh,Jodie %A Caron,Stacey %A Watters,Amber N %A Vaidyanathan,Mahesh %A Melnick,David %A Santi,Alyssa %A Hudson,Kenneth %A Arguelles,Catherine %A Mathur,Priyanka %A Etemadi,Mozziyar %+ Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL, 60208, United States, 1 847 491 3300, jodie.koh@kellogg.northwestern.edu %K digital health %K patient recruitment %K consent %K technological adjuncts %K data management %K clinical research processes %K automation %K digital platforms %K data warehouse %K patient data %K imaging data %K pregnancy %K clinical research methods %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient recruitment and data management are laborious, resource-intensive aspects of clinical research that often dictate whether the successful completion of studies is possible. Technological advances present opportunities for streamlining these processes, thus improving completion rates for clinical research studies. Objective: This paper aims to demonstrate how technological adjuncts can enhance clinical research processes via automation and digital integration. Methods: Using one clinical research study as an example, we highlighted the use of technological adjuncts to automate and streamline research processes across various digital platforms, including a centralized database of electronic medical records (enterprise data warehouse [EDW]); a clinical research data management tool (REDCap [Research Electronic Data Capture]); and a locally managed, Health Insurance Portability and Accountability Act–compliant server. Eligible participants were identified through automated queries in the EDW, after which they received personalized email invitations with digital consent forms. After digital consent, patient data were transferred to a single Health Insurance Portability and Accountability Act–compliant server where each participant was assigned a unique QR code to facilitate data collection and integration. After the research study visit, data obtained were associated with existing electronic medical record data for each participant via a QR code system that collated participant consent, imaging data, and associated clinical data according to a unique examination ID. Results: Over a 19-month period, automated EDW queries identified 20,988 eligible patients, and 10,582 patients received personalized email invitations. In total, 1000 (9.45%) patients signed consents to participate in the study. Of the consented patients, 549 unique patients completed 779 study visits; some patients consented to the study at more than 1 time period during their pregnancy. Conclusions: Technological adjuncts in clinical research decrease human labor while increasing participant reach and minimizing disruptions to clinic operations. Automating portions of the clinical research process benefits clinical research efforts by expanding and optimizing participant reach while reducing the limitations of labor and time in completing research studies. %M 39879093 %R 10.2196/58628 %U https://formative.jmir.org/2025/1/e58628 %U https://doi.org/10.2196/58628 %U http://www.ncbi.nlm.nih.gov/pubmed/39879093 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e69554 %T Mindfulness Intervention for Health Information Avoidance in Older Adults: Mixed Methods Study %A Gu,Chenyu %A Qian,Liquan %A Zhuo,Xiaojie %+ School of Arts and Media, Wuhan College, No. 333 Huangjiahu Avenue, Jiangxia District, Hubei Province, Wuhan, 430212, China, 86 180 5922 1673, 3074@mju.edu.cn %K health information avoidance %K cyberchondria %K self-determination theory %K mindfulness %K elderly %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global aging population and rapid development of digital technology have made health management among older adults an urgent public health issue. The complexity of online health information often leads to psychological challenges, such as cyberchondria, exacerbating health information avoidance behaviors. These behaviors hinder effective health management; yet, little research examines their mechanisms or intervention strategies. Objective: This study investigates the mechanisms influencing health information avoidance among older adults, emphasizing the mediating role of cyberchondria. In addition, it evaluates the effectiveness of mindfulness meditation as an intervention strategy to mitigate these behaviors. Methods: A mixed methods approach was used, combining quantitative and qualitative methodologies. Substudy 1 developed a theoretical model based on self-determination theory to explore internal (positive metacognition and health self-efficacy) and external (subjective norms and health information similarity) factors influencing health information avoidance, with cyberchondria as a mediator. A cross-sectional survey (N=236) was conducted to test the proposed model. Substudy 2 involved a 4-week mindfulness meditation intervention (N=94) to assess its impact on reducing health information avoidance behaviors. Results: Study 1 showed that positive metacognition (β=.26, P=.002), health self-efficacy (β=.25, P<.001), and health information similarity (β=.29, P<.001) significantly predicted health information avoidance among older adults. Cyberchondria mediated these effects: positive metacognition (effect=0.106, 95% CI 0.035-0.189), health self-efficacy (effect=0.103, 95% CI 0.043-0.185), and health information similarity (effect=0.120, 95% CI 0.063-0.191). Subjective norms did not significantly predict health information avoidance (β=‒.11, P=.13), and cyberchondria did not mediate this relationship (effect=‒0.045, 95% CI ‒0.102 to 0.016). Study 2 found that after the 4-week mindfulness intervention, the intervention group (group 1: n=46) exhibited significantly higher mindfulness levels than the control group (group 2: n=48; Mgroup1=4.122, Mgroup2=3.606, P<.001) and higher levels compared with preintervention (Mt2=4.122, Mt1=3.502, P<.001, where t1=preintervention and t2=postintervention). However, cyberchondria levels did not change significantly (Mt1=2.848, Mt2=2.685, P=.18). Nevertheless, the results revealed a significant interaction effect between mindfulness and cyberchondria on health information avoidance (effect=‒0.357, P=.002, 95% CI ‒0.580 to ‒0.131), suggesting that mindfulness intervention effectively inhibited the transformation of cyberchondria into health information avoidance behavior. Conclusions: This study reveals the role of cyberchondria in health information avoidance and validates mindfulness meditation as an effective intervention for mitigating such behaviors. Findings offer practical recommendations for improving digital health information delivery and health management strategies for older adults. %M 39874579 %R 10.2196/69554 %U https://publichealth.jmir.org/2025/1/e69554 %U https://doi.org/10.2196/69554 %U http://www.ncbi.nlm.nih.gov/pubmed/39874579 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e60708 %T The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being–Related Outcomes in Police Officers: Longitudinal Mixed Design Study %A de Vries,Herman Jaap %A Delahaij,Roos %A van Zwieten,Marianne %A Verhoef,Helen %A Kamphuis,Wim %K wearable electronic devices %K ecological momentary assessment %K psychological stress %K psychological well-being %K awareness %K self-efficacy %K occupational medicine %K emergency responders %K well-being %K psychological %K efficacy %K stress %K wearables %K wearable device %K smartwatch %K smartphone app %K app %K sensor %K sensor technology %K police officers %K questionnaire %K stress awareness %K stress management %D 2025 %7 28.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Wearable sensor technologies, often referred to as “wearables,” have seen a rapid rise in consumer interest in recent years. Initially often seen as “activity trackers,” wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being–related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. Objective: The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being–related outcomes in police officers and (2) whether extending a basic “off-the-shelf” wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. Methods: A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. Results: The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25‐0.46) but consistent effect on 8 of 15 of the stress- and well-being–related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Conclusions: Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being–related outcomes. Complementing the basic “off-the-shelf” wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects. %R 10.2196/60708 %U https://mhealth.jmir.org/2025/1/e60708 %U https://doi.org/10.2196/60708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e62782 %T Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Health Care Workers: Randomized Controlled Trial %A Nomeikaite,Auguste %A Gelezelyte,Odeta %A Böttche,Maria %A Andersson,Gerhard %A Kazlauskas,Evaldas %+ Center for Psychotraumatology, Institute of Psychology, Vilnius University, Room 203, 29 MK Čiurlionio St, Vilnius, LT-03100, Lithuania, 370 52667615, auguste.nomeikaite@fsf.vu.lt %K internet interventions %K mental health %K stress %K health care workers %K short message service %K cognitive behavioral therapy %K internet-delivered cognitive behavioral therapy %K psychotherapy %K randomized %K controlled trial %K engagement %K SMSl worker %K usage %K occupational health %K provider %K prompt %K message %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. Methods: The 2-arm randomized controlled trial included 87 health care workers (99% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98%), did not improve intervention usage indicators, such as the number of logins (t85=–0.91; P=.36), modules opened (t83.57=–1.47; P=.15), modules completed (t85=–0.71; P=.48), exercises completed (t85=–1.05; P=.30), or the time spent using the program (χ22=1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=–0.08; –0.70), depression (d=–0.11; –0.38), anxiety (d=–0.32; –0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β=–0.24, P=.03). Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210 %M 39874572 %R 10.2196/62782 %U https://mental.jmir.org/2025/1/e62782 %U https://doi.org/10.2196/62782 %U http://www.ncbi.nlm.nih.gov/pubmed/39874572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51689 %T Cross-Platform Ecological Momentary Assessment App (JTrack-EMA+): Development and Usability Study %A Sahandi Far,Mehran %A Fischer,Jona M %A Senge,Svea %A Rathmakers,Robin %A Meissner,Thomas %A Schneble,Dominik %A Narava,Mamaka %A Eickhoff,Simon B %A Dukart,Juergen %+ Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Wilhelm-Johnen-Straße, Jülich, 52428, Germany, 49 17636977109, m.sahandi.far@fz-juelich.de %K digital biomarkers %K mobile health %K remote monitoring %K smartphone %K mobile phone %K monitoring %K biomarker %K ecological momentary assessment %K application %K costly %K user experience %K data management %K mobility %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional in-clinic methods of collecting self-reported information are costly, time-consuming, subjective, and often limited in the quality and quantity of observation. However, smartphone-based ecological momentary assessments (EMAs) provide complementary information to in-clinic visits by collecting real-time, frequent, and longitudinal data that are ecologically valid. While these methods are promising, they are often prone to various technical obstacles. However, despite the potential of smartphone-based EMAs, they face technical obstacles that impact adaptability, availability, and interoperability across devices and operating systems. Deficiencies in these areas can contribute to selection bias by excluding participants with unsupported devices or limited digital literacy, increase development and maintenance costs, and extend deployment timelines. Moreover, these limitations not only impede the configurability of existing solutions but also hinder their adoption for addressing diverse clinical challenges. Objective: The primary aim of this research was to develop a cross-platform EMA app that ensures a uniform user experience and core features across various operating systems. Emphasis was placed on maximizing the integration and adaptability to various study designs, all while maintaining strict adherence to security and privacy protocols. JTrack-EMA+ was designed and implemented per the FAIR (findable, accessible, interpretable, and reusable) principles in both its architecture and data management layers, thereby reducing the burden of integration for clinicians and researchers. Methods: JTrack-EMA+ was built using the Flutter framework, enabling it to run seamlessly across different platforms. This platform comprises two main components. JDash (Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour [INM-7]) is an online management tool created using Python (Python Software Foundation) with the Django (Django Software Foundation) framework. This online dashboard offers comprehensive study management tools, including assessment design, user administration, data quality control, and a reminder casting center. The JTrack-EMA+ app supports a wide range of question types, allowing flexibility in assessment design. It also has configurable assessment logic and the ability to include supplementary materials for a richer user experience. It strongly commits to security and privacy and complies with the General Data Protection Regulations to safeguard user data and ensure confidentiality. Results: We investigated our platform in a pilot study with 480 days of follow-up to assess participants’ compliance. The 6-month average compliance was 49.3%, significantly declining (P=.004) from 66.7% in the first month to 42% in the sixth month. Conclusions: The JTrack-EMA+ platform prioritizes platform-independent architecture, providing an easy entry point for clinical researchers to deploy EMA in their respective clinical studies. Remote and home-based assessments of EMA using this platform can provide valuable insights into patients’ daily lives, particularly in a population with limited mobility or inconsistent access to health care services. %M 39874571 %R 10.2196/51689 %U https://www.jmir.org/2025/1/e51689 %U https://doi.org/10.2196/51689 %U http://www.ncbi.nlm.nih.gov/pubmed/39874571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59461 %T Feasibility of a Mobile App–Based Cognitive-Behavioral Perinatal Skills Program: Protocol for Nonrandomized Pilot Trial %A Temkin-Yu,Andrea B %A Ayaz,Aliza %A Blicker,Ella %A Liu,Michael X %A Oh,Ace %A Siegel,Isabelle E %A Seewald,Meredith J %A Hermann,Alison D %A Givrad,Soudebah %A Baez,Lara M %A Osborne,Lauren M %A Green,Cori M %A Schier,Maddy M %A Davis,Alexandra M %A Zhu,Shasha %A Falk,Avital %A Bennett,Shannon M %+ Psychiatry Department, Weill Cornell Medicine, 525 E 68th Street, New York, NY, 10065, United States, 1 6402038301, andreabtemkin@gmail.com %K perinatal mood and anxiety disorders %K apps %K smartphones %K digital intervention %K cognitive behavioral therapy %K feasibility %K pilot trial %K mobile phones %D 2025 %7 28.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental illness is one of the top causes of preventable pregnancy-related deaths in the United States. There are many barriers that interfere with the ability of perinatal individuals to access traditional mental health care. Digital health interventions, including app-based programs, have the potential to increase access to useful tools for these individuals. Although numerous mental health apps exist, there is little research on developing programs to address the unique needs of perinatal individuals. In an effort to fill this gap, a multidisciplinary team of experts in psychology, psychiatry, obstetrics, and pediatric primary care collaborated to develop the novel Perinatal Skills Program within Maya, a flexible and customizable cognitive-behavioral skills app. Maya-Perinatal Skills Program (M-PSP) uses evidence-based strategies to help individuals manage their mood and anxiety symptoms during pregnancy and post partum. Objective: This pilot study aims to assess the feasibility, acceptability, and usability of M-PSP and explore links between program use and symptoms of anxiety and low mood. Methods: This single-arm trial will recruit 50 pregnant or postpartum individuals with mild-to-moderate anxiety or mood symptoms. Participants will be recruited from a variety of public and private insurance-based psychiatry, obstetrics, and primary care clinics at a large academic medical center located in New York City. Participants will complete all sessions of M-PSP and provide feedback. Outcome measures will include qualitative and quantitative assessments of feasibility, acceptability, and usability, passively collected program usage data, and symptom measures assessing mood, anxiety, and trauma. Planned data analysis includes the use of the grounded theory approach to identify common themes in qualitative feedback, as well as an exploration of possible associations between quantitative data regarding program use and symptoms. Results: The recruitment began on August 2023. As of October 2024, a total of 32 participants have been enrolled. The recruitment will continue until 50 participants have been enrolled. Conclusions: Digital health interventions, like M-PSP, have the potential to create new pathways to reach individuals struggling with their mental health. The results of this study will be the groundwork for future iterations of M-PSP in the hopes of providing an accessible and helpful tool for pregnant and postpartum individuals. Trial Registration: ClinicalTrials.gov NCT05897619; https://classic.clinicaltrials.gov/ct2/show/NCT05897619 International Registered Report Identifier (IRRID): PRR1-10.2196/59461 %M 39874578 %R 10.2196/59461 %U https://www.researchprotocols.org/2025/1/e59461 %U https://doi.org/10.2196/59461 %U http://www.ncbi.nlm.nih.gov/pubmed/39874578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59414 %T A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan %A Saleem,Maham %A Zafar,Shamsa %A Klein,Thomas %A Koesters,Markus %A Bashir,Adnan %A Fuhr,Daniela C %A Sikander,Siham %A Zeeb,Hajo %+ Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 421 218 ext 56760, saleem@leibniz-bips.de %K digital mental health %K digital technology %K digital intervention %K Problem Management Plus %K lay health worker programme %K common mental health disorders %K low- and middle-income countries %K co-production %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization–endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for "lady health workers" (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. %M 39874072 %R 10.2196/59414 %U https://formative.jmir.org/2025/1/e59414 %U https://doi.org/10.2196/59414 %U http://www.ncbi.nlm.nih.gov/pubmed/39874072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54777 %T Factors Influencing Telemedicine Adoption Among Health Care Professionals: Qualitative Interview Study %A Schürmann,Fiona %A Westmattelmann,Daniel %A Schewe,Gerhard %+ Center for Management, University of Münster, Schlossplatz 3, Münster, 48149, Germany, 49 2518325010, d.west@uni-muenster.de %K trust referents %K multidimensional risk %K benefits %K transparency %K technology adoption %K telemedicine %K extended valence framework %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine is transforming health care by enabling remote diagnosis, consultation, and treatment. Despite rapid adoption during the COVID-19 pandemic, telemedicine uptake among health care professionals (HCPs) remains inconsistent due to perceived risks and lack of tailored policies. Existing studies focus on patient perspectives or general adoption factors, neglecting the complex interplay of contextual variables and trust constructs influencing HCPs’ telemedicine adoption. This gap highlights the need for a framework integrating risks, benefits, and trust in telemedicine adoption, while addressing health care’s unique dynamics. Objective: This study aimed to adapt and extend the extended valence framework (EVF) to telemedicine, deconstructing factors driving adoption from an HCP perspective. Specifically, it investigated the nuanced roles of perceived risks, benefits, and trust referents (eg, technology, treatment, technology provider, and patient) in shaping behavioral intentions, while integrating contextual factors. Methods: We used a qualitative research design involving semistructured interviews with 14 HCPs experienced in offering video consultations. The interview data were analyzed with deductive and inductive coding based on the EVF. Two coders conducted the coding process independently, achieving an intercoder reliability of 86.14%. The qualitative content analysis aimed to uncover the nuanced perspectives of HCPs, identifying key risk and benefit dimensions and trust referents relevant to telemedicine adoption. Results: The study reveals the complex considerations HCPs have when adopting telemedicine. Perceived risks were multidimensional, including performance risks such as treatment limitations (mentioned by 7/14, 50% of the participants) and reliance on technical proficiency of patients (5/14, 36%), privacy risks related to data security (10/14, 71%), and time and financial risks associated with training (7/14, 50%) and equipment costs (4/14, 29%). Perceived benefits encompassed convenience through reduced travel time (5/14, 36%), improved care quality due to higher accessibility (8/14, 57%), and operational efficiency (7/14, 50%). Trust referents played a pivotal role; trust in technology was linked to functionality (6/14, 43%) and reliability (5/14, 36%), while trust in treatment depended on effective collaboration (9/14, 64%). Transparency emerged as a critical antecedent of trust across different referents, comprising disclosure, clarity, and accuracy. In addition, the study highlighted the importance of context-specific variables such as symptom characteristics (10/14, 71%) and prior professional experience with telemedicine (11/14, 79%). Conclusions: This study expands the EVF for telemedicine, providing a framework integrating multidimensional risks, benefits, trust, and contextual factors. It advances theory by decomposing trust referents and transparency into actionable subdimensions and emphasizing context-specific variables. Practically, the findings guide stakeholders: policy makers should prioritize transparent regulations and data security, health care organizations should provide training and support for HCPs, and technology developers must design telemedicine solutions aligning with trust and usability needs. This understanding equips health care to address barriers, optimize adoption, and leverage telemedicine’s potential for sustainable clinical integration. %M 39869885 %R 10.2196/54777 %U https://formative.jmir.org/2025/1/e54777 %U https://doi.org/10.2196/54777 %U http://www.ncbi.nlm.nih.gov/pubmed/39869885 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64959 %T Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies %A Snipes,Cassandra %A Dorner‑Ciossek,Cornelia %A Hare,Brendan D %A Besedina,Olya %A Campellone,Tim %A Petrova,Mariya %A Lakhan,Shaheen E %A Pratap,Abhishek %+ Boehringer Ingelheim International GmbH, Binger Straße 173, Ingelheim am Rhein, 55216, Germany, 49 (7351) 54 97758, cornelia.dorner-ciossek@boehringer-ingelheim.com %K therapeutic alliance %K digital working alliance %K experiential negative symptoms %K schizophrenia %K digital therapeutics %K digital literacy %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (≥12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 %M 39869902 %R 10.2196/64959 %U https://mental.jmir.org/2025/1/e64959 %U https://doi.org/10.2196/64959 %U http://www.ncbi.nlm.nih.gov/pubmed/39869902 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66715 %T Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study %A Feusner,Jamie D %A Farrell,Nicholas R %A Nunez,Mia %A Lume,Nicholas %A MacDonald,Catherine W %A McGrath,Patrick B %A Trusky,Larry %A Smith,Stephen %A Rhode,Andreas %+ NOCD, Inc, 225 N Michigan Ave Suite 1430, Chicago, IL, 60601, United States, jamie@nocdhelp.com %K digital behavioral health %K youth %K cognitive-behavioral therapy %K exposure and response prevention %K CBT %K ERP %K OCD %K psychiatry %K clinical trial %K psychology %K video therapy %K teletherapy %K e-therapy %K e-counseling %K cyber-counseling %K adolescents %K adolescence %K obsessive-compulsive disorder %K retrospective study %K longitudinal study %K observational study %K ERP therapy %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. Objective: This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Methods: Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Results: Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. Conclusions: These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD. %M 39869894 %R 10.2196/66715 %U https://www.jmir.org/2025/1/e66715 %U https://doi.org/10.2196/66715 %U http://www.ncbi.nlm.nih.gov/pubmed/39869894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66769 %T The Development of an Instagram Reel-Based Bystander Intervention Message Among College Students: Formative Survey and Mixed Methods Pilot Study %A Couto,Leticia %K bystander intervention %K message development %K sexual health %K college %K student %K sexual violence %K bystander %K reel-based %K Instagram %K social media %K short message %K formative research %K mixed methods %K social norms %K perceived behavior %K qualitative %K behavioral health %K digital health %D 2025 %7 27.1.2025 %9 %J JMIR Form Res %G English %X Background: Bystander intervention is a common method to address the ubiquitous issue that is sexual violence across college campuses. Short messages that incentivize bystander intervention behavior can be another tool to fight sexual violence. Objective: This study aimed to conduct formative research surrounding social norms and bystander barriers to pilot and develop Instagram (Meta) reel-based messages addressing bystander intervention among college students. Methods: The first step was to conduct a formative survey to identify peer norms and actual behavior of the intended population. Once that data were collected, a mixed methods message pilot was conducted by a survey where participants randomly saw 5 of the 12 messages developed, assessing them for credibility, perceived message effect, and intended audience. Results: The formative survey was conducted among 195 college students from the same institution, and the pilot test was conducted among 107 college students. The formative survey indicated a discrepancy between perceived peer behavior and actual behavior of the participants in all 3 measures, allowing for the development of normative messaging. The pilot testing indicated the credibility was acceptable (eg, mean 3.94, SD 1.15 on a 5-point scale) as well as the perceived message effect (eg, mean 4.26, SD 0.94 on a 5-point scale). Intended audiences were also identified and reached. Qualitative results indicated that the messages may have lacked credibility, although the quantitative results suggest otherwise. Conclusions: Participants understood the messages concerned bystander intervention, and perceived message effects results indicated the messages to be effective in assisting bystander intervention engagement by normative messaging. Messages were considered credible and reached the intended audience. The qualitative results provided further insights on how the messages can be adapted before being tested for effects. Future research should focus on further adapting the messages and testing their effects among the studied population. %R 10.2196/66769 %U https://formative.jmir.org/2025/1/e66769 %U https://doi.org/10.2196/66769 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e62809 %T Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial %A Ríos Rincón,Adriana M %A Guptill,Christine %A Liubaoerjijin,Yilina %A Figeys,Mathieu %A Koubasi,Farnaz %A Gregson,Geoffrey %A Miguel Cruz,Antonio %K hand %K upper limb %K motion %K movement %K wrist %K therapeutics %K rehabilitation %K musculoskeletal %K musculoskeletal diseases %K stroke %K wrist fractures %K feasibility studies %K randomized controlled trial %K digital health %K physiotherapy %K physical therapy %K occupational therapy %D 2025 %7 27.1.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. Results: The trial retention rate (36/38, 95%) and compliance (control group: 100%; intervention group: 89%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=−0.335, P=.008) and grip strength (t34=−1.841, P=.04). Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 %R 10.2196/62809 %U https://rehab.jmir.org/2025/1/e62809 %U https://doi.org/10.2196/62809 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63197 %T Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach %A Antico,Lia %A Brewer,Judson %+ Brown University, Department of Behavioral and Social Sciences, 121 S Main St, Providence, RI, 02903, United States, 1 401 328 0763, lia_antico@brown.edu %K burnout %K anxiety %K empathy fatigue %K physician %K mindfulness %K digital therapeutics %K app %K smartphone %K podcast %K compassion %K health care provider %K training %K physician burnout %K cynicism %K efficacy %K treatment %K meditation %K chronic %K workplace stress %K digital health %K mHealth %K mobile phone %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules. Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians. Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up. Results: Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001). Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians. Trial Registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425 %M 39854701 %R 10.2196/63197 %U https://formative.jmir.org/2025/1/e63197 %U https://doi.org/10.2196/63197 %U http://www.ncbi.nlm.nih.gov/pubmed/39854701 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e58183 %T Medical Students’ Acceptance of Tailored e–Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study %A Grüneberg,Catharina %A Bäuerle,Alexander %A Karunakaran,Sophia %A Darici,Dogus %A Dörrie,Nora %A Teufel,Martin %A Benson,Sven %A Robitzsch,Anita %K eHealth %K medical education %K medical students %K tailored interventions %K UTAUT %K intention to use %K e–mental health apps %K app %K foster %K cross-sectional study %K mental health problems %K physician %K well-being %K mobile apps %K acceptance %K assessment %K mental health apps %D 2025 %7 24.1.2025 %9 %J JMIR Med Educ %G English %X Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e–mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e–mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=–2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (β=.11; P=.045), depressive symptoms (β=–.11; P=.05), internet anxiety (β=–.12; P=.01), digital overload (β=.1; P=.03), and the 3 UTAUT core predictors—performance expectancy (β=.24; P<.001), effort expectancy (β=.26; P<.001), and social influence (β=.43; P<.001). Conclusions: The high acceptance of e–mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e–mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students’ specific needs and demands regarding the framework of tailored e–mental health apps. %R 10.2196/58183 %U https://mededu.jmir.org/2025/1/e58183 %U https://doi.org/10.2196/58183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64763 %T Evaluating Older Adults’ Engagement and Usability With AI-Driven Interventions: Randomized Pilot Study %A Shade,Marcia %A Yan,Changmin %A Jones,Valerie K %A Boron,Julie %K voice assistant %K interventions %K usability %K engagement %K personality %K older adults %K aging %K technology %K artificial intelligence %K AI %K self-management %K pilot trial %K chronic %K musculoskeletal pain %K AI assistant %K Alexa %K user experience %K digital health %K digital intervention %K mobile phone %D 2025 %7 24.1.2025 %9 %J JMIR Form Res %G English %X Background: Technologies that serve as assistants are growing more popular for entertainment and aiding in daily tasks. Artificial intelligence (AI) in these technologies could also be helpful to deliver interventions that assist older adults with symptoms or self-management. Personality traits may play a role in how older adults engage with AI technologies. To ensure the best intervention delivery, we must understand older adults’ engagement with and usability of AI-driven technologies. Objective: This study aimed to describe how older adults engaged with routines facilitated by a conversational AI assistant. Methods: A randomized pilot trial was conducted for 12-weeks in adults aged 60 years or older, self-reported living alone, and having chronic musculoskeletal pain. Participants (N=50) were randomly assigned to 1 of 2 intervention groups (standard vs enhanced) to engage with routines delivered by the AI assistant Alexa (Amazon). Participants were encouraged to interact with prescribed routines twice daily (morning and evening) and as needed. Data were collected and analyzed on routine engagement characteristics and perceived usability of the AI assistant. An analysis of the participants’ personality traits was conducted to describe how personality may impact engagement and usability of AI technologies as interventions. Results: The participants had a mean age of 79 years, with moderate to high levels of comfort and trust in technology, and were predominately White (48/50, 96%) and women (44/50, 88%). In both intervention groups, morning routines (n=62, 74%) were initiated more frequently than evening routines (n=52, 62%; z=−2.81, P=.005). Older adult participants in the enhanced group self-reported routine usability as good (mean 74.50, SD 11.90), and those in the standard group reported lower but acceptable usability scores (mean 66.29, SD 6.94). Higher extraversion personality trait scores predicted higher rates of routine initiation throughout the whole day and morning in both groups (standard day: B=0.47, P=.004; enhanced day: B=0.44, P=.045; standard morning: B=0.50, P=.03; enhanced morning: B=0.53, P=.02). Higher agreeableness (standard: B=0.50, P=.02; enhanced B=0.46, P=.002) and higher conscientiousness (standard: B=0.33, P=.04; enhanced: B=0.38, P=.006) personality trait scores predicted better usability scores in both groups. Conclusions: he prescribed interactive routines delivered by an AI assistant were feasible to use as interventions with older adults. Engagement and usability by older adults may be influenced by personality traits such as extraversion, agreeableness, and conscientiousness. While integrating AI-driven interventions into health care, it is important to consider these factors to promote positive outcomes. Trial Registration: ClinicalTrials.gov NCT05387447; https://clinicaltrials.gov/study/NCT05387447 %R 10.2196/64763 %U https://formative.jmir.org/2025/1/e64763 %U https://doi.org/10.2196/64763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68031 %T Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data %A Metaxa,Athina Marina %A Liverpool,Shaun %A Eisenstadt,Mia %A Pollard,John %A Carlsson,Courtney %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 30 6930228210, athina.metaxa@hmc.ox.ac.uk %K well-being %K awareness %K mental health %K formative %K mobile phone %K well-being %K apps %K quantitative evaluation %K real-world data %K emotional well-being %K pre-post %K single arm %K quantitative data %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users’ lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data. Objective: This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes. Results: A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively. Conclusions: This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app’s effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research. %M 39848610 %R 10.2196/68031 %U https://formative.jmir.org/2025/1/e68031 %U https://doi.org/10.2196/68031 %U http://www.ncbi.nlm.nih.gov/pubmed/39848610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60843 %T Characterizing Telehealth Barriers and Preferences to Promote Acceptable Implementation Strategies in Central Uganda: Multilevel Formative Evaluation %A Kizito,Michael %A Mugabi,Erina Nabunjo %A Ford,Sabrina %A Holtz,Bree %A Hirko,Kelly %K telehealth %K telemedicine %K health care %K disparities %K technology %K barriers %K resource-limited %K preferences %K Uganda %K Africa %K barrier %K formative evaluation %K health service provider %K primary care %K satisfaction %K Sub-Saharan Africa %K survey %K utility %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. Objective: This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. Methods: We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Results: Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient’s self-reported health status were observed. Conclusions: Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa. %R 10.2196/60843 %U https://formative.jmir.org/2025/1/e60843 %U https://doi.org/10.2196/60843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57659 %T Usability and Usefulness of a Symptom Management Coaching System for Patients With Cancer Treated With Immune Checkpoint Inhibitors: Comparative Mixed Methods Study %A Glaser,Savannah Lucia Caterina %A Fraterman,Itske %A van Brummelen,Noah %A Tibollo,Valentina %A Del Campo,Laura Maria %A Mallo,Henk %A Wilgenhof,Sofie %A Wilk,Szymon %A Gisko,Vitali %A Khadakou,Vadzim %A Cornet,Ronald %A Ottaviano,Manuel %A Medlock,Stephanie %+ Department of Medical Informatics, Amsterdam UMC - University of Amsterdam, Amsterdam, Netherlands, 31 205669111, s.k.medlock@amsterdamumc.nl %K oncology %K usability %K usefulness %K symptom management %K coaching system %K patients with cancer %K immune checkpoint inhibitors %K comparative qualitative study %K medication %K eHealth applications %K caregivers %K cancer treatment %K patient education %K well-being interventions %K acceptability %K melanoma %K renal cell carcinoma %K immunotherapy %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prognosis for patients with several types of cancer has substantially improved following the introduction of immune checkpoint inhibitors, a novel type of immunotherapy. However, patients may experience symptoms both from the cancer itself and from the medication. A prototype of the eHealth tool Cancer Patients Better Life Experience (CAPABLE) was developed to facilitate symptom management, aimed at patients with melanoma and renal cell carcinoma treated with immunotherapy. Better usability of such eHealth tools can lead to improved user well-being and reduced risk of harm. It is unknown for usability evaluations whether certain usability problems would only be evident to patients whose condition closely resembles the target population, or if a broader group of patients would lead to the identification of a broader range of potential usability issues. Objective: This study aims to evaluate the CAPABLE prototype by conducting tests to assess usability, user experience, and perceived acceptability among end users, and to assess any agreements or differences in the results of our wide range of participants. Methods: This usability study was executed by interviewing participants with a melanoma or renal cell carcinoma diagnosis who have received immunotherapy and participants without direct experience with the targeted cancer types who have not received immunotherapy. Participants were asked to review the concept of the tool, perform think-aloud tasks, and complete the System Usability Scale and a Perceived Usefulness questionnaire. Usability problems were extracted from the interview data by independent coding and mapped to an eHealth Usability Problem Framework. Results: We included 21 participants in the study, aged 29 to 73 years; 13 participants who had received immunotherapy and 8 participants who had not received immunotherapy. In total, 76 usability problems were identified. A total of 22 usability problems were in the task-technology fit category of the usability framework, mostly regarding the coaching and symptom functionality of the prototype. Critical problems regarding the symptom monitoring functionality were mainly found by participants who had received immunotherapy. For 8 out of 10 statements in the Perceived Usefulness questionnaire, more than 75% of participants agreed or strongly agreed. The overall mean System Usability Scale score was 80 out of 100 (SD 11.3). Conclusions: Despite identified usability issues, participants responded positively to the Perceived Usefulness questionnaire regarding the evaluated tool. Further analysis of the usability problems indicates that it was essential to include participants who matched the target end users. Participants treated with immunotherapy, specifically with previous experience in immune-related adverse events, encountered critical problems with symptom reporting that would not have been identified if these participants were not included. For other tasks and functionalities, it seems likely that loosening the inclusion criteria would have resulted in sufficient feedback without critical missing usability issues. %M 39847771 %R 10.2196/57659 %U https://formative.jmir.org/2025/1/e57659 %U https://doi.org/10.2196/57659 %U http://www.ncbi.nlm.nih.gov/pubmed/39847771 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58128 %T Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study %A McMullan,Christel %A Turner,Grace %A Retzer,Ameeta %A Belli,Antonio %A Davies,Elin Haf %A Nice,Laura %A Flavell,Luke %A Flavell,Jackie %A Calvert,Melanie %K usability study %K usability %K patient reported outcome %K PRO %K electronic patient reported outcome %K ePRO %K traumatic brain injury %K TBI %K think aloud %K cognitive interviews %K early warning %K early detection %K mobile phone %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform—Atom5—for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK—an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the “Think Aloud” method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury – Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. %R 10.2196/58128 %U https://formative.jmir.org/2025/1/e58128 %U https://doi.org/10.2196/58128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64483 %T Identifying the Minimal Clinically Important Difference in Emotion Regulation Among Youth Using the JoyPop App: Survey Study %A Charlton,Jaidyn %A Malik,Ishaq %A Ashley,Angela M %A Newton,Amanda %A Toombs,Elaine %A Schmidt,Fred %A Olthuis,Janine V %A Stasiuk,Kristine %A Bobinski,Tina %A Mushquash,Aislin %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada, 1 8073438010 ext 8771, aislin.mushquash@lakeheadu.ca %K mHealth %K mobile health %K app %K psychometrics %K emotion regulation %K Indigenous mental health %K Indigenous youth %K mental health interventions %K resilience %K clinical psychology %K adolescent mental health %K mental health %K JoyPop %K pediatrics %K mobile phone %D 2025 %7 23.1.2025 %9 Short Paper %J JMIR Form Res %G English %X Background: The minimal clinically important difference (MCID) is an important threshold to consider when evaluating the meaningfulness of improvement following an intervention. The JoyPop app is an evidence-based smartphone app designed to improve resilience and emotion regulation. Information is needed regarding the JoyPop app’s MCID among culturally diverse youth. Objective: This study aims to calculate the MCID for youth using the JoyPop app and to explore how the MCID may differ for a subset of Indigenous youth. Methods: Youth (N=36; aged 12-18 years) were recruited to use the JoyPop app for up to 4 weeks as part of a larger pilot evaluation. Results were based on measures completed after 2 weeks of app use. The MCID was calculated using emotion regulation change scores (Difficulties in Emotion Regulation–Short Form [DERS-SF]) and subjective ratings on the Global Rating of Change Scale (GRCS). This MCID calculation was completed for youth overall and separately for Indigenous youth only. Results: A significant correlation between GRCS scores and change scores on the DERS-SF supported face validity (r=–0.37; P=.04). The MCID in emotion regulation following the use of the JoyPop app for youth overall was 2.80 on the DERS-SF. The MCID for Indigenous youth was 4.29 on the DERS-SF. In addition, most youth reported improved emotion regulation after using the JoyPop app. Conclusions: These MCID findings provide a meaningful threshold for improvement in emotion regulation for the JoyPop app. They provide potential effect sizes and can aid in sample size estimations for future research with the JoyPop app or e-mental health technologies in general. The difference between overall youth and Indigenous youth MCID values also highlights the importance of patient-oriented ratings of symptom improvement as well as cultural considerations when conducting intervention research and monitoring new interventions in clinical practice. %M 39847426 %R 10.2196/64483 %U https://formative.jmir.org/2025/1/e64483 %U https://doi.org/10.2196/64483 %U http://www.ncbi.nlm.nih.gov/pubmed/39847426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60868 %T Use of Go-Beyond as a Self-Directed Internet-Based Program Supporting Veterans’ Transition to Civilian Life: Preliminary Usability Study %A Alichniewicz,Karolina Katarzyna %A Hampton,Sarah %A Romaniuk,Madeline %A Bennett,Darcy %A Guindalini,Camila %+ Greenslopes Private Hospital, Gallipoli Medical Research, Newdegate Street, Greenslopes, Brisbane, QLD 4120, Australia, 61 7 33947613, alichniewiczkarolina@gallipoliresearch.org.au %K military transition %K web-based interventions %K military-civilian adjustment %K Go-Beyond %K internet-based program %K civilian %K military service %K veteran %K premilitary life %K mental health issues %K physical injuries %K adoption %K quantitative analysis %K survey %K family %K support %K digital technology %K user engagement %K effectiveness %K assessment %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from military service to civilian life presents a variety of challenges for veterans, influenced by individual factors such as premilitary life, length of service, and deployment history. Mental health issues, physical injuries, difficulties in relationships, and identity loss compound the reintegration process. To address these challenges, various face-to-face and internet-based programs are available yet underused. This paper presents the preliminary evaluation of “Go-Beyond, Navigating Life Beyond Service,” an internet-based psychoeducational program for veterans. Objective: The study aims to identify the reach, adoption, and engagement with the program and to generate future recommendations to enhance its overall impact. Methods: This study exclusively used data that were automatically and routinely collected from the start of the Go-Beyond program’s launch on May 24, 2021, until May 7, 2023. When accessing the Go-Beyond website, veterans were asked to complete the Military-Civilian Adjustment and Reintegration Measure (M-CARM) questionnaire, which produces a unique M-CARM profile of results specifying potential areas of need on the 5 domains of the measure. Users were then automatically allocated to Go-Beyond modules that aligned with their M-CARM profile. Additionally, quantitative and qualitative data were collected from a survey on aesthetics, interactivity, user journey, and user experience, which was optional for users to complete at the end of each module. Results: Results show a conversion rate of 28.5% (273/959) from the M-CARM survey to the Go-Beyond program. This rate is notably higher compared with similar internet-based self-help programs, such as VetChange (1033/22,087, 4.7%) and resources for gambling behavior (5652/8083, 14%), but lower than the MoodGYM program (82,159/194,840, 42.2%). However, these comparisons should be interpreted with caution due to the limited availability of published conversion rates and varying definitions of uptake and adoption across studies. Additionally, individuals were 1.64 (95% CI 1.17-2.28) more likely to enroll when they express a need in Purpose and Connection, and they were 1.50 (95% CI 1.06-2.18) times more likely to enroll when they express the need Beliefs About Civilians, compared with those without these needs. The overall completion rate for the program was 31% (85/273) and modules’ individual completion rates varied from 8.4% (17/203) to 20% (41/206). Feedback survey revealed high overall user satisfaction with Go-Beyond, emphasizing its engaging content and user-friendly modules. Notably, 94% (88/94) of survey respondents indicated they would recommend the program to other veterans, family, or friends. Conclusions: The Go-Beyond program may offer promising support for veterans transitioning to civilian life through digital technology. Our study reveals insights on user engagement and adoption, emphasizing the need for ongoing evaluation to further address the diverse needs of military personnel. Future research should explore predictors of engagement, the addition of peer or facilitator support, and the use of outcome measures for effectiveness assessment. %M 39847427 %R 10.2196/60868 %U https://formative.jmir.org/2025/1/e60868 %U https://doi.org/10.2196/60868 %U http://www.ncbi.nlm.nih.gov/pubmed/39847427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64244 %T The Association of Psychological Factors With Willingness to Share Health-Related Data From Technological Devices: Cross-Sectional Questionnaire Study %A Eversdijk,Marijn %A Douma,Emma Rixt %A Habibovic,Mirela %A Kop,Willem Johan %K health data sharing %K privacy concerns %K wearable health technology %K personality %K psychological flexibility %K optimism %K social inhibition %K psychological factors %K willingness %K health-related data %K mobile phone %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Health-related data from technological devices are increasingly obtained through smartphone apps and wearable devices. These data could enable physicians and other care providers to monitor patients outside the clinic or assist individuals in improving lifestyle factors. However, the use of health technology data might be hampered by the reluctance of patients to share personal health technology data because of the privacy sensitivity of this information. Objective: This study investigates to what extent psychological factors play a role in people’s willingness to share personal health technology data. Methods: Data for this cross-sectional study were obtained by quota sampling based on age and sex in a community-based sample (N=1013; mean age 48.6, SD 16.6 years; 522/1013, 51.5% women). Willingness to share personal health technology data and related privacy concerns were assessed using an 8-item questionnaire with good psychometric properties (Cronbach’s α=0.82). Psychological variables were assessed using validated questionnaires for optimism (Life Orientation Test—Revised), psychological flexibility (Psychological Flexibility Questionnaire), negative affectivity (Type D Scale-14—Negative Affectivity), social inhibition (Type D Scale-14—Social Inhibition), generalized anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data were analyzed using multiple linear regression analyses, and network analysis was used to visualize the associations between the item scores. Results: Higher levels of optimism (β=.093; P=.004) and psychological flexibility (β=.127; P<.001) and lower levels of social inhibition (β=−.096; P=.002) were significantly associated with higher levels of willingness to share health technology data when adjusting for age, sex, and education level in separate regression models. Other associations with psychological variables were not statistically significant. Network analysis revealed that psychological flexibility clustered more with items that focused on the benefits of sharing data, while optimism was negatively associated with privacy concerns. Conclusions: The current results suggest that people with higher levels of optimism and psychological flexibility and those with lower social inhibition levels are more likely to share health technology data. The magnitude of the effect sizes was low, and future studies with additional psychological measures are needed to establish which factors identify people who are reluctant to share their data such that optimal use of devices in health care can be facilitated. %R 10.2196/64244 %U https://formative.jmir.org/2025/1/e64244 %U https://doi.org/10.2196/64244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53928 %T Discrimination of Radiologists' Experience Level Using Eye-Tracking Technology and Machine Learning: Case Study %A Martinez,Stanford %A Ramirez-Tamayo,Carolina %A Akhter Faruqui,Syed Hasib %A Clark,Kal %A Alaeddini,Adel %A Czarnek,Nicholas %A Aggarwal,Aarushi %A Emamzadeh,Sahra %A Mock,Jeffrey R %A Golob,Edward J %+ Department of Mechanical Engineering, Southern Methodist University, 3101 Dyer Street, Dallas, TX, 75205, United States, 1 214 768 3050, aalaeddini@smu.edu %K machine learning %K eye-tracking %K experience level determination %K radiology education %K search pattern feature extraction %K search pattern %K radiology %K classification %K gaze %K fixation %K education %K experience %K spatio-temporal %K image %K x-ray %K eye movement %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Perception-related errors comprise most diagnostic mistakes in radiology. To mitigate this problem, radiologists use personalized and high-dimensional visual search strategies, otherwise known as search patterns. Qualitative descriptions of these search patterns, which involve the physician verbalizing or annotating the order he or she analyzes the image, can be unreliable due to discrepancies in what is reported versus the actual visual patterns. This discrepancy can interfere with quality improvement interventions and negatively impact patient care. Objective: The objective of this study is to provide an alternative method for distinguishing between radiologists by means of captured eye-tracking data such that the raw gaze (or processed fixation data) can be used to discriminate users based on subconscious behavior in visual inspection. Methods: We present a novel discretized feature encoding based on spatiotemporal binning of fixation data for efficient geometric alignment and temporal ordering of eye movement when reading chest x-rays. The encoded features of the eye-fixation data are used by machine learning classifiers to discriminate between faculty and trainee radiologists. A clinical trial case study was conducted using metrics such as the area under the curve, accuracy, F1-score, sensitivity, and specificity to evaluate the discriminability between the 2 groups regarding their level of experience. The classification performance was then compared with state-of-the-art methodologies. In addition, a repeatability experiment using a separate dataset, experimental protocol, and eye tracker was performed with 8 participants to evaluate the robustness of the proposed approach. Results: The numerical results from both experiments demonstrate that classifiers using the proposed feature encoding methods outperform the current state-of-the-art in differentiating between radiologists in terms of experience level. An average performance gain of 6.9% is observed compared with traditional features while classifying experience levels of radiologists. This gain in accuracy is also substantial across different eye tracker–collected datasets, with improvements of 6.41% using the Tobii eye tracker and 7.29% using the EyeLink eye tracker. These results signify the potential impact of the proposed method for identifying radiologists’ level of expertise and those who would benefit from additional training. Conclusions: The effectiveness of the proposed spatiotemporal discretization approach, validated across diverse datasets and various classification metrics, underscores its potential for objective evaluation, informing targeted interventions and training strategies in radiology. This research advances reliable assessment tools, addressing challenges in perception-related errors to enhance patient care outcomes. %M 39842001 %R 10.2196/53928 %U https://formative.jmir.org/2025/1/e53928 %U https://doi.org/10.2196/53928 %U http://www.ncbi.nlm.nih.gov/pubmed/39842001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56310 %T Attitudes of German General Practitioners Toward eHealth Apps for Dementia Risk Reduction: Qualitative Interview Study %A Schultz,Adrian %A Luppa,Melanie %A Bleckwenn,Markus %A Riedel-Heller,Steffi G %A Zuelke,Andrea %+ Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Philipp Rosenthal Str. 55, Leipzig, 04103, Germany, 49 03419715483, andrea.zuelke@medizin.uni-leipzig.de %K eHealth %K dementia %K primary care %K lifestyle %K risk factor %K older adults %K prevention %K brain health %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions constitute a promising approach to disease prevention, particularly because of their ability to facilitate lifestyle changes. Although a rather recent development, eHealth interventions might be able to promote brain health and reduce dementia risk in older adults. Objective: This study aimed to explore the perspective of general practitioners (GPs) on the potentials and barriers of eHealth interventions for brain health. Understanding the perspective of GPs allows us to identify chances and challenges for implementing eHealth apps for dementia risk reduction. Methods: We conducted semistructured expert interviews with 9 GPs working in an outpatient setting in and near Leipzig, Germany. Data were fully transcribed and analyzed using a process model of qualitative content analysis with codes and categories being constructed inductively and deductively. Results: We found generally favorable but balanced views of eHealth apps for brain health. Eight themes were identified and elaborated on in the data as follows: “addressing dementia,” “knowledge about dementia,” “need for information,” “potential for prevention,” “chances for apps for prevention,” “development of apps for prevention,” and “barriers of apps for prevention.” GPs talked mostly about how and when to address dementia and the requirements for their use of eHealth apps for dementia prevention. GPs stated that they only addressed dementia once abnormalities were already present or less frequently when a patient or relative expressed a direct wish, while individual dementia risk or standardized diagnostic during routine check-ups were mentioned much less frequently. According to GPs, knowledge about dementia in patients was low; therefore, patients expressed little need for information on dementia risk factors and prevention in GP practices. Most patients wished for quick information regarding diagnostics, treatment options, and progression of the disease. GPs mentioned a lack of overview of the available eHealth apps and their content. They also expressed a fear of inducing health anxiety when talking to patients about risk factors and prevention. Conclusions: GPs want patients to receive relevant and individualized information. Prerequisites for the use of eHealth apps for dementia prevention were app characteristics related to design and content. GPs need to address dementia more routinely, assess relevant risk factors, and aid patients in a preventive role. Concerns were expressed over limited effectiveness, overwhelming patients, limited use in clinical practice, and only targeting patients with an already low risk of dementia. %M 39841983 %R 10.2196/56310 %U https://formative.jmir.org/2025/1/e56310 %U https://doi.org/10.2196/56310 %U http://www.ncbi.nlm.nih.gov/pubmed/39841983 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e47951 %T Home-Based Intervention Tool for Cardiac Telerehabilitation: Protocol for a Controlled Trial %A Mastorci,Francesca %A Lazzeri,Maria Francesca Lodovica %A Ait-Ali,Lamia %A Marcheschi,Paolo %A Quadrelli,Paola %A Mariani,Massimiliano %A Margaryan,Rafik %A Pennè,Wanda %A Savino,Marco %A Prencipe,Giuseppe %A Sirbu,Alina %A Ferragina,Paolo %A Priami,Corrado %A Tommasi,Alessandro %A Zavattari,Cesare %A Festa,Pierluigi %A Dalmiani,Stefano %A Pingitore,Alessandro %+ Clinical Physiology Institute, Consiglio Nazionale delle Ricerche, 1 Via Moruzzi, Pisa, 56124, Italy, 39 050 315 2216, alessandro.pingitore@cnr.it %K cardiac rehabilitation %K exercise %K patient education %K patient-centered approach %K eHealth %K artificial intelligence %D 2025 %7 22.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20% of these patients will require surgery in adulthood and 40% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one’s state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices. Objective: The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a “real-life” context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway. Methods: The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan. Results: The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section. Conclusions: The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life. International Registered Report Identifier (IRRID): DERR1-10.2196/47951 %M 39841521 %R 10.2196/47951 %U https://www.researchprotocols.org/2025/1/e47951 %U https://doi.org/10.2196/47951 %U http://www.ncbi.nlm.nih.gov/pubmed/39841521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57874 %T AI Machine Learning–Based Diabetes Prediction in Older Adults in South Korea: Cross-Sectional Analysis %A Lee,Hocheol %A Park,Myung-Bae %A Won,Young-Joo %K diabetes %K prediction model %K super-aging population %K extreme gradient boosting model %K geriatrics %K older adults %K aging %K artificial intelligence %K machine learning %D 2025 %7 21.1.2025 %9 %J JMIR Form Res %G English %X Background: Diabetes is prevalent in older adults, and machine learning algorithms could help predict diabetes in this population. Objective: This study determined diabetes risk factors among older adults aged ≥60 years using machine learning algorithms and selected an optimized prediction model. Methods: This cross-sectional study was conducted on 3084 older adults aged ≥60 years in Seoul from January to November 2023. Data were collected using a mobile app (Gosufit) that measured depression, stress, anxiety, basal metabolic rate, oxygen saturation, heart rate, and average daily step count. Health coordinators recorded data on diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, percent body fat, and percent muscle. The presence of diabetes was the target variable, with various health indicators as predictors. Machine learning algorithms, including random forest, gradient boosting model, light gradient boosting model, extreme gradient boosting model, and k-nearest neighbors, were employed for analysis. The dataset was split into 70% training and 30% testing sets. Model performance was evaluated using accuracy, precision, recall, F1 score, and area under the curve (AUC). Shapley additive explanations (SHAPs) were used for model interpretability. Results: Significant predictors of diabetes included hypertension (χ²1=197.294; P<.001), hyperlipidemia (χ²1=47.671; P<.001), age (mean: diabetes group 72.66 years vs nondiabetes group 71.81 years), stress (mean: diabetes group 42.68 vs nondiabetes group 41.47; t3082=−2.858; P=.004), and heart rate (mean: diabetes group 75.05 beats/min vs nondiabetes group 73.14 beats/min; t3082=−7.948; P<.001). The extreme gradient boosting model (XGBM) demonstrated the best performance, with an accuracy of 84.88%, precision of 77.92%, recall of 66.91%, F1 score of 72.00, and AUC of 0.7957. The SHAP analysis of the top-performing XGBM revealed key predictors for diabetes: hypertension, age, percent body fat, heart rate, hyperlipidemia, basal metabolic rate, stress, and oxygen saturation. Hypertension strongly increased diabetes risk, while advanced age and elevated stress levels also showed significant associations. Hyperlipidemia and higher heart rates further heightened diabetes probability. These results highlight the importance and directional impact of specific features in predicting diabetes, providing valuable insights for risk stratification and targeted interventions. Conclusions: This study focused on modifiable risk factors, providing crucial data for establishing a system for the automated collection of health information and lifelog data from older adults using digital devices at service facilities. %R 10.2196/57874 %U https://formative.jmir.org/2025/1/e57874 %U https://doi.org/10.2196/57874 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60286 %T Psychological and Behavioral Insights From Social Media Users: Natural Language Processing–Based Quantitative Study on Mental Well-Being %A Yang,Xingwei %A Li,Guang %+ Information Technology Management, Ted Rogers School of Management, Toronto Metropolitan University, 55 Dundas St W, Toronto, ON, M5G 2C3, Canada, 1 416 979 5044, nancy.yang@torontomu.ca %K social media %K natural language processing %K social interaction %K decision support system %K depression detection %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression significantly impacts an individual’s thoughts, emotions, behaviors, and moods; this prevalent mental health condition affects millions globally. Traditional approaches to detecting and treating depression rely on questionnaires and personal interviews, which can be time consuming and potentially inefficient. As social media has permanently shifted the pattern of our daily communications, social media postings can offer new perspectives in understanding mental illness in individuals because they provide an unbiased exploration of their language use and behavioral patterns. Objective: This study aimed to develop and evaluate a methodological language framework that integrates psychological patterns, contextual information, and social interactions using natural language processing and machine learning techniques. The goal was to enhance intelligent decision-making for detecting depression at the user level. Methods: We extracted language patterns via natural language processing approaches that facilitate understanding contextual and psychological factors, such as affective patterns and personality traits linked with depression. Then, we extracted social interaction influence features. The resultant social interaction influence that users have within their online social group is derived based on users’ emotions, psychological states, and context of communication extracted from status updates and the social network structure. We empirically evaluated the effectiveness of our framework by applying machine learning models to detect depression, reporting accuracy, recall, precision, and F1-score using social media status updates from 1047 users along with their associated depression diagnosis questionnaire scores. These datasets also include user postings, network connections, and personality responses. Results: The proposed framework demonstrates accurate and effective detection of depression, improving performance compared to traditional baselines with an average improvement of 6% in accuracy and 10% in F1-score. It also shows competitive performance relative to state-of-the-art models. The inclusion of social interaction features demonstrates strong performance. By using all influence features (affective influence features, contextual influence features, and personality influence features), the model achieved an accuracy of 77% and a precision of 80%. Using affective features and affective influence features also showed strong performance, achieving 81% precision and an F1-score of 79%. Conclusions: The developed framework offers practical applications, such as accelerating hospital diagnoses, improving prediction accuracy, facilitating timely referrals, and providing actionable insights for early interventions in mental health treatment plans. %M 39832365 %R 10.2196/60286 %U https://formative.jmir.org/2025/1/e60286 %U https://doi.org/10.2196/60286 %U http://www.ncbi.nlm.nih.gov/pubmed/39832365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64265 %T Insights From Diverse Perspectives on Social Media Messages to Inform Young Adults With Cancer About Clinical Trials: Focus Group Study %A Beauchemin,Melissa P %A Walker,Desiree %A Rosen,Allison %A Frazer,Maria %A Eisenberger,Meital %A Khurana,Rhea K %A Bentlyewski,Edward %A Fedorko,Victoria %A Basch,Corey H %A Hillyer,Grace C %K young adults %K adolescent and young adult cancer %K cancer %K cancer treatment %K clinical trials %K clinical trial awareness %K clinical trial enrollment %K clinical trial knowledge %K clinical trial attitudes %K clinical trial enrollment barriers %K social media %K social media messages %K psychosocial %K United States %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: Low rates of adolescent and young adult (YA; aged 15-39 y) clinical trial enrollment (CTE), particularly among underserved groups, have resulted in a lack of standardized cancer treatments and follow-up guidelines for this group that may limit improvement in cancer treatments and survival outcomes for YAs. Objective: To understand and address unique barriers to CTE, we conducted focus groups to learn about informational, financial, and psychosocial needs of YAs surrounding CTE and identify strategies to address these barriers. Methods: We conducted 5 focus groups in 2023 among a diverse sample of YA patients from across the United States. An interview guide was developed collaboratively with YA advocates. Specifically, informational needs, financial concerns, and psychosocial issues were explored, and participants were probed to suggest strategies, especially those that leverage technology, to address these barriers. Sessions were audio recorded, transcribed, and coded using direct content analysis. Findings were synthesized through consensus discussions. Results: We confirmed the previously proposed thematic barriers regarding YA CTE and identified 9 subthemes: awareness, lack of clear and accessible CTE information, fear of the unknown, assumptions about costs, insurance coverage, navigating financial responsibilities, clinical trial discussions, clinical trial misconceptions, and desire for a support network. Throughout, YAs mentioned needs that might be addressed through informational outreach leveraging digital technology, the internet, and social media. Conclusions: This study expands knowledge of YA perceived barriers to CTE. These findings suggest that leveraging digital technology to disseminate reliable information to address needs may be an effective strategy to improve clinical trial participation in the YA population. %R 10.2196/64265 %U https://formative.jmir.org/2025/1/e64265 %U https://doi.org/10.2196/64265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e46390 %T Developing a Machine Learning–Based Automated Patient Engagement Estimator for Telehealth: Algorithm Development and Validation Study %A Guhan,Pooja %A Awasthi,Naman %A McDonald,Kathryn %A Bussell,Kristin %A Reeves,Gloria %A Manocha,Dinesh %A Bera,Aniket %+ Department of Computer Science, University of Maryland, 8125 Paint Branch Dr, College Park, MD, 20742, United States, 1 2406309133, pguhan@umd.edu %K machine learning %K mental health %K telehealth %K engagement detection %K patient engagement %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient engagement is a critical but challenging public health priority in behavioral health care. During telehealth sessions, health care providers need to rely predominantly on verbal strategies rather than typical nonverbal cues to effectively engage patients. Hence, the typical patient engagement behaviors are now different, and health care provider training on telehealth patient engagement is unavailable or quite limited. Therefore, we explore the application of machine learning for estimating patient engagement. This can assist psychotherapists in the development of a therapeutic relationship with the patient and enhance patient engagement in the treatment of mental health conditions during tele–mental health sessions. Objective: This study aimed to examine the ability of machine learning models to estimate patient engagement levels during a tele–mental health session and understand whether the machine learning approach could support therapeutic engagement between the client and psychotherapist. Methods: We proposed a multimodal learning-based approach. We uniquely leveraged latent vectors corresponding to affective and cognitive features frequently used in psychology literature to understand a person’s level of engagement. Given the labeled data constraints that exist in health care, we explored a semisupervised learning solution. To support the development of similar technologies for telehealth, we also plan to release a dataset called Multimodal Engagement Detection in Clinical Analysis (MEDICA). This dataset includes 1229 video clips, each lasting 3 seconds. In addition, we present experiments conducted on this dataset, along with real-world tests that demonstrate the effectiveness of our method. Results: Our algorithm reports a 40% improvement in root mean square error over state-of-the-art methods for engagement estimation. In our real-world tests on 438 video clips from psychotherapy sessions with 20 patients, in comparison to prior methods, positive correlations were observed between psychotherapists’ Working Alliance Inventory scores and our mean and median engagement level estimates. This indicates the potential of the proposed model to present patient engagement estimations that align well with the engagement measures used by psychotherapists. Conclusions: Patient engagement has been identified as being important to improve therapeutic alliance. However, limited research has been conducted to measure this in a telehealth setting, where the therapist lacks conventional cues to make a confident assessment. The algorithm developed is an attempt to model person-oriented engagement modeling theories within machine learning frameworks to estimate the level of engagement of the patient accurately and reliably in telehealth. The results are encouraging and emphasize the value of combining psychology and machine learning to understand patient engagement. Further testing in the real-world setting is necessary to fully assess its usefulness in helping therapists gauge patient engagement during online sessions. However, the proposed approach and the creation of the new dataset, MEDICA, open avenues for future research and the development of impactful tools for telehealth. %M 39832353 %R 10.2196/46390 %U https://formative.jmir.org/2025/1/e46390 %U https://doi.org/10.2196/46390 %U http://www.ncbi.nlm.nih.gov/pubmed/39832353 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64560 %T At-Home Immersive Virtual Reality Exergames to Reduce Cardiometabolic Risk Among Office Workers: Protocol for a Randomized Controlled Trial %A Zhao,Jing %A Yasunaga,Akitomo %A Kaczynski,Andrew T %A Park,Hyuntae %A Luo,Yufeng %A Li,Jiuling %A Shibata,Ai %A Ishii,Kaori %A Yano,Shohei %A Oka,Koichiro %A Koohsari,Mohammad Javad %+ School of Architecture and Urban Planning, Guangzhou University, 230 Wai Huan Xi Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China, 86 13170322723, zhaojing@gzhu.edu.cn %K metabolic syndrome %K noncommunicable diseases %K active video game %K interactive virtual reality environment %K physical activity %K workplace health %K at-home intervention %D 2025 %7 20.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The worldwide rise in the prevalence of noncommunicable diseases has increased the recognition of the need to identify modifiable risk factors for preventing and managing these diseases. The office worker, as a representative group of physically inactive workers, is exposed to risk factors for metabolic syndrome, which is a primary driver of noncommunicable diseases. The use of virtual reality (VR) exergames may offer a potential solution to the problem of increasing noncommunicable disease prevalence, as it can help individuals increase their physical activity levels while providing a more immersive experience. Objective: This exploratory study aims to examine the interventional efficacy of at-home immersive VR exergames on metabolic syndrome biomarkers among office workers. Additionally, it seeks to investigate the impacts of at-home immersive VR exergames on the active and sedentary behaviors of office workers. Methods: A 3-arm, single-blinded pilot randomized controlled trial will be conducted to examine the therapeutic effects of at-home immersive VR exergames. A total of 120 Chinese office workers, engaging in less than 150 minutes per week of moderate to vigorous intensity physical activity, will be recruited via a convenience sampling method. The participants, who will be tested over a 12-week period, will be randomly assigned to one of three groups: (1) the VR exergame intervention group, (2) the regular physical activity control group, and (3) the nonexercise control group. Throughout the 12-week trial, three categories of variables will be collected across the three groups: clinical risk factors associated with metabolic syndrome, active and sedentary behaviors, and demographics. To analyze variance among the groups, a mixed linear model will be applied to assess the efficacy of each group. Differences in metabolic syndrome clinical risk factors among all groups will be used to evaluate the effects of at-home immersive VR exergames. Changes in active and sedentary behaviors will also be used to determine the impacts of VR exergames on metabolic syndrome. Results: The ethics committee of Guangzhou University, China, approved this study on September 25, 2024. Participant recruitment will begin in early 2025 and continue for approximately 3 months. Data will be analyzed after the 12-week trial is completed, with full results expected to be presented in early 2026. Conclusions: This study explores an emerging topic by applying an at-home immersive VR exergame intervention, potentially contributing to understanding the effects of an exergame program on metabolic syndrome risk among office workers. Trial Registration: ClinicalTrials.gov NCT06556784; https://clinicaltrials.gov/study/NCT06556784 International Registered Report Identifier (IRRID): PRR1-10.2196/64560 %M 39832174 %R 10.2196/64560 %U https://www.researchprotocols.org/2025/1/e64560 %U https://doi.org/10.2196/64560 %U http://www.ncbi.nlm.nih.gov/pubmed/39832174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64427 %T Feasibility, User Acceptance, and Outcomes of Using a Cancer Prehabilitation App for Exercise: Pilot Cohort Study %A Zhang,Fuquan %A Bang,Deepali %A Visperas,Christine Alejandro %A Tun,Mon Hnin %A Tay,San San %K cancer prehabilitation %K mobile app %K technology %K feasibility %K acceptance %K cancer %K prehabilitation %K mHealth %K exercise %K application %K app %K mobile application %K reliability %K smartphone app %K sustainability %K effectiveness %K older patients %K older adults %K elderly %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The efficacy of cancer prehabilitation programs is supported by international reviews and meta-analyses. Technology has been deployed in cancer prehabilitation to address challenges such as access or limited resources. This study evaluated the feasibility, user acceptance, safety, and program outcomes of a newly developed mobile app for cancer prehabilitation. The app integrates with Singapore’s existing health care mobile app, Health Buddy, and provides instructional videos for prescribed exercises. Objective: The objectives of this study were to investigate the feasibility, user experience, safety, and outcomes of a mobile app for cancer prehabilitation within a hospital-associated, home-based, multimodal cancer prehabilitation program. Methods: This retrospective study analyzed the records of patients enrolled in the cancer prehabilitation program from September 1, 2022, to March 30, 2023. Patients who participated in the prehabilitation program (n=63) were categorized into 2 groups: those prescribed the app (n=41) and those who were not (n=22). There was further subgroup analysis of those who were prescribed: app users (n=25) versus those who were non-app users (n=16). Demographics, Fried Frailty Phenotype, prehabilitation duration, app use, and functional outcome measures (6-minute walk test [6MWT], 30-second sit-to-stand test [STS], timed up and go test [TUG], and Hospital Anxiety and Depression Scale [HADS]) were collected. Compliance was determined by the completion of prescribed exercises and the accuracy of executing these exercises, with a high compliance rate considered to be at 80% or more. Baseline characteristics and preoperative outcomes were compared between the groups. User satisfaction was assessed through surveys among app users (n=25). Results: Among 63 patients, 41 (65.1%) patients were prescribed the app, of which 22 (34.9%) patients were users. No significant differences in preoperative functional improvements were observed between app users and nonusers (6MWT: P=.60; STS: P=.81; TUG: P=.53; HADS: P=.36), or between those prescribed and not prescribed the app (6MWT: P=.94; STS: P=.26; TUG: P=.39; HADS: P=.62). However, high compliance rates (80%) were observed among app users. Patient satisfaction with the app was high (>90%), with positive feedback on ease of use and technical reliability. Baseline measures revealed significantly lower functional scores and higher mean frailty scores in the nonprescribed group. Conclusions: This preliminary study demonstrates the acceptability, feasibility, and safety of Singapore’s first smartphone app for exercise prescription in cancer prehabilitation. Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation. Further studies should include strategies to enhance patients’ readiness for technology, sustainability, and effectiveness in older patients. %R 10.2196/64427 %U https://formative.jmir.org/2025/1/e64427 %U https://doi.org/10.2196/64427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56523 %T Public Understanding and Expectations of Digital Health Evidence Generation: Focus Group Study %A Bondaronek,Paulina %A Li,Jingfeng %A Potts,Henry W W %K mobile apps %K digital health %K public expectations %K evidence of effectiveness %K health risk perception %K effectiveness %K health risk %K health app %K public health %K well-being %K public trust %K diagnostic tools %K safety %K mobile phone %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The rapid proliferation of health apps has not been matched by a comparable growth in scientific evaluations of their effectiveness, particularly for apps available to the public. This gap has prompted ongoing debate about the types of evidence necessary to validate health apps, especially as the perceived risk level varies from wellness tools to diagnostic aids. The perspectives of the general public, who are direct stakeholders, are notably underrepresented in discussions on digital health evidence generation. Objective: This study aimed to explore public understanding and expectations regarding the evidence required to demonstrate health apps’ effectiveness, including at varying levels of health risk. Methods: A total of 4 focus group discussions were held with UK residents aged 18 years and older, recruited through targeted advertisements to ensure demographic diversity. Participants discussed their views on evidence requirements for 5 hypothetical health apps, ranging from low-risk wellness apps to high-risk diagnostic tools. Focus groups were moderated using a structured guide, and data were analyzed using reflexive thematic analysis to extract common themes. Results: A total of 5 key themes were established: personal needs, app functionality, social approval, expectations of testing, and authority. Participants relied on personal experiences and social endorsements when judging the effectiveness of low-risk digital health interventions, while making minimal reference to traditional scientific evidence. However, as the perceived risk of an app increased, there was a noticeable shift toward preferring evidence from authoritative sources, such as government or National Health Service endorsements. Conclusions: The public have a preference for evidence that resonates on a personal level, but also show a heightened demand for authoritative guidance as the potential risk of digital health interventions increases. These perspectives should guide developers, regulators, and policy makers as they balance how to achieve innovation, safety, and public trust in the digital health landscape. Engaging the public in evidence-generation processes and ensuring transparency in app functionality and testing can bridge the gap between public expectations and regulatory standards, fostering trust in digital health technologies. %R 10.2196/56523 %U https://formative.jmir.org/2025/1/e56523 %U https://doi.org/10.2196/56523 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53231 %T Reflections of Foster Youth Engaging in the Co-Design of Digital Mental Health Technology: Duoethnography Study %A Ezimora,Ifunanya %A Lundberg,Tylia %A Miars,Dylan %A Trujeque,Jeruel %A Papias,Ashley %A Del Cid,Margareth V %A Folk,Johanna B %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, United States, 1 4156029521, johanna.folk@ucsf.edu %K foster youth %K digital health technology %K co-design %K app development %K mental health %K adolescent %K young adult %K mobile health %K mHealth %K foster care %K duoethnography %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Current research on digital applications to support the mental health and well-being of foster youth is limited to theoretical applications for transition-aged foster youth and support platforms developed without intentional input from foster youth themselves. Centering the lived expertise of foster youth in digital solutions is crucial to dismantling barriers to care, leading to an increase in service access and improving mental health outcomes. Co-design centers the intended end users during the design process, creating a direct relationship between potential users and developers. This methodology holds promise for creating tools centered on foster youth, yet little is known about the co-design experience for foster youth. Understanding foster youth’s experience with co-design is crucial to identifying best practices, knowledge of which is currently limited. Objective: The aim of this paper is to reflect on the experiences of 4 foster youth involved in the co-design of FostrSpace, a mobile app designed through a collaboration among foster youth in the San Francisco Bay Area; clinicians and academics from the Juvenile Justice Behavioral Health research team at the University of California, San Francisco; and Chorus Innovations, a rapid technology development platform specializing in participatory design practices. Key recommendations for co-designing with foster youth were generated with reference to these reflections. Methods: A duoethnography study was conducted over a 1-month period with the 4 transition-aged former foster youth co-designers of FostrSpace via written reflections and a single in-person roundtable discussion. Reflections were coded and analyzed via reflexive thematic analysis. Results: In total, 4 main themes were identified from coding of the duoethnography reflections: power and control, resource navigation, building community and safe spaces, and identity. Themes of power and control and resource navigation highlighted the challenges FostrSpace co-designers experienced trying to access basic needs, support from caregivers, and mental health resources as foster youth and former foster youth. Discussions pertaining to building community and safe spaces highlighted the positive effect of foster youth communities on co-designers, and discussions related to identity revealed the complexities associated with understanding and embracing foster youth identity. Conclusions: This duoethnography study highlights the importance of centering the lived expertise of co-designers throughout the app development process. As the digital health field increasingly shifts toward using co-design methods to develop digital mental health technologies for underserved youth populations, we offer recommendations for researchers seeking to ethically and effectively engage youth co-designers. Actively reflecting throughout the co-design process, finding creative ways to engage in power-sharing practices to build community, and ensuring mutual benefit among co-designers are some of the recommended core components to address when co-designing behavioral health technologies for youth. %M 39832159 %R 10.2196/53231 %U https://formative.jmir.org/2025/1/e53231 %U https://doi.org/10.2196/53231 %U http://www.ncbi.nlm.nih.gov/pubmed/39832159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58265 %T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies %A Rizzi,Silvia %A Pavesi,Maria Chiara %A Moser,Alessia %A Paolazzi,Francesca %A Marchesoni,Michele %A Poggianella,Stefania %A Gadotti,Erik %A Forti,Stefano %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K well-being %K maternal health %K digital health %K intervention %K design %K preliminary testing %K technology-based %K interview %K multidisciplinary approach %K mother %K women %K WhatsApp %K email %K midwife %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. %M 39625414 %R 10.2196/58265 %U https://formative.jmir.org/2025/1/e58265 %U https://doi.org/10.2196/58265 %U http://www.ncbi.nlm.nih.gov/pubmed/39625414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54209 %T Sentiments of Individuals with Interstitial Cystitis/Bladder Pain Syndrome Toward Pentosan Polysulfate Sodium: Infodemiology Study %A Hswen,Yulin %A Qin,Qiuyuan %A Smith,Pressley %A Swierczynski,Alison %A Bauer,Stuart %A Ladson,Erika %A Garrett,Amanda Leigh %A Brownstein,Catherine A %K interstitial cystitis %K IC %K painful bladder syndrome %K bladder pain syndrome %K BPS %K social media %K social network %K pain %K treatment %K chronic condition %K chronic disease %K chronic illness %K Elmiron %K pentosan polysulfate sodium %K PPS %K internet forum %D 2025 %7 17.1.2025 %9 %J JMIR Form Res %G English %X Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a multifactorial, chronic syndrome involving urinary frequency, urgency, and bladder discomfort. These IC/BPS symptoms can significantly impact individuals’ quality of life, affecting their mental, physical, sexual, and financial well-being. Individuals sometimes rely on peer-to-peer support to understand the disease and find methods of alleviating symptoms. The only US Food and Drug Administration–approved medication to treat IC/BPS is pentosan polysulfate sodium (PPS). However, ocular pigmentary maculopathy has been described in some individuals, with greater severity associated with prolonged PPS exposure. Objective: While prior research has separately assessed the benefits and side effects of PPS, this study sought to identify (1) sentiments of individuals with IC/BPS toward PPS and (2) topics discussed by individuals with IC/BPS in conjunction with PPS through use of an internet peer-to-peer forum. Methods: Data were collected from Inspire—an anonymous web-based health community where individuals gather by condition to find support and information. Sentiment analysis and percentages of negative, positive, and neutral sentiment for PPS discussions encompassing each topic was conducted using VADER (Valence Aware Dictionary for Sentiment Reasoning). Topic modeling was conducted using latent Dirichlet allocation. Words with the highest probability were ranked to categorize each topic, and authors manually investigated and labeled discussions. Results: There were 354 forum posts related to PPS. Topic modeling with latent Dirichlet allocation revealed 5 topic categories: “ineffectiveness or discontinued use,” “alternative treatments,” “personal treatment suggestions based on experience,” “severe side effects,” and “risk of long-term use.” Topics related to “severe side effects” and “risk of long-term use” garnered less discussion, with the former also having the lowest positive sentiment (4.28, 14.29%). The topic “ineffectiveness or discontinued use” was most frequently discussed. This topic also had the highest percentage of negative posts (52/152, 34.21%). However, the average compound score was within the neutral compound score range (−0.094, SD 0.625). In addition, forum data highlighted individuals’ acknowledgment of the efficacy of PPS in improving their quality of life, with statements such as “saved my sanity” being representative. The overall compound individuals’ sentiment toward PPS was −0.083, split across 32.49% (115/354) negative, 22.03% (78/354) positive, and 45.48% (161/354) neutral sentiment categories. Conclusions: The overall authentic sentiment toward PPS is broad but balances to neutral. This neutral sentiment suggests that while some individuals express concerns about the side effects and long-term risks associated with PPS, others appreciate its positive impact on their quality of life. This research confirms that individuals with IC/BPS actively engage with health forums like Inspire to seek information, share their experiences, and explore different treatment options. As IC/BPS remains a complex syndrome, this study highlights the value of patient-led discussions in informing treatment decisions. Furthermore, these findings suggest that health care providers might benefit from considering the insights shared on peer-to-peer forums to better understand individual preferences, concerns, and expectations. %R 10.2196/54209 %U https://formative.jmir.org/2025/1/e54209 %U https://doi.org/10.2196/54209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57614 %T A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability %A Romm,Kristin Lie %A Skoge,Mari %A Barrett,Elizabeth Ann %A Berentzen,Lars-Christian %A Bergsager,Dagfinn %A Fugelli,Pål %A Bjella,Thomas %A Gardsjord,Erlend Strand %A Kling,Kristine %A Kruse,Sindre Hembre %A Kværner,Kari Jorunn %A Melle,Ingrid %A Mork,Erlend %A Ihler,Henrik Myhre %A Rognli,Eline Borger %A Simonsen,Carmen %A Værnes,Tor Gunnar %A Aminoff,Sofie Ragnhild %+ Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 21, Oslo, 0372, Norway, 47 91 50 27 70, k.l.romm@medisin.uio.no %K eHealth %K shared decision-making %K user involvement %K user-centered design %K mental disorder %K mobile technology %K illness course %K recovery %K mobile apps %K mHealth %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings—from development to implementation—and to conduct further research on early health technology assessments to guide these processes. %M 39823632 %R 10.2196/57614 %U https://formative.jmir.org/2025/1/e57614 %U https://doi.org/10.2196/57614 %U http://www.ncbi.nlm.nih.gov/pubmed/39823632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60398 %T Sexual and Gender Minority Adolescents’ Preferences for HIV Pre-Exposure Prophylaxis Social Marketing Campaigns: Qualitative Preimplementation Study %A Macapagal,Kathryn %A Zapata,Juan Pablo %A Ma,Junye %A Gordon,Jacob D %A Owens,Christopher %A Valadez-Tapia,Silvia %A Cummings,Peter %A Walter,Nathan %A Pickett,Jim %+ Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 3605, kathryn.macapagal@northwestern.edu %K social marketing campaigns %K sexual and gender minority %K adolescent %K HIV %K pre-exposure prophylaxis %K PrEP %K human-centered design %K implementation science %K dissemination %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority (SGM) adolescents in the United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, but its awareness and uptake among SGM adolescents are low. There are no adolescent-centered PrEP social marketing campaigns in the United States that have the potential to increase awareness and interest in PrEP. Objective: To address this gap, this qualitative study aims to examine SGM adolescents’ needs and preferences regarding adolescent-centered PrEP social marketing campaigns. Methods: SGM adolescents from Chicago and its surrounding areas participated in web-based asynchronous focus groups from February to May 2021. Questions elicited their preferences for content, design, and delivery of SGM adolescent–centered PrEP campaigns. We used rapid qualitative data analysis and organized the findings around key components of social marketing, known as the 4 Ps: product, price, place, and promotion. Results: Participants (N=56) were aged 14 to 19 years (mean 18.16, SD 1.22 y), and 64% (36/56) of them identified as a racial or ethnic minority. Among the 56 participants, 70% (n=39) were aware of PrEP; however, 95% (n=53) did not know that PrEP could be prescribed to those aged under 18 years. Adolescents expressed a need for PrEP campaign messaging that provides simple, accurate, and easily accessible information (eg, what is PrEP, for whom PrEP is indicated, and where and how to access PrEP). For product and price, SGM adolescents wanted a campaign to address barriers to, costs of, and how to access PrEP and desired to know about other adolescents’ PrEP experiences to improve campaign relatability. For place and promotion, participants preferred digital campaigns on social media to reduce the possibility of embarrassment and stigma and increase the accessibility of health content. Conclusions: These findings lay the groundwork for designing adolescent-centered educational PrEP campaigns that prioritize both user preferences in PrEP marketing design and strategies to overcome common barriers to PrEP awareness. %R 10.2196/60398 %U https://formative.jmir.org/2025/1/e60398 %U https://doi.org/10.2196/60398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54460 %T Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study %A Weidinger,Florian %A Dietzel,Nikolas %A Graessel,Elmar %A Prokosch,Hans-Ulrich %A Kolominsky-Rabas,Peter %K dementia %K mild cognitive impairment %K cognitive impairment %K information sources %K health information %K health information–seeking behavior %K Digital Dementia Registry Bavaria %K digiDEM %D 2025 %7 15.1.2025 %9 %J JMIR Form Res %G English %X Background: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information–seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information–seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context. Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression. Methods: This study is part of the ongoing project “Digital Dementia Registry Bavaria – digiDEM Bayern.” The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group. Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were “Personal visit to a medical professional” (mean 3.9, SD 1.1) and “Family / Friends” (mean 3.9, SD 1.2). “Internet” was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources “Internet” (F2,921=61.23; P<.001), “Courses / Lectures” (F2,921=18.88; P<.001), and “Family / Friends” (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as “Internet” (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were “TV / Radio” and “Family / Friends,” with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from “Internet” (mean difference=0.4; t685=4.97; P<.001). Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043473 %R 10.2196/54460 %U https://formative.jmir.org/2025/1/e54460 %U https://doi.org/10.2196/54460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63737 %T Mobile Phone App to Promote Lifestyle Change in People at Risk of Type 2 Diabetes: Feasibility 3-Arm Randomized Controlled Trial %A Skoglund,Gyri %A Hilde,Gunvor %A Lunde,Pernille %A Cruz Naceno,Venessa Vera %A Fromholt Olsen,Cecilie %A Blakstad Nilsson,Birgitta %K prevention %K risk of type 2 diabetes %K lifestyle change %K feasibility %K app adherence %K mobile health %K mHealth %K mobile phone %D 2025 %7 15.1.2025 %9 %J JMIR Form Res %G English %X Background: The use of mobile health interventions, such as apps, are proposed to meet the challenges faced by preventive health care services due to the increasing prevalence of type 2 diabetes (T2D). Thus, we developed and conducted initial feasibility testing of the Plunde app for promoting and monitoring individual goals related to lifestyle change for people at risk of T2D. Objective: The primary aim of this study was to assess the feasibility of an app for promoting lifestyle change in people at risk of T2D. The secondary aim was to assess recruitment rate, resource requirements, and change in potential outcomes for a full scale randomized controlled trial (RCT) study . Methods: A 3-arm feasibility RCT lasting 12 weeks was designed. Participants were recruited from 9 general practitioners in Norway. Eligible participants were randomized to either (1) app follow-up; (2) app follow-up and referral to care as usual in Healthy Life Centers; or (3) referral to care as usual in a Healthy Life Center, only. The primary outcome was feasibility and was measured by app adherence (actual usage of the app), the System Usability Scale, and app motivation score gained from a questionnaire designed for this study. Criteria for success were preset based on these measures. Secondary outcomes included recruitment rate, resource requirements, and potential primary outcomes of a full-scale RCT. This included change in body weight, waist circumference, and self-evaluated functional health status, assessed with the Dartmouth Primary Care Cooperative Research Network/World Organization of Family Doctors (COOP/WONCA) functional health assessment chart. Results: Within 8 months, 9 general practitioners recruited a total of 54 participants, of which 45 were eligble for participation in the study. Mean age was 61 (SD 13) years and 53% (n=24) were female. App adherence was 86%, the mean System Usability Scale score was 87.3 (SD 11.9), and the mean app motivation score was 74.8 (SD 30.3). Throughout the intervention period, health care professionals spent on average 3.0 (SD 1.0) minutes per participant per week providing follow-up. Statistically significant reduction in body weight and waist circumference was shown in group 1 and 3. Conclusions: Based on the preset criteria for success, the Plunde app is feasible in providing support for lifestyle change. The Plunde app had excellent user satisfaction. The amount of time spent on monitoring and promoting lifestyle change through the app was low; however, the recruitment was slow. Results from this study will guide the development of further research within this field. Trial Registration: ClinicalTrials.gov NCT06117098; https://clinicaltrials.gov/study/NCT06117098 %R 10.2196/63737 %U https://formative.jmir.org/2025/1/e63737 %U https://doi.org/10.2196/63737 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60382 %T A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia %A McCage,Sydney %A Walker,Kristin %A Cornelius,Talea %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Brad %A Ritchie,Christine %A Vranceanu,Ana-Maria %A Bannon,Sarah %+ Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, Annex B-12, New York, NY, 10029, United States, 1 212 241 6866, sarah.bannon@mountsinai.org %K dementia %K dyad %K emotional distress %K intervention %K diagnosis %K telehealth %K resilient %K dyadic intervention %K care-partner %K Alzheimer’s disease %K ADRD %K psychosocial %K depression %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners—together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis. Objective: This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial. Methods: All study procedures will be conducted on the web (via phone and health care system–supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial. Results: This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024. Conclusions: We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs. International Registered Report Identifier (IRRID): DERR1-10.2196/60382 %M 39814366 %R 10.2196/60382 %U https://www.researchprotocols.org/2025/1/e60382 %U https://doi.org/10.2196/60382 %U http://www.ncbi.nlm.nih.gov/pubmed/39814366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57423 %T Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial %A Kim,Yumi %A Rimmer,James H %A Lai,Byron %A Oster,Robert %A Cowan,Rachel %A Young,Hui-Ju %A Fisher,Gordon %A Kim,Younguk %A Giannone,John %A Wilroy,Jereme D %+ Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 1717 6th Avenue South, Birmingham, AL, United States, 1 2059344508, jdwilroy@uab.edu %K exercise %K physical activity %K wheelchair user %K telehealth %K disability %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective: The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods: This study’s design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results: Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions: The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration: ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID): DERR1-10.2196/57423 %M 39814364 %R 10.2196/57423 %U https://www.researchprotocols.org/2025/1/e57423 %U https://doi.org/10.2196/57423 %U http://www.ncbi.nlm.nih.gov/pubmed/39814364 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53971 %T Smoking Cessation Smartphone App for Nondaily Smoking With Telephone Onboarding: Proof-of-Concept Randomized Controlled Trial %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Futter,Allison E %A Finley-Abboud,Diadora %A Williamson,Alivia C %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Health through Flourishing (HtF) program, Department of Psychiatry, Massachusetts General Hospital, 125 Nashua St, 4th Fl., Boston, MA, 02114, United States, 1 617 643 198, bhoeppner@mgh.harvard.edu %K mobile health %K mHealth %K smoking cessation %K nondaily smoking %K smartphone %K smoking %K positive psychology %K mobile phone %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nondaily smoking is a widespread and increasingly prevalent pattern of use. To date, no effective treatment approach for nondaily smoking has been identified. Objective: This study aimed to conduct an unblinded randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smartphone app for smoking cessation, designed specifically for people who smoke less than daily, within the framework of positive psychology. Methods: Overall, 226 adults who smoke less than daily were recruited on the web and asked to undertake a quit attempt while using assigned smoking cessation support materials. Participants were randomly assigned to 1 of 3 materials: the SiS smartphone app, the National Cancer Institute’s smartphone app QuitGuide (QG), or the National Cancer Institute’s smoking cessation brochure, “Clearing the Air” (CtA). All participants engaged in a 15-minute scripted onboarding phone call and were introduced to their support materials to use for the next 7 weeks. Follow-up self-assessment web surveys were sent 2, 6, 12, and 24 weeks after participants’ initially chosen quit date (ie, 1 week after onboarding). The primary outcome for this study was self-efficacy to remain abstinent from smoking at treatment end. Secondary outcomes assessed treatment acceptability, treatment feasibility (eg, number of days of app use, time spent using app, and use of smoking cessation strategies), and secondary proof-of-concept efficacy outcomes (eg, positive affect, craving, and attitudes toward smoking). Smoking outcomes (ie, 30-day point prevalence abstinence and smoking reduction) were also assessed. Results: Results indicated a significant effect of treatment on the primary outcome, where SiS participants (n=80) reported higher self-efficacy to abstain from smoking at the end of treatment than the 2 control groups (QG: n=75; P=.02; Cohen d=0.40 and CtA: n=71; P=.007; Cohen d=0.50). This effect was also significant on both self-efficacy subscales (ie, internal cues and external cues) with effect sizes ranging from Cohen d=0.34 to 0.50 across the pairwise comparisons. The SiS app group also reported lower craving (QG: P=.005; Cohen d=–0.57 and CtA: P=.005; Cohen d=–0.57) and higher positive affect than QG (QG: P=.01; Cohen d=0.44 and CtA: P=.05; Cohen d=0.38); attitudes toward smoking were largely similar across groups. Treatment acceptability was comparable across groups (P values for all groups >.05; Cohen d range 0.06-0.23). Treatment feasibility measures indicated that participants used the SiS app on 33 out of 49 days, for 35 to 40 minutes per week, resulting in greater use of smoking cessation strategies than QG (QG: P=.04; Cohen d=0.38 and CtA: P=.16; Cohen d=0.24). Conclusions: These findings provide strong evidence for the conceptual underpinnings of the SiS app, and thereby provide compelling justification for conducting a large-scale randomized controlled trial that can test the effectiveness of the SiS app on smoking cessation. Trial Registration: ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/study/NCT04672239 International Registered Report Identifier (IRRID): RR2-10.2196/40867 %M 39814363 %R 10.2196/53971 %U https://mhealth.jmir.org/2025/1/e53971 %U https://doi.org/10.2196/53971 %U http://www.ncbi.nlm.nih.gov/pubmed/39814363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66109 %T Teaching in the Digital Age—Developing a Support Program for Nursing Education Providers: Design-Based Research %A Walzer,Stefan %A Barthel,Carolin %A Pazouki,Ronja %A Marx,Helga %A Ziegler,Sven %A Koenig,Peter %A Kugler,Christiane %A Jobst,Stefan %+ Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723 920 2957, stefan.walzer@hs-furtwangen.de %K digital competencies %K nursing education %K support program %K needs assessment %K design-based research %K feasibility study %K nursing education provider %K qualitative research %K nurse %K health care %K focus group %K digital age %K expert consultation %K thematic content analysis %K feasibility test %K satisfaction %K competency-based approach %K workplace barrier %K health care digitalization %K digital technology %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. %M 39813674 %R 10.2196/66109 %U https://formative.jmir.org/2025/1/e66109 %U https://doi.org/10.2196/66109 %U http://www.ncbi.nlm.nih.gov/pubmed/39813674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63941 %T Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study %A Simioni,Lisa %A Tessitore,Elena %A Hagberg,Hamdi %A Schneider-Paccot,Aurélie %A Blondon,Katherine %A Gschwind,Liliane %A Meyer,Philippe %A Ehrler,Frederic %+ Faculty of Medicine, University of Geneva, Université de Genève Rue du Général-Dufour 24 CH, 1211 Genève 4, Geneva, Switzerland, 41 786420657, lisa.simioni@hotmail.com %K usability %K medication %K mobile health %K mHealth %K Cardiomeds %K mobile app %K patient empowerment %K eHealth %K smartphone %K heart failure %K HF %K chronic disease %K interactive %K self-monitoring %K usability test %K mobile phone %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. Objective: This study aimed to perform a mixed methods usability study of Cardiomeds. Methods: Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Results: Twenty patients with HF, 75% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77% (SD 0.23%) for the first stage and 94% (SD 0.07%) for the second stage. A total of 30% (3/10) of participants in the first stage completed all tasks without any help compared with 50% (5/10) of participants during the second stage. The average System Usability Scale score was 80% (SD 17%), showing a slight increase from 79% (SD 16%) in the first stage to 80% (SD 28%) in the second stage, which qualifies the app as “good” in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36% (8/22) of the problems in the first stage and 40% (6/15) in the second stage. In response to open questions, 85% (17/20) of the participants responded that they would like to use the app when it became available. Conclusions: The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients’ knowledge about HF, self-care, and quality of life. %M 39813081 %R 10.2196/63941 %U https://formative.jmir.org/2025/1/e63941 %U https://doi.org/10.2196/63941 %U http://www.ncbi.nlm.nih.gov/pubmed/39813081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59154 %T Considering Comorbidities and Individual Differences in Testing a Gaming Behavioral Activation App for Perinatal Depression and Anxiety: Open Trial Pilot Intervention Study %A Hamlett,Gabriella E %A Schrader,Chloe %A Ferguson,Craig %A Kobylski,Lauren A %A Picard,Rosalind %A Locascio,Joseph J %A McNally,Richard J %A Cohen,Lee S %A Vanderkruik,Rachel %K perinatal anxiety %K perinatal depression %K behavioral activation %K digital mental health %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: There is increasing interest in the development of scalable digital mental health interventions for perinatal populations to increase accessibility. Mobile behavioral activation (BA) is efficacious for the treatment of perinatal depression; however, the effect of comorbid anxiety and depression (CAD) on symptom trajectories remains underexplored. This is important given that at least 10% of women in the perinatal period experience CAD. Objective: We assessed whether there were differences in symptom trajectories in pregnant participants with CAD as compared to those with depression only (ie, major depressive disorder [MDD]) during intervention with a BA mobile gaming app. Methods: Pregnant adults with either CAD (n=10) or MDD (n=7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models. Results: When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (β=.18, SE 0.07; t62=2.61; P=.01), revealing a tendency for anxiety in the CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on depression (β=−.39, SE 0.11; t68=−3.51; P=.001), showing that depression declined steadily across time for both groups. There was a significant effect of baseline diagnosis on depression (β=−8.53, SE 3.93; t13=−2.17; P=.05), suggesting that those with MDD had higher follow-up depression compared to those with CAD when holding other predictors constant. Conclusions: The app was beneficial in reducing depression symptoms in perinatal individuals with different comorbidity profiles. With respect to anxiety symptom trajectories, however, there was more variability. The app may be especially effective for the treatment of anxiety symptoms among individuals with CAD, as it encourages in-the-moment ecologically relevant exposure to anxiety-provoking stimuli. Despite no significant group difference in baseline anxiety symptoms, the MDD group did not have a significant reduction in their anxiety symptoms across the study period, and some individuals had an increase in anxiety. Findings may point to opportunities for the augmentation of BA gaming apps for those with MDD to more effectively target anxiety symptoms. Overall, findings suggest there may be value in considering comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations. %R 10.2196/59154 %U https://formative.jmir.org/2025/1/e59154 %U https://doi.org/10.2196/59154 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e62930 %T Exploring Dance as a Therapeutic Approach for Parkinson Disease Through the Social Robotics for Active and Healthy Ageing (SI-Robotics): Results From a Technical Feasibility Study %A Bevilacqua,Roberta %A Maranesi,Elvira %A Benadduci,Marco %A Cortellessa,Gabriella %A Umbrico,Alessandro %A Fracasso,Francesca %A Melone,Giovanni %A Margaritini,Arianna %A La Forgia,Angela %A Di Bitonto,Pierpaolo %A Potenza,Ada %A Fiorini,Laura %A La Viola,Carlo %A Cavallo,Filippo %A Leone,Alessandro %A Caroppo,Andrea %A Rescio,Gabriele %A Marzorati,Mauro %A Cesta,Amedeo %A Pelliccioni,Giuseppe %A Riccardi,Giovanni Renato %A Rossi,Lorena %K Parkinson disease %K rehabilitation %K Irish dancing %K balance %K gait %K socially interacting robot %D 2025 %7 14.1.2025 %9 %J JMIR Aging %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients’ posture and enhancing workout routines with tailored cues. Objective: This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence–based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated. Methods: The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance–based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise. Results: Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale–III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users’ perceptions and interactions with the system. Conclusions: This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD. Trial Registration: ClinicalTrials.gov NCT05005208; https://clinicaltrials.gov/study/NCT05005208 %R 10.2196/62930 %U https://aging.jmir.org/2025/1/e62930 %U https://doi.org/10.2196/62930 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66181 %T Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study %A Vonderlin,Ruben %A Boritz,Tali %A Claus,Carola %A Senyüz,Büsra %A Mahalingam,Saskia %A Tennenhouse,Rachel %A Lis,Stefanie %A Schmahl,Christian %A Margraf,Jürgen %A Teismann,Tobias %A Kleindienst,Nikolaus %A McMain,Shelley %A Bohus,Martin %+ Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 4445, ruben.vonderlin@zi-mannheim.de %K dialectical behavior therapy %K borderline personality disorder %K online psychotherapy %K virtual psychotherapy %K telehealth %K personality disorders %K mental %K psychotherapy %K online %K internet %K telemedicine %K psychiatry %K psychiatric %K acceptance %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial Registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 %M 39808784 %R 10.2196/66181 %U https://formative.jmir.org/2025/1/e66181 %U https://doi.org/10.2196/66181 %U http://www.ncbi.nlm.nih.gov/pubmed/39808784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62772 %T Verification of the Reliability of an Automated Urine Test Strip Colorimetric Program Using Colorimetric Analysis: Survey Study %A Inagaki,Keigo %A Tsuriya,Daisuke %A Hashimoto,Takuya %A Nakamura,Katsumasa %K urine test strip %K reliability %K automatic urine analyzer %K quasi-experimental study %K colorimetric analysis %K colorimetric %K urinalysis %K urinary %K urine %K evaluation %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: One method for noninvasive and simple urinary microalbumin testing is urine test strips. However, when visually assessing urine test strips, accurate assessment may be difficult due to environmental influences—such as lighting color and intensity—and the physical and psychological influences of the assessor. These complicate the formation of an objective assessment. Objectives: This study developed an “automated urine test strip colorimetric program” (hereinafter referred to as “this program”) to objectively assess urine test strips. Using this program may allow urine tests to be conducted at home. In this study, urine samples from hospitalized or outpatient patients were randomly obtained, and the reliability of this program was verified by comparing the agreement rate between this program and an automatic urine analyzer (US-3500 [Eiken Chemical Co, Ltd] and LABOSPECT 006 [Hitachi High-Tech Co, Ltd]). Furthermore, the sensitivity and specificity of the urine albumin test were investigated, and its applicability to screening for microalbuminuria was verified. Methods: A urine test strip was placed in a photography box with constant light intensity and color temperature conditions. The image taken with a smartphone camera on top of the photography box was judged by this program. This program used Accelerated KAZE to perform image-matching processing to reduce the effect of misalignment during photography. It also calculated and judged the item with the smallest color difference between the color chart and the urine test strip using the CIEDE2000 color difference formula. The agreement rate of the results of this program was investigated using the results of an automatic urine analyzer as the gold standard. Results: Compared with the judgments of an automatic urine analyzer, the average agreement rate for 12 items (protein, glucose, urobilinogen, bilirubin, ketone bodies, specific gravity, occult blood, pH, white blood cells, nitrite, creatinine, and albumin) was 78.6%. Furthermore, the average agreement rate of the 12 items within ±1 rank was 95.4%. The results showed a sensitivity of 100% and a specificity of 58.6% in determining albumin in urine, which is important for determining the stage of diabetic nephropathy. Finally, the area under the curve (0.907) derived from the receiver operating characteristic curve was satisfactory. Conclusions: The program developed by the authors can determine urine test strips without requiring calibration in a certain shooting environment. If this program can be used at home to perform urinary microalbumin tests, the early detection and treatment of diabetic nephropathy may prevent the condition from becoming severe. %R 10.2196/62772 %U https://formative.jmir.org/2025/1/e62772 %U https://doi.org/10.2196/62772 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 8 %N %P e58878 %T A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study %A Toben,Daan %A de Wind,Astrid %A van der Meij,Eva %A Huirne,Judith A F %A Anema,Johannes R %+ Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands, 31 647861694, d.j.toben@amsterdamumc.nl %K perioperative care %K recovery %K feasibility %K convalescence %K patient-oriented %K surgery %K perioperative %K eHealth %K mHealth %K tailor %K customize %K patient care %K digital intervention %K health intervention %K patient education %K surgical care %K hospital care %K digital health %K perioperative medicine %K elective surgery %K technology %K caregiver %K mobile app %K digital care %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital. Objective: We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was “How well are patients able to use ikHerstel independently of their health care professional?” Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data. Results: Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients. Conclusions: In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals. %R 10.2196/58878 %U https://periop.jmir.org/2025/1/e58878 %U https://doi.org/10.2196/58878 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59540 %T Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial %A Katsushima,Masayuki %A Nakamura,Hideki %A Shiko,Yuki %A Hanaoka,Hideki %A Shimizu,Eiji %+ Department of Rehabilitation, Faculty of Health Care and Medical Sports, Teikyo Heisei University, 4-1 UruidoMinami, Ichihara, 290-0193, Japan, 81 436 74 6915, m.katsushima@thu.ac.jp %K schizophrenia %K randomized controlled trial %K cognitive behavioral therapy %K videoconference %K remote therapy %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. Objective: The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. Methods: In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). Results: The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was –9.5 (95% CI –12.09 to –6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. Conclusions: A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069734 %M 39610049 %R 10.2196/59540 %U https://formative.jmir.org/2025/1/e59540 %U https://doi.org/10.2196/59540 %U http://www.ncbi.nlm.nih.gov/pubmed/39610049 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55043 %T A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives %A Hemler,Jennifer R %A Wagner,Rachel B %A Sullivan,Brittany %A Macenat,Myneka %A Tagai,Erin K %A Vega,Jazmarie L %A Hernandez,Enrique %A Miller,Suzanne M %A Wen,Kuang-Yi %A Ayers,Charletta A %A Einstein,Mark H %A Hudson,Shawna V %A Kohler,Racquel E %+ Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 303 George St., Suite 301, Rm 305, New Brunswick, NJ, 08901, United States, 1 848 932 0209, hemlerje@rwjms.rutgers.edu %K cervical cancer screening %K colposcopy %K HPV %K human papillomavirus %K mHealth %K health communication %K qualitative research %K cancer screening %K cancer %K cervical cancer %K screening %K women %K clinic staff %K barrier %K messaging %K privacy %K text message %K qualitative %K colposcopic %K mhealth intervention %K mobile phone %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. Objective: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Methods: Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Results: Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Conclusions: Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial. %M 39808485 %R 10.2196/55043 %U https://formative.jmir.org/2025/1/e55043 %U https://doi.org/10.2196/55043 %U http://www.ncbi.nlm.nih.gov/pubmed/39808485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55042 %T The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial %A Khatib,Sewar %A Palgi,Yuval %A Ashar,Yoni K %A Polyvyannaya,Natalya %A Goldstein,Pavel %+ School of Public Health, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, 3103301, Israel, 972 48240519, pavelg@stat.haifa.ac.il %K Snoezelen room %K mental health %K sensory stimulation environment %K social support %K nursing homes %K older adults %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults’ chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults’ physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=–0.35, P=.003) and TS alone (B=–0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=–4.29, P<.0001) compared with SS (B=–2.38, P=.0042) and TS alone (B=–1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 %M 39808474 %R 10.2196/55042 %U https://www.jmir.org/2025/1/e55042 %U https://doi.org/10.2196/55042 %U http://www.ncbi.nlm.nih.gov/pubmed/39808474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58258 %T Determinants of Dropping Out of Remote Patient-Reported Outcome–Based Follow-Up Among Patients With Epilepsy: Prospective Cohort Study %A Vestergaard,Sofie Bech %A Roost,Mette %A Christiansen,David Høyrup %A Schougaard,Liv Marit Valen %K patient-reported outcome measures %K dropouts %K digital solutions %K outpatient care %K epilepsy %K seizure disorder %K neurological condition %K cohort study %K health care %K Denmark %K self-reported %K self-management %K mental health %K patient satisfaction %K logistic regression %K social support %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: The use of patient-reported outcome (PRO) measures is an emerging field in health care. In the Central Denmark Region, epilepsy outpatients can participate in remote PRO-based follow-up by completing a questionnaire at home instead of attending a traditional outpatient appointment. This approach aims to encourage patient engagement and is used in approximately half of all epilepsy outpatient consultations. However, dropout in this type of follow-up is a challenging issue. Objective: This study aimed to examine the association between potential self-reported determinants and dropout in remote PRO-based follow-up for patients with epilepsy. Methods: This prospective cohort study (n=2282) explored the association between dropout in remote PRO-based follow-up for patients with epilepsy and 9 potential determinants covering 3 domains: health-related self-management, general and mental health status, and patient satisfaction. The associations were examined using multiple logistic regression analyses with adjustment for sex, age, education, and cohabitation. Results: A total of 770 patients (33.7%) dropped out of remote PRO-based follow-up over 5 years. Statistically significant associations were identified between all potential determinants and dropouts in PRO-based follow-up. Patients with low social support had an odds ratio of 2.20 (95% CI 1.38-3.50) for dropout. Patients with poor health ratings had an odds ratio of 2.17 (95% CI 1.65-2.85) for dropout. Similar estimates were identified for the remaining determinants in question. Conclusions: Patients with reduced self-management, poor health status, and low patient satisfaction had higher odds of dropout in remote PRO-based follow-up. However, further research is needed to determine the reasons for dropout. %R 10.2196/58258 %U https://formative.jmir.org/2025/1/e58258 %U https://doi.org/10.2196/58258 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e56718 %T Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study %A Dunston,Emily R %A Oza,Sonal %A Bai,Yang %A Newton,Maria %A Podlog,Leslie %A Larson,Kish %A Walker,Darren %A Zingg,Rebecca W %A Hansen,Pamela A %A Coletta,Adriana M %K physical activity %K physical function %K telerehabilitation %K remote exercise %K digital health %K cancer survivors %K older adults %K smartphone %D 2025 %7 13.1.2025 %9 %J JMIR Cancer %G English %X Background: Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective: We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods: In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (≥65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results: Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65‐92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5%) and III (n=18, 26.5%) being the most common. A follow-up telehealth assessment was completed by 29.4% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions: Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings. %R 10.2196/56718 %U https://cancer.jmir.org/2025/1/e56718 %U https://doi.org/10.2196/56718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63568 %T Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study %A Kwek,Siong Peng %A Leong,Qiao Ying %A Lee,V Vien %A Lau,Ni Yin %A Vijayakumar,Smrithi %A Ng,Wei Ying %A Rai,Bina %A Raczkowska,Marlena Natalia %A Asplund,Christopher L %A Remus,Alexandria %A Ho,Dean %+ Yong Loo Lin School of Medicine, Heat Resilience & Performance Centre, National University of Singapore, 27 Medical Drive, #03-01, Singapore, 117510, Singapore, 65 66017766, alexandria.remus@nus.edu.sg %K older adults %K cognitive training %K digital therapeutic %K DTx %K remote %K usability %K acceptance %K interviews %K gerontology %K geriatric %K elderly %K experiences %K attitudes %K opinions %K perceptions %K perspectives %K interview %K cognition %K digital health %K qualitative %K thematic %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. %M 39805580 %R 10.2196/63568 %U https://formative.jmir.org/2025/1/e63568 %U https://doi.org/10.2196/63568 %U http://www.ncbi.nlm.nih.gov/pubmed/39805580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60447 %T Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study %A Rosin,Magda %A Ni Mhurchu,Cliona %A Umali,Elaine %A Mackay,Sally %+ Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 093737599 ext 88733, m.rosin@auckland.ac.nz %K healthy food policy %K policy implementation %K nutrition %K food environment %K hospital %K workplace %K web-based tool %K digital tool %K database %K user testing %K food %K drink %K nutrition professionals %K acceptability %K usability %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the “Discover” (understanding of current gaps) and “Define” (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the “Develop” phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final “Deliver” phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker—a searchable database of packaged food and drink products that classifies items according to the Policy’s nutritional criteria—was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool’s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool’s utility. %M 39805585 %R 10.2196/60447 %U https://formative.jmir.org/2025/1/e60447 %U https://doi.org/10.2196/60447 %U http://www.ncbi.nlm.nih.gov/pubmed/39805585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53460 %T Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study %A Ramkumar,Vidya %A Joshi B,Deepashree %A Prabhakar,Anil %A Hall,James W %A Vaidyanath,Ramya %+ Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Sri Ramachandra Nagar, Porur, Chennai, 600116, India, 91 9894170609, deepasrijoshi25@sriramachandra.edu.in %K audiometry %K mHealth %K devices %K wireless %K tablet-based screening %K childhood hearing loss %K early hearing detection and intervention %K tablets %K children %K neonates %K hearing loss %K infants %K development %K validation %K mobile phones %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry–screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task–screening for children 1 to 3 years old; and (3) speech recognition task–screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. %M 39805111 %R 10.2196/53460 %U https://formative.jmir.org/2025/1/e53460 %U https://doi.org/10.2196/53460 %U http://www.ncbi.nlm.nih.gov/pubmed/39805111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64191 %T A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study %A Fan,Heidi Sze Lok %A Leung,Emily Tsz Yan %A Lau,Ka Wing %A Wong,Janet Yuen Ha %A Choi,Edmond Pui Hang %A Lam,Christine %A Tarrant,Marie %A Ngan,Hextan Yuen Sheung %A Ip,Patrick %A Lin,Chia Chin %A Lok,Kris Yuet Wan %K Baby-Friendly Community Initiative %K Baby-Friendly Hospital Initiative %K breastfeeding %K community %K stakeholders %K mobile app %K friendly communities %K baby-friendly %K well-being %K mother %K infant %K application %K mHealth %K qualitative %K user-friendly %K self-management %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called “bfGPS” (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged—bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant’s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app’s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. %R 10.2196/64191 %U https://formative.jmir.org/2025/1/e64191 %U https://doi.org/10.2196/64191 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e59478 %T A Novel Telehealth Exercise Program Designed for Rural Survivors of Cancer With Cancer-Related Fatigue: Single-Arm Feasibility Trial %A Marker,Ryan J %A Kittelson,Andrew J %A Scorsone,Jared J %A Moran,Ian A %A Quindry,John C %A Leach,Heather J %+ Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12348 E Montview Boulevard, Aurora, CO, 80045, United States, 1 13037240819, ryan.marker@cuanschutz.edu %K cancer-related fatigue %K telehealth %K physical activity %K survivorship %K digital health %K lifestyle intervention %K videoconference %K symptom burden %K symptom monitoring %K geographic disparities %K mHealth %D 2025 %7 10.1.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural survivors of cancer, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs. Objective: The purpose of this investigation was to assess the feasibility of a novel telehealth exercise program designed specifically for rural survivors of cancer with CRF. Methods: A single-arm clinical trial of the BfitBwell Telehealth Program was performed. Based on an established clinical program, this adapted 12-week program addressed barriers previously reported by rural survivors by providing synchronous videoconference exercise sessions (2 per program), asynchronous exercise sessions using a personal training smartphone or internet app (3-5 per week), and regular symptom (CRF) monitoring using automated emailed surveys (every 2 weeks). Personalized exercise prescriptions containing aerobic and resistance activities were implemented by cancer exercise specialists. Symptom-triggered synchronous sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements observed during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by objective measures of recruitment, data collection, intervention acceptability and suitability, and preliminary evaluations of participant responses. CRF was the primary clinical outcome (assessed using the Functional Assessment of Chronic Illness Therapy—Fatigue Scale [FACIT-Fatigue]) and was measured before, after, and 6 months after program completion. Results: In total, 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. A total of 14 participants were recruited through internet advertisements, and the total recruitment rate peaked at 5 participants per month. Participants completed 100% of initial and final assessments (30 assessments across all participants) and 93% (70/75 possible surveys across all participants) of emailed surveys and attended 97% (29/30 possible sessions across all participants) of synchronous exercise sessions. In total, 6 participants initiated symptom-triggered sessions, with 6 of 7 initiated sessions attended. The mean FACIT-Fatigue scores significantly improved (P=.001) by 11.2 (SD 6.8) points following the completion of the program. A total of 13 participants demonstrated at least a minimal clinically important difference in FACIT-Fatigue scores (≥ +3 points) at this time. FACIT-Fatigue scores did not significantly change from program completion to 6-month follow-up (n=13; mean change –1.1, SD 3.4 points; P=.29). Conclusions: Results from this investigation support the feasibility of the BfitBwell Telehealth Program and a subsequent efficacy trial. Novel program components also provide potential models for improving exercise program efficacy and efficiency through asynchronous exercise prescription and symptom monitoring. Trial Registration: ClinicalTrials.gov NCT04533165; https://clinicaltrials.gov/study/NCT04533165 %M 39793972 %R 10.2196/59478 %U https://cancer.jmir.org/2025/1/e59478 %U https://doi.org/10.2196/59478 %U http://www.ncbi.nlm.nih.gov/pubmed/39793972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58421 %T Predicting Age and Visual-Motor Integration Using Origami Photographs: Deep Learning Study %A Huang,Chien-Yu %A Yu,Yen-Ting %A Chen,Kuan-Lin %A Lien,Jenn-Jier %A Lin,Gong-Hong %A Hsieh,Ching-Lin %K artificial intelligence %K origami %K child development screening %K child development %K visual motor integration %K children %K developmental status %K activity performance %K deep learning %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Origami is a popular activity among preschool children and can be used by therapists as an evaluation tool to assess children’s development in clinical settings. It is easy to implement, appealing to children, and time-efficient, requiring only simple materials—pieces of paper. Furthermore, the products of origami may reflect children’s ages and their visual-motor integration (VMI) development. However, therapists typically evaluate children’s origami creations based primarily on their personal background knowledge and clinical experience, leading to subjective and descriptive feedback. Consequently, the effectiveness of using origami products to determine children’s age and VMI development lacks empirical support. Objective: This study had two main aims. First, we sought to apply artificial intelligence (AI) techniques to origami products to predict children’s ages and VMI development, including VMI level (standardized scores) and VMI developmental status (typical, borderline, or delayed). Second, we explored the performance of the AI models using all combinations of photographs taken from different angles. Methods: A total of 515 children aged 2-6 years were recruited and divided into training and testing groups at a 4:1 ratio. Children created origami dogs, which were photographed from 8 different angles. The Beery–Buktenica Developmental Test of Visual-Motor Integration, 6th Edition, was used to assess the children’s VMI levels and developmental status. Three AI models—ResNet-50, XGBoost, and a multilayer perceptron—were combined sequentially to predict age z scores and VMI z scores using the training group. The trained models were then tested using the testing group, and the accuracy of the predicted VMI developmental status was also calculated. Results: The R2 of the age and the VMI trained models ranged from 0.50 to 0.73 and from 0.50 to 0.66, respectively. The AI models that obtained an R2>0.70 for the age model and an R2>0.60 for the VMI model were selected for model testing. Those models were further examined for the accuracy of the VMI developmental status, the correlations, and the mean absolute error (MAE) of both the age and the VMI models. The accuracy of the VMI developmental status was about 71%-76%. The correlations between the final predicted age z score and the real age z score ranged from 0.84 to 0.85, and the correlations of the final predicted VMI z scores to the real z scores ranged from 0.77 to 0.81. The MAE of the age models ranged from 0.42 to 0.46 and those of the VMI models ranged from 0.43 to 0.48. Conclusion: Our findings indicate that AI techniques have a significant potential for predicting children’s development. The insights provided by AI may assist therapists in better interpreting children’s performance in activities. %R 10.2196/58421 %U https://formative.jmir.org/2025/1/e58421 %U https://doi.org/10.2196/58421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59261 %T Analysis of Social Performance and Action Units During Social Skills Training: Focus Group Study of Adults With Autism Spectrum Disorder and Schizophrenia %A Tanaka,Hiroki %A Miyamoto,Kana %A Hamet Bagnou,Jennifer %A Prigent,Elise %A Clavel,Céline %A Martin,Jean-Claude %A Nakamura,Satoshi %K social performance rating scale %K social skills training %K autism spectrum disorder %K schizophrenia %K facial expressions %K social %K autism %K training %K communication %K trainers %K tool %K neurological %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Social communication is a crucial factor influencing human social life. Quantifying the degree of difficulty faced in social communication is necessary for understanding developmental and neurological disorders and for creating systems used in automatic symptom screening and assistive methods such as social skills training (SST). SST by a human trainer is a well-established method. Previous SST used a modified roleplay test to evaluate human social communication skills. However, there are no widely accepted evaluation criteria or social behavioral markers to quantify social performance during SST. Objective: This paper has 2 objectives. First, we propose applying the Social Performance Rating Scale (SPRS) to SST data to measure social communication skills. We constructed a Japanese version of the SPRS already developed in English and French. Second, we attempt to quantify action units during SST for people with autism spectrum disorder (ASD) or schizophrenia. Methods: We used videos of interactions between trainers, adults with ASD (n=16) or schizophrenia (n=15), and control participants (n=19) during SST sessions. Two raters applied the proposed scale to annotate the collected data. We investigated the differences between roleplay tasks and participant groups (ASD, schizophrenia, and control). Furthermore, the intensity of action units on the OpenFace toolkit was measured in terms of mean and SD during SST roleplaying. Results: We found significantly greater gaze scores in adults with ASD than in adults with schizophrenia. Differences were also found between the ratings of different tasks in the adults with schizophrenia and the control participants. Action units numbered AU06 and AU12 were significantly deactivated in people with schizophrenia compared with the control group. Moreover, AU02 was significantly activated in people with ASD compared with the other groups. Conclusions: The results suggest that the SPRS can be a useful tool for assessing social communication skills in different cultures and different pathologies when used with the modified roleplay test. Furthermore, facial expressions could provide effective social and behavioral markers to characterize psychometric properties. Possible future directions include using the SPRS for assessing social behavior during interaction with a digital agent. %R 10.2196/59261 %U https://formative.jmir.org/2025/1/e59261 %U https://doi.org/10.2196/59261 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e62711 %T Design and Use of Patient-Facing Electronic Patient-Reported Outcomes and Sensor Data Visualizations During Outpatient Chemotherapy %A Bartel,Christianna %A Chen,Leeann %A Huang,Weiyu %A Li,Qichang %A Li,Qingyang %A Fedor,Jennifer %A Durica,Krina C %A Low,Carissa A %K oncology %K cancer %K data visualization %K remote monitoring %K mobile technology %K patients %K outpatient %K chemotherapy %K symptoms %K side effects %K cancer treatment %K electronic patient-reported outcome %K online %K monitoring %K self-management %D 2025 %7 10.1.2025 %9 %J JMIR Cancer %G English %X This study describes patients’ interaction with a personalized web-based visualization displaying daily electronic patient-reported outcomes and wearable device data during outpatient chemotherapy. %R 10.2196/62711 %U https://cancer.jmir.org/2025/1/e62711 %U https://doi.org/10.2196/62711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64137 %T Impact of a Virtual Care Navigation Service on Member-Reported Outcomes Among Lesbian, Gay, Bisexual, Transgender, and Queer Populations: Case Study %A Choi,Seul Ki %A Marshall,Jaclyn %A Sexton Topper,Patrina %A Pregnall,Andrew %A Bauermeister,José %K health care navigation %K LGBTQ+ %K lesbian %K gay %K bisexual %K transgender %K queer %K access to care %K care avoidance %K identity-affirming care %K minority %K stress %K stigma %K health outcomes %D 2025 %7 9.1.2025 %9 %J JMIR Form Res %G English %X Background: While the significance of care navigation in facilitating access to health care within the lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) communities has been acknowledged, there is limited research examining how care navigation influences an individual’s ability to understand and access the care they need in real-world settings. By analyzing private sector data, we can bridge the gap between theoretical research findings and practical applications, ultimately informing both business strategies and public policy with evidence grounded in real-world efficacy. Objective: The objective of this study was to evaluate the impact of specialized virtual care navigation services on LGBTQ+ individuals’ ability to comprehend and access necessary care within a national cohort of commercially insured members. Methods: This case study is based on the experience of commercially insured members, aged 18 or older, who used the LGBTQ+ Health Care Navigation (LGBTQ+ Navigation) service by Included Health between January 26 and July 31, 2023. Care coordinators assisted members by connecting them with vetted identity-affirming in-network providers, helping them navigate and understand their LGBTQ+ health benefits, and providing education and advocacy for clinical and nonclinical needs. We examined the impact of navigation on 5 member-reported outcomes. In addition to reporting the proportion who agreed or strongly agreed, we calculated an impact score that averaged assigned numerical values to all 5 question responses (1=strongly disagree to 5=strongly agree) for each respondent. We used ANOVA with Tukey post hoc tests and t tests to explore the relationships between the impact score and member characteristics, including optional self-reported demographics. Results: Out of 4703 LGBTQ+ Navigation cases, 7.53% (n=354) had member-reported outcomes. A large majority of LGBTQ+ members agreed or strongly agreed that care navigation resulted in less stress (315/354, 89%), less care avoidance (305/354, 86.2%), higher confidence in finding an identity-affirming provider (327/354, 92.4%), improved ability to comprehend health care information (312/354, 88.1%), and improved ability to engage with providers (308/354, 87%). The average impact score was 4.44 (SD 0.69), with statistically significant differences by gender identity (P=.003), race (P=.01), ethnicity (P=.008), and pronouns (P=.02). The scores were highest for members with multiple gender identities (mean 4.56, SD 0.37), and members who did not provide their race, ethnicity, or their pronouns (mean 4.55, SD 0.64). Impact scores were lowest for transgender members (mean 4.11, SD 0.95). Conclusions: The LGBTQ+ Navigation service, by enhancing members’ comprehension and use of necessary care, demonstrates potential public health utility and value. Continuous evaluation of navigation services can serve as a supplementary tool for employers seeking to promote health equity and improve belonging among employees. This is particularly important as discrimination and stigma against LGBTQ+ communities persist in the United States. Therefore, scalable and system-level changes that use navigation services are essential to reach a larger proportion of the LGBTQ+ population. %R 10.2196/64137 %U https://formative.jmir.org/2025/1/e64137 %U https://doi.org/10.2196/64137 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e65981 %T Efficacy of Unsupervised YouTube Dance Exercise for Patients With Hypertension: Randomized Controlled Trial %A Sakairi,Mizuki %A Miyagami,Taiju %A Tabata,Hiroki %A Yanagisawa,Naotake %A Saita,Mizue %A Suzuki,Mai %A Fujibayashi,Kazutoshi %A Fukuda,Hiroshi %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 338133111, tmiyaga@juntendo.ac.jp %K dance %K video %K exercise therapy %K hypertension %K blood pressure therapy %K YouTube %K mHealth %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure (BP) is linked to unhealthy lifestyles, and its treatment includes medications and exercise therapy. Many previous studies have evaluated the effects of exercise on BP improvement; however, exercise requires securing a location, time, and staff, which can be challenging in clinical settings. The antihypertensive effects of dance exercise for patients with hypertension have already been verified, and it has been found that adherence and dropout rates are better compared to other forms of exercise. If the burden of providing dance instruction is reduced, dance exercise will become a highly useful intervention for hypertension treatment. Objective: This study aims to investigate the effects of regular exercise therapy using dance videos on the BP of patients with hypertension, with the goal of providing a reference for prescribing exercise therapy that is highly feasible in clinical settings. Methods: This nonblind, double-arm, randomized controlled trial was conducted at Juntendo University, Tokyo, from April to December 2023. A total of 40 patients with hypertension were randomly assigned to either an intervention group (dance) or a control group (self-selected exercise), with each group comprising 20 participants. The intervention group performed daily dance exercises using street dance videos (10 min per video) uploaded to YouTube. The control group was instructed to choose any exercise other than dance and perform it for 10 minutes each day. The activity levels of the participants were monitored using a triaxial accelerometer. BP and body composition were measured on the day of participation and after 2 months. During the intervention period, we did not provide exercise instruction or supervise participants’ activities. Results: A total of 34 patients were included in the study (16 in the intervention group and 18 in the control group). The exclusion criteria were the absence of BP data, medication changes, or withdrawal from the study. The mean age was 56 (SD 9.8) years, and 18 (53%) of the patients were female. The mean BMI was 28.0 (SD 6.3) m/kg2, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 139.5 (SD 17.1) mm Hg and 85.8 (SD 9.1) mm Hg, respectively. The basic characteristics did not differ between the two groups. In the multivariate analysis, SBP and DBP improved significantly in the intervention group compared to the control group (mean SBP –12.8, SD 6.1 mm Hg; P=.047; mean DBP –9.7, SD 3.3 mm Hg; P=.006). Conclusions: This study evaluated the effects of dance exercise on patients with hypertension, as previously verified, under the additional condition of using dance videos without direct staff instruction or supervision. The results showed that dance videos were more effective in lowering BP than conventional exercise prescriptions. Trial Registration: University Hospital Medical Information Network UMIN 000051251; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058446 %M 39787590 %R 10.2196/65981 %U https://cardio.jmir.org/2025/1/e65981 %U https://doi.org/10.2196/65981 %U http://www.ncbi.nlm.nih.gov/pubmed/39787590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63948 %T User Outcomes for an App-Delivered Hypnosis Intervention for Menopausal Hot Flashes: Retrospective Analysis %A Scheffrahn,Katherine %A Hall,Claire %A Muñiz,Vanessa %A Elkins,Gary %+ Mind-Body Medicine Lab, Department of Psychology and Neuroscience, Baylor University, 801 Washington Ave, Waco, TX, 76701, United States, 1 254 296 0824, gary_elkins@baylor.edu %K hypnosis %K hypnotherapy %K hot flash %K menopause %K women’s health %K gynecology %K smartphone app %K applications %K mobile health %K mHealth %K user %K outcome %K intervention %K alternative %K complementary %K mind-body %K mobile phone %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypnotherapy has been shown to be a safe, nonhormonal intervention effective for treating menopausal hot flashes. However, women experiencing hot flashes may face accessibility barriers to in-person hypnotherapy. To solve this issue, a smartphone app has been created to deliver hypnotherapy. The Evia app delivers audio-recorded hypnotherapy and has the potential to help individuals experiencing hot flashes. Objective: This study aims to determine user outcomes in hot flash frequency and severity for users of the Evia app. Methods: This study is a retrospective analysis of a dataset of Evia app users. Participants were divided into 2 groups for analysis. The first group reported daytime hot flashes and night sweats, while the second group was asked to report only daytime hot flashes. The participants in the first group (daytime hot flashes and night sweats) were 139 women with ≥3 daily hot flashes who downloaded the Evia app between November 6, 2021, and June 9, 2022, with a baseline mean of 8.330 (SD 3.977) daily hot flashes. The participants in the second group (daytime hot flashes) were 271 women with ≥3 daily hot flashes who downloaded the Evia app between June 10, 2022, and February 5, 2024, with a baseline mean of 6.040 (SD 3.282) daily hot flashes. The Evia program included a 5-week program for all participants with daily tasks such as educational readings, hypnotic inductions, and daily hot-flash tracking. The app uses audio-recorded hypnosis and mental imagery for coolness, such as imagery for a cool breeze, snow, or calmness. Results: A clinically significant reduction, defined as a 50% reduction, in daily hot flashes was experienced by 76.3% (106/139) of the women with hot flashes and night sweats and 56.8% (154/271) of the women with daily hot flashes from baseline to their last logged Evia app survey. On average, the women with hot flashes and night sweats experienced a reduction of 61.4% (SD 33.185%) in their hot flashes experienced at day and night while using the Evia app, and the women with daily hot flashes experienced a reduction of 45.2% (SD 42.567%) in their daytime hot flashes. In both groups, there was a large, statistically significant difference in the average number of daily hot flashes from baseline to end point (women with hot flashes and night sweats: Cohen d=1.28; t138=15.055; P<.001; women with daily hot flashes: Cohen d=0.82; t270=13.555; P<.001). Conclusions: Hypnotherapy is an efficacious intervention for hot flashes, with the potential to improve women’s lives by reducing hot flashes without hormonal or pharmacological intervention. This study takes the first step in evaluating the efficacy of an app-delivered hypnosis intervention for menopausal hot flashes, demonstrating the Evia app provides a promising app delivery of hypnotherapy with potential to increase accessibility to hypnotherapy. %M 39787588 %R 10.2196/63948 %U https://formative.jmir.org/2025/1/e63948 %U https://doi.org/10.2196/63948 %U http://www.ncbi.nlm.nih.gov/pubmed/39787588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65139 %T Comparative Evaluation of Consumer Wearable Devices for Atrial Fibrillation Detection: Validation Study %A Wouters,Femke %A Gruwez,Henri %A Smeets,Christophe %A Pijalovic,Anessa %A Wilms,Wouter %A Vranken,Julie %A Pieters,Zoë %A Van Herendael,Hugo %A Nuyens,Dieter %A Rivero-Ayerza,Maximo %A Vandervoort,Pieter %A Haemers,Peter %A Pison,Laurent %K atrial fibrillation %K AF %K mobile health %K photoplethysmography %K electrocardiography %K smartphone %K consumer wearable device %K wearable devices %K detection %K electrocardiogram %K ECG %K mHealth %D 2025 %7 9.1.2025 %9 %J JMIR Form Res %G English %X Background: Consumer-oriented wearable devices (CWDs) such as smartphones and smartwatches have gained prominence for their ability to detect atrial fibrillation (AF) through proprietary algorithms using electrocardiography or photoplethysmography (PPG)–based digital recordings. Despite numerous individual validation studies, a direct comparison of interdevice performance is lacking. Objective: This study aimed to evaluate and compare the ability of CWDs to distinguish between sinus rhythm and AF. Methods: Patients exhibiting sinus rhythm or AF were enrolled through a cardiology outpatient clinic. The participants were instructed to perform heart rhythm measurements using a handheld 6-lead electrocardiogram (ECG) device (KardiaMobile 6L), a smartwatch-derived single-lead ECG (Apple Watch), and two PPG-based smartphone apps (FibriCheck and Preventicus) in a random sequence, with simultaneous 12-lead reference ECG as the gold standard. Results: A total of 122 participants were included in the study: median age 69 (IQR 61-77) years, 63.9% (n=78) men, 25% (n=30) with AF, 9.8% (n=12) without prior smartphone experience, and 73% (n=89) without experience in using a smartwatch. The sensitivity to detect AF was 100% for all devices. The specificity to detect sinus rhythm was 96.4% (95% CI 89.5%-98.8%) for KardiaMobile 6L, 97.8% (95% CI 91.6%‐99.5%) for Apple Watch, 98.9% (95% CI 92.5%‐99.8%) for FibriCheck, and 97.8% (95% CI 91.5%‐99.4%) for Preventicus (P=.50). Insufficient quality measurements were observed in 10.7% (95% CI 6.3%-17.5%) of cases for both KardiaMobile 6L and Apple Watch, 7.4% (95% CI 3.9%‐13.6%) for FibriCheck, and 14.8% (95% CI 9.5%‐22.2%) for Preventicus (P=.21). Participants preferred Apple Watch over the other devices to monitor their heart rhythm. Conclusions: In this study population, the discrimination between sinus rhythm and AF using CWDs based on ECG or PPG was highly accurate, with no significant variations in performance across the examined devices. Trial Registration: ClinicalTrials.gov NCT06023290; https://clinicaltrials.gov/study/NCT06023290 %R 10.2196/65139 %U https://formative.jmir.org/2025/1/e65139 %U https://doi.org/10.2196/65139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59605 %T Effect of a Narrative-Based Online Course Aimed at Reducing Stigma Toward Transgender Children and Adolescents: Longitudinal Observational Study %A Greuel,Merlin %A Nguyen,Van Kinh %A Amsalem,Doron %A Adam,Maya %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 6221565344, greuel@stud.uni-heidelberg.de %K stigma %K transgender %K children %K adolescents %K mental health %K online course evaluation %K entertainment-education %K narratives %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Stigma toward transgender children and adolescents negatively impacts their health and educational outcomes. Contact with members of stigmatized groups can dismantle stereotypes and reduce stigma by facilitating exposure to the unique cognitive and emotional perspectives of individuals within the group. Recent evidence suggests that video-based contact interventions can be as effective as face-to-face encounters, but challenges lie in protecting the identities of transgender youth, since many of them live in stealth. Objective: This study aims to evaluate the impact of an animated online course, rooted in authentic, personal narratives, on course participants’ stigma toward transgender youth. Methods: The online course was offered free of charge on Coursera and contained 19 teaching videos (3-7 minutes each), intermittent practice quizzes, and discussion prompts. Using real voice recordings of transgender children and their caregivers, the videos were designed to elicit empathy and transmit knowledge. All videos conveying the narratives of transgender youth were animated to protect their identities. A total of 447 course participants, distributed around the globe, completed pre- and postcourse surveys. While the course primarily targeted parents and caregivers of transgender youth, it was open to anyone with a Coursera account. The survey was based on the Transgender Attitudes and Beliefs Scale but modified to reflect the context of parents and caregivers. Using a 5-point Likert scale, it contained 5 questions that captured participants’ levels of transgender stigma. Results of the pre- and postcourse surveys were then compared. Results: The results were obtained in January 2023. Baseline levels of stigma were relatively low (18/25 across all questions, with 25 representing the lowest possible levels of stigma) and decreased further after completion of the course (to 19/25 across all questions, P<.001). A multivariate ordinal probit regression showed that, depending on the question, participants were 7%-34% more likely to endorse statements that indicated the lowest levels of stigma after completing the course. The course was equally effective across all demographics represented in our participant population. Conclusions: Our findings document a significant reduction in stigma toward transgender youth in participants who chose to enroll in the first animated, open online gender health course, rooted in the authentic narratives of transgender youth. Stigma levels decreased significantly after taking the course, even among participants whose baseline levels of stigma were low. Future interventions should include participants with more variable baseline levels of stigma, ideally in the setting of a randomized controlled trial. Despite its limitations, this evaluation adds to the existing evidence that digital, contact-based antistigma interventions, animated to protect the identity of the narrators, can effectively reduce stigma toward transgender youth. %M 39786893 %R 10.2196/59605 %U https://formative.jmir.org/2025/1/e59605 %U https://doi.org/10.2196/59605 %U http://www.ncbi.nlm.nih.gov/pubmed/39786893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67272 %T Development of Personas and Journey Maps for Artificial Intelligence Agents Supporting the Use of Health Big Data: Human-Centered Design Approach %A Lee,Yoon Heui %A Choi,Hanna %A Lee,Soo-Kyoung %+ Big Data Convergence and Open Sharing System, Seoul National University, 1 Gwanak-ro, Seoul, 08826, Republic of Korea, 82 880 2344, soo1005@snu.ac.kr %K analysis %K health big data %K human-centered design %K persona %K user journey map %K artificial intelligence %K human-AI %K interviews %K users’ experiences %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid proliferation of artificial intelligence (AI) requires new approaches for human-AI interfaces that are different from classic human-computer interfaces. In developing a system that is conducive to the analysis and use of health big data (HBD), reflecting the empirical characteristics of users who have performed HBD analysis is the most crucial aspect to consider. Recently, human-centered design methodology, a field of user-centered design, has been expanded and is used not only to develop types of products but also technologies and services. Objective: This study was conducted to integrate and analyze users’ experiences along the HBD analysis journey using the human-centered design methodology and reflect them in the development of AI agents that support future HBD analysis. This research aims to help accelerate the development of novel human-AI interfaces for AI agents that support the analysis and use of HBD, which will be urgently needed in the near future. Methods: Using human-centered design methodology, we collected data through shadowing and in-depth interviews with 16 people with experience in analyzing and using HBD. We identified users’ empirical characteristics, emotions, pain points, and needs related to HBD analysis and use and created personas and journey maps. Results: The general characteristics of participants (n=16) were as follows: the majority were in their 40s (n=6, 38%) and held a PhD degree (n=10, 63%). Professors (n=7, 44%) and health care personnel (n=10, 63%) represented the largest professional groups. Participants’ experiences with big data analysis varied, with 25% (n=4) being beginners and 38% (n=6) having extensive experience. Common analysis methods included statistical analysis (n=7, 44%) and data mining (n=6, 38%). Qualitative findings from shadowing and in-depth interviews revealed key challenges: lack of knowledge on using analytical solutions, crisis management difficulties during errors, and inadequate understanding of health care data and clinical decision-making, especially among non–health care professionals. Three types of personas and journey maps—health care professionals as big data analysis beginners, health care professionals who have experience in big data analytics, and non–health care professionals who are experts in big data analytics—were derived. They showed a need for personalized platforms tailored to the user level, appropriate direction through a navigation function, a crisis management support system, communication and sharing among users, and expert linkage service. Conclusions: The knowledge obtained from this study can be leveraged in designing an AI agent to support future HBD analysis and use. This is expected to further increase the usability of HBD by helping users perform effective use of HBD more easily. %M 39778198 %R 10.2196/67272 %U https://formative.jmir.org/2025/1/e67272 %U https://doi.org/10.2196/67272 %U http://www.ncbi.nlm.nih.gov/pubmed/39778198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62910 %T Testing the Recruitment Frequency, Implementation Fidelity, and Feasibility of Outcomes of the Heart Failure Activity Coach Study (HEALTHY): Pilot Randomized Controlled Trial %A Blomqvist,Andreas %A Bäck,Maria %A Klompstra,Leonie %A Strömberg,Anna %A Jaarsma,Tiny %+ Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, Linköping, SE-581 83, Sweden, 46 739617729, andreas.blomqvist@liu.se %K heart failure %K disease management %K physical activity %K sedentary %K older adults %K aging %K mobile health %K mHealth %K feasibility %K quality of life %K digital health %K smartphone %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). Objective: We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. Methods: In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants’ electronic health records (EHRs). Results: We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants’ daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was –1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was –9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). Conclusions: The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. Trial Registration: ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763 %M 39778202 %R 10.2196/62910 %U https://formative.jmir.org/2025/1/e62910 %U https://doi.org/10.2196/62910 %U http://www.ncbi.nlm.nih.gov/pubmed/39778202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62740 %T Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study %A Schneider,Tim %A Cetin,Timur %A Uppenkamp,Stefan %A Weyhe,Dirk %A Muender,Thomas %A Reinschluessel,Anke V %A Salzmann,Daniela %A Uslar,Verena %+ University Hospital for Visceral Surgery, PIUS-Hospital, Department for Human Medicine, Faculty VI, University of Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 4412292922, tim.schneider@uol.de %K workload measurement %K virtual reality %K VR %K augmented reality %K AR %K electroencephalography %K EEG %K event-related potential %K ERP %K auditory evoked potential %K AEP %K oddball experiment %K National Aeronautics and Space Administration Task Load Index %K NASA-TLX %K surgical planning %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of advanced technologies such as augmented reality (AR) and virtual reality (VR) into surgical procedures has garnered significant attention. However, the introduction of these innovations requires thorough evaluation in the context of human-machine interaction. Despite their potential benefits, new technologies can complicate surgical tasks and increase the cognitive load on surgeons, potentially offsetting their intended advantages. It is crucial to evaluate these technologies not only for their functional improvements but also for their impact on the surgeon’s workload in clinical settings. A surgical team today must increasingly navigate advanced technologies such as AR and VR, aiming to reduce surgical trauma and enhance patient safety. However, each innovation needs to be evaluated in terms of human-machine interaction. Even if an innovation appears to bring advancements to the field it is applied in, it may complicate the work and increase the surgeon’s workload rather than benefiting the surgeon. Objective: This study aims to establish a method for objectively determining the additional workload generated using AR or VR glasses in a clinical context for the first time. Methods: Electroencephalography (EEG) signals were recorded using a passive auditory oddball paradigm while 9 participants performed surgical planning for liver resection across 3 different conditions: (1) using AR glasses, (2) VR glasses, and (3) the conventional planning software on a computer. Results: The electrophysiological results, that is, the potentials evoked by the auditory stimulus, were compared with the subjectively perceived stress of the participants, as determined by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions. The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses. In addition, EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition. For the P1 component, the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms). Conclusions: The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model. Additionally, the alignment between subjectively determined results and objectively determined results confirms the validity of the study design applied in this research. %M 39773449 %R 10.2196/62740 %U https://formative.jmir.org/2025/1/e62740 %U https://doi.org/10.2196/62740 %U http://www.ncbi.nlm.nih.gov/pubmed/39773449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58650 %T Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study %A Bierbooms,Joyce J P A %A Sluis-Thiescheffer,Wouter R J W %A Feijt,Milou Anne %A Bongers,Inge M B %+ Tilburg University, PO box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 31 39, j.j.p.a.bierbooms@tilburguniversity.edu %K serious gaming %K mental health care professionals %K e-mental health %K skill enhancement %K training %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals. Objective: This study aims to co-design an escape room for training mental health care professionals’ eMH skills and test the escape room’s usability by exploring their experiences with this concept as a training method. Methods: This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice. Results: An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game’s complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training. Conclusions: We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals’ clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals. %M 39773391 %R 10.2196/58650 %U https://formative.jmir.org/2025/1/e58650 %U https://doi.org/10.2196/58650 %U http://www.ncbi.nlm.nih.gov/pubmed/39773391 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57624 %T The Trifecta of Industry, Academic, and Health System Partnership to Improve Mental Health Care Through Smartphone-Based Remote Patient Monitoring: Development and Usability Study %A Epperson,C Neill %A Davis,Rachel %A Dempsey,Allison %A Haller,Heinrich C %A Kupfer,David J %A Love,Tiffany %A Villarreal,Pamela M %A Matthews,Mark %A Moore,Susan L %A Muller,Kimberly %A Schneck,Christopher D %A Scott,Jessica L %A Zane,Richard D %A Frank,Ellen %+ Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Suite 4003, Mail Stop F546, Aurora, CO, 80045, United States, 1 303 724 4940, neill.epperson@cuanschutz.edu %K digital health %K mobile intervention %K telepsychiatry %K artificial intelligence %K psychiatry %K mental health %K depression %K mood %K bipolar %K monitor %K diagnostic tool %K diagnosis %K electronic health record %K EHR %K alert %K notification %K prediction %K mHealth %K mobile health %K smartphone %K passive %K self-reported %K patient generated %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health treatment is hindered by the limited number of mental health care providers and the infrequency of care. Digital mental health technology can help supplement treatment by remotely monitoring patient symptoms and predicting mental health crises in between clinical visits. However, the feasibility of digital mental health technologies has not yet been sufficiently explored. Rhythms, from the company Health Rhythms, is a smartphone platform that uses passively acquired smartphone data with artificial intelligence and predictive analytics to alert patients and providers to an emerging mental health crisis. Objective: The objective of this study was to test the feasibility and acceptability of Rhythms among patients attending an academic psychiatric outpatient clinic. Methods: Our group embedded Rhythms into the electronic health record of a large health system. Patients with a diagnosis of major depressive disorder, bipolar disorder, or other mood disorder were contacted online and enrolled for a 6-week trial of Rhythms. Participants provided data by completing electronic surveys as well as by active and passive use of Rhythms. Emergent and urgent alerts were monitored and managed according to passively collected data and patient self-ratings. A purposively sampled group of participants also participated in qualitative interviews about their experience with Rhythms at the end of the study. Results: Of the 104 participants, 89 (85.6%) completed 6 weeks of monitoring. The majority of the participants were women (72/104, 69.2%), White (84/104, 80.8%), and non-Hispanic (100/104, 96.2%) and had a diagnosis of major depressive disorder (71/104, 68.3%). Two emergent alerts and 19 urgent alerts were received and managed according to protocol over 16 weeks. More than two-thirds (63/87, 72%) of those participating continued to use Rhythms after study completion. Comments from participants indicated appreciation for greater self-awareness and provider connection, while providers reported that Rhythms provided a more nuanced understanding of patient experience between clinical visits. Conclusions: Rhythms is a user-friendly, electronic health record–adaptable, smartphone-based tool that provides patients and providers with a greater understanding of patient mental health status. Integration of Rhythms into health systems has the potential to facilitate mental health care and improve the experience of both patients and providers. %M 39773396 %R 10.2196/57624 %U https://formative.jmir.org/2025/1/e57624 %U https://doi.org/10.2196/57624 %U http://www.ncbi.nlm.nih.gov/pubmed/39773396 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e49585 %T Differences in eHealth Access, Use, and Perceived Benefit Between Different Socioeconomic Groups in the Dutch Context: Secondary Cross-Sectional Study %A Standaar,Lucille %A van Tuyl,Lilian %A Suijkerbuijk,Anita %A Brabers,Anne %A Friele,Roland %+ Department of Population Health and Health Services Research, Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, PO Box 1, Bilthoven, 3723 BA, Netherlands, 31 302743243, lucille.standaar@rivm.nl %K eHealth %K digital divide %K socioeconomic factors %K education %K income %K neighborhood %K health disparities %K cross-sectional studies %K digital health care %K health equity %K Netherlands %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables—education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators—education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups. %R 10.2196/49585 %U https://formative.jmir.org/2025/1/e49585 %U https://doi.org/10.2196/49585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64936 %T Real-Time Analytics and AI for Managing No-Show Appointments in Primary Health Care in the United Arab Emirates: Before-and-After Study %A AlSerkal,Yousif Mohamed %A Ibrahim,Naseem Mohamed %A Alsereidi,Aisha Suhail %A Ibrahim,Mubaraka %A Kurakula,Sudheer %A Naqvi,Sadaf Ahsan %A Khan,Yasir %A Oottumadathil,Neema Preman %K electronic health record %K EHR %K artificial intelligence %K AI %K no-show appointments %K real-time data %K primary health care %K risk prediction %K clinic waiting time %K operational efficiency %D 2025 %7 6.1.2025 %9 %J JMIR Form Res %G English %X Background: Primary health care (PHC) services face operational challenges due to high patient volumes, leading to complex management needs. Patients access services through booked appointments and walk-in visits, with walk-in visits often facing longer waiting times. No-show appointments are significant contributors to inefficiency in PHC operations, which can lead to an estimated 3%-14% revenue loss, disrupt resource allocation, and negatively impact health care quality. Emirates Health Services (EHS) PHC centers handle over 140,000 visits monthly. Baseline data indicate a 21% no-show rate and an average patient wait time exceeding 16 minutes, necessitating an advanced scheduling and resource management system to enhance patient experiences and operational efficiency. Objective: The objective of this study was to evaluate the impact of an artificial intelligence (AI)-driven solution that was integrated with an interactive real-time data dashboard on reducing no-show appointments and improving patient waiting times at the EHS PHCs. Methods: This study introduced an innovative AI-based data application to enhance PHC efficiency. Leveraging our electronic health record system, we deployed an AI model with an 86% accuracy rate to predict no-shows by analyzing historical data and categorizing appointments based on no-show risk. The model was integrated with a real-time dashboard to monitor patient journeys and wait times. Clinic coordinators used the dashboard to proactively manage high-risk appointments and optimize resource allocation. The intervention was assessed through a before-and-after comparison of PHC appointment dynamics and wait times, analyzing data from 135,393 appointments (67,429 before implementation and 67,964 after implementation). Results: Implementation of the AI-powered no-show prediction model resulted in a significant 50.7% reduction in no-show rates (P<.001). The odds ratio for no-shows after implementation was 0.43 (95% CI 0.42-0.45; P<.001), indicating a 57% reduction in the likelihood of no-shows. Additionally, patient wait times decreased by an average of 5.7 minutes overall (P<.001), with some PHCs achieving up to a 50% reduction in wait times. Conclusions: This project demonstrates that integrating AI with a data analytics platform and an electronic health record systems can significantly improve operational efficiency and patient satisfaction in PHC settings. The AI model enabled daily assessments of wait times and allowed for real-time adjustments, such as reallocating patients to different clinicians, thus reducing wait times and optimizing resource use. These findings illustrate the transformative potential of AI and real-time data analytics in health care delivery. %R 10.2196/64936 %U https://formative.jmir.org/2025/1/e64936 %U https://doi.org/10.2196/64936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63529 %T Validation of Sleep Measurements of an Actigraphy Watch: Instrument Validation Study %A Waki,Mari %A Nakada,Ryohei %A Waki,Kayo %A Ban,Yuki %A Suzuki,Ryo %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7-chōme-3-1 Hongō, Bunkyo City, Tokyo, 113-8654, Japan, 81 03 5800 9129, kwaki-tky@m.u-tokyo.ac.jp %K actigraphy %K sleep %K Motion Watch 8 %K iAide2 %K total sleep time %D 2025 %7 6.1.2025 %9 Short Paper %J JMIR Form Res %G English %X Background: The iAide2 (Tokai) physical activity monitoring system includes diverse measurements and wireless features useful to researchers. The iAide2’s sleep measurement capabilities have not been compared to validated sleep measurement standards in any published work. Objective: We aimed to assess the iAide2’s sleep duration and total sleep time (TST) measurement performance and perform calibration if needed. Methods: We performed free-living sleep monitoring in 6 convenience-sampled participants without known sleep disorders recruited from within the Waki DTx Laboratory at the Graduate School of Medicine, University of Tokyo. To assess free-living sleep, we validated the iAide2 against a second actigraph that was previously validated against polysomnography, the MotionWatch 8 (MW8; CamNtech Ltd). The participants wore both devices on the nondominant arm, with the MW8 closest to the hand, all day except when bathing. The MW8 and iAide2 assessments both used the MW8 EVENT-marker button to record bedtime and risetime. For the MW8, MotionWare Software (version 1.4.20; CamNtech Ltd) provided TST, and we calculated sleep duration from the sleep onset and sleep offset provided by the software. We used a similar process with the iAide2, using iAide2 software (version 7.0). We analyzed 64 nights and evaluated the agreement between the iAide2 and the MW8 for sleep duration and TST based on intraclass correlation coefficients (ICCs). Results: The absolute ICCs (2-way mixed effects, absolute agreement, single measurement) for sleep duration (0.69, 95% CI –0.07 to 0.91) and TST (0.56, 95% CI –0.07 to 0.82) were moderate. The consistency ICC (2-way mixed effects, consistency, single measurement) was excellent for sleep duration (0.91, 95% CI 0.86-0.95) and moderate for TST (0.78, 95% CI 0.67-0.86). We determined a simple calibration approach. After calibration, the ICCs improved to 0.96 (95% CI 0.94-0.98) for sleep duration and 0.82 (95% CI 0.71-0.88) for TST. The results were not sensitive to the specific participants included, with an ICC range of 0.96-0.97 for sleep duration and 0.79-0.87 for TST when applying our calibration equation to data removing one participant at a time and 0.96-0.97 for sleep duration and 0.79-0.86 for TST when recalibrating while removing one participant at a time. Conclusions: The measurement errors of the uncalibrated iAide2 for both sleep duration and TST seem too large for them to be useful as absolute measurements, though they could be useful as relative measurements. The measurement errors after calibration are low, and the calibration approach is general and robust, validating the use of iAide2’s sleep measurement functions alongside its other features in physical activity research. %M 39761102 %R 10.2196/63529 %U https://formative.jmir.org/2025/1/e63529 %U https://doi.org/10.2196/63529 %U http://www.ncbi.nlm.nih.gov/pubmed/39761102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58611 %T A Digital Parenting Intervention With Intimate Partner Violence Prevention Content: Quantitative Pre-Post Pilot Study %A Schafer,Moa %A Lachman,Jamie %A Zinser,Paula %A Calderón Alfaro,Francisco Antonio %A Han,Qing %A Facciola,Chiara %A Clements,Lily %A Gardner,Frances %A Haupt Ronnie,Genevieve %A Sheil,Ross %+ Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 2703, moa.schafer@spi.ox.ac.uk %K intimate partner violence %K SMS text messaging %K chatbot %K user engagement %K parenting %K violence %K mobile phone %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) and violence against children are global issues with severe consequences. Intersections shared by the 2 forms of violence have led to calls for joint programming efforts to prevent both IPV and violence against children. Parenting programs have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting program ParentText, a digital parenting chatbot, this pilot study seeks to explore parents’ engagement with the IPV prevention content in ParentText and explore preliminary changes in IPV. Objective: This study aimed to assess parents’ and caregivers’ level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary changes in experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviors following the intervention. Methods: Caregivers of children aged between 0 and 18 years were recruited through convenience sampling by research assistants in Cape Town, South Africa, and by UNICEF (United Nations Children's Fund) Jamaica staff in 3 parishes of Jamaica. Quantitative data from women in Jamaica (n=28) and South Africa (n=19) and men in South Africa (n=21) were collected electronically via weblinks sent to caregivers’ phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviors and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Chi-square tests and 2-tailed paired dependent-sample t tests were used to investigate potential changes in IPV outcomes between pretest and posttest. Results: The average daily interaction rate with the program was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least 1 IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses indicated significant pre-post reductions in overall IPV experience among women in South Africa (P=.01) and Jamaica (P=.01) and in men’s overall harmful IPV attitudes (P=.01) and increases in men’s overall gender-equitable behaviors (P=.02) in South Africa. Conclusions: To the best of our knowledge, this is the first pilot study to investigate user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results suggest promising yet modest reductions in IPV and improvements in attitudes after the program. Further research using a randomized controlled trial is warranted to establish causality. %M 39753219 %R 10.2196/58611 %U https://formative.jmir.org/2025/1/e58611 %U https://doi.org/10.2196/58611 %U http://www.ncbi.nlm.nih.gov/pubmed/39753219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66121 %T The Use of Social Media on Enhancing Dental Care and Practice Among Dental Professionals: Cross-Sectional Survey Study %A Acosta,Joseph Macadaeg %A Detsomboonrat,Palinee %A Pisarnturakit,Pagaporn Pantuwadee %A Urwannachotima,Nipaporn %K social media %K oral health promotion %K oral health education %K dentists %K dental practice %K dental professionals %K dental practitioners %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X Background: As digitalization continues to advance globally, the health care sector, including dental practice, increasingly recognizes social media as a vital tool for health care promotion, patient recruitment, marketing, and communication strategies. Objective: This study aimed to investigate the use of social media and assess its impact on enhancing dental care and practice among dental professionals in the Philippines. Methods: A cross-sectional survey was conducted among dental practitioners in the Philippines. The study used a 23-item questionnaire, which included 5 questions on dentists’ background and demographic information and 18 questions regarding the use, frequency, and purpose of social media in patient advising and quality of care improvement. Data were analyzed using SPSS software, with frequency distributions and χ2 tests used to assess the association between social media use and demographic variables and the impact on dental practice. Results: The 265 dental practitioners in this study were predominantly female (n=204, 77%) and aged between 20‐30 years (n=145, 54.7%). Most of the participants were general practitioners (n=260, 98.1%) working in a private practice (n=240, 90.6%), with 58.5% (n=155) having 0‐5 years of clinical experience. Social media use was significantly higher among younger practitioners (20‐30 years old) compared to older age groups (P<.001), though factors such as sex, dental specialty, and years of clinical practice did not significantly influence use. The majority (n=179, 67.5%) reported using social media in their practice, primarily for oral health promotion and education (n=191, 72.1%), connecting with patients and colleagues (n=165, 62.3%), and marketing (n=150, 56.6%). Facebook (n=179, 67.5%) and YouTube (n=163, 61.5%) were the most frequented platforms for clinical information, with Twitter (subsequently rebranded X) being the least used (n=4, 1.5%). Despite widespread social media engagement, only 8.7% (n=23) trusted the credibility of web-based information, and 63.4% (n=168) perceived a potential impact on the patient-dentist relationship due to patients seeking information on the internet. Social media was also perceived to enhance practice quality, with users reporting significant improvements in patient care (P=.001). Conclusions: The findings highlight that social media is widely used among younger dental practitioners, primarily for education, communication, and marketing purposes. While social media use is associated with perceived improvements in practice quality and patient care, trust in information on social media remains low, and concerns remain regarding its effect on patient relationships. It is recommended to establish enhanced guidelines and provide reliable web-based resources to help dental practitioners use social media effectively and responsibly. %R 10.2196/66121 %U https://formative.jmir.org/2025/1/e66121 %U https://doi.org/10.2196/66121 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58426 %T Artificial Intelligence–Powered Training Database for Clinical Thinking: App Development Study %A Wang,Heng %A Zheng,Danni %A Wang,Mengying %A Ji,Hong %A Han,Jiangli %A Wang,Yan %A Shen,Ning %A Qiao,Jie %K artificial intelligence %K clinical thinking ability %K virtual medical records %K distance education %K medical education %K online learning %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X Background: With the development of artificial intelligence (AI), medicine has entered the era of intelligent medicine, and various aspects, such as medical education and talent cultivation, are also being redefined. The cultivation of clinical thinking abilities poses a formidable challenge even for seasoned clinical educators, as offline training modalities often fall short in bridging the divide between current practice and the desired ideal. Consequently, there arises an imperative need for the expeditious development of a web-based database, tailored to empower physicians in their quest to learn and hone their clinical reasoning skills. Objective: This study aimed to introduce an app named “XueYiKu,” which includes consultations, physical examinations, auxiliary examinations, and diagnosis, incorporating AI and actual complete hospital medical records to build an online-learning platform using human-computer interaction. Methods: The “XueYiKu” app was designed as a contactless, self-service, trial-and-error system application based on actual complete hospital medical records and natural language processing technology to comprehensively assess the “clinical competence” of residents at different stages. Case extraction was performed at a hospital’s case data center, and the best-matching cases were differentiated through natural language processing, word segmentation, synonym conversion, and sorting. More than 400 teaching cases covering 65 kinds of diseases were released for students to learn, and the subjects covered internal medicine, surgery, gynecology and obstetrics, and pediatrics. The difficulty of learning cases was divided into four levels in ascending order. Moreover, the learning and teaching effects were evaluated using 6 dimensions covering systematicness, agility, logic, knowledge expansion, multidimensional evaluation indicators, and preciseness. Results: From the app’s first launch on the Android platform in May 2019 to the last version updated in May 2023, the total number of teacher and student users was 6209 and 1180, respectively. The top 3 subjects most frequently learned were respirology (n=606, 24.1%), general surgery (n=506, 20.1%), and urinary surgery (n=390, 15.5%). For diseases, pneumonia was the most frequently learned, followed by cholecystolithiasis (n=216, 14.1%), benign prostate hyperplasia (n=196, 12.8%), and bladder tumor (n=193, 12.6%). Among 479 students, roughly a third (n=168, 35.1%) scored in the 60 to 80 range, and half of them scored over 80 points (n=238, 49.7%). The app enabled medical students’ learning to become more active and self-motivated, with a variety of formats, and provided real-time feedback through assessments on the platform. The learning effect was satisfactory overall and provided important precedence for establishing scientific models and methods for assessing clinical thinking skills in the future. Conclusions: The integration of AI and medical education will undoubtedly assist in the restructuring of education processes; promote the evolution of the education ecosystem; and provide new convenient ways for independent learning, interactive communication, and educational resource sharing. %R 10.2196/58426 %U https://formative.jmir.org/2025/1/e58426 %U https://doi.org/10.2196/58426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58461 %T Effects of Smart Goggles Used at Bedtime on Objectively Measured Sleep and Self-Reported Anxiety, Stress, and Relaxation: Pre-Post Pilot Study %A Danoff-Burg,Sharon %A Gottlieb,Elie %A Weaver,Morgan A %A Carmon,Kiara C %A Lara Ledesma,Duvia %A Rus,Holly M %K relaxation %K stress %K anxiety %K sleep %K health technology %K intervention %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X Background: Insufficient sleep is a problem affecting millions. Poor sleep can trigger or worsen anxiety; conversely, anxiety can lead to or exacerbate poor sleep. Advances in innovative consumer products designed to promote relaxation and support healthy sleep are emerging, and their effectiveness can be evaluated accurately using sleep measurement technologies in the home environment. Objective: This pilot study examined the effects of smart goggles used at bedtime to deliver gentle, slow vibration to the eyes and temples. The study hypothesized that objective sleep, perceived sleep, self-reported stress, anxiety, relaxation, and sleepiness would improve after using the smart goggles. Methods: A within-participants, pre-post study design was implemented. Healthy adults with subclinical threshold sleep problems (N=20) tracked their sleep nightly using a polysomnography-validated noncontact biomotion device and completed daily questionnaires over two phases: a 3-week baseline period and a 3-week intervention period. During the baseline period, participants followed their usual sleep routines at home. During the intervention period, participants used Therabody SmartGoggles in “Sleep” mode at bedtime. This mode, designed for relaxation, delivers a gentle eye and temple massage through the inflation of internal compartments to create a kneading sensation combined with vibrating motors. Each night, the participants completed questionnaires assessing relaxation, stress, anxiety, and sleepiness immediately before and after using the goggles. Daily morning questionnaires assessed perceived sleep, complementing the objective sleep data measured every night. Results: Multilevel regression analysis of 676 nights of objective sleep parameters showed improvements during nights when the goggles were used compared to the baseline period. Key findings include sleep duration (increased by 12 minutes, P=.01); duration of deep sleep (increased by 6 minutes, P=.002); proportion of deep sleep (7% relative increase, P=.02); BodyScore, an age- and gender-normalized measure of deep sleep (4% increase, P=.002); number of nighttime awakenings (7% decrease, P=.02); total time awake after sleep onset (reduced by 6 minutes, P=.047); and SleepScore, a measure of overall sleep quality (3% increase, P=.02). Questionnaire responses showed that compared to baseline, participants felt they had better sleep quality (P<.001) and woke feeling more well-rested (P<.001). Additionally, participants reported feeling sleepier, less stressed, less anxious, and more relaxed (all P values <.05) immediately after using the goggles each night, compared to immediately before use. A standardized inventory administered before and after the 3-week intervention period indicated reduced anxiety (P=.03), confirming the nightly analysis. Conclusions: The use of smart goggles at bedtime significantly improved objectively measured sleep metrics and perceived sleep quality. Further, participants reported increased feelings of relaxation along with reduced stress and anxiety. Future research expanding on this pilot study is warranted to confirm and expand on the preliminary evidence presented in this brief report. %R 10.2196/58461 %U https://formative.jmir.org/2025/1/e58461 %U https://doi.org/10.2196/58461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63494 %T ChatGPT’s Attitude, Knowledge, and Clinical Application in Geriatrics Practice and Education: Exploratory Observational Study %A Cheng,Huai Yong %+ Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN, 55417, United States, 1 6124672051, wchengwcheng@gmail.com %K ChatGPT %K geriatrics attitude %K ageism %K geriatrics competence %K geriatric syndromes %K polypharmacy %K falls %K aging, older adults %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing use of ChatGPT in clinical practice and medical education necessitates the evaluation of its reliability, particularly in geriatrics. Objective: This study aimed to evaluate ChatGPT’s trustworthiness in geriatrics through 3 distinct approaches: evaluating ChatGPT’s geriatrics attitude, knowledge, and clinical application with 2 vignettes of geriatric syndromes (polypharmacy and falls). Methods: We used the validated University of California, Los Angeles, geriatrics attitude and knowledge instruments to evaluate ChatGPT’s geriatrics attitude and knowledge and compare its performance with that of medical students, residents, and geriatrics fellows from reported results in the literature. We also evaluated ChatGPT’s application to 2 vignettes of geriatric syndromes (polypharmacy and falls). Results: The mean total score on geriatrics attitude of ChatGPT was significantly lower than that of trainees (medical students, internal medicine residents, and geriatric medicine fellows; 2.7 vs 3.7 on a scale from 1-5; 1=strongly disagree; 5=strongly agree). The mean subscore on positive geriatrics attitude of ChatGPT was higher than that of the trainees (medical students, internal medicine residents, and neurologists; 4.1 vs 3.7 on a scale from 1 to 5 where a higher score means a more positive attitude toward older adults). The mean subscore on negative geriatrics attitude of ChatGPT was lower than that of the trainees and neurologists (1.8 vs 2.8 on a scale from 1 to 5 where a lower subscore means a less negative attitude toward aging). On the University of California, Los Angeles geriatrics knowledge test, ChatGPT outperformed all medical students, internal medicine residents, and geriatric medicine fellows from validated studies (14.7 vs 11.3 with a score range of –18 to +18 where +18 means that all questions were answered correctly). Regarding the polypharmacy vignette, ChatGPT not only demonstrated solid knowledge of potentially inappropriate medications but also accurately identified 7 common potentially inappropriate medications and 5 drug-drug and 3 drug-disease interactions. However, ChatGPT missed 5 drug-disease and 1 drug-drug interaction and produced 2 hallucinations. Regarding the fall vignette, ChatGPT answered 3 of 5 pretests correctly and 2 of 5 pretests partially correctly, identified 6 categories of fall risks, followed fall guidelines correctly, listed 6 key physical examinations, and recommended 6 categories of fall prevention methods. Conclusions: This study suggests that ChatGPT can be a valuable supplemental tool in geriatrics, offering reliable information with less age bias, robust geriatrics knowledge, and comprehensive recommendations for managing 2 common geriatric syndromes (polypharmacy and falls) that are consistent with evidence from guidelines, systematic reviews, and other types of studies. ChatGPT’s potential as an educational and clinical resource could significantly benefit trainees, health care providers, and laypeople. Further research using GPT-4o, larger geriatrics question sets, and more geriatric syndromes is needed to expand and confirm these findings before adopting ChatGPT widely for geriatrics education and practice. %M 39752214 %R 10.2196/63494 %U https://formative.jmir.org/2025/1/e63494 %U https://doi.org/10.2196/63494 %U http://www.ncbi.nlm.nih.gov/pubmed/39752214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57604 %T The Physical Activity at Work (PAW) Program in Thai Office Workers: Mixed Methods Process Evaluation Study %A Akksilp,Katika %A Rouyard,Thomas %A Isaranuwatchai,Wanrudee %A Nakamura,Ryota %A Müller-Riemenschneider,Falk %A Teerawattananon,Yot %A Chen,Cynthia %+ Health Intervention and Technology Assessment Programme, Ministry of Public Health, 6th Floor, 6th Building, Department of Health, Tiwanon Rd., Muang, Nonthaburi, 11000, Thailand, 66 2 590 4549, gochi.akk@gmail.com %K process evaluation %K sedentary behavior %K physical activity %K workplace %K movement breaks %D 2025 %7 2.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of multicomponent workplace interventions are being developed to reduce sedentary time and promote physical activity among office workers. The Physical Activity at Work (PAW) trial was one of these interventions, but it yielded an inconclusive effect on sedentary time after 6 months, with a low uptake of movement breaks, the main intervention component. Objective: This study investigates the factors contributing to the outcomes of the PAW cluster randomized trial. Methods: Following the Medical Research Council’s guidance for process evaluation of complex interventions, we used a mixed methods study design to evaluate the PAW study’s recruitment and context (how job nature and cluster recruitment affected movement break participation), implementation (dose and fidelity), and mechanisms of impact (assessing how intervention components affected movement break participation and identifying the facilitators and barriers to participation in the movement breaks). Data from accelerometers, pedometers, questionnaires, on-site monitoring, and focus group discussions were used for the evaluation. Linear mixed effects models were used to analyze the effects of different intervention components on the movement breaks. Subsequently, qualitative analysis of the focus group discussions provided additional insights into the relationship between the intervention components. Results: The participation in movement breaks declined after the third week, averaging 12.7 sessions (SD 4.94) per participant per week for the first 3 weeks, and continuing to decrease throughout the intervention. On-site monitoring confirmed high implementation fidelity. Analysis of Fitbit data revealed that each additional movement break was associated with a reduction of 6.20 (95% CI 6.99-5.41) minutes in sedentary time and an increase of 245 (95% CI 222-267) steps. Regarding the mechanisms of impact, clusters with higher baseline sedentary time demonstrated greater participation in movement breaks, while those with frequent out-of-office duties showed minimal engagement. Moreover, clusters with enthusiastic and encouraging movement break leaders were associated with a 24.1% (95% CI 8.88%-39.4%) increase in participation. Environmental and organizational support components using posters and leaders’ messages were ineffective, showing no significant change in percentage participation in movement breaks (4.49%, 95% CI –0.49% to 9.47% and 1.82%, 95% CI –2.25% to 5.9%, respectively). Barriers such as high workloads and meetings further hindered participation, while the facilitators included participants’ motivation to feel active and the perceived health benefits from movement breaks. Conclusions: Despite high fidelity, the PAW trial did not significantly reduce sedentary time, with limited uptake of movement breaks due to context-related challenges, ineffective environmental support, and high workloads during the COVID-19 pandemic. %M 39746195 %R 10.2196/57604 %U https://formative.jmir.org/2025/1/e57604 %U https://doi.org/10.2196/57604 %U http://www.ncbi.nlm.nih.gov/pubmed/39746195 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64636 %T Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study %A Rong,Jian %A Pathiravasan,Chathurangi H %A Zhang,Yuankai %A Faro,Jamie M %A Wang,Xuzhi %A Schramm,Eric %A Borrelli,Belinda %A Benjamin,Emelia J %A Liu,Chunyu %A Murabito,Joanne M %K mHealth %K mobile health %K mobile application %K smartphone %K digital health %K digital technology %K digital intervention %K gerontology %K geriatric %K older adult %K aging %K eFHS %K eCohort %K smartphone app %K baseline app surveys %K Framingham Heart Study %K health information %K information collection %K mobile phone %D 2024 %7 31.12.2024 %9 %J JMIR Aging %G English %X Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study’s app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study’s app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6% women; n=88, 14.4% Omni participants; 478, 78.2% iPhone users) and 596 (97.5%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5% to 98.3% vs 73.8% to 95.2%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9% (380/470) for the gait task to 88.9% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1‐10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study’s app. %R 10.2196/64636 %U https://aging.jmir.org/2024/1/e64636 %U https://doi.org/10.2196/64636 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54438 %T Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment %A Zhao,Yiran %A Arora,Jatin %A Tao,Yujie %A Miller,Dave B %A Adams,Alexander T %A Choudhury,Tanzeem %+ Department of Information Science, Cornell University, 2 West Loop Rd, New York, NY, 10044, United States, 1 240 888 3213, yz2647@cornell.edu %K wearable device %K alcohol craving %K risky drinking %K digital intervention %K entrainment %K offset heart rate biofeedback %K mindless intervention %D 2024 %7 31.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. Objective: This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. Methods: We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. Results: We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. Conclusions: Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency. %M 39740221 %R 10.2196/54438 %U https://formative.jmir.org/2024/1/e54438 %U https://doi.org/10.2196/54438 %U http://www.ncbi.nlm.nih.gov/pubmed/39740221 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e60066 %T Exploring the Use of Activity Trackers to Support Physical Activity and Reduce Sedentary Behavior in Adults Diagnosed With Type 2 Diabetes: Qualitative Interview Study Using the RE-AIM Framework %A Hodgson,William %A Kirk,Alison %A Lennon,Marilyn %A Janssen,Xanne %K type 2 diabetes %K physical activity %K sedentary behavior %K Fitbit %K activity tracker %K My Diabetes My Way %K RE-AIM framework %K diabetes care %K clinical care %K thematic analysis %K health promotion %D 2024 %7 30.12.2024 %9 %J JMIR Diabetes %G English %X Background: The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform. Objective: This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care. Methods: Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care. Results: Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients’ health. Conclusions: Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved. %R 10.2196/60066 %U https://diabetes.jmir.org/2024/1/e60066 %U https://doi.org/10.2196/60066 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57204 %T Allied Health Professionals’ Perceptions of Artificial Intelligence in the Clinical Setting: Cross-Sectional Survey %A Hoffman,Jane %A Hattingh,Laetitia %A Shinners,Lucy %A Angus,Rebecca L %A Richards,Brent %A Hughes,Ian %A Wenke,Rachel %+ Pharmacy Department, Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Australia, 61 756870620, jane.hoffman@health.qld.gov.au %K allied health %K artificial intelligence %K hospital %K digital health %K impact %K AI %K mHealth %K cross sectional %K survey %K health professional %K medical professional %K perception %K clinical setting %K opportunity %K challenge %K healthcare %K delivery %K Australia %K clinician %K confirmatory factor analysis %K linear regression %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has the potential to address growing logistical and economic pressures on the health care system by reducing risk, increasing productivity, and improving patient safety; however, implementing digital health technologies can be disruptive. Workforce perception is a powerful indicator of technology use and acceptance, however, there is little research available on the perceptions of allied health professionals (AHPs) toward AI in health care. Objective: This study aimed to explore AHP perceptions of AI and the opportunities and challenges for its use in health care delivery. Methods: A cross-sectional survey was conducted at a health service in, Queensland, Australia, using the Shinners Artificial Intelligence Perception tool. Results: A total of 231 (22.1%) participants from 11 AHPs responded to the survey. Participants were mostly younger than 40 years (157/231, 67.9%), female (189/231, 81.8%), working in a clinical role (196/231, 84.8%) with a median of 10 years’ experience in their profession. Most participants had not used AI (185/231, 80.1%), had little to no knowledge about AI (201/231, 87%), and reported workforce knowledge and skill as the greatest challenges to incorporating AI in health care (178/231, 77.1%). Age (P=.01), profession (P=.009), and AI knowledge (P=.02) were strong predictors of the perceived professional impact of AI. AHPs generally felt unprepared for the implementation of AI in health care, with concerns about a lack of workforce knowledge on AI and losing valued tasks to AI. Prior use of AI (P=.02) and years of experience as a health care professional (P=.02) were significant predictors of perceived preparedness for AI. Most participants had not received education on AI (190/231, 82.3%) and desired training (170/231, 73.6%) and believed AI would improve health care. Ideas and opportunities suggested for the use of AI within the allied health setting were predominantly nonclinical, administrative, and to support patient assessment tasks, with a view to improving efficiencies and increasing clinical time for direct patient care. Conclusions: Education and experience with AI are needed in health care to support its implementation across allied health, the second largest workforce in health. Industry and academic partnerships with clinicians should not be limited to AHPs with high AI literacy as clinicians across all knowledge levels can identify many opportunities for AI in health care. %M 39753215 %R 10.2196/57204 %U https://formative.jmir.org/2024/1/e57204 %U https://doi.org/10.2196/57204 %U http://www.ncbi.nlm.nih.gov/pubmed/39753215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53613 %T Using Active and Passive Smartphone Data to Enhance Adolescents’ Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study %A Leijse,Merel M L %A van Dam,Levi %A Jambroes,Tijs %A Timmerman,Amber %A Popma,Arne %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 8901000, m.m.l.leijse@amsterdamumc.nl %K emotion regulation %K emotion awareness %K smartphone data %K forensic outpatient youth care %K treatment motivation %K treatment alliance %K emotion %K behavioral %K interview %K mHealth %K app %K forensic %K usability %K feasibility %K delinquent %K pediatrics %K youth %K adolescent %K teenager %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K emoji %K behavioral data %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents’ limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee’s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. %M 39753211 %R 10.2196/53613 %U https://formative.jmir.org/2024/1/e53613 %U https://doi.org/10.2196/53613 %U http://www.ncbi.nlm.nih.gov/pubmed/39753211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54661 %T Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis %A Han,Eileen %A Lempert,Lauren K %A Vescia,Francesca %A Halpern-Felsher,Bonnie %K e-cigarette %K social media marketing %K Vuse %K adolescents and young adults %K Food and Drug Administration %K FDA %K smoker %K smoking %K smoking device %K tobacco %K social media %K Instagram %K Facebook %K promote %K marketing %K mobile phone %D 2024 %7 27.12.2024 %9 %J JMIR Form Res %G English %X Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only (“original”) e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs’ stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising. Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes. Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts’ characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present. Results: A total of 439 unique posts were identified. During this study’s period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5% (n=261) of the posts specifically mentioning the product name. Further, “Vuse” more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1%), individuality or freedom (n=106, 24.2%), and themes related to art (n=150, 34.2%), music (n=77, 17.5%), sports (n=125, 28.5%), nature (with n=49, 11.2% of the posts containing flora imageries), alcohol imagery (n=10, 2.3%), and technology (n=6, 1.4%). Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features. %R 10.2196/54661 %U https://formative.jmir.org/2024/1/e54661 %U https://doi.org/10.2196/54661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64081 %T Effects of Large Language Model–Based Offerings on the Well-Being of Students: Qualitative Study %A Selim,Rania %A Basu,Arunima %A Anto,Ailin %A Foscht,Thomas %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, rania.selim18@imperial.ac.uk %K large language models %K ChatGPT %K functional support %K escapism %K fantasy fulfillment %K angst %K despair %K anxiety %K deskilling %K pessimism about the future %D 2024 %7 27.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, the adoption of large language model (LLM) applications, such as ChatGPT, has seen a significant surge, particularly among students. These artificial intelligence–driven tools offer unprecedented access to information and conversational assistance, which is reshaping the way students engage with academic content and manage the learning process. Despite the growing prevalence of LLMs and reliance on these technologies, there remains a notable gap in qualitative in-depth research examining the emotional and psychological effects of LLMs on users’ mental well-being. Objective: In order to address these emerging and critical issues, this study explores the role of LLM-based offerings, such as ChatGPT, in students’ lives, namely, how postgraduate students use such offerings and how they make students feel, and examines the impact on students’ well-being. Methods: To address the aims of this study, we employed an exploratory approach, using in-depth, semistructured, qualitative, face-to-face interviews with 23 users (13 female and 10 male users; mean age 23 years, SD 1.55 years) of ChatGPT-4o, who were also university students at the time (inclusion criteria). Interviewees were invited to reflect upon how they use ChatGPT, how it makes them feel, and how it may influence their lives. Results: The current findings from the exploratory qualitative interviews showed that users appreciate the functional support (8/23, 35%), escapism (8/23, 35%), and fantasy fulfillment (7/23, 30%) they receive from LLM-based offerings, such as ChatGPT, but at the same time, such usage is seen as a “double-edged sword,” with respondents indicating anxiety (8/23, 35%), dependence (11/23, 48%), concerns about deskilling (12/23, 52%), and angst or pessimism about the future (11/23, 48%). Conclusions: This study employed exploratory in-depth interviews to examine how the usage of LLM-based offerings, such as ChatGPT, makes users feel and assess the effects of using LLM-based offerings on mental well-being. The findings of this study show that students used ChatGPT to make their lives easier and felt a sense of cognitive escapism and even fantasy fulfillment, but this came at the cost of feeling anxious and pessimistic about the future. %M 39729617 %R 10.2196/64081 %U https://formative.jmir.org/2024/1/e64081 %U https://doi.org/10.2196/64081 %U http://www.ncbi.nlm.nih.gov/pubmed/39729617 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e63425 %T Evaluation of a Telemonitoring System Using Electronic National Early Warning Scores for Patients Receiving Medical Home Care: Pilot Implementation Study %A Lin,Cheng-Fu %A Chang,Pei‐Jung %A Chang,Hui-Min %A Chen,Ching-Tsung %A Hsu,Pi-Shan %A Wu,Chieh-Liang %A Lin,Shih-Yi %K aging in place %K early warning score %K home hospitalization %K remote monitoring %K telemonitoring %D 2024 %7 26.12.2024 %9 %J JMIR Med Inform %G English %X Background: Telehealth programs and wearable sensors that enable patients to monitor their vital signs have expanded due to the COVID-19 pandemic. The electronic National Early Warning Score (e-NEWS) system helps identify and respond to acute illness. Objective: This study aimed to implement and evaluate a comprehensive telehealth system to monitor vital signs using e-NEWS for patients receiving integrated home-based medical care (iHBMC). The goal was to improve the early detection of patient deterioration and enhance care delivery in home settings. The system was deployed to optimize remote monitoring in iHBMC and reduce emergency visits and hospitalizations. Methods: The study was conducted at a medical center and its affiliated home health agency in central Taiwan from November 1, 2022, to October 31, 2023. Patients eligible for iHBMC were enrolled, and sensor data from devices such as blood pressure monitors, thermometers, and pulse oximeters were transmitted to a cloud-based server for e-NEWS calculations at least twice per day over a 2-week period. Patients with e-NEWSs up to 4 received nursing or physician recommendations and interventions based on abnormal physiological data, with reassessment occurring after 2 hours. Implementation (Results): A total of 28 participants were enrolled, with a median age of 84.5 (IQR 79.3‐90.8) years, and 32% (n=9) were male. All participants had caregivers, with only 5 out of 28 (18%) able to make decisions independently. The system was implemented across one medical center and its affiliated home health agency. Of the 28 participants, 27 completed the study, while 1 exited early due to low blood pressure and shortness of breath. The median e-NEWS value was 4 (IQR 3‐6), with 397 abnormal readings recorded. Of the remaining 27 participants, 8 participants had earlier home visits due to abnormal readings, 6 required hypertension medication adjustments, and 9 received advice on oxygen supplementation. Overall, 24 out of 28 (86%) participants reported being satisfied with the system. Conclusions: This study demonstrated the feasibility of implementing a telehealth system integrated with e-NEWS in iHBMC settings, potentially aiding in the early detection of clinical deterioration. Although caregivers receive training and resources for their tasks, the system may increase their workload, which could lead to higher stress levels. The small sample size, short monitoring duration, and regional focus in central Taiwan may further limit the applicability of the findings to areas with differing countries, regions, and health care infrastructures. Further research is required to confirm its impact. %R 10.2196/63425 %U https://medinform.jmir.org/2024/1/e63425 %U https://doi.org/10.2196/63425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63777 %T Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study %A Segal,Hila %A Benis,Arriel %A Saar,Shirley %A Shachar-Lavie,Iris %A Fennig,Silvana %K pediatric mental health %K digital platform %K pediatricians %K prevention %K early intervention %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives: This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform’s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods: A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform’s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results: Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions: This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform’s impact on clinical outcomes. %R 10.2196/63777 %U https://formative.jmir.org/2024/1/e63777 %U https://doi.org/10.2196/63777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60483 %T Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors %A Chadwick,Helen %A Laverty,Louise %A Finnigan,Robert %A Elias,Robert %A Farrington,Ken %A Caskey,Fergus J %A van der Veer,Sabine N %K aged %K digital health %K health equity %K intersectionality, qualitative research %K social deprivation %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized. Objective: This study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived. Methods: We conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework. Results: We interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were “not for them.” We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care. Conclusions: We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity. %R 10.2196/60483 %U https://formative.jmir.org/2024/1/e60483 %U https://doi.org/10.2196/60483 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60024 %T Impact of Artificial Intelligence–Generated Content Labels On Perceived Accuracy, Message Credibility, and Sharing Intentions for Misinformation: Web-Based, Randomized, Controlled Experiment %A Li,Fan %A Yang,Ya %+ School of Journalism and Communication, Beijing Normal University, NO.19, Xinjiekouwai Street, Haidian District, Beijing, 100875, China, 86 18810305219, yangya@bnu.edu.cn %K generative AI %K artificial intelligence %K ChatGPT %K AIGC label %K misinformation %K perceived accuracy %K message credibility %K sharing intention %K social media %K health information %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The proliferation of generative artificial intelligence (AI), such as ChatGPT, has added complexity and richness to the virtual environment by increasing the presence of AI-generated content (AIGC). Although social media platforms such as TikTok have begun labeling AIGC to facilitate the ability for users to distinguish it from human-generated content, little research has been performed to examine the effect of these AIGC labels. Objective: This study investigated the impact of AIGC labels on perceived accuracy, message credibility, and sharing intention for misinformation through a web-based experimental design, aiming to refine the strategic application of AIGC labels. Methods: The study conducted a 2×2×2 mixed experimental design, using the AIGC labels (presence vs absence) as the between-subjects factor and information type (accurate vs inaccurate) and content category (for-profit vs not-for-profit) as within-subjects factors. Participants, recruited via the Credamo platform, were randomly assigned to either an experimental group (with labels) or a control group (without labels). Each participant evaluated 4 sets of content, providing feedback on perceived accuracy, message credibility, and sharing intention for misinformation. Statistical analyses were performed using SPSS version 29 and included repeated-measures ANOVA and simple effects analysis, with significance set at P<.05. Results: As of April 2024, this study recruited a total of 957 participants, and after screening, 400 participants each were allocated to the experimental and control groups. The main effects of AIGC labels were not significant for perceived accuracy, message credibility, or sharing intention. However, the main effects of information type were significant for all 3 dependent variables (P<.001), as were the effects of content category (P<.001). There were significant differences in interaction effects among the 3 variables. For perceived accuracy, the interaction between information type and content category was significant (P=.005). For message credibility, the interaction between information type and content category was significant (P<.001). Regarding sharing intention, both the interaction between information type and content category (P<.001) and the interaction between information type and AIGC labels (P=.008) were significant. Conclusions: This study found that AIGC labels minimally affect perceived accuracy, message credibility, or sharing intention but help distinguish AIGC from human-generated content. The labels do not negatively impact users’ perceptions of platform content, indicating their potential for fact-checking and governance. However, AIGC labeling applications should vary by information type; they can slightly enhance sharing intention and perceived accuracy for misinformation. This highlights the need for more nuanced strategies for AIGC labels, necessitating further research. %R 10.2196/60024 %U https://formative.jmir.org/2024/1/e60024 %U https://doi.org/10.2196/60024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55916 %T Consensus Between Radiologists, Specialists in Internal Medicine, and AI Software on Chest X-Rays in a Hospital-at-Home Service: Prospective Observational Study %A Grossbard,Eitan %A Marziano,Yehonatan %A Sharabi,Adam %A Abutbul,Eliyahu %A Berman,Aya %A Kassif-Lerner,Reut %A Barkai,Galia %A Hakim,Hila %A Segal,Gad %K chest x-ray %K hospital-at-home %K telemedicine %K artificial intelligence %K kappa %K x-ray %K home hospitalization %K clinical data %K chest %K implementation %K comparative analysis %K radiologist %K AI %D 2024 %7 24.12.2024 %9 %J JMIR Form Res %G English %X Background: Home hospitalization is a care modality growing in popularity worldwide. Telemedicine-driven hospital-at-home (HAH) services could replace traditional hospital departments for selected patients. Chest x-rays typically serve as a key diagnostic tool in such cases. Objective: The implementation, analysis, and clinical assimilation of chest x-rays into an HAH service has not been described yet. Our objective is to introduce this essential information to the realm of HAH services for the first time worldwide. Methods: The study involved a prospective follow-up, description, and analysis of the HAH patient population who underwent chest x-rays at home. A comparative analysis was performed to evaluate the level of agreement among three interpretation modalities: a radiologist, a specialist in internal medicine, and a designated artificial intelligence (AI) algorithm. Results: Between February 2021 and May 2023, 300 chest radiographs were performed at the homes of 260 patients, with the median age being 78 (IQR 65‐87) years. The most frequent underlying morbidity was cardiovascular disease (n=185, 71.2%). Of the x-rays, 286 (95.3%) were interpreted by a specialist in internal medicine, 29 (9.7%) by a specialized radiologist, and 95 (31.7%) by the AI software. The overall raw agreement level among these three modalities exceeded 90%. The consensus level evaluated using the Cohen κ coefficient showed substantial agreement (κ=0.65) and moderate agreement (κ=0.49) between the specialist in internal medicine and the radiologist, and between the specialist in internal medicine and the AI software, respectively. Conclusions: Chest x-rays play a crucial role in the HAH setting. Rapid and reliable interpretation of these x-rays is essential for determining whether a patient requires transfer back to in-hospital surveillance. Our comparative results showed that interpretation by an experienced specialist in internal medicine demonstrates a significant level of consensus with that of the radiologists. However, AI algorithm-based interpretation needs to be further developed and revalidated prior to clinical applications. %R 10.2196/55916 %U https://formative.jmir.org/2024/1/e55916 %U https://doi.org/10.2196/55916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59333 %T Developing a Mood and Menstrual Tracking App for People With Premenstrual Dysphoric Disorder: User-Centered Design Study %A Apsey,Chloe %A Di Florio,Arianna %A Stawarz,Katarzyna %K premenstrual dysphoric disorder %K menstrual tracking %K mood tracking %K mobile health %K mHealth %K user-centered design %K menstrual %K tracking app %K hormonal fluctuations %K mood monitoring %K menstruation %D 2024 %7 24.12.2024 %9 %J JMIR Form Res %G English %X Background: People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women’s health issues) has resulted in a large quantity of “period-tracking apps” being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective: This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods: We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results: A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users’ benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions: To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use. %R 10.2196/59333 %U https://formative.jmir.org/2024/1/e59333 %U https://doi.org/10.2196/59333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63866 %T Building a Human Digital Twin (HDTwin) Using Large Language Models for Cognitive Diagnosis: Algorithm Development and Validation %A Sprint,Gina %A Schmitter-Edgecombe,Maureen %A Cook,Diane %+ School of Electrical Engineering and Computer Science, Washington State University, Box 642752, Pullman, WA, 99164-2752, United States, 1 509 335 4985, djcook@wsu.edu %K human digital twin %K cognitive health %K cognitive diagnosis %K large language models %K artificial intelligence %K machine learning %K digital behavior marker %K interview marker %K health information %K chatbot %K digital twin %K smartwatch %D 2024 %7 23.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Human digital twins have the potential to change the practice of personalizing cognitive health diagnosis because these systems can integrate multiple sources of health information and influence into a unified model. Cognitive health is multifaceted, yet researchers and clinical professionals struggle to align diverse sources of information into a single model. Objective: This study aims to introduce a method called HDTwin, for unifying heterogeneous data using large language models. HDTwin is designed to predict cognitive diagnoses and offer explanations for its inferences. Methods: HDTwin integrates cognitive health data from multiple sources, including demographic, behavioral, ecological momentary assessment, n-back test, speech, and baseline experimenter testing session markers. Data are converted into text prompts for a large language model. The system then combines these inputs with relevant external knowledge from scientific literature to construct a predictive model. The model’s performance is validated using data from 3 studies involving 124 participants, comparing its diagnostic accuracy with baseline machine learning classifiers. Results: HDTwin achieves a peak accuracy of 0.81 based on the automated selection of markers, significantly outperforming baseline classifiers. On average, HDTwin yielded accuracy=0.77, precision=0.88, recall=0.63, and Matthews correlation coefficient=0.57. In comparison, the baseline classifiers yielded average accuracy=0.65, precision=0.86, recall=0.35, and Matthews correlation coefficient=0.36. The experiments also reveal that HDTwin yields superior predictive accuracy when information sources are fused compared to single sources. HDTwin’s chatbot interface provides interactive dialogues, aiding in diagnosis interpretation and allowing further exploration of patient data. Conclusions: HDTwin integrates diverse cognitive health data, enhancing the accuracy and explainability of cognitive diagnoses. This approach outperforms traditional models and provides an interface for navigating patient information. The approach shows promise for improving early detection and intervention strategies in cognitive health. %M 39715540 %R 10.2196/63866 %U https://formative.jmir.org/2024/1/e63866 %U https://doi.org/10.2196/63866 %U http://www.ncbi.nlm.nih.gov/pubmed/39715540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56954 %T Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study %A Eze,Chinwe E %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen B %K remote blood pressure monitoring %K telemonitoring %K hypertension %K blood pressure %K technology %K health behaviors %K quantitative %K cross-sectional study %K United States %K lack of awareness %K health information %K health provider %K electronic communication channels %K adult %K aging %K mobile phone %D 2024 %7 23.12.2024 %9 %J JMIR Form Res %G English %X Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35‐150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39‐21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62‐47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers’ recommendations, and tailoring RBPM services to patients’ preferred electronic communication channels. %R 10.2196/56954 %U https://formative.jmir.org/2024/1/e56954 %U https://doi.org/10.2196/56954 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48170 %T Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study %A Lally,Phillippa %A May,Christine N %A Mitchell,E Siobhan %A McCallum,Meaghan %A Michaelides,Andreas %A Fisher,Abigail %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20276791722, abigail.fisher@ucl.ac.uk %K breast cancer %K self-management %K app %K health behaviors %K weight %K prototype %K user experience %K development %K application %K coaching %K peer support %K oncology %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ≥18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88%) were white, 6 (75%) had a graduate degree or above, and 6 (75%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. %M 39705674 %R 10.2196/48170 %U https://cancer.jmir.org/2024/1/e48170 %U https://doi.org/10.2196/48170 %U http://www.ncbi.nlm.nih.gov/pubmed/39705674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59521 %T Accuracy of the Huawei GT2 Smartwatch for Measuring Physical Activity and Sleep Among Adults During Daily Life: Instrument Validation Study %A Mei,Longfei %A He,Ziwei %A Hu,Liang %K smartwatch %K accelerometry %K free-living %K physical activity %K sleep %K validity %D 2024 %7 20.12.2024 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly popular for physical activity and health promotion. However, ongoing validation studies on commercial smartwatches are still needed to ensure their accuracy in assessing daily activity levels, which is important for both promoting activity-related health behaviors and serving research purposes. Objective: This study aimed to evaluate the accuracy of a popular smartwatch, the Huawei Watch GT2, in measuring step count (SC), total daily activity energy expenditure (TDAEE), and total sleep time (TST) during daily activities among Chinese adults, and test whether there are population differences. Methods: A total of 102 individuals were recruited and divided into 2 age groups: young adults (YAs) and middle-aged and older (MAAO) adults. Participants’ daily activity data were collected for 1 week by wearing the Huawei Watch GT2 on their nondominant wrist and the Actigraph GT3X+ (ActiGraph) on their right hip as the reference measure. The accuracy of the GT2 was examined using the intraclass correlation coefficient (ICC), Pearson product-moment correlation coefficient (PPMCC), Bland-Altman analysis, mean percentage error, and mean absolute percentage error (MAPE). Results: The GT2 demonstrated reasonable agreement with the Actigraph, as evidenced by a consistency test ICC of 0.88 (P<.001) and an MAPE of 25.77% for step measurement, an ICC of 0.75 (P<.001) and an MAPE of 33.79% for activity energy expenditure estimation, and an ICC of 0.25 (P<.001) and an MAPE of 23.29% for sleep time assessment. Bland-Altman analysis revealed that the GT2 overestimated SC and underestimated TDAEE and TST. The GT2 was better at measuring SC and TDAEE among YAs than among MAAO adults, and there was no significant difference between these 2 groups in measuring TST (P=.12). Conclusions: The Huawei Watch GT2 demonstrates good accuracy in step counting. However, its accuracy in assessing activity energy expenditure and sleep time measurement needs further examination. The GT2 demonstrated higher accuracy in measuring SC and TDAEE in the YA group than in the MAAO group. However, the measurement errors for TST did not differ significantly between the 2 age groups. Therefore, the watch may be suitable for monitoring several key parameters (eg, SC) of daily activity, yet caution is advised for its use in research studies that require high accuracy. %R 10.2196/59521 %U https://formative.jmir.org/2024/1/e59521 %U https://doi.org/10.2196/59521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e42774 %T Identification of Gender Differences in Acute Myocardial Infarction Presentation and Management at Aga Khan University Hospital-Pakistan: Natural Language Processing Application in a Dataset of Patients With Cardiovascular Disease %A Ngaruiya,Christine %A Samad,Zainab %A Tajuddin,Salma %A Nasim,Zarmeen %A Leff,Rebecca %A Farhad,Awais %A Pires,Kyle %A Khan,Muhammad Alamgir %A Hartz,Lauren %A Safdar,Basmah %+ Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, United States, 1 2037852353, christine.ngaruiya@yale.edu %K natural language processing %K gender-based differences %K acute coronary syndrome %K global health %K Pakistan %K gender %K data %K dataset %K clinical %K research %K management %K patient %K medication %K women %K tool %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ischemic heart disease is a leading cause of death globally with a disproportionate burden in low- and middle-income countries (LMICs). Natural language processing (NLP) allows for data enrichment in large datasets to facilitate key clinical research. We used NLP to assess gender differences in symptoms and management of patients hospitalized with acute myocardial infarction (AMI) at Aga Khan University Hospital-Pakistan. Objective: The primary objective of this study was to use NLP to assess gender differences in the symptoms and management of patients hospitalized with AMI at a tertiary care hospital in Pakistan. Methods: We developed an NLP-based methodology to extract AMI symptoms and medications from 5358 discharge summaries spanning the years 1988 to 2018. This dataset included patients admitted and discharged between January 1, 1988, and December 31, 2018, who were older than 18 years with a primary discharge diagnosis of AMI (using ICD-9 [International Classification of Diseases, Ninth Revision], diagnostic codes). The methodology used a fuzzy keyword-matching algorithm to extract AMI symptoms from the discharge summaries automatically. It first preprocesses the free text within the discharge summaries to extract passages indicating the presenting symptoms. Then, it applies fuzzy matching techniques to identify relevant keywords or phrases indicative of AMI symptoms, incorporating negation handling to minimize false positives. After manually reviewing the quality of extracted symptoms in a subset of discharge summaries through preliminary experiments, a similarity threshold of 80% was determined. Results: Among 1769 women and 3589 men with AMI, women had higher odds of presenting with shortness of breath (odds ratio [OR] 1.46, 95% CI 1.26-1.70) and lower odds of presenting with chest pain (OR 0.65, 95% CI 0.55-0.75), even after adjustment for diabetes and age. Presentation with abdominal pain, nausea, or vomiting was much less frequent but consistently more common in women (P<.001). “Ghabrahat,” a culturally distinct term for a feeling of impending doom was used by 5.09% of women and 3.69% of men as presenting symptom for AMI (P=.06). First-line medication prescription (statin and β-blockers) was lower in women: women had nearly 30% lower odds (OR 0.71, 95% CI 0.57-0.90) of being prescribed statins, and they had 40% lower odds (OR 0.67, 95% CI 0.57-0.78) of being prescribed β-blockers. Conclusions: Gender-based differences in clinical presentation and medication management were demonstrated in patients with AMI at a tertiary care hospital in Pakistan. The use of NLP for the identification of culturally nuanced clinical characteristics and management is feasible in LMICs and could be used as a tool to understand gender disparities and address key clinical priorities in LMICs. %M 39705071 %R 10.2196/42774 %U https://formative.jmir.org/2024/1/e42774 %U https://doi.org/10.2196/42774 %U http://www.ncbi.nlm.nih.gov/pubmed/39705071 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57819 %T Real-Time Triage, Position, and Documentation (TriPoD) During Medical Response to Major Incidents: Protocol for an Action Research Study %A Rådestad,Monica %A Kanfjäll,Torkel %A Lindström,Veronica %+ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, 118 83, Sweden, 46 704846212, monica.radestad@capiostgoran.se %K action research %K decision support technique %K information technology %K medical response %K major incident %K management %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a need to address the implementation of technological innovation into emergency medical services to facilitate and improve information exchange between prehospital emergency care providers, command centers, and hospitals during major incidents to enable better allocation of resources and minimize loss of life. At present, there is a lack of technology supporting real-time information sharing in managing major incidents to optimize the use of resources available. Objective: The aim of this protocol is to develop, design, and evaluate information technology innovations for use in medical response to major incidents. Methods: This study has a qualitative action research design. This research approach is suitable for developing and changing practice in health care settings since it is cyclical in nature and involves development, evaluation, redevelopment, and replanning. The qualitative data collection will include workshops, structured meetings, semistructured interviews, questionnaires, observations, and focus group interviews. This study assesses the use of a digital solution for real-time information sharing by involving 3 groups of indented users: prehospital emergency care personnel, hospital personnel, and designated duty officers with experience and specific knowledge in managing major incidents. This study will explore end users’ experiences and needs, and a digital solution for prehospital and hospital settings will be developed in collaboration with technology producers. Results: The trial implementation and evaluation phase for this study is from April 2024 to May 2026. Interviews and questionnaires with end users were conducted during the planning phase. We have performed observations in connection with 2 major exercises in April 2024 and November 2024. The outcome of this analysis will form the basis for the design and development of a new information technology system. We aim to complete the observations in training sessions and exercises (phase 3) by September 2025, followed by modification of the technology solutions tested (phase 4) before dissemination in a scientific journal. Conclusions: This protocol includes several methods for data collection that will form the basis for the design and development process of a digital solution for real-time information sharing to support efficient management in major incidents based on the experiences and requirements of end users. The findings from this study will contribute to the limited research on users’ perspectives and the development of digital solutions for real-time information during major incidents. International Registered Report Identifier (IRRID): PRR1-10.2196/57819 %M 39701586 %R 10.2196/57819 %U https://www.researchprotocols.org/2024/1/e57819 %U https://doi.org/10.2196/57819 %U http://www.ncbi.nlm.nih.gov/pubmed/39701586 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59372 %T A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study %A Taylor,Kayla V %A Garchitorena,Laurent %A Scaramutti-Gladfelter,Carolina %A Wyrick,Mykayla %A Grill,Katherine B %A Seixas,Azizi A %+ Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, United States, 1 3052438256, lgg82@miami.edu %K mental health %K digital health %K mHealth %K usability %K pilot study %K United States %K mental health crisis %K Science Technology Engineering Math and Social and Emotional Learning %K STEMSEL %K efficacy %K well-being %K barriers %K facilitators %K resources %K youth %K adolescents %K teenagers %K students %K feasibility %K adoption %K evidence-based %K intervention %K anxiety %K depression %K Neolth %K digital app %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth’s functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study’s completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention’s efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 %M 39701588 %R 10.2196/59372 %U https://www.researchprotocols.org/2024/1/e59372 %U https://doi.org/10.2196/59372 %U http://www.ncbi.nlm.nih.gov/pubmed/39701588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55450 %T Service Attributes and Acceptability of Digital and Nondigital Depression Management Methods Among Individuals With Depressive Symptoms: Survey Study %A Auyeung,Larry %A Mak,Winnie W S %A Tsang,Ella Zoe %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China (Hong Kong), 852 31906792, larryauyeung@link.cuhk.edu.hk %K eHealth %K acceptability %K user preference %K diffusion of innovation %K mental health services %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings. Objective: This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users’ expectations. Methods: A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire–9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing. Results: A Friedman test with a Dunn posttest showed the average importance rank of “effectiveness” was significantly higher than all other measured attributes. “Privacy,” “credibility,” and “cost” were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication. Conclusions: The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services. %M 39699956 %R 10.2196/55450 %U https://formative.jmir.org/2024/1/e55450 %U https://doi.org/10.2196/55450 %U http://www.ncbi.nlm.nih.gov/pubmed/39699956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57403 %T Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study %A Fletcher,Kathryn %A Robert-Hendren,Dominique %K app %K alcohol use %K self-monitoring %K tracker %K digital health %D 2024 %7 18.12.2024 %9 %J JMIR Form Res %G English %X Background: Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. Objective: We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. Methods: The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Results: Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Conclusions: Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required. %R 10.2196/57403 %U https://formative.jmir.org/2024/1/e57403 %U https://doi.org/10.2196/57403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55176 %T User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study %A Park,Ye-Eun %A Tak,Yae Won %A Kim,Inhye %A Lee,Hui Jeong %A Lee,Jung Bok %A Lee,Jong Won %A Lee,Yura %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 1498, haepary@amc.seoul.kr %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients’ abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness (β=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. %M 39693615 %R 10.2196/55176 %U https://www.jmir.org/2024/1/e55176 %U https://doi.org/10.2196/55176 %U http://www.ncbi.nlm.nih.gov/pubmed/39693615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63680 %T Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study %A Jones,Debra %A Sowerbutts,Anne Marie %A Burden,Sorrel %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, 5th Floor, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613061508, debra.jones@manchester.ac.uk %K malnutrition %K malnutrition risk %K malnutrition screening %K MUST %K mobile application %K mHealth app %K malnutrition universal screening tool %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings. Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST. Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users’ views on the app’s content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom–wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis. Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length. Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings. %M 39693128 %R 10.2196/63680 %U https://formative.jmir.org/2024/1/e63680 %U https://doi.org/10.2196/63680 %U http://www.ncbi.nlm.nih.gov/pubmed/39693128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57580 %T Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study %A Ahmed,Nisar %A Hall,Alex %A Poku,Brenda %A McDermott,Jane %A Astbury,Jayne %A Todd,Chris %+ National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK, United Kingdom, 44 161306600, nisar.ahmed-2@manchester.ac.uk %K digital health and primary care services %K digital exclusion %K digital divide %K health inequalities %K older adults %K South Asian %K Black African %K Caribbean %K COVID-19 pandemic %K qualitative focus group study %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales—people of South Asian, Black African, and Caribbean backgrounds—in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. %M 39693146 %R 10.2196/57580 %U https://formative.jmir.org/2024/1/e57580 %U https://doi.org/10.2196/57580 %U http://www.ncbi.nlm.nih.gov/pubmed/39693146 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e56917 %T Exploring Opportunities and Challenges for the Spread, Scale-Up, and Sustainability of mHealth Apps for Self-Management of Patients With Type 2 Diabetes Mellitus in the Netherlands: Citizen Science Approach %A van Leersum,Catharina Margaretha %A Bults,Marloes %A Siebrand,Egbert %A Olthuis,Theodorus Johannes Josef %A Bekhuis,Robin Enya Marije %A Konijnendijk,Annemieke Ariënne Johanneke %A den Ouden,Marjolein Elisabeth Maria %+ Department of Technology, Policy, and Society, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 6419 AT, Netherlands, 31 0534899111, karin.vanleersum@ou.nl %K mHealth %K type 2 diabetes mellitus %K implementation %K self-management %K health care system %K citizen science %K mobile health %K mobile app %K digital health %K digital technology %K digital intervention %K smartphone %K diabetes %K DM %K type 2 diabetes %K type 1 diabetes %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Technologies evolve at a breakneck pace, and the success of mobile health (mHealth) for people with type 2 diabetes mellitus (T2DM) depends on whether health care professionals, care management, government regulators, and consumers will adopt the technology as a viable solution to enhance patient self-management. Objective: In this study, we explored the challenges of the implementation of mHealth apps in care for patients with T2DM and determined to what extent these challenges complicate the dissemination, limit scale-up, and influence the sustainability of technological interventions for patients with T2DM. Methods: The nonadoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) framework served as the basis for our study. The 7 domains of the NASSS framework were explored with a citizen science approach using questionnaires, semistructured in-depth interviews, and focus groups together with patients with T2DM, care professionals, technology developers, policy officers, and a patient organization. Results: Regarding the domain “condition,” being aware of their condition and changing lifestyle were crucial for patients with T2DM to get to grips with their life. The rapid development of health apps for T2DM was highlighted in the domain “technology.” Users should be aware of these apps and know how to use them. The domain “value proposition” included the patient perspective and elaborated on personal values, as well as care professionals who focus on personalized care and pressure on health care. Regarding the “adopters,” it is crucial to know who needs to use and introduce the apps. Responsibility, a shared vision, and resistance among care professionals were mentioned as important determinants for “organization.” Finally, the domain “wider system” showed the importance of involving multiple institutes, care guidelines, and reimbursements. Conclusions: This study investigated the implementation of mHealth apps in an early stage of the implementation process. Key stakeholders were involved, who attributed to the possibilities and limitations of the implementation. It is crucial to have a clear vision from an organizational perspective and specific prerequisites for implementation strategies at micro, meso, and macro levels. Essential strategies at the national level include guidelines for regulations, privacy, and security; the integration of mHealth into T2DM care guidelines; and sufficient reimbursement by health insurers. %M 39689302 %R 10.2196/56917 %U https://diabetes.jmir.org/2024/1/e56917 %U https://doi.org/10.2196/56917 %U http://www.ncbi.nlm.nih.gov/pubmed/39689302 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63068 %T The Impact and Wider Implications of Remote Consultations for General Practice in Norway: Qualitative Study Among Norwegian Contract General Practitioners %A Norberg,Børge Lønnebakke %A Austad,Bjarne %A Kristiansen,Eli %A Zanaboni,Paolo %A Getz,Linn Okkenhaug %+ General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 73598859, borge.norberg@ntnu.no %K remote consultations %K e-health %K digital medicine %K telemedicine %K impact %K downsides %K disadvantages %K pitfalls %K safety %K general practice %K family medicine %K practice organization %K ecology of healthcare %K remote consultation %K monitoring %K teleconsultation %K social determinants of health %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The digital shift toward remote consultations in general practice needs ongoing monitoring to understand its impact on general practice organizations and the wider health care system. Objective: This study aimed to explore how remote consultations impact on contracted general practitioner (GP) practices and how GPs perceive the implications of this uptake for the overall health care system. Methods: In total, 5 focus groups were conducted with a total of 18 GPs from all 4 health regions of Norway in 2022. The material was subjected to Braun and Clarke’s thematic analysis. Results: The analysis yielded six themes: (1) the design of novel effective clinical pathways: remote consultations empower GPs to tailor new effective clinical trajectories, blending modalities to address diverse needs across clinical episodes—from initial triage, through investigations to case closure; (2) increased workday flexibility: remote consultations introduce variability into daily work, allowing GPs to adjust patient contact intensity, and leading to a less stressful work-home balance; (3) erosion of organizational boundaries: easy remote access to GPs appears to reduce patients’ tolerance for minor illness and self-care, hindering effective gatekeeping and shifting GPs’ focus from proactive to more reactive work, increasing work-related stress; (4) degradation of clinical shrewdness: confronted with an increasing amount of unsorted and trivial remote inquiries, GPs observe challenges in detecting and prioritizing serious cases; (5) dilemmas related to responsibility, ethics, and legislation: remote consultations highlight a tension for contract GPs between legal responsibilities and ethical obligations, with implications for patients with limited health literacy; this may entail suboptimal evaluation or delayed treatment—potentially contributing to increased health care inequity; and (6) retaining clinical core values in a changing world. Overall, GPs affirm that remote consultations have come to stay and describe efforts to effectively manage the advantages and disadvantages inherent in such interactions to safeguard clinical effectiveness and organizational sustainability of primary health care. Conclusions: The widespread adoption of remote consultations in the Norwegian contract GP scheme fundamentally reshapes the dynamics of GP work and the overall health care system. Awareness and proactive management of these changes are essential for maintaining sustainable, high-quality primary health care. %M 39688890 %R 10.2196/63068 %U https://formative.jmir.org/2024/1/e63068 %U https://doi.org/10.2196/63068 %U http://www.ncbi.nlm.nih.gov/pubmed/39688890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46497 %T Mental Health Benefits of Listening to Music During COVID-19 Quarantine: Cross-Sectional Study %A Xian,Xuechang %A Zhang,Xiaoran %A Zheng,Danhe %A Wang,Yanlin %K COVID-19 %K quarantine %K social connectedness %K sense of security %K mental well-being %K cross-sectional study %K contagion %K treatment %K music %K security %K mental health %K questionnaire %K China %K intervention %K relaxation %K meditation %K mental illness %K stimuli %K environmental %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: COVID-19 has posed a significant global threat to public health due to its high contagion risk and lack of effective treatment. While quarantine measures have been crucial in controlling the virus’ spread, they have also contributed to negative impacts on individuals’ mental health. Music listening has emerged as a potential coping mechanism, yet it remains unclear whether mental well-being varies across music preferences. Objective: This study examined individuals’ music-listening preferences in the context of COVID-19 quarantine and assessed the mediation pathways linking 5 types of music to mental health levels, mediated by perceived social connectedness as well as sense of security. Methods: A web-based survey was conducted among people with quarantine experience in September 2022, in mainland China. A total of 712 valid questionnaires were returned and 596 samples were finally included in our study for mediation analysis. Results: The results revealed that the vast majority (596/623, 96%) of respondents had music-listening experiences during the COVID-19 quarantine, with pop music emerging as the most popular preference among respondents, while quyi was the least listened-to genre. Additionally, listening to music across 5 different genres appeared as a significant parameter indirectly linked to mental health through perceived social connectedness. Specifically, engaging with quyi was associated with higher levels of perceived social connectedness and sense of security, which in turn correlated with improved mental well-being. Conversely, individuals listening to jazz reported lower social connectedness and sense of security, which was subsequently linked to increased mental health problems. The potential reasons for these findings and implications are discussed. Conclusions: This study significantly contributes to the understanding of the mechanisms behind music-listening preferences in stressful environments. Specifically, our findings highlight the mediating roles of perceived social connectedness and sense of security in the relationship between music preferences and mental health outcomes during the quarantine period. These insights provide valuable guidance for developing interventions that use music to enhance mental health, thereby broadening the scope of studies on environmental stimuli and their impact on mental well-being. %R 10.2196/46497 %U https://formative.jmir.org/2024/1/e46497 %U https://doi.org/10.2196/46497 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66052 %T Evaluating the Effectiveness and Scalability of the World Health Organization MyopiaEd Digital Intervention: Mixed Methods Study %A Lee,Yeonsu %A Keel,Stuart %A Yoon,Sangchul %+ Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2467, littleluke@yuhs.ac %K World Health Organization %K digital intervention %K MyopiaEd %K behavior change %K risk factor %K myopia %K refractive error %K mobile phone %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. To address this growing public health concern, the World Health Organization and International Telecommunication Union launched the MyopiaEd program. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for implementing and evaluating the MyopiaEd program. Objective: This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. Methods: Parents of children aged 7 and 8 years were recruited through an open-access website with a recruitment notice distributed to public elementary schools in Gwangju Metropolitan City. Beginning in September 2022, parents received 42 SMS text messages from the MyopiaEd program over 6 months. This digital trial used a mixed methods approach combining both quantitative and qualitative data collection. Pre- and postintervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Additionally, semistructured interviews were conducted to explore participants’ experiences in depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following World Health Organization and International Telecommunication Union guidelines. Results: A total of 133 parents participated in this study, including 60 parents whose children had myopia and 73 parents whose children did not. Both groups reported high engagement and satisfaction with the program. Significant increases in knowledge about myopia were observed in both groups (P<.001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time for their children (P=.048). A substantial increase in eye checkups was observed, with 52 (86.7%) out of 60 children with myopia and 50 (68.5%) out of 73 children without myopia receiving eye examinations following the intervention. Qualitative analysis indicated a shift in parents’ attitudes toward outdoor activities, as increased recognition of their benefits prompted positive changes in behavior. However, reducing near-work activities posed challenges due to children’s preference for smartphone use during leisure periods and the demands of after-school academies. The credibility of the institution delivering the program enhanced parental engagement and children’s adoption of healthy behaviors. Messages that corrected common misconceptions about eye health and provided specific behavioral guidance were regarded as impactful elements of the program. Conclusions: This study demonstrates the MyopiaEd program’s potential as a scalable and innovative digital intervention to reduce myopia risk in children. The program’s effectiveness provides support for broader adoption and offers valuable insights to inform future myopia prevention policies. %M 39680893 %R 10.2196/66052 %U https://publichealth.jmir.org/2024/1/e66052 %U https://doi.org/10.2196/66052 %U http://www.ncbi.nlm.nih.gov/pubmed/39680893 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66049 %T Using Video Cameras to Assess Physical Activity and Other Well-Being Behaviors in Urban Environments: Feasibility, Reliability, and Participant Reactivity Studies %A Benton,Jack S %A Evans,James %A Anderson,Jamie %A French,David P %+ Manchester Centre for Health Psychology, Division of Psychology and Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613066000, jack.benton@manchester.ac.uk %K unobtrusive observation %K video cameras %K measurement %K physical activity %K well-being %K urban environments %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unobtrusive observation is a promising method for assessing physical activity and other well-being behaviors (eg, social interactions) in urban environments, without participant burden and biases associated with self-report. However, current methods require multiple in-person observers. Using video cameras instead could allow for more accurate observations at lower cost and with greater flexibility in scheduling. Objective: This research aimed to test the feasibility of using stationary wireless video cameras to observe physical activity and other well-being behaviors, and to assess its reliability and potential participant reactivity. Methods: Across 3 cross-sectional studies, 148 hours of video recordings were collected from 6 outdoor public spaces in Manchester, United Kingdom. The videos were coded by 3 researchers using MOHAWk (Method for Observing Physical Activity and Wellbeing)—a validated in-person observation tool for assessing physical activity, social interactions, and people taking notice of the environment. Inter- and intrarater reliabilities were assessed using intraclass correlation coefficients (ICCs). Intercept surveys were conducted to assess public awareness of the cameras and whether they altered their behavior due to the presence of cameras. Results: The 148 hours of video recordings were coded in 85 hours. Interrater reliability between independent coders was mostly “excellent” (ICCs>0.90; n=36), with a small number of “good” (ICCs>0.75; n=2), “moderate” (ICCs=0.5-0.75; n=3), or “poor” (ICCs<0.5; n=1) ICC values. Reliability decreased at night, particularly for coding ethnic group and social interactions, but remained mostly “excellent” or “good.” Intrarater reliability within a single coder after a 2-week interval was “excellent” for all but 1 code, with 1 “good” ICC value for assessing vigorous physical activity, indicating that the coder could reproduce similar results over time. Intrarater reliability was generally similar during the day and night, apart from ICC values for coding ethnic group, which reduced from “excellent” to “good” at night. Intercept surveys with 86 public space users found that only 5 (5.8%) participants noticed the cameras used for this study. Importantly, all 5 said that they did not alter their behavior as a result of noticing these cameras, therefore, indicating no evidence of reactivity. Conclusions: Camera-based observation methods are more reliable than in-person observations and do not produce participant reactivity often associated with self-report methods. This method requires less time for data collection and coding, while allowing for safe nighttime observation without the risk to research staff. This research is a significant first step in demonstrating the potential for camera-based methods to improve natural experimental studies of real-world environmental interventions. It also provides a rigorous foundation for developing more scalable automated computer vision algorithms for assessing human behaviors. %M 39680427 %R 10.2196/66049 %U https://publichealth.jmir.org/2024/1/e66049 %U https://doi.org/10.2196/66049 %U http://www.ncbi.nlm.nih.gov/pubmed/39680427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64343 %T “Crying in the Wilderness”—The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis %A Pearce,Emily Eidenier %A Majid,Alina %A Brown,Toniya %A Shepherd,Rowan Forbes %A Rising,Camella %A Wilsnack,Catherine %A Thompson,Ashley S %A Gilkey,Melissa B %A Ribisl,Kurt M %A Lazard,Allison J %A Han,Paul KJ %A Werner-Lin,Allison %A Hutson,Sadie P %A Savage,Sharon A %+ Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 6E578, Rockville, MD, 20850, United States, 1 919 699 2547, emily.pearce@nih.gov %K social media %K dyskeratosis congenita %K telomere biology disorder %K health communication %K qualitative %K thematic analysis %K web-based information %K web-based support %K telomere %K biology disorder %K social support %K emotional support %K genetic %K internet-based %K information-seeking %K descriptive study %K semistructured interview %K adult %K illness experience %K psychosocial %K digital health %K health intervention %K health informatics %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91%) and TBD-specific social media (n=26, 81%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated “safe spaces” designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. %M 39680438 %R 10.2196/64343 %U https://formative.jmir.org/2024/1/e64343 %U https://doi.org/10.2196/64343 %U http://www.ncbi.nlm.nih.gov/pubmed/39680438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46860 %T Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study %A Bur,Oliver Thomas %A Berger,Thomas %K internet intervention %K depression %K guidance %K contact behavior %K messages %K adherence %K online %K intervention %K digital health %K therapy %K participant %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants’ messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.62, P=.004) and group 2 (Z=–2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 %R 10.2196/46860 %U https://formative.jmir.org/2024/1/e46860 %U https://doi.org/10.2196/46860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58510 %T Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study %A Alfozan,Mohammed %A Alshahrani,Saad %A Alasmi,Raed %K delivery of health care %K social media %K urologists %K urology %K Saudi Arabia %K professional communication %K physician behavior %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. Objective: This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. Methods: The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists’ knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Results: Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30‐40 (n=68, 46.8%) and 41‐50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson χ2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). Conclusions: This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines. %R 10.2196/58510 %U https://formative.jmir.org/2024/1/e58510 %U https://doi.org/10.2196/58510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65626 %T Appropriately Matching Transport Care Units to Patients in Interhospital Transport Care: Implementation Study %A Hasavari,Shirin %A Esmaeilzadeh,Pouyan %+ Department of Information Science & Systems, Graves School of Business & Management, Morgan State University, 21251, 4100 Hillen Rd, Baltimore, MD, 21218, United States, 1 3015090562, shirin.hasavari@morgan.edu %K interfacility transport care %K electronic health records %K data sharing %K blockchain %K hyperledger fabric %K privacy %K implementation %K EMS %K emergency medical services %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In interfacility transport care, a critical challenge exists in accurately matching ambulance response levels to patients’ needs, often hindered by limited access to essential patient data at the time of transport requests. Existing systems cannot integrate patient data from sending hospitals’ electronic health records (EHRs) into the transfer request process, primarily due to privacy concerns, interoperability challenges, and the sensitive nature of EHR data. We introduce a distributed digital health platform, Interfacility Transport Care (ITC)–InfoChain, designed to solve this problem without compromising EHR security or data privacy. Objective: This study aimed to detail the implementation of ITC-InfoChain, a secure, blockchain-based platform designed to enhance real-time data sharing without compromising data privacy or EHR security. Methods: The ITC-InfoChain platform prototype was implemented on Amazon Web Services cloud infrastructure, using Hyperledger Fabric as a permissioned blockchain. Key elements included participant registration, identity management, and patient data collection isolated from the sending hospital’s EHR system. The client program submits encrypted patient data to a distributed ledger, accessible to the receiving facility’s critical care unit at the time of transport request and emergency medical services (EMS) teams during transport through the PatienTrack web app. Performance was evaluated through key performance indicators such as data transaction times and scalability across transaction loads. Results: The ITC-InfoChain demonstrated strong performance and scalability. Data transaction times averaged 3.1 seconds for smaller volumes (1-20 transactions) and 6.4 seconds for 100 transactions. Optimized configurations improved processing times to 1.8-1.9 seconds for 400 transactions. These results confirm the platform’s capacity to handle high transaction volumes, supporting timely, real-time data access for decision-making during transport requests and patient transfers. Conclusions: The ITC-InfoChain platform addresses the challenge of matching appropriate transport units to patient needs by ensuring data privacy, integrity, and real-time data sharing, enhancing the coordination of patient care. The platform’s success suggests potential for regional pilots and broader adoption in secure health care systems. Stakeholder resistance due to blockchain unfamiliarity and data privacy concerns remains. Funding has been sought to support a pilot program to address these challenges through targeted education and engagement. %M 39540868 %R 10.2196/65626 %U https://formative.jmir.org/2024/1/e65626 %U https://doi.org/10.2196/65626 %U http://www.ncbi.nlm.nih.gov/pubmed/39540868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63041 %T Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study %A Grewal,Karl S %A Gowda-Sookochoff,Rory %A Peacock,Shelley %A Cammer,Allison %A McWilliams,Lachlan A %A Spiteri,Raymond J %A Haase,Kristen R %A Harrison,Mary %A Holtslander,Lorraine %A MacRae,Rhoda %A Michael,Joanne %A Green,Shoshana %A O'Connell,Megan E %+ Department of Psychology and Health Studies, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, Sasktoon, SK, S7N 5A5, Canada, 1 3069662496, karl.grewal@usask.ca %K care partner %K caregiving %K dementia %K technology %K content analysis %K mobile phone %K technology adoption %K assistive technology %K support %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease’s impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner’s everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners’ relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners’ reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. %M 39671589 %R 10.2196/63041 %U https://formative.jmir.org/2024/1/e63041 %U https://doi.org/10.2196/63041 %U http://www.ncbi.nlm.nih.gov/pubmed/39671589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64437 %T Mitochondrial Fitness Science Communication for Aging Adults: Prospective Formative Pilot Study %A Maxwell,Cathy A %A Grubbs,Brandon %A Dietrich,Mary S %A Boon,Jeffrey T %A Dunavan,John %A Knickerbocker,Kelly J %A Patel,Maulik R %+ College of Nursing, University of Utah, 10 South, 2000 Eaast, Salt Lake City, UT, 84112, United States, 1 7065738853, cathy.maxwell@nurs.utah.edu %K older adults %K physical activity %K exercise %K science communication %K gerontology %K usability %K behavior change %K mitochondria %K fitness %K health intervention %K digital health %K evaluation %K feasibility study %K community dwelling %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our previous work revealed strong community interest in the concept of mitochondrial fitness, which led to the development of a video-based science communication intervention to prompt behavior change in adults aged 50 years and older. Objective: This study aimed to conduct formative and summative evaluations of MitoFit, an instructional, biologically based communication intervention aimed at improving physical activity in older adults aged 50 years and older. Methods: In the phase-1 formative evaluation, community-dwelling older adults (N=101) rated the acceptability, appropriateness, and helpfulness of our MitoFit video series, titled “How to Slow Down Aging Through Mitochondrial Fitness.” In the phase-2 summative evaluation, a subgroup of phase-1 participants (n=19) participated in a 1-month MitoFit intervention prototype to evaluate the intervention and data collection feasibility. Results: In phase 1, participants (mean age 67.8, SD 8.9 y; 75/100, 75% female) rated the MitoFit videos as acceptable (≥4 out of 5 on a Likert-scale survey; from 97/101, 96% to 100/101, 99%), appropriate (101/101, 100%), and helpful (from 95/101, 94% to 100/101, 99%) to support adaptation and continued work on our novel approach. Previous knowledge of mitochondria ranged from 52% (50/97; What are mitochondria?) to 80% (78/97; What are the primary functions of mitochondria?). In phase 2, participants (mean age 71.4, SD 7.9 y; 13/19, 72% female) scored better than the national average (50) on the Patient-Reported Outcomes Measurement Information System-19 for physical function (57), social activities (55.5), depression (41), fatigue (48.6), and sleep disturbance (49.6) but worse for anxiety (55.3) and pain interference (52.4). Additionally, 95% (18/19) of participants demonstrated MitoFit competencies within 2 attempts (obtaining pulse: 19/19, 100%; calculating maximum and zone 2 heart rate: 18/19, 95%; and demonstration of exercises: 19/19, 100%). At 1 month after instruction, 68% (13/19) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. A walking pulse was documented by 85% (11/13) of participants. The time needed to walk 1 mile ranged from 17.4 to 27.1 minutes. The number of miles walked in 1 month was documented by 62% (8/13) of participants and ranged from 10 miles to 31 miles. The number of days of strength training ranged from 2 to 31 days/month. Intervention feasibility scores ranged from 89% (17/19; seems easy to follow) to 95% (18/19; seems implementable, possible, and doable). Overall, 79% (15/19) stated an intention to continue the MitoFit intervention. Furthermore, 4 weeks after delivery of the prototype intervention, the percentage of participants doing aerobic activity for regular moderate activity increased from 35% (6/17) to 59% (10/17; P=.03). Conclusions: MitoFit was enthusiastically embraced and is a cost-effective, scalable, and potentially efficacious intervention to advance with community-dwelling older adults. %M 39671578 %R 10.2196/64437 %U https://formative.jmir.org/2024/1/e64437 %U https://doi.org/10.2196/64437 %U http://www.ncbi.nlm.nih.gov/pubmed/39671578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52834 %T Exploring Older Adults’ Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study %A Choukou,Mohamed-Amine %A Banihani,Jasem %A Azizkhani,Sarah %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R111, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 333 4778, amine.choukou@umanitoba.ca %K agetech %K attitude %K opinion %K perception %K perspective %K home based %K community based %K research %K strategic planning %K gerontechnology %K geriatric %K older adults %K aging %K co-construction %K workshop %K inductive analysis %K development %K aging-in-place %K independent %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. %M 39671577 %R 10.2196/52834 %U https://formative.jmir.org/2024/1/e52834 %U https://doi.org/10.2196/52834 %U http://www.ncbi.nlm.nih.gov/pubmed/39671577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54664 %T Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment %A Fernandez,Isabel Diana %A Yang,Yu-Ching %A Chang,Wonkyung %A Kautz,Amber %A Farchaus Stein,Karen %+ Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, United States, 1 585 275 9554, Diana_fernandez@urmc.rochester.edu %K Mexican immigrant farmworker %K diet-related noncommunicable diseases %K mHealth %K dietary assessment %K image-based %K healthcare disparities %K minority %K feasibility study %K food photography %K rural health %K health literacy %K culutural adaptation %K women %K technology acceptance %K mobile health %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non–text-based dietary intervention. Objective: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. Methods: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. Results: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Conclusions: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases. %M 39671581 %R 10.2196/54664 %U https://formative.jmir.org/2024/1/e54664 %U https://doi.org/10.2196/54664 %U http://www.ncbi.nlm.nih.gov/pubmed/39671581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65469 %T Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study %A Wickham,Aidan P %A Hewings-Martin,Yella %A Goddard,Frederick GB %A Rodgers,Allison K %A Cunningham,Adam C %A Prentice,Carley %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Meczner,András %A Stsefanovich,Heorhi %A Klepchukova,Anna %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 44 60396823, a_wickham@flo.health %K polycystic ovary syndrome %K PCOS %K self-assessment %K self-reported %K endometriosis %K uterine fibroids %K symptoms %K digital symptom checker %K women's health %K gynecological conditions %K reproductive health %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. Objective: This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. Methods: Flo’s symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants’ symptoms were processed by Flo’s 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant’s condition designation. Results: A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92%), feeling anxious (87%), BMI over 25 (84%); for endometriosis: very regular lower abdominal pain (89%), fatigue (85%), and referred lower back pain (80%); for uterine fibroids: fatigue (76%), bloating (69%), and changing sanitary protection often (68%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78%, 73%, and 75% for PCOS, endometriosis, and uterine fibroids, respectively. Conclusions: This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy. %M 39666967 %R 10.2196/65469 %U https://formative.jmir.org/2024/1/e65469 %U https://doi.org/10.2196/65469 %U http://www.ncbi.nlm.nih.gov/pubmed/39666967 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56567 %T Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study %A Bunnell,Brian E %A Schuler,Kaitlyn R %A Ivanova,Julia %A Flynn,Lea %A Barrera,Janelle F %A Niazi,Jasmine %A Turner,Dylan %A Welch,Brandon M %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613-4706, United States, 1 8139748607, bbunnell@usf.edu %K mental health %K mental illness %K mental disease %K mental disorder %K homework %K homework challenge %K therapy %K therapist %K barriers %K adult client %K adult %K technology-based solution %K health technology %K digital health %K digital technology %K digital intervention %K mobile phone %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act–compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. %M 39665475 %R 10.2196/56567 %U https://humanfactors.jmir.org/2024/1/e56567 %U https://doi.org/10.2196/56567 %U http://www.ncbi.nlm.nih.gov/pubmed/39665475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60033 %T Quality of Pancreatic Neuroendocrine Tumor Videos Available on TikTok and Bilibili: Content Analysis %A Niu,Zheyu %A Hao,Yijie %A Yang,Faji %A Jiang,Qirong %A Jiang,Yupeng %A Zhang,Shizhe %A Song,Xie %A Chang,Hong %A Zhou,Xu %A Zhu,Huaqiang %A Gao,Hengjun %A Lu,Jun %K pancreatic neuroendocrine tumors %K short videos %K quality analysis %K TikTok %K Bilibili %K social media %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: Disseminating disease knowledge through concise videos on various platforms is an innovative and efficient approach. However, it remains uncertain whether pancreatic neuroendocrine tumor (pNET)-related videos available on current short video platforms can effectively convey accurate and impactful information to the general public. Objective: Our study aims to extensively analyze the quality of pNET-related videos on TikTok and Bilibili, intending to enhance the development of pNET-related social media content to provide the general public with more comprehensive and suitable avenues for accessing pNET-related information. Methods: A total of 168 qualifying videos pertaining to pNETs were evaluated from the video-sharing platforms Bilibili and TikTok. Initially, the fundamental information conveyed in the videos was documented. Subsequently, we discerned the source and content type of each video. Following that, the Global Quality Scale (GQS) and modified DISCERN (mDISCERN) scale were employed to appraise the educational value and quality of each video. A comparative evaluation was conducted on the videos obtained from these two platforms. Results: The number of pNET-related videos saw a significant increase since 2020, with 9 videos in 2020, 19 videos in 2021, 29 videos in 2022, and 106 videos in 2023. There were no significant improvements in the mean GQS or mDISCERN scores from 2020 to 2023, which were 3.22 and 3.00 in 2020, 3.33 and 2.94 in 2021, 2.83 and 2.79 in 2022, and 2.78 and 2.94 in 2023, respectively. The average quality scores of the videos on Bilibili and Tiktok were comparable, with GQS and mDISCERN scores of 2.98 on Bilibili versus 2.77 on TikTok and 2.82 on Bilibili versus 3.05 on TikTok, respectively. The source and format of the videos remained independent factors affecting the two quality scores. Videos that were uploaded by professionals (hazard ratio=7.02, P=.002) and recorded in specialized popular science formats (hazard ratio=12.45, P<.001) tended to exhibit superior quality. Conclusions: This study demonstrates that the number of short videos on pNETs has increased in recent years, but video quality has not improved significantly. This comprehensive analysis shows that the source and format of videos are independent factors affecting video quality, which provides potential measures for improving the quality of short videos. %R 10.2196/60033 %U https://formative.jmir.org/2024/1/e60033 %U https://doi.org/10.2196/60033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58623 %T Integrating GPT-Based AI into Virtual Patients to Facilitate Communication Training Among Medical First Responders: Usability Study of Mixed Reality Simulation %A Gutiérrez Maquilón,Rodrigo %A Uhl,Jakob %A Schrom-Feiertag,Helmut %A Tscheligi,Manfred %+ Center for Technology Experience, AIT - Austrian Institute of Technology, Giefinggasse 4, Vienna, 1210, Austria, 43 66478588121, rodrigo.gutierrez@ait.ac.at %K medical first responders %K verbal communication skills %K training %K virtual patient %K generative artificial intelligence %K GPT %K large language models %K prompt engineering %K mixed reality %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Training in social-verbal interactions is crucial for medical first responders (MFRs) to assess a patient’s condition and perform urgent treatment during emergency medical service administration. Integrating conversational agents (CAs) in virtual patients (VPs), that is, digital simulations, is a cost-effective alternative to resource-intensive human role-playing. There is moderate evidence that CAs improve communication skills more effectively when used with instructional interventions. However, more recent GPT-based artificial intelligence (AI) produces richer, more diverse, and more natural responses than previous CAs and has control of prosodic voice qualities like pitch and duration. These functionalities have the potential to better match the interaction expectations of MFRs regarding habitability. Objective: We aimed to study how the integration of GPT-based AI in a mixed reality (MR)–VP could support communication training of MFRs. Methods: We developed an MR simulation of a traffic accident with a VP. ChatGPT (OpenAI) was integrated into the VP and prompted with verified characteristics of accident victims. MFRs (N=24) were instructed on how to interact with the MR scenario. After assessing and treating the VP, the MFRs were administered the Mean Opinion Scale-Expanded, version 2, and the Subjective Assessment of Speech System Interfaces questionnaires to study their perception of the voice quality and the usability of the voice interactions, respectively. Open-ended questions were asked after completing the questionnaires. The observed and logged interactions with the VP, descriptive statistics of the questionnaires, and the output of the open-ended questions are reported. Results: The usability assessment of the VP resulted in moderate positive ratings, especially in habitability (median 4.25, IQR 4-4.81) and likeability (median 4.50, IQR 3.97-5.91). Interactions were negatively affected by the approximately 3-second latency of the responses. MFRs acknowledged the naturalness of determining the physiological states of the VP through verbal communication, for example, with questions such as “Where does it hurt?” However, the question-answer dynamic in the verbal exchange with the VP and the lack of the VP’s ability to start the verbal exchange were noticed. Noteworthy insights highlighted the potential of domain-knowledge prompt engineering to steer the actions of MFRs for effective training. Conclusions: Generative AI in VPs facilitates MFRs’ training but continues to rely on instructions for effective verbal interactions. Therefore, the capabilities of the GPT-VP and a training protocol need to be communicated to trainees. Future interactions should implement triggers based on keyword recognition, the VP pointing to the hurting area, conversational turn-taking techniques, and add the ability for the VP to start a verbal exchange. Furthermore, a local AI server, chunk processing, and lowering the audio resolution of the VP’s voice could ameliorate the delay in response and allay privacy concerns. Prompting could be used in future studies to create a virtual MFR capable of assisting trainees. %M 39661979 %R 10.2196/58623 %U https://formative.jmir.org/2024/1/e58623 %U https://doi.org/10.2196/58623 %U http://www.ncbi.nlm.nih.gov/pubmed/39661979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60760 %T Prevalence and Independent Predictors of Anxiety and Depression Among Elementary and High School Educators: Cross-Sectional Study %A Agyapong,Belinda %A Brett-MacLean,Pamela %A Orimalade,Adedamola %A Dias,Raquel da Luz %A Wei,Yifeng %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, 4-142A Katz Group Centre for Research, 11315- 87 Ave NW, Edmonton, AB, T6G 2H5, Canada, 1 7804928560, bagyapon@ualberta.ca %K generalized anxiety disorder %K major depressive disorder %K resilience %K stress %K Wellness4Teachers %K teachers %K prevalence %K predictors %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, anxiety and depression are primary contributors to work disability and impact the mental and physical well-being of educators. Objective: This study aims to determine the prevalence and independent predictors of likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) among teachers in the Canadian provinces of Newfoundland and Labrador, Alberta, and Nova Scotia. Methods: The study used a cross-sectional design. Educators from the 3 Canadian provinces participated by completing a web-based survey after enrolling in the Wellness4Teachers program, a free, self-subscription, daily, supportive SMS text messaging initiative. The program was launched at the beginning of the 2022-2023 academic year, and all teachers in the 3 provinces were eligible to enroll. Likely GAD and likely MDD among subscribers were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9, respectively. Data analysis was conducted using SPSS (version 28.0). Results: Of the 1912 Wellness4Teachers subscribers, 763 (39.9%) completed the survey. The prevalence of likely MDD was 55.7% (425/763) and that of likely GAD was 46% (349/759). After controlling for all other variables in the regression model, participants who reported high stress were 7.24 times more likely to experience MDD (odds ratio [OR] 7.24, 95% CI 4.22-12.42) and 7.40 times more likely to experience GAD (OR 7.40, 95% CI 4.63-11.80) than those with mild to moderate stress. Participants with emotional exhaustion were 4.92 times more likely to experience MDD (OR 4.92, 95% CI 3.01-8.05) and 4.34 times more likely to experience GAD (OR 4.34, 95% CI 2.47-7.62) than those without. Moreover, respondents with a lack of professional accomplishment were 2.13 times as likely to have MDD symptoms (OR 2.13, 95% CI 1.41-3.23) and 1.52 times more likely to experience GAD symptoms (OR 1.524, 95% CI 1.013-2.293) than those without. Similarly, respondents with low resilience were 1.82 times more likely to have likely MDD than those with normal to high resilience (OR 1.82, 95% CI 1.24-2.66). In addition, respondents with low resilience were 3.01 times more likely to experience likely GAD than those with normal to high resilience (OR 3.01, 95% CI 2.03-7.62). Participants with >20 years of teaching experience were 0.28 times less likely to experience GAD symptoms than those with ≤5 years of teaching experience (OR 0.28, 95% CI 0.12-0.64). Sociodemographic and work-related variables did not independently predict likely GAD and likely MDD. Conclusions: This study underscores the need for governments and policy makers in the education sector to implement comprehensive mental health support programs. Addressing the unique stressors faced by educators, reducing emotional exhaustion, and enhancing resilience are crucial steps toward mitigating anxiety and depression, promoting educators’ well-being, and improving the quality of educational delivery. International Registered Report Identifier (IRRID): RR2-10.2196/37934. %M 39528340 %R 10.2196/60760 %U https://formative.jmir.org/2024/1/e60760 %U https://doi.org/10.2196/60760 %U http://www.ncbi.nlm.nih.gov/pubmed/39528340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59513 %T Usability Testing of a Digitized Interventional Prehabilitation Tool for Health Care Professionals and Patients Before Major Surgeries: Formative and Summative Evaluation %A Schnitzbauer,Andreas A %A Detemble,Charlotte %A Faqar-Uz-Zaman,Sara Fatima %A Dreilich,Julia %A Mohr,Lisa %A Sliwinski,Svenja %A Zmuc,Dora %A Siller,Mark %A Fleckenstein,Johannes %+ Department of General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, 49 696301, andreas.schnitzbauer@icloud.com %K usability testing %K prehabilitation %K MARS %K Mobile Application Rating Scale %K trustworthiness %K surgical research %K usability %K prerehabilitation tool %K tool %K medical device %K surgery %K device %K application %K design %K engineering %K development %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of a medical device requires strict adherence to regulatory processes. Prehabilitation in this context is a new area in surgery that trains, coaches, and advises patients in mental well-being, nutrition, and physical activity. As staff is permanently drained from clinical care, remote and digital solutions with real-time assessments of data, including patient-related outcome reporting, may simplify preparation before major surgeries. Objective: This study aimed to evaluate the usability engineering process for the Prehab App, a newly developed medical device, in order to identify and adapt any design and usability flaws found. Methods: We hypothesized that formative and summative usability testing would achieve 80% interrater and intrarater reliability and consistency and that the safety-relevant scenarios would uncover undetected risks of the medical device (stand-alone software class IIa). In total, 8 experts and 8 laypersons (patients and potential patients) were asked to evaluate paper-based mockups, followed by an evaluation of the minimal viable product (MVP) of the Prehab App at least more than 8 weeks later after instruction and training. The experts had to face 5 and the laypersons 6 usability scenarios. Their evaluations were measured with the Mobile App Rating Scale (MARS) and trustworthiness checklists (range 0-64, with higher scores indicating trustworthiness), and the usability scenarios were evaluated with the After Scenario Questionnaire (ASQ) and a judgment by an observer. The time taken for the scenarios was also recorded. Results: MARS achieved constant scores of more than 4 out of 5 points for both experts and laypersons. The mean trustworthiness score was 51.3 (SD 2.7) for the experts and 50.8 (SD 2.1) for the laypersons (P=.68) in task I. The interrater correlation, shown by the Fleiss-Kappa value, was 0.87 (range 0.85-0.89) for all raters (N=16), 0.86 (range 0.82-0.91) for the experts (n=8, 50%), and 0.88 (range 0.84-0.93) for the laypersons (n=8, 50%), reflecting almost perfect agreement between the raters. This indicated the high quality of the usability. The usability scenarios were performed with ease, except for the onboarding part, when the wearable was required to be connected; this took a considerable amount of time and was recognized as a challenge to good usability. Conclusions: The formative and summative evaluation of the Prehab App design resulted in good-to-acceptable results of the design and usability of the critical and safety-relevant areas of the medical device and stand-alone software. Usability testing improves medical devices early in the design and development process, reduces errors, and mitigates risks, and in this study, it delivered a profound ethical and medical justification for a randomized controlled trial (RCT) of the Prehab App in a remote setting as a next step in the development process. Trial Registration: German Registry for Clinical Trials (DRKS00026985); https://drks.de/search/en/trial/DRKS00026985 %M 39661439 %R 10.2196/59513 %U https://formative.jmir.org/2024/1/e59513 %U https://doi.org/10.2196/59513 %U http://www.ncbi.nlm.nih.gov/pubmed/39661439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64463 %T Improving Self-Efficacy, Quality of Life, and Glycemic Control in Adolescents With Type 1 Diabetes: Randomized Controlled Trial for the Evaluation of the Family-Centered Empowerment Model %A Alzawahreh,Salah %A Ozturk,Candan %+ Ministry of Health, Al-muzdalefah Street, Amman, 11118, Jordan, 962 0772260125, Salahalzwaherh78@yahoo.com %K adolescents %K family-centered empowerment model %K glycemic control %K quality of life %K self-efficacy %K type 1 diabetes mellitus %K T1DM %K family-centered %K teenager %K glycemic %K experimental evaluation %K empowerment %K Jordan %K glycosylated hemoglobin %K HbA1c %K experimental study %K family %K care education %K self-care %K educational program %K mobile phone %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor glycemic management in adolescents with type 1 diabetes mellitus (T1DM) increases complications. Enhanced control is associated with other factors, such as cultural, socioeconomic, and health care system disparities specific to the Middle East, which can greatly influence individuals’ ability to get and use health care services as well as their reaction to treatment approaches. Objective: This study aims to evaluate the impact of the family-centered empowerment model on Jordanian adolescents with T1DM, focusing on their glycosylated hemoglobin levels, self-efficacy, and quality of life (QOL). Methods: A randomized controlled trial involved 68 adolescents with T1DM visiting Jordanian Royal Medical Services’ clinics. Two sets of participant groups were created: control (n=34) and intervention (n=34). Participants were randomly assigned to either the intervention group, receiving the family-centered empowerment model intervention, or the control group, receiving standard care. Data were collected through face-to-face interviews and medical records. Results: From April to October 2023, a total of 68 adolescents with T1DM participated in the study at the Jordanian Royal Medical Services. QOL had significant improvement among 13 (38%) of the 34 participants in the intervention group, and the program significantly improved moderate self-efficacy levels in 12 (35%) patients (P<.001). In addition, the average glycosylated hemoglobin levels dropped from 11.25% to 10.23% (P<.001). Additionally, improvements were seen in stress management, communication, and treatment adherence, with a substantial decrease in treatment obstacles. The intervention was successful in improving both clinical and psychosocial outcomes, as evidenced by the fact that the control group showed no noticeable improvements in these parameters. Conclusions: The study suggests that patients with T1DM should receive continuous care education sessions, including self-care training, to improve their health. Nurses should also incorporate this training into treatment plans and educational programs for adolescents to enhance their QOL. Trial Registration: ClinicalTrials.gov NCT06694467; https://clinicaltrials.gov/study/NCT06694467 %M 39658013 %R 10.2196/64463 %U https://formative.jmir.org/2024/1/e64463 %U https://doi.org/10.2196/64463 %U http://www.ncbi.nlm.nih.gov/pubmed/39658013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60530 %T Characteristics and Popularity of Videos of Abusive Head Trauma Prevention: Systematic Appraisal %A Goethals,Luc %A Prokofieva Nelson,Victoria %A Fenouillet,Fabien %A Chevreul,Karine %A Bergerat,Manon %A Lebreton,Christine %A Refes,Yacine %A Blangis,Flora %A Chalumeau,Martin %A Le Roux,Enora %+ Obstetrical, Perinatal and Pediatric Epidemiology Research team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Inserm, 123 Bd de Port-Royal, Paris, 75014, France, 33 0699222119, luc.goethals@inserm.fr %K abusive head trauma %K child physical abuse %K shaken baby syndrome %K SBS %K primary prevention %K web-based videos %K digital tools %K head trauma %K prevention %K video %K internet %K infant %K mortality %K morbidity %K parent %K caregivers %K communication %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous strategies for preventing abusive head trauma (AHT) have been proposed, but controlled studies failed to demonstrate their effectiveness. Digital tools may improve the effectiveness of AHT prevention strategies by reaching a large proportion of the adult population. Objective: This study aimed to describe the characteristics of videos of AHT prevention published on the internet, including their quality content, and to study their association with popularity. Methods: From a systematic appraisal performed in June 2023, we identified videos addressing the primary prevention of AHT in children younger than 2 years that were published in English or French on the internet by public organizations or mainstream associations. We analyzed the characteristics of the videos; their quality with the Global Quality Scale (GQS); and their association with an index of popularity, the Video Power Index, using multivariable quasi-Poisson modeling. Results: We included 53 (6.6%) of the 804 videos identified. Videos were mainly published by public organizations (43/53, 81%). The median time spent on the web was 6 (IQR 3-9) years, the median length was 202 (IQR 94-333) seconds, and the median GQS score was 4 (IQR 3-4). Infants were often depicted (42/53, 79%), including while crying (35/53, 66%) and being shaken (21/53, 40%). The characterization of shaking as an abuse and its legal consequences were cited in 47% (25/53) and 4% (2/53) of videos, respectively. The main prevention strategies in the videos were to raise awareness of the noxious outcome of shaking (49/53, 93%) and convince viewers of the effectiveness of coping strategies for infants’ cries (45/53, 85%). The Video Power Index was positively correlated with the GQS (r=0.38; P=.007) and was independently associated with depicting an infant being shaken (P=.03; β=1.74, 95% CI 1.06-2.85) and the use of text or headers (P=.04; β=2.15, 95% CI 1.08-4.26). Conclusions: AHT prevention videos had high quality but did not frequently deal with parental risk factors. The characteristics identified as being associated with the popularity of AHT prevention videos could help improve the impact of future prevention programs by enhancing their popularity. %M 39657172 %R 10.2196/60530 %U https://www.jmir.org/2024/1/e60530 %U https://doi.org/10.2196/60530 %U http://www.ncbi.nlm.nih.gov/pubmed/39657172 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63355 %T The Implementation Outcomes and Population Impact of a Statewide IT Deployment for Family Caregivers: Mixed Methods Study %A Tonkikh,Orly %A Young,Heather M %A Bell,Janice F %A Famula,Jessica %A Whitney,Robin %A Mongoven,Jennifer %A Kelly,Kathleen %+ Betty Irene Moore School of Nursing, University of California Davis, 2570 48th Street, Sacramento, CA, 95817, United States, 1 9167342145, hmyoung@ucdavis.edu %K web-based assessment %K caregiver %K technology implementation %K Consolidated Framework for Implementation Research %K CFIR %K information technology %K IT %K family caregivers %K eHealth %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective: This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods: The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results: We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions: This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact. %M 39657176 %R 10.2196/63355 %U https://aging.jmir.org/2024/1/e63355 %U https://doi.org/10.2196/63355 %U http://www.ncbi.nlm.nih.gov/pubmed/39657176 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56205 %T mHealth Apps in German Outpatient Mental Health Care: Protocol for a Mixed Methods Approach %A Höfer,Klemens %A Plescher,Felix %A Schlierenkamp,Sarah %A Solar,Stefanie %A Neusser,Silke %A Schneider,Udo %A Best,Dieter %A Wasem,Jürgen %A Abels,Carina %A Bußmann,Anna %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 2011834037, klemens.hoefer@medman.uni-due.de %K mental health care %K mHealth %K digital health applications %K Digitale Gesundheitsanwendungen %K mental disorders %K health care research %K applications %K app %K mental health %K outpatient %K digital health %K adults %K Germany %K mobile health apps %K treatment %D 2024 %7 10.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. Objective: This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. Methods: The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. Results: The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. Conclusions: There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/56205 %M 39657173 %R 10.2196/56205 %U https://www.researchprotocols.org/2024/1/e56205 %U https://doi.org/10.2196/56205 %U http://www.ncbi.nlm.nih.gov/pubmed/39657173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50041 %T Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study %A McCarthy,Hannah %A Potts,Henry W W %A Fisher,Abigail %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, h.potts@ucl.ac.uk %K mHealth %K rewards %K incentives %K physical activity %K smartphone %K apps %K mobile apps %K app-based intervention %K behavior change %K exercise %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level. Objective: This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness. Methods: Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way. Results: There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman χ22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis. Conclusions: Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost. %M 39657165 %R 10.2196/50041 %U https://formative.jmir.org/2024/1/e50041 %U https://doi.org/10.2196/50041 %U http://www.ncbi.nlm.nih.gov/pubmed/39657165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60650 %T Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study %A Bosco,Cristina %A Shojaei,Fereshtehossadat %A Theisz,Alec Andrew %A Osorio Torres,John %A Cureton,Bianca %A Himes,Anna K %A Jessup,Nenette M %A Barnes,Priscilla A %A Lu,Yvonne %A Hendrie,Hugh C %A Hill,Carl V %A Shih,Patrick C %+ Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 (812) 856 5754, cribosco@iu.edu %K older African American and Black adults %K Alzheimer disease and related dementias %K health literacy %K Wizard of Oz %K voice assistant %K chatbot %K mobile app %K dementia %K geriatric %K aging %K Alzheimer disease %K artificial intelligence %K AI %K mHealth %K digital tools %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities—voice assistants, chatbots, and mobile apps—can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants’ cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user’s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community’s values and construct an interaction with the technology that is built on African American and Black communities’ needs and demands. %R 10.2196/60650 %U https://formative.jmir.org/2024/1/e60650 %U https://doi.org/10.2196/60650 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52032 %T Rapid, Tailored Dietary and Health Education Through A Social Media Chatbot Microintervention: Development and Usability Study With Practical Recommendations %A Ali,Shahmir H %A Rahman,Fardin %A Kuwar,Aakanksha %A Khanna,Twesha %A Nayak,Anika %A Sharma,Priyanshi %A Dasraj,Sarika %A Auer,Sian %A Rouf,Rejowana %A Patel,Tanvi %A Dhar,Biswadeep %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 87918862, sali@nus.edu.sg %K social media %K chatbot %K conversational agent %K intervention %K diet %K health education %K feasibility %K microintervention %K innovation %K dietary education %K social media chatbot %K public health professional %K young adult %K Asian %K curriculum %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an urgent need to innovate methods of health education, which can often be resource- and time-intensive. Microinterventions have shown promise as a platform for rapid, tailored resource dissemination yet have been underexplored as a method of standardized health or dietary education; social media chatbots display unique potential as a modality for accessible, efficient, and affordable educational microinterventions. Objective: This study aims to provide public health professionals with practical recommendations on the use of social media chatbots for health education by (1) documenting the development of a novel social media chatbot intervention aimed at improving dietary attitudes and self-efficacy among South Asian American young adults and (2) describing the applied experiences of implementing the chatbot, along with user experience and engagement data. Methods: In 2023, the “Roti” chatbot was developed on Facebook and Instagram to administer a 4-lesson tailored dietary health curriculum, informed by formative research and the Theory of Planned Behavior, to 18- to 29-year-old South Asian American participants (recruited through social media from across the United States). Each lesson (10-15 minutes) consisted of 40-50 prescripted interactive texts with the chatbot (including multiple-choice and open-response questions). A preintervention survey determined which lesson(s) were suggested to participants based on their unique needs, followed by a postintervention survey informed by the Theory of Planned Behavior to assess changes in attitudes, self-efficacy, and user experiences (User Experience Questionnaire). This study uses a cross-sectional design to examine postintervention user experiences, engagement, challenges encountered, and solutions developed during the chatbot implementation. Results: Data from 168 participants of the intervention (n=92, 54.8% Facebook; n=76, 45.2% Instagram) were analyzed (mean age 24.5, SD 3.1 years; n=129, 76.8% female). Participants completed an average of 2.6 lessons (13.9 minutes per lesson) and answered an average of 75% of questions asked by the chatbot. Most reported a positive chatbot experience (User Experience Questionnaire: 1.34; 81/116, 69.8% positive), with pragmatic quality (ease of use) being higher than hedonic quality (how interesting it felt; 88/116, 75.9% vs 64/116, 55.2% positive evaluation); younger participants reported greater hedonic quality (P=.04). On a scale out of 10 (highest agreement), participants reported that the chatbot was relevant (8.53), that they learned something new (8.24), and that the chatbot was helpful (8.28). Qualitative data revealed an appreciation for the cheerful, interactive messaging of the chatbot and outlined areas of improvement for the length, timing, and scope of text content. Quick replies, checkpoints, online forums, and self-administered troubleshooting were some solutions developed to meet the challenges experienced. Conclusions: The implementation of a standardized, tailored health education curriculum through an interactive social media chatbot displayed strong feasibility. Lessons learned from challenges encountered and user input provide a tangible roadmap for future exploration of such chatbots for accessible, engaging health interventions. %M 39652870 %R 10.2196/52032 %U https://formative.jmir.org/2024/1/e52032 %U https://doi.org/10.2196/52032 %U http://www.ncbi.nlm.nih.gov/pubmed/39652870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58729 %T Association Between Visual Impairment and Daily Internet Use Among Older Japanese Individuals: Cross-Sectional Questionnaire Study %A Takesue,Atsuhide %A Hiratsuka,Yoshimune %A Kondo,Katsunori %A Aida,Jun %A Nakagomi,Atsushi %A Nakao,Shintaro %K visual impairment %K visually impaired %K internet %K internet use %K internet usage %K older adults %K digital divide %K telemedicine %K mobile phone %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: Older adults might not use computers due to psychological barriers, environmental barriers such as not owning a computer or lack of internet access, and health-related barriers such as difficulties with fine motor skills, low cognitive function, or low vision. Given the health benefits of internet use among older adults, inadequate use of the internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study. It included functionally independent community-dwelling individuals aged ≥65 years (N=19,452) in Japan. The respondents reported their visual status by answering the question, “Is your eyesight (without or with usual glasses or corrective lenses) excellent, very good, good, fair, or poor?” We defined “internet user” as a person who uses the internet “almost daily.” We used multivariate logistic regression with multiple imputations to analyze visual status, daily internet use, and any correlations between them. Results: We observed that 23.6% (4599/19,452) of respondents used the internet almost daily. Respondents with good visual status notably tended to use the internet more frequently than those with poor visual status. Specifically, 13% and 31% of respondents with poor and excellent vision, respectively, used the internet almost daily. In contrast, 66% and 45% of respondents with poor and excellent vision, respectively, did not use the internet. Even after adjusting for several covariates (age, sex, equivalized income, years of education, marital status, depression, history of systemic comorbidities, frequency of meeting friends, and total social participation score), significant associations persisted between visual status and daily internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend <.001). The adjusted ORs for individuals with excellent and very good visual status who used the internet almost daily were 1.38 (95% CI 1.22-1.56) and 1.25 (95% CI 1.15-1.36), respectively. Conversely, the adjusted OR for those with fair or poor visual status was 0.73 (95% CI 0.62-0.86). Conclusions: In this study, we reaffirmed what several previous studies have pointed out using a very large dataset; visual impairment negatively impacted daily internet use by older adults. This highlights the need to address visual impairments to promote web use as health care services become more easily accessed on the web. %R 10.2196/58729 %U https://formative.jmir.org/2024/1/e58729 %U https://doi.org/10.2196/58729 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56407 %T Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial %A Pisani,Anthony R %A Wyman,Peter A %A Cero,Ian %A Kelberman,Caroline %A Gurditta,Kunali %A Judd,Emily %A Schmeelk-Cone,Karen %A Mohr,David %A Goldston,David %A Ertefaie,Ashkan %+ Department of Psychiatry, University of Rochester Medical Center, University of Rochester, 301 Crittenden Blvd, Rochester, NY, 14627, United States, 1 585 507 7177, anthony_pisani@urmc.rochester.edu %K suicide prevention %K text messaging %K self-violence %K self-harm %K suicidal behavior %K randomized controlled trial %K adolescent %K teenager %K student %K school %K United States %K Text4Strength %K help-seeking attitude %K coping %K awareness %K depression %K mood disorder %K mental health %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength—a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 %M 39642360 %R 10.2196/56407 %U https://mental.jmir.org/2024/1/e56407 %U https://doi.org/10.2196/56407 %U http://www.ncbi.nlm.nih.gov/pubmed/39642360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55478 %T Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers %A Ng,Hei-Yin Hydra %A Wu,Changwei W %A Hsu,Hao-Che %A Huang,Chih-Mao %A Hsu,Ai-Ling %A Chao,Yi-Ping %A Jung,Tzyy-Ping %A Chuang,Chun-Hsiang %+ Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Rm. 1515, 5/F, Administration Building, National Tsing Hua University, No. 521, Nanda Rd., Hsinchu, 300193, Taiwan, 886 35715131 ext 78608, cch.chuang@gmail.com %K biofeedback %K virtual reality %K breathing training %K EEG %K electroencephalography %K effective connectivity %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques. Objective: We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap. Methods: Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests. Results: The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ≥1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques. Conclusions: This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training. Trial Registration: ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741 %M 39642375 %R 10.2196/55478 %U https://formative.jmir.org/2024/1/e55478 %U https://doi.org/10.2196/55478 %U http://www.ncbi.nlm.nih.gov/pubmed/39642375 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63288 %T eHealth Literacy and Health-Related Internet Use Among Swedish Primary Health Care Visitors: Cross-Sectional Questionnaire Study %A Sjöström,Anna %A Hajdarevic,Senada %A Hörnsten,Åsa %A Isaksson,Ulf %K eHealth literacy %K primary health care %K health-related internet information %K health literacy %K digitalization %K eHealth %K cost-effective care %K internet %K health applications %K digital health %K patient participation %K health behaviors %K questionnaire %K well-being %D 2024 %7 5.12.2024 %9 %J JMIR Form Res %G English %X Background: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. Objective: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. Methods: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. Results: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8‐3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2‐3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2‐3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2‐3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2‐3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1‐1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02‐1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1‐1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Conclusions: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users’ individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible. %R 10.2196/63288 %U https://formative.jmir.org/2024/1/e63288 %U https://doi.org/10.2196/63288 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56796 %T Exploring How Older Adults Experience semAPP, a 360° Media–Based Tool for Memory Assessment: Qualitative Study %A Bruni,Francesca %A Mancuso,Valentina %A Panigada,Jonathan %A Stramba-Badiale,Marco %A Cipresso,Pietro %A Pedroli,Elisa %+ Department of Theoretical and Applied Sciences, eCampus University, Via Isimbardi 10, Novedrate, 22060, Italy, 39 3460066231, v.mancuso95@gmail.com %K assessment %K virtual reality %K 360-degree videos %K user experience %K memory %K aging %K psycho gerontology %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users—whether they are patients, health care professionals, or both—in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360° media–based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47%) healthy individuals and 18 (53%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. %M 39637375 %R 10.2196/56796 %U https://aging.jmir.org/2024/1/e56796 %U https://doi.org/10.2196/56796 %U http://www.ncbi.nlm.nih.gov/pubmed/39637375 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59610 %T Influencing Factors and Implementation Pathways of Adherence Behavior in Intelligent Personalized Exercise Prescription: Qualitative Study %A Xu,Xuejie %A Zhang,Guoli %A Xia,Yuxin %A Xie,Hui %A Ding,Zenghui %A Wang,Hongyu %A Ma,Zuchang %A Sun,Ting %+ School of Nursing, Bengbu Medical University, Number 2600, Donghai Avenue, Bengbu, 233030, China, 86 18005529759, cangwuge21@163.com %K exercise prescription %K adherence behavior %K qualitative %K influence factors %K Transtheoretical Model %K multiple motivations of behavior %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized intelligent exercise prescriptions have demonstrated significant benefits in increasing physical activity and improving individual health. However, the health benefits of these prescriptions depend on long-term adherence. Therefore, it is essential to analyze the factors influencing adherence to personalized intelligent exercise prescriptions and explore the intrinsic relationship between individual behavioral motivation and adherence. This understanding can help improve adherence and maximize the effectiveness of such prescriptions. Objective: This study aims to identify the factors influencing adherence behavior among middle-aged and older community residents who have been prescribed personalized exercise regimens through an electronic health promotion system. It also explores how these factors affect the initiation and maintenance of adherence behavior. Methods: We used purposive sampling to conduct individual, face-to-face semistructured interviews based on the Transtheoretical Model (TTM) with 12 middle-aged and older community residents who had been following personalized exercise regimens for 8 months. These residents had received detailed exercise health education and guidance from staff. The interviews were recorded, transcribed verbatim, and analyzed using NVivo software through grounded theory. We then applied the TTM and multibehavioral motivation theory to analyze the factors influencing adherence. Additionally, the relationship between behavioral motivations and adherence was explored. Results: Using the behavior change stages of the TTM, open coding yielded 21 initial categories, which were then organized into 8 main categories through axial coding: intrinsic motivation, extrinsic motivation, benefit motivation, pleasure motivation, achievement motivation, perceived barriers, self-regulation, and optimization strategies. Selective coding further condensed these 8 main categories into 3 core categories: “multitheory motivation,” “obstacle factors,” and “solution strategies.” Using the coding results, a 3-level model of factors influencing adherence to intelligent personalized exercise prescriptions was developed. Based on this, an implementation path for promoting adherence to intelligent personalized exercise prescriptions was proposed by integrating the model with the TTM. Conclusions: Adherence to personalized exercise prescriptions is influenced by both facilitating factors (eg, multibehavioral motivation, optimization strategies) and obstructive factors (eg, perceived barriers). Achieving and maintaining adherence is a gradual process, shaped by a range of motivations and factors. Personalized solutions, long-term support, feedback mechanisms, and social support networks are essential for promoting adherence. Future efforts should focus on enhancing adherence by strengthening multibehavioral motivation, optimizing solutions, and addressing barriers to improve overall adherence. %M 39636668 %R 10.2196/59610 %U https://mhealth.jmir.org/2024/1/e59610 %U https://doi.org/10.2196/59610 %U http://www.ncbi.nlm.nih.gov/pubmed/39636668 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59045 %T Intersection of Performance, Interpretability, and Fairness in Neural Prototype Tree for Chest X-Ray Pathology Detection: Algorithm Development and Validation Study %A Chen,Hongbo %A Alfred,Myrtede %A Brown,Andrew D %A Atinga,Angela %A Cohen,Eldan %+ Department of Mechanical and Industrial Engineering, University of Toronto, 27 King's College Cir, Toronto, ON, Canada, 1 416 978 4184, ecohen@mie.utoronto.ca %K explainable artificial intelligence %K deep learning %K chest x-ray %K thoracic pathology %K fairness %K interpretability %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While deep learning classifiers have shown remarkable results in detecting chest X-ray (CXR) pathologies, their adoption in clinical settings is often hampered by the lack of transparency. To bridge this gap, this study introduces the neural prototype tree (NPT), an interpretable image classifier that combines the diagnostic capability of deep learning models and the interpretability of the decision tree for CXR pathology detection. Objective: This study aimed to investigate the utility of the NPT classifier in 3 dimensions, including performance, interpretability, and fairness, and subsequently examined the complex interaction between these dimensions. We highlight both local and global explanations of the NPT classifier and discuss its potential utility in clinical settings. Methods: This study used CXRs from the publicly available Chest X-ray 14, CheXpert, and MIMIC-CXR datasets. We trained 6 separate classifiers for each CXR pathology in all datasets, 1 baseline residual neural network (ResNet)–152, and 5 NPT classifiers with varying levels of interpretability. Performance, interpretability, and fairness were measured using the area under the receiver operating characteristic curve (ROC AUC), interpretation complexity (IC), and mean true positive rate (TPR) disparity, respectively. Linear regression analyses were performed to investigate the relationship between IC and ROC AUC, as well as between IC and mean TPR disparity. Results: The performance of the NPT classifier improved as the IC level increased, surpassing that of ResNet-152 at IC level 15 for the Chest X-ray 14 dataset and IC level 31 for the CheXpert and MIMIC-CXR datasets. The NPT classifier at IC level 1 exhibited the highest degree of unfairness, as indicated by the mean TPR disparity. The magnitude of unfairness, as measured by the mean TPR disparity, was more pronounced in groups differentiated by age (chest X-ray 14 0.112, SD 0.015; CheXpert 0.097, SD 0.010; MIMIC 0.093, SD 0.017) compared to sex (chest X-ray 14 0.054 SD 0.012; CheXpert 0.062, SD 0.008; MIMIC 0.066, SD 0.013). A significant positive relationship between interpretability (ie, IC level) and performance (ie, ROC AUC) was observed across all CXR pathologies (P<.001). Furthermore, linear regression analysis revealed a significant negative relationship between interpretability and fairness (ie, mean TPR disparity) across age and sex subgroups (P<.001). Conclusions: By illuminating the intricate relationship between performance, interpretability, and fairness of the NPT classifier, this research offers insightful perspectives that could guide future developments in effective, interpretable, and equitable deep learning classifiers for CXR pathology detection. %M 39636692 %R 10.2196/59045 %U https://formative.jmir.org/2024/1/e59045 %U https://doi.org/10.2196/59045 %U http://www.ncbi.nlm.nih.gov/pubmed/39636692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45763 %T Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study %A Huang,Xuan %A Wang,Ying %A Yang,Xixian %A Jiang,Ruo %A Liu,Yicheng %A Wang,Hui %+ Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China, 86 21 24058249, wangh2005@alumni.sjtu.edu.cn %K mobile health technology %K smartphones %K mobile phone %K internet hospital %K China %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China’s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. %M 39631758 %R 10.2196/45763 %U https://formative.jmir.org/2024/1/e45763 %U https://doi.org/10.2196/45763 %U http://www.ncbi.nlm.nih.gov/pubmed/39631758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63038 %T Insights From Art Therapists on Using AI-Generated Art in Art Therapy: Mixed Methods Study %A Shojaei,Fereshtehossadat %A Shojaei,Fatemehalsadat %A Osorio Torres,John %A Shih,Patrick C %K art therapy %K artificial intelligence %K AI %K therapeutic interventions %K assistive AI %K engagement %K health care %K therapy %K art %K therapists' insights %K daily life %K practitioner %K assistive %K AI-generated image %K accessibility %K therapy sessions %K AI-generated tool %D 2024 %7 4.12.2024 %9 %J JMIR Form Res %G English %X Background: With the increasing integration of artificial intelligence (AI) into various aspects of daily life, there is a growing interest among designers and practitioners in incorporating AI into their fields. In health care domains like art therapy, AI is also becoming a subject of exploration. However, the use of AI in art therapy is still undergoing investigation, with its benefits and challenges being actively explored. Objective: This study aims to investigate the integration of AI into art therapy practices to comprehend its potential impact on therapeutic processes and outcomes. Specifically, the focus is on understanding the perspectives of art therapists regarding the use of AI-assisted tools in their practice with clients, as demonstrated through the presentation of our prototype consisting of a deck of cards with words covering various categories alongside an AI-generated image. Methods: Using a co-design approach, 10 art therapists affiliated with the American Art Therapy Association participated in this study. They engaged in individual interviews where they discussed their professional perspectives on integrating AI into their therapeutic approaches and evaluating the prototype. Qualitative analysis was conducted to derive themes and insights from these sessions. Results: The study began in August 2023, with data collection involving 10 participants taking place in October 2023. Our qualitative findings provide a comprehensive evaluation of the impact of AI on facilitating therapeutic processes. The combination of a deck of cards and the use of an AI-generated tool demonstrated an enhancement in the quality and accessibility of therapy sessions. However, challenges such as credibility and privacy concerns were also identified. Conclusions: The integration of AI into art therapy presents promising avenues for innovation and progress within the field. By gaining insights into the perspectives and experiences of art therapists, this study contributes knowledge for both practical application and further research. %R 10.2196/63038 %U https://formative.jmir.org/2024/1/e63038 %U https://doi.org/10.2196/63038 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e58014 %T Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial %A Fox,Rina S %A Torres,Tara K %A Badger,Terry A %A Katsanis,Emmanuel %A Yang,DerShung %A Sanford,Stacy D %A Victorson,David E %A Yanez,Betina %A Penedo,Frank J %A Antoni,Michael H %A Oswald,Laura B %K cancer survivors %K survivorship %K clinical trials %K psychosocial intervention %K usability testing %K digital therapeutics %K young adults %K nonrandomized %D 2024 %7 4.12.2024 %9 %J JMIR Cancer %G English %X Background: Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors’ HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. Objective: In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18‐39 years at the time of participation and aged 15‐39 years at the time of initial cancer diagnosis. Methods: In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Results: Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1‐7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57%). Recruitment (58%) and retention (71%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1‐7) demonstrated acceptability. Conclusions: Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs’ expressed preference for convenience. Future studies are needed to increase TOGETHER’s efficiency and explore its efficacy for improving targeted outcomes. Trial Registration: NCT05597228, October 24, 2022; https://clinicaltrials.gov/study/NCT05597228 %R 10.2196/58014 %U https://cancer.jmir.org/2024/1/e58014 %U https://doi.org/10.2196/58014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57312 %T A 360° Approach to Personalize Lifestyle Treatment in Primary Care for People With Type 2 Diabetes: Feasibility Study %A Harakeh,Zeena %A de Hoogh,Iris %A Krijger-Dijkema,Anne-Margreeth %A Berbée,Susanne %A Kalkman,Gino %A van Empelen,Pepijn %A Otten,Wilma %+ Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Sylviusweg 71, Leiden, 2333 BE, Netherlands, 31 611615907, zeena.harakeh@tno.nl %K type 2 diabetes %K diagnostic tool %K holistic approach %K personalized treatment %K shared decision-making %K health professionals %K intervention %K feasibility study %K primary care %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the multifactorial nature of type 2 diabetes (T2D), health care for this condition would benefit from a holistic approach and multidisciplinary consultation. To address this, we developed the web-based 360-degree (360°) diagnostic tool, which assesses 4 key domains: “body” (physical health parameters), “thinking and feeling” (eg, mental health and stress), “behavior” (lifestyle factors), and “environment” (eg, work and housing conditions). Objective: This work examines the acceptability, implementation, and potential effects of the 360° diagnostic tool and subsequent tailored treatment (360° approach) in a 6-month intervention and feasibility study conducted in standard primary health care settings in the Netherlands. Methods: A single-group design with baseline, 3-month, and 6-month follow-ups was used. A total of 15 people with T2D and their health care providers from 2 practices participated in a 6-month intervention, which included the 360° diagnosis, tailored treatment, and both individual and group consultations. The 360° diagnosis involved clinical measurements for the “body” domain and self-reports for the “thinking and feeling,” “behavior,” and “environment” domains. After multidisciplinary consultations involving the general practitioner, pharmacist, nurse practitioner (NP), and dietitian, the NP and dietitian provided tailored advice, lifestyle treatment, and ongoing support. At the end of the intervention, face-to-face semistructured interviews were conducted with health care professionals (n=6) and participants (n=13) to assess the acceptability and implementation of the 360° approach in primary health care. Additionally, data from 14 participants on the “thinking and feeling” and “behavior” domains at baseline, 3 months, and 6 months were analyzed to assess changes over time. Results: The semistructured interviews revealed that both participants with T2D and health care professionals were generally positive about various aspects of the 360° approach, including onboarding, data collection with the 360° diagnosis, consultations and advice from the NP and dietitian, the visual representation of parameters in the profile wheel, counseling during the intervention (including professional collaboration), and the group meetings. The interviews also identified factors that promoted or hindered the implementation of the 360° approach. Promoting factors included (1) the care, attention, support, and experience of professionals; (2) the multidisciplinary team; (3) social support; and (4) the experience of positive health effects. Hindering factors included (1) too much information, (2) survey-related issues, and (3) time-consuming counseling. In terms of effects over time, improvements were observed at 3 months in mental health, diabetes-related problems, and fast-food consumption. At 6 months, there was a reduction in perceived stress and fast-food consumption. Additionally, fruit intake decreased at both 3 and 6 months. Conclusions: Our findings suggest that the 360° approach is acceptable to both people with T2D and health care professionals, implementable, and potentially effective in fostering positive health changes. Overall, it appears feasible to implement the 360° approach in standard primary health care. Trial Registration: Netherlands Trial Register NL-7509/NL-OMON45788; https://onderzoekmetmensen.nl/nl/trial/45788 %M 39631068 %R 10.2196/57312 %U https://formative.jmir.org/2024/1/e57312 %U https://doi.org/10.2196/57312 %U http://www.ncbi.nlm.nih.gov/pubmed/39631068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60461 %T Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study %A Golsong,Konstanze %A Kaufmann,Luisa %A Baldofski,Sabrina %A Kohls,Elisabeth %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Haus 13, Semmelweisstraße 10, Leipzig, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K mental health %K eHealth %K app %K health care %K app-based support %K psychiatric symptoms %K mobile phone %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment–like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment–like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt “definitely” or “rather” encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. %M 39630503 %R 10.2196/60461 %U https://formative.jmir.org/2024/1/e60461 %U https://doi.org/10.2196/60461 %U http://www.ncbi.nlm.nih.gov/pubmed/39630503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60380 %T Application of Chatbots to Help Patients Self-Manage Diabetes: Systematic Review and Meta-Analysis %A Wu,Yibo %A Zhang,Jinzi %A Ge,Pu %A Duan,Tingyu %A Zhou,Junyu %A Wu,Yiwei %A Zhang,Yuening %A Liu,Siyu %A Liu,Xinyi %A Wan,Erya %A Sun,Xinying %+ School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 13691212050, xysun@bjmu.edu.cn %K artificial intelligence %K chatbot %K diabetes %K health education %K self-management %K systematic review %D 2024 %7 3.12.2024 %9 Review %J J Med Internet Res %G English %X Background: The number of people with diabetes is on the rise globally. Self-management and health education of patients are the keys to control diabetes. With the development of digital therapies and artificial intelligence, chatbots have the potential to provide health-related information and improve accessibility and effectiveness in the field of patient self-management. Objective: This study systematically reviews the current research status and effectiveness of chatbots in the field of diabetes self-management to support the development of diabetes chatbots. Methods: A systematic review and meta-analysis of chatbots that can help patients with diabetes with self-management was conducted. PubMed and Web of Science databases were searched using keywords around diabetes, chatbots, conversational agents, virtual assistants, and more. The search period was from the date of creation of the databases to January 1, 2023. Research articles in English that fit the study topic were selected, and articles that did not fit the study topic or were not available in full text were excluded. Results: In total, 25 studies were included in the review. In terms of study type, all articles could be classified as systematic design studies (n=8, 32%), pilot studies (n=8, 32%), and intervention studies (n=9, 36%). Many articles adopted a nonrandomized controlled trial design in intervention studies (n=6, 24%), and there was only 1 (4%) randomized controlled trial. In terms of research strategy, all articles can be divided into quantitative studies (n=10, 40%), mixed studies (n=6, 24%), and qualitative studies (n=1, 4%). The evaluation criteria for chatbot effectiveness can be divided into technical performance evaluation, user experience evaluation, and user health evaluation. Most chatbots (n=17, 68%) provided education and management focused on patient diet, exercise, glucose monitoring, medications, and complications, and only a few studies (n=2, 8%) provided education on mental health. The meta-analysis found that the chatbot intervention was effective in lowering blood glucose (mean difference 0.30, 95% CI 0.04-0.55; P=.02) and had no significant effect in reducing weight (mean difference 1.41, 95% CI –2.29 to 5.11; P=.46) compared with the baseline. Conclusions: Chatbots have potential for the development of self-management for people with diabetes. However, the evidence level of current research is low, and higher level research (such as randomized controlled trials) is needed to strengthen the evidence base. More use of mixed research in the research strategy is needed to fully use the strengths of both quantitative and qualitative research. Appropriate and innovative theoretical frameworks should be used in the research to provide theoretical support for the study. In addition, researchers should focus on the personalized and user-friendly interactive features of chatbots, as well as improvements in study design. %M 39626235 %R 10.2196/60380 %U https://www.jmir.org/2024/1/e60380 %U https://doi.org/10.2196/60380 %U http://www.ncbi.nlm.nih.gov/pubmed/39626235 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e64669 %T Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence–Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study %A Sada,Fatos %A Chivers,Paola %A Cecelia,Sokol %A Statovci,Sejdi %A Ukperaj,Kujtim %A Hughes,Jeffery %A Hoti,Kreshnik %+ Faculty of Medicine, University of Prishtina, 31 George Bush St, Prishtina, 10000, Kosovo, 383 44945173, kreshnik.hoti@uni-pr.edu %K PainChek Infant %K Observer-Administered Visual Analog Scale %K parents %K infant pain %K pain assessment %K circumcision %K infant home assessment %K clinical utility %K construct validity %K artificial intelligence %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools. Objective: This study aimed to explore parents’ assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools. Methods: This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence–enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used. Results: A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ22=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ21=7.2, P=.007) and intervention (χ22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments. Conclusions: The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents. %M 39626240 %R 10.2196/64669 %U https://pediatrics.jmir.org/2024/1/e64669 %U https://doi.org/10.2196/64669 %U http://www.ncbi.nlm.nih.gov/pubmed/39626240 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55231 %T Incorporating an Intelligent Tutoring System Into a Game-Based Auditory Rehabilitation Training for Adult Cochlear Implant Recipients: Algorithm Development and Validation %A Gnadlinger,Florian %A Werminghaus,Maika %A Selmanagić,André %A Filla,Tim %A Richter,Jutta G %A Kriglstein,Simone %A Klenzner,Thomas %+ Faculty of Informatics, Masaryk University, Botanická 68a, Brno, 602 00, Czech Republic, 420 549 49 ext 4382, florian.gnadlinger@mail.muni.cz %K cochlear implant %K eHealth %K evidence-centered design %K hearing rehabilitation %K adaptive learning %K intelligent tutoring system %K game-based learning %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cochlear implants are implanted hearing devices; instead of amplifying sounds like common hearing aids, this technology delivers preprocessed sound information directly to the hearing (ie, auditory) nerves. After surgery and the first cochlear implant activation, patients must practice interpreting the new auditory sensations, especially for language comprehension. This rehabilitation process is accompanied by hearing therapy through face-to-face training with a therapist, self-directed training, and computer-based auditory training. Objective: In general, self-directed, computer-based auditory training tasks have already shown advantages. However, compliance of cochlear implant recipients is still a major factor, especially for self-directed training at home. Hence, we aimed to explore the combination of 2 techniques to enhance learner motivation in this context: adaptive learning (in the form of an intelligent tutoring system) and game-based learning (in the form of a serious game). Methods: Following the suggestions of the evidence-centered design framework, a domain analysis of hearing therapy was conducted, allowing us to partially describe human hearing skill as a probabilistic competence model (Bayesian network). We developed an algorithm that uses such a model to estimate the current competence level of a patient and create training recommendations. For training, our developed task system was based on 7 language comprehension task types that act as a blueprint for generating tasks of diverse difficulty automatically. To achieve this, 1053 audio assets with meta-information labels were created. We embedded the adaptive task system into a graphic novel–like mobile serious game. German-speaking cochlear implant recipients used the system during a feasibility study for 4 weeks. Results: The 23 adult participants (20 women; 3 men) fulfilled 2259 tasks. In total, 2004 (90.5%) tasks were solved correctly, and 255 (9.5%) tasks were solved incorrectly. A generalized additive model analysis of these tasks indicated that the system adapted to the estimated competency levels of the cochlear implant recipients more quickly in the beginning than at the end. Compared with a uniform distribution of all task types, the recommended task types differed (χ²6=86.713; P<.001), indicating that the system selected specific task types for each patient. This is underlined by the identified categories for the error proportions of the task types. Conclusions: This contribution demonstrates the feasibility of combining an intelligent tutoring system with a serious game in cochlear implant rehabilitation therapies. The findings presented here could lead to further advances in cochlear implant care and aural rehabilitation in general. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022860; https://drks.de/search/en/trial/DRKS00022860 %M 39626219 %R 10.2196/55231 %U https://games.jmir.org/2024/1/e55231 %U https://doi.org/10.2196/55231 %U http://www.ncbi.nlm.nih.gov/pubmed/39626219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57009 %T The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. %M 39625744 %R 10.2196/57009 %U https://formative.jmir.org/2024/1/e57009 %U https://doi.org/10.2196/57009 %U http://www.ncbi.nlm.nih.gov/pubmed/39625744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63188 %T Comparing the Accuracy of Two Generated Large Language Models in Identifying Health-Related Rumors or Misconceptions and the Applicability in Health Science Popularization: Proof-of-Concept Study %A Luo,Yuan %A Miao,Yiqun %A Zhao,Yuhan %A Li,Jiawei %A Chen,Yuling %A Yue,Yuexue %A Wu,Ying %K rumor %K misconception %K health science popularization %K health education %K large language model %K LLM %K applicability %K accuracy %K effectiveness %K health related %K education %K health science %K proof of concept %D 2024 %7 2.12.2024 %9 %J JMIR Form Res %G English %X Background: Health-related rumors and misconceptions are spreading at an alarming rate, fueled by the rapid development of the internet and the exponential growth of social media platforms. This phenomenon has become a pressing global concern, as the dissemination of false information can have severe consequences, including widespread panic, social instability, and even public health crises. Objective: The aim of the study is to compare the accuracy of rumor identification and the effectiveness of health science popularization between 2 generated large language models in Chinese (GPT-4 by OpenAI and Enhanced Representation through Knowledge Integration Bot [ERNIE Bot] 4.0 by Baidu). Methods: In total, 20 health rumors and misconceptions, along with 10 health truths, were randomly inputted into GPT-4 and ERNIE Bot 4.0. We prompted them to determine whether the statements were rumors or misconceptions and provide explanations for their judgment. Further, we asked them to generate a health science popularization essay. We evaluated the outcomes in terms of accuracy, effectiveness, readability, and applicability. Accuracy was assessed by the rate of correctly identifying health-related rumors, misconceptions, and truths. Effectiveness was determined by the accuracy of the generated explanation, which was assessed collaboratively by 2 research team members with a PhD in nursing. Readability was calculated by the readability formula of Chinese health education materials. Applicability was evaluated by the Chinese Suitability Assessment of Materials. Results: GPT-4 and ERNIE Bot 4.0 correctly identified all health rumors and misconceptions (100% accuracy rate). For truths, the accuracy rate was 70% (7/10) and 100% (10/10), respectively. Both mostly provided widely recognized viewpoints without obvious errors. The average readability score for the health essays was 2.92 (SD 0.85) for GPT-4 and 3.02 (SD 0.84) for ERNIE Bot 4.0 (P=.65). For applicability, except for the content and cultural appropriateness category, significant differences were observed in the total score and scores in other dimensions between them (P<.05). Conclusions: ERNIE Bot 4.0 demonstrated similar accuracy to GPT-4 in identifying Chinese rumors. Both provided widely accepted views, despite some inaccuracies. These insights enhance understanding and correct misunderstandings. For health essays, educators can learn from readable language styles of GLLMs. Finally, ERNIE Bot 4.0 aligns with Chinese expression habits, making it a good choice for a better Chinese reading experience. %R 10.2196/63188 %U https://formative.jmir.org/2024/1/e63188 %U https://doi.org/10.2196/63188 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58051 %T Investigating the Acceptability of an Interactive Television Intervention Promoting Social Links Among Older Adults Living at Home and in Care Institutions: Qualitative Interview and Questionnaire Study %A Naudé,Bérangère %A Rigaud,Anne-Sophie %A Pino,Maribel %+ Broca Living Lab, CEN STIMCO, 54 rue Pascal, Paris, 75013, France, 33 1 44 08 33 60, berangere.naude@etu.u-paris.fr %K interactive television %K iTV %K acceptance %K older adults %K nursing home %K residential facility %K technology acceptance model %K TAM %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents’ rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model. Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings. Methods: User tests were carried out to evaluate OAs’ experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics. Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts. Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection. %M 39622505 %R 10.2196/58051 %U https://humanfactors.jmir.org/2024/1/e58051 %U https://doi.org/10.2196/58051 %U http://www.ncbi.nlm.nih.gov/pubmed/39622505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51470 %T Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study %A Luo,Lingzi %A Li,Gen %A Tang,Weiming %A Wu,Dan %A Hall,Brian %+ New York University Shanghai, Center for Global Health Equity, N812 567 West Yangsi Road, Shanghai, 200124, China, 86 62899837, bhall41@gmail.com %K COVID-19 %K mental health services %K intention %K mobile %K digital %K lockdowns %K depression %K anxiety %K help-seeking %K regression %K applications %K mHealth %K WeChat %K pandemic %K social isolation %K mental health %K intent %K outbreak %K SARS-CoV-2 %K survey %K usage %K service %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes–mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19–related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. %M 39622023 %R 10.2196/51470 %U https://formative.jmir.org/2024/1/e51470 %U https://doi.org/10.2196/51470 %U http://www.ncbi.nlm.nih.gov/pubmed/39622023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58682 %T An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial %A Oei,Krista %A Choi,Elizabeth EY %A Bar-Dayan,Alisa %A Stinson,Jennifer N %A Palmert,Mark R %A Alfonsi,Jeffrey E %A Hamilton,Jill %+ Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 4168131500, krista.oei@sickkids.ca %K obesity %K weight management %K dietary assessment %K nutrition %K adolescent %K digital health app %K mHealth %K mobile health %K image recognition %K teens %K weight %K youth %K diet %K dietary %K dietary app %K usability %K feasibility %K pilot randomized controlled trial %K obesity management %K nutritional %K user %K patient engagement %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI≥97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 %M 39621405 %R 10.2196/58682 %U https://formative.jmir.org/2024/1/e58682 %U https://doi.org/10.2196/58682 %U http://www.ncbi.nlm.nih.gov/pubmed/39621405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56598 %T High-Frequency Cognitive Control Training for Depression: Case Report %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %A Demeester,David %A Koster,Ernst H W %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649107, y.vander.zwalmen@ugent.be %K cognitive control training %K CCT %K cognitive function %K depression %K recurrence %K relapse %K prevention %K case report %K working memory %K memory training %K task performance %K digital health %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime. Objective: This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions. Methods: This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning. Results: Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training. Conclusions: Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms. Trial Registration: ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798 %M 39612206 %R 10.2196/56598 %U https://formative.jmir.org/2024/1/e56598 %U https://doi.org/10.2196/56598 %U http://www.ncbi.nlm.nih.gov/pubmed/39612206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63262 %T Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study %A Brandl,Lena %A Jansen-Kosterink,Stephanie %A Brodbeck,Jeannette %A Jacinto,Sofia %A Mooser,Bettina %A Heylen,Dirk %K e-mental health %K digital mental health service %K mental health %K digital health %K internet intervention %K monitoring mental health %K monitor %K e-coach %K coaching %K grieve %K mourn %K old %K affective states %K artificial intelligence %K predictive %K repeatedly measured predictors in regression %K fuzzy cognitive map %K algorithm %K AI %D 2024 %7 28.11.2024 %9 %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike. Objective: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health. Method: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool’s capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users’ monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention. Results: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants’ (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants’ response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants’ mental health deteriorated during the intervention. Conclusions: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context. %R 10.2196/63262 %U https://formative.jmir.org/2024/1/e63262 %U https://doi.org/10.2196/63262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64380 %T Public Perception on Artificial Intelligence–Driven Mental Health Interventions: Survey Research %A Varghese,Mahima Anna %A Sharma,Poonam %A Patwardhan,Maitreyee %+ Department of Social Science and Language, Vellore Institute of Technology, Vellore Campus, Tiruvalam Road, Vellore, 632014, India, 91 9702872251, poonam.sharma@vit.ac.in %K public perception %K artificial intelligence %K AI %K AI-driven %K human-driven %K mental health inteventions %K mental health stigma %K trust in AI %K public perception %K digital health %K India %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has become increasingly important in health care, generating both curiosity and concern. With a doctor-patient ratio of 1:834 in India, AI has the potential to alleviate a significant health care burden. Public perception plays a crucial role in shaping attitudes that can facilitate the adoption of new technologies. Similarly, the acceptance of AI-driven mental health interventions is crucial in determining their effectiveness and widespread adoption. Therefore, it is essential to study public perceptions and usage of existing AI-driven mental health interventions by exploring user experiences and opinions on their future applicability, particularly in comparison to traditional, human-based interventions. Objective: This study aims to explore the use, perception, and acceptance of AI-driven mental health interventions in comparison to traditional, human-based interventions. Methods: A total of 466 adult participants from India voluntarily completed a 30-item web-based survey on the use and perception of AI-based mental health interventions between November and December 2023. Results: Of the 466 respondents, only 163 (35%) had ever consulted a mental health professional. Additionally, 305 (65.5%) reported very low knowledge of AI-driven interventions. In terms of trust, 247 (53%) expressed a moderate level of Trust in AI-Driven Mental Health Interventions, while only 24 (5.2%) reported a high level of trust. By contrast, 114 (24.5%) reported high trust and 309 (66.3%) reported moderate Trust in Human-Based Mental Health Interventions; 242 (51.9%) participants reported a high level of stigma associated with using human-based interventions, compared with only 50 (10.7%) who expressed concerns about stigma related to AI-driven interventions. Additionally, 162 (34.8%) expressed a positive outlook toward the future use and social acceptance of AI-based interventions. The majority of respondents indicated that AI could be a useful option for providing general mental health tips and conducting initial assessments. The key benefits of AI highlighted by participants were accessibility, cost-effectiveness, 24/7 availability, and reduced stigma. Major concerns included data privacy, security, the lack of human touch, and the potential for misdiagnosis. Conclusions: There is a general lack of awareness about AI-driven mental health interventions. However, AI shows potential as a viable option for prevention, primary assessment, and ongoing mental health maintenance. Currently, people tend to trust traditional mental health practices more. Stigma remains a significant barrier to accessing traditional mental health services. Currently, the human touch remains an indispensable aspect of human-based mental health care, one that AI cannot replace. However, integrating AI with human mental health professionals is seen as a compelling model. AI is positively perceived in terms of accessibility, availability, and destigmatization. Knowledge and perceived trustworthiness are key factors influencing the acceptance and effectiveness of AI-driven mental health interventions. %M 39607994 %R 10.2196/64380 %U https://formative.jmir.org/2024/1/e64380 %U https://doi.org/10.2196/64380 %U http://www.ncbi.nlm.nih.gov/pubmed/39607994 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59145 %T Effects of a Digital Therapeutic Adjunct to Eating Disorder Treatment on Health Care Service Utilization and Clinical Outcomes: Retrospective Observational Study Using Electronic Health Records %A Palacios,Jorge E %A Erickson-Ridout,Kathryn K %A Paik Kim,Jane %A Buttlaire,Stuart %A Ridout,Samuel %A Argue,Stuart %A Tregarthen,Jenna %+ Bright Therapeutics, 304 Moultrie St, San Francisco, CA, 94110, United States, 1 6504047098, jorge.palacios@brighttherapeutics.com %K digital therapeutics %K app-augmented therapy %K eating disorders %K health care utilization %K costs %K real-world data %K depression %K emergency department %K outpatient care %K eating %K treatment %K therapy %K retrospective analysis %K electronic health record %K patient %K app %K outpatient %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The need for scalable solutions facilitating access to eating disorder (ED) treatment services that are efficient, effective, and inclusive is a major public health priority. Remote access to synchronous and asynchronous support delivered via health apps has shown promise, but results are so far mixed, and there are limited data on whether apps can enhance health care utilization. Objective: This study aims to examine the effects of app-augmented treatment on clinical outcomes and health care utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care. Methods: Recovery Record was implemented in outpatient and intensive outpatient services in a California-based health maintenance organization. We examined outcomes for eligible patients with ED by comparing clinical and service utilization medical record data over a 6-month period after implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. Results: App-augmented treatment was associated with a significant decrease in emergency department visits (P<.001) and a significant increase in outpatient treatment utilization (P<.001). There was a significantly larger weight gain for patients in low-weight categories (ie, underweight, those with anorexia, or those with severe anorexia) with app-augmented treatment (treatment effect: 0.74, 0.25, and 0.35, respectively; P=.02), with a greater percentage of patients moving into a higher BMI class (P=.01). Conclusions: Integrating remote patient engagement apps into ED treatment plans can have beneficial effects on both clinical outcomes and service utilization. More research should be undertaken on long-term efficacy and cost-effectiveness to further explore the impact of digital health interventions in ED care. %M 39602804 %R 10.2196/59145 %U https://mental.jmir.org/2024/1/e59145 %U https://doi.org/10.2196/59145 %U http://www.ncbi.nlm.nih.gov/pubmed/39602804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58666 %T Facilitating Trust Calibration in Artificial Intelligence–Driven Diagnostic Decision Support Systems for Determining Physicians’ Diagnostic Accuracy: Quasi-Experimental Study %A Sakamoto,Tetsu %A Harada,Yukinori %A Shimizu,Taro %K trust calibration %K artificial intelligence %K diagnostic accuracy %K diagnostic decision support %K decision support %K diagnosis %K diagnostic %K chart %K history %K reliable %K reliability %K accurate %K accuracy %K AI %D 2024 %7 27.11.2024 %9 %J JMIR Form Res %G English %X Background: Diagnostic errors are significant problems in medical care. Despite the usefulness of artificial intelligence (AI)–based diagnostic decision support systems, the overreliance of physicians on AI-generated diagnoses may lead to diagnostic errors. Objective: We investigated the safe use of AI-based diagnostic decision support systems with trust calibration by adjusting trust levels to match the actual reliability of AI. Methods: A quasi-experimental study was conducted at Dokkyo Medical University, Japan, with physicians allocated (1:1) to the intervention and control groups. A total of 20 clinical cases were created based on the medical histories recorded by an AI-driven automated medical history–taking system from actual patients who visited a community-based hospital in Japan. The participants reviewed the medical histories of 20 clinical cases generated by an AI-driven automated medical history–taking system with an AI-generated list of 10 differential diagnoses and provided 1 to 3 possible diagnoses. Physicians were asked whether the final diagnosis was in the AI-generated list of 10 differential diagnoses in the intervention group, which served as the trust calibration. We analyzed the diagnostic accuracy of physicians and the correctness of the trust calibration in the intervention group. We also investigated the relationship between the accuracy of the trust calibration and the diagnostic accuracy of physicians, and the physicians’ confidence level regarding the use of AI. Results: Among the 20 physicians assigned to the intervention (n=10) and control (n=10) groups, the mean age was 30.9 (SD 3.9) years and 31.7 (SD 4.2) years, the proportion of men was 80% and 60%, and the mean postgraduate year was 5.8 (SD 2.9) and 7.2 (SD 4.6), respectively, with no significant differences. The physicians’ diagnostic accuracy was 41.5% in the intervention group and 46% in the control group, with no significant difference (95% CI −0.75 to 2.55; P=.27). The overall accuracy of the trust calibration was only 61.5%, and despite correct calibration, the diagnostic accuracy was 54.5%. In the multivariate logistic regression model, the accuracy of the trust calibration was a significant contributor to the diagnostic accuracy of physicians (adjusted odds ratio 5.90, 95% CI 2.93‐12.46; P<.001). The mean confidence level for AI was 72.5% in the intervention group and 45% in the control group, with no significant difference. Conclusions: Trust calibration did not significantly improve physicians’ diagnostic accuracy when considering the differential diagnoses generated by reading medical histories and the possible differential diagnosis lists of an AI-driven automated medical history–taking system. As this was a formative study, the small sample size and suboptimal trust calibration methods may have contributed to the lack of significant differences. This study highlights the need for a larger sample size and the implementation of supportive measures of trust calibration. %R 10.2196/58666 %U https://formative.jmir.org/2024/1/e58666 %U https://doi.org/10.2196/58666 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63234 %T Effectiveness of a Novel Web-Based Intervention to Enhance Therapeutic Relationships and Treatment Outcomes in Adult Individual Psychotherapy: Randomized Controlled Trial and Analysis of Predictors of Dropouts %A Stefana,Alberto %A Fusar-Poli,Paolo %A Vieta,Eduard %A Youngstrom,Eric A %+ Department of Brain and Behavioral Sciences, University of Pavia, Via Forlanini 14, Pavia, 27100, Italy, 39 0382987537, alberto.stefana@gmail.com %K therapeutic relationship %K real relationship %K routine outcome monitoring %K measurement-based care %K patient-focused research %K psychotherapy process %K randomized controlled trial %K RCT %K psychotherapy %K assessment %K mental health %K digital mental health %K eHealth %K self monitoring %K outcomes research %K digital health %K health intervention %K therapy %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Routine process and outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness. Objective: This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared with a treatment-as-usual control group among individuals already engaged in individual psychotherapy. Methods: We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at 5 weeks and 10 weeks used the Clinical Outcomes in Routine Evaluation-Outcome Measure as the primary outcome, with the Working Alliance Inventory-Short Revised and the Real Relationship Inventory-Client form as secondary outcomes. Results: Per-protocol analyses (n=166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d=–0.27, compared with d=0.01 in the control group. In the intervention group (but not in the control group), dropouts showed significantly lower real relationship levels (P=.002), working alliance quality (P=.051), and emotional disclosure (P=.01) compared with those who completed the study. Additionally, logistic regression revealed distinct predictors of dropout within the control group and intervention group. Conclusions: The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients’ emotional responses to their therapists. However, the intervention appears to influence patients’ perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants. Trial Registration: ClinicalTrials.gov NCT06038747; https://clinicaltrials.gov/study/NCT06038747 International Registered Report Identifier (IRRID): RR2-10.2196/55369 %M 39602203 %R 10.2196/63234 %U https://mental.jmir.org/2024/1/e63234 %U https://doi.org/10.2196/63234 %U http://www.ncbi.nlm.nih.gov/pubmed/39602203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60674 %T Evaluating a Virtual Reality Game to Enhance Teen Distracted Driving Education: Mixed Methods Pilot Study %A Peterson,Colleen M %A Visclosky,Timothy %A Flannagan,Carol A %A Mahajan,Prashant %A Gabanyicz,Andrew %A Bouchard,Jean-Jacques %A Cervantes,Vincent %A Gribbin,William %A Hashikawa,Andrew Nobuhide %+ Michigan Medicine-Department of Emergency Medicine, University of Michigan, NCRC B10-G080, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, United States, 1 734 936 9312, drewhash@umich.edu %K safety %K virtual reality %K VR %K distracted driving %K intervention %K inattention %K smartphone %K novice drivers %K risky driving %K mobile phone %K awareness %K game %K driving education %K gamification %K adolescent %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers. Objective: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game “Distracted Navigator” to educate novice teenage drivers about DDB. Methods: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming. Results: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?218=–8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; β=–.78; t46=–2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion. Conclusions: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study. %M 39591605 %R 10.2196/60674 %U https://formative.jmir.org/2024/1/e60674 %U https://doi.org/10.2196/60674 %U http://www.ncbi.nlm.nih.gov/pubmed/39591605 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57579 %T Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study %A Willinge,Gijs J A %A Spierings,Jelle F %A Romijnders,Kim A G J %A Mathijssen,Elke G E %A Twigt,Bas A %A Goslings,J Carel %A van Veen,Ruben N %K musculoskeletal extremity injury %K patient portal %K follow-up treatment %K healthcare utilization %K patient experience %K feasibility %K orthopedics %K trauma %K Netherlands %K mixed methods %K resource utilization %K electronic patient records %K thematic analysis %K qualitative data %K digital treatment %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Form Res %G English %X Background: Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences. Objective: We aim to assess digital follow-up treatment pathway feasibility from the patient’s perspective and its impact on health care resource use. Methods: A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1‐3, 4‐6 weeks, and 10‐12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10‐12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy. Results: Sixty-six patients were included for quantitative data collection. Survey response rates were 100% (66/66) at day 1‐3, 92% (61/66) at 4‐6 weeks, and 79% (52/66) at 10‐12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6‐8) with digital treatment pathways and 8 (IQR 7‐9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0‐0) versus the control group (median 1, IQR 0‐1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1‐2) than for the control group (median 2, IQR 1‐3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence. Conclusions: Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice. %R 10.2196/57579 %U https://formative.jmir.org/2024/1/e57579 %U https://doi.org/10.2196/57579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60222 %T Enhancing Care Coordination in Oncology and Nononcology Thoracic Surgery Care Pathways Through a Digital Health Solution: Mixed Methods Study %A Nabelsi,Véronique %A Plouffe,Véronique %+ Département des sciences administratives, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 8195953900 ext 1915, veronique.nabelsi@uqo.ca %K digital health solution %K care coordination %K optimization %K health care providers %K oncology %K nononcology %K thoracic surgery %K pathways %K continuity of care %K interfacility %K Quebec %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-system fragmentation in Quebec significantly impacts care coordination, leading to interruptions in patients’ care pathways and adverse effects on their health. Coordinating interfacility service corridors is complex and requires collaboration between multiple health care providers (HCPs) and care settings. Effective care coordination is essential to ensure optimal patient management at transition points. Objective: This study aims to improve oncology and nononcology thoracic surgery care pathways by enhancing care coordination during interfacility transfers through a digital health solution. Methods: A multicenter implementation study was conducted across 2 health regions and 2 health care facilities in Quebec. We conducted 27 semistructured interviews with HCPs and managers to better understand the care pathways. Participatory design workshops were held with future users and key stakeholders at an early stage of the technology’s design to validate the prototype’s functionalities and workflows. A web survey was sent to all end users (N=13) to assess their experience with the platform. Results: All participants (100%) either “agreed” or “strongly agreed” that the platform provided significant benefits. It enhanced interestablishment coordination (4/13, 31% agreed and 9/13, 69% strongly agreed) and continuity of care and services (8/13, 62% agreed and 5/13, 38% strongly agreed), and it contributed to better management and patient intake (10/13, 77% agreed and 3/13, 23% strongly agreed) and process fluidity (3/13, 77% agreed and 3/13, 23% strongly agreed). Surgeons from the McGill University Health Centre confirmed that the platform facilitated and secured information transmission (2/5, 40% agreed and 3/5, 60% strongly agreed) and kept track of oncology patient referrals, follow-up needs, and cases where surgery is unnecessary (2/5, 40% agreed and 3/5, 60% strongly agreed). Nursing staff from the Centre intégré de santé et de services sociaux de l’Outaouais and McGill University Health Centre reported high satisfaction with the platform’s support during preoperative visit, surgery, and discharge processes. All participants perceived the platform as intuitive and easy to use. Additionally, participants valued its efficiency in providing rapid access to patient data, which reduces task time and ensures document security, thereby improving care coordination across facilities. The project’s success has convinced the HCPs and senior management at both health care facilities to pursue long-term use of the Akinox digital health platform. Conclusions: This pilot project represents a significant advancement in thoracic surgery care pathways and the coordination of interfacility health care service corridors. The project provides care pathways that are adaptable to other surgical specialties. It also paves the way for improving care in cancer and other health care networks while highlighting the key role of nurse navigators in patient care management. The project underscores the value of strategic leadership and stakeholders’ collaboration to improve care coordination and operational efficiency by demonstrating technology’s essential role in patient care pathways. %M 39591606 %R 10.2196/60222 %U https://formative.jmir.org/2024/1/e60222 %U https://doi.org/10.2196/60222 %U http://www.ncbi.nlm.nih.gov/pubmed/39591606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60918 %T Evaluating an App-Based Intervention for Preventing Firearm Violence and Substance Use in Young Black Boys and Men: Usability Evaluation Study %A Emezue,Chuka %A Dan-Irabor,Dale %A Froilan,Andrew %A Dunlap,Aaron %A Zamora,Pablo %A Negron,Sarah %A Simmons,Janiya %A Watkins,Jayla %A Julion,Wrenetha A %A Karnik,Niranjan S %+ Department of Women, Children and Family Nursing, Rush University Medical Center, 600 S Paulina St AAC Suite 1064A, Armour Academic Center, Chicago, IL, 60612, United States, 1 312 942 6151, chuka_emezue@rush.edu %K telemedicine %K mobile app %K adolescent %K violence %K substance-related disorder %K African American %K user-computer interface %K software validation %K software development %K mobile phone %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT—a nurse-led, culturally tailored, multicomponent app—to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence–powered talk therapy, and zip code–based service connections directly to young Black male individuals at risk for violence and substance use. Objective: The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE). Methods: Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person. Results: Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app’s visual and functional design was generally well received. Conclusions: BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app’s efficacy in community health and emergency care settings. International Registered Report Identifier (IRRID): RR2-10.2196/43842 %M 39589765 %R 10.2196/60918 %U https://formative.jmir.org/2024/1/e60918 %U https://doi.org/10.2196/60918 %U http://www.ncbi.nlm.nih.gov/pubmed/39589765 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63661 %T Impact of Telehealth on Health Disparities Associated With Travel Time to Hospital for Patients With Recurrent Admissions: 4-Year Panel Data Analysis %A Tao,Youyou %A Vo,Ace %A Wu,Dezhi %A Lin,Junyuan %A Seal,Kala %A Mishra,Abhay %A Brahma,Arindam %+ Loyola Marymount University, 1 LMU Drive, Los Angeles, CA, 90045, United States, 1 2069722430, youyou.tao@lmu.edu %K telehealth %K health disparities %K travel time %K length of stay %K recurrent admissions %K health care access %K virtualization potential %K virtual care %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time—the time required for patients to travel from their residences to health facilities—remain understudied compared with others. Objective: This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital. Methods: We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients’ travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups. Results: Our summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients’ drive time to the hospital increases. Specifically, the coefficient for drive time is –0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases. Conclusions: Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth’s role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth. %M 39586091 %R 10.2196/63661 %U https://www.jmir.org/2024/1/e63661 %U https://doi.org/10.2196/63661 %U http://www.ncbi.nlm.nih.gov/pubmed/39586091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62742 %T Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers %A Jain,Ekta %A Gupta,Srishti %A Yadav,Vandana %A Kachnowski,Stan %+ Healthcare Innovation and Technology Lab, Lasker Hall, 3960 Broadway, Room 501, New York, NY, 10032, United States, 1 (212) 543 0100, vyadav@hitlab.org %K usability study %K telemedicine %K web platform %K patient-provider feedback %K artificial intelligence %K AI triage %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has revolutionized health care by significantly enhancing accessibility and convenience, yet barriers remain, such as providers’ challenges with technology use. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports the findings on the usability and effectiveness of the HelixVM artificial intelligence powered platform, analyzing key aspetcs like asynchronous health care, access, time efficiency, productivity, data exchange, security, privacy, and quality of care from patient and provider perspectives. Objective: This study aims to assess the usability and effectiveness of the HelixVM marketplace platform. Methods: We recruited 102 patients and 12 providers in a mixed methods study design involving surveys and in-depth structured interviews with a subset of the providers. The survey questionnaires are a modified version of the Telehealth Usability Questionnaire. We analyzed patient data using descriptive statistics and exploratory factor analysis to identify latent demographic patterns. For provider data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers as negative, neutral, or positive. We also calculated percentages of different provider responses from the survey and interviews, where applicable. Results: Overall, 86.3% (88/102) of the patients reported satisfaction with HelixVM, and 89.2% (91/102) indicated that they would use the services again. A total of 91.1% (93/102) of the patients agreed that HelixVM improves access to health care and is an acceptable way to receive health care, and 98% (100/102) agreed it saves time. Chi-square tests demonstrated statistical significance for all survey questions (P<.001). The results from factor analysis show a higher propensity of middle-aged women, who had a fast-track encounter type, who self-reported a medium level of technology savviness, and who are residing in the South region of the United States rating the platform more positively. With regard to the providers, the thematic analysis identified themes of asynchronous medicine in terms of the accessibility and quality of care, time and productivity, integration within the workflow, data exchange, and artificial intelligence triage. Certain challenges regarding incomplete data in patient charts and its impact on provider time were cited. Suggestions for improvements included options to ensure the completeness of patient charts and better screening to ensure that only asynchronous, qualified patients are able to reach the provider. Conclusions: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription was considered favorable compared to traditional telemedicine. Some concerns on data completeness, gaps, and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledge base of existing literature and provides a detailed analysis of the real-world implementation of a telemedicine market-place platform. %M 39418632 %R 10.2196/62742 %U https://formative.jmir.org/2024/1/e62742 %U https://doi.org/10.2196/62742 %U http://www.ncbi.nlm.nih.gov/pubmed/39418632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54206 %T Long-Term Efficacy of an AI-Based Health Coaching Mobile App in Slowing the Progression of Nondialysis-Dependent Chronic Kidney Disease: Retrospective Cohort Study %A Ma,Jianwei %A Wang,Jiangyuan %A Ying,Jiapei %A Xie,Shasha %A Su,Qin %A Zhou,Tianmeng %A Han,Fuman %A Xu,Jiayan %A Zhu,Siyi %A Yuan,Chenyi %A Huang,Ziyuan %A Xu,Jingfang %A Chen,Xuyong %A Bian,Xueyan %+ Department of Nephrology, The First Affiliated Hospital of Ningbo University, The 5th floor of Building 6, Number 59 Liuting Street, Haishu District, Ningbo, 315000, China, 86 87085300, fyybianxueyan@nbu.edu.cn %K artificial intelligence %K chronic kidney disease %K eHealth care %K mobile app %K self-management %K kidney function %K telemedicine %K app %K health coaching %K CKD %K mobile phone %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic kidney disease (CKD) is a significant public health concern. Therefore, practical strategies for slowing CKD progression and improving patient outcomes are imperative. There is limited evidence to substantiate the efficacy of mobile app–based nursing systems for decelerating CKD progression. Objective: This study aimed to evaluate the long-term efficacy of the KidneyOnline intelligent care system in slowing the progression of nondialysis-dependent CKD. Methods: In this retrospective study, the KidneyOnline app was used for patients with CKD in China who were registered between January 2017 and April 2023. Patients were divided into 2 groups: an intervention group using the app’s nurse-led, patient-oriented management system and a conventional care group that did not use the app. Patients’ uploaded health data were processed via deep learning optical character recognition, and the artificial intelligence (AI) system provided personalized health care plans and interventions. Conversely, the conventional care group received suggestions from nephrologists during regular visits without AI. Monitoring extended for an average duration of 2.1 (SD 1.4) years. The study’s objective is to assess the app’s effectiveness in preserving kidney function. The primary outcome was the estimated glomerular filtration rate slope over the follow-up period, and secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and mean arterial pressure. Results: A total of 12,297 eligible patients were enrolled for the analysis. Among them, 808 patients were successfully matched using 1:1 propensity score matching, resulting in 404 (50%) patients in the KidneyOnline care system group and another 404 (50%) patients in the conventional care group. The estimated glomerular filtration rate slope in the KidneyOnline care group was significantly lower than that in the conventional care group (odds ratio –1.3, 95% CI –2.4 to –0.1 mL/min/1.73 m2 per year vs odds ratio –2.8, 95% CI –3.8 to –1.9 mL/min/1.73 m2 per year; P=.009). Subgroup analysis revealed that the effect of the KidneyOnline care group was more significant in male patients, patients older than 45 years, and patients with worse baseline kidney function, higher blood pressure, and heavier proteinuria. After 3 and 6 months, the mean arterial pressure in the KidneyOnline care group decreased to 85.6 (SD 9.2) and 83.6 (SD 10.5) mm Hg, respectively, compared to 94.9 (SD 10.6) and 95.2 (SD 11.6) mm Hg in the conventional care group (P<.001). The ACR in the KidneyOnline care group showed a more significant reduction after 3 and 6 months (736 vs 980 mg/g and 572 vs 840 mg/g; P=.07 and P=.03); however, there was no significant difference in ACR between the two groups at the end of the follow-up period (618 vs 639 mg/g; P=.90). Conclusions: The utilization of KidneyOnline, an AI-based, nurse-led, patient-centered care system, may be beneficial in slowing the progression of nondialysis-dependent CKD. %M 39402012 %R 10.2196/54206 %U https://www.jmir.org/2024/1/e54206 %U https://doi.org/10.2196/54206 %U http://www.ncbi.nlm.nih.gov/pubmed/39402012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59837 %T Willingness to Be Contacted via a Patient Portal for Health Screening, Research Recruitment, and at-Home Self-Test Kits for Health Monitoring: Pilot Quantitative Survey %A Lockhart,Elizabeth %A Gootee,Jordan %A Copeland,Leah %A Turner,DeAnne %K patient portals %K patient engagement %K personal health records %K risk assessments %K health information %K information access %K open notes %K user perceptions %D 2024 %7 22.11.2024 %9 %J JMIR Form Res %G English %X Background: Patient portals are being increasingly used by health systems in the United States. Although some patients use portals for clinical use, patient perspectives on using portals for research-related activities, to complete health screenings, and to request at-home self-test kits are unclear. Objective: We aimed to understand patient perspectives on using electronic health portals for research; health-related screenings; and patient-initiated, home-based self-testing. Methods: Patients (N=105) from the Patient Engaged Research Center at a large, urban, midwestern health system completed a 23-item web-based survey on patient portal (MyChart) use and willingness to use the patient portal for research, risk assessments, and self-test kits. Frequencies and percentages were generated. Results: Almost all participants (102/105, 97.1%) had accessed MyChart at least once, with most (44/102, 43.1%) indicating they logged in at least once per month. Participants indicated logging into MyChart to check laboratory results or other health data (89/105, 84.8%), because they received a message to log in (85/105, 81%), and to message their health care professional (83/105, 79%). Fewer participants logged in to see what medications they had been prescribed (16/105, 15.2%) and to learn more about their health conditions (29/105, 27.6%). Most participants indicated logging into MyChart on a computer via a website (70/105, 66.7%) or on a smartphone via an app (54/105, 51.4%). When asked about how likely they would be to participate in different types of research if contacted via MyChart, most (90/105, 85.7%) said they would be likely to answer a survey, fill out a health assessment (87/105, 82.9%), or watch a video (86/105, 81.9%). Finally, participants would be willing to answer risk assessment questions on MyChart regarding sleep (74/101, 73.3%), stress (65/105, 61.9%), diabetes (60/105, 57.1%), anxiety (59/105, 56.2%), and depression (54/105, 51.4%) and would be interested in receiving an at-home self-test kit for COVID-19 (66/105, 62.9%), cholesterol (63/105, 60%), colon cancer (62/105, 59%), and allergies (56/105, 53.3%). There were no significant demographic differences for any results (all P values were >.05). Conclusions: Patient portals may be used for research recruitment; sending research-related information; and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks. The lack of significant findings based on race and gender suggests that patient portals may be acceptable tools for recruiting research participants and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their health care. Future research should examine if patient portal recruitment may help address persistent biases in clinical trial recruitment to increase enrollment of women and racial minority groups. %R 10.2196/59837 %U https://formative.jmir.org/2024/1/e59837 %U https://doi.org/10.2196/59837 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59974 %T Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study %A Hackett,Katherine %A Xu,Shiyun %A McKniff,Moira %A Paglia,Lido %A Barnett,Ian %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 484 843 1321, tania.giovannetti@temple.edu %K digital phenotyping %K digital biomarkers %K monitoring %K mHealth %K cognition %K mobility %K life space %K depression %K location data %K Alzheimer disease %K aging %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants’ scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r≥0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults’ personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. %M 39576984 %R 10.2196/59974 %U https://humanfactors.jmir.org/2024/1/e59974 %U https://doi.org/10.2196/59974 %U http://www.ncbi.nlm.nih.gov/pubmed/39576984 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58441 %T A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial %A Wettstein,Reto %A Sedaghat-Hamedani,Farbod %A Heinze,Oliver %A Amr,Ali %A Reich,Christoph %A Betz,Theresa %A Kayvanpour,Elham %A Merzweiler,Angela %A Büsch,Christopher %A Mohr,Isabell %A Friedmann-Bette,Birgit %A Frey,Norbert %A Dugas,Martin %A Meder,Benjamin %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215636617, reto.wettstein@med.uni-heidelberg.de %K wearable %K consumer device %K mobile phone %K mobile health %K telemedicine %K remote patient monitoring %K usability %K Health Level 7 Fast Healthcare Interoperability Resources %K HL7 FHIR %K cardiology %K heart failure %K dilated cardiomyopathy %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system’s app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61% (SD 26%) of days enrolled in the study. SHD were available on average for 78% (SD 23%) of days, and PROM data were available on 64% (SD 27%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients’ daily routines. %M 39365164 %R 10.2196/58441 %U https://mhealth.jmir.org/2024/1/e58441 %U https://doi.org/10.2196/58441 %U http://www.ncbi.nlm.nih.gov/pubmed/39365164 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e64994 %T Indigenous Parents’ Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study %A Butt,Michelle L %A Willett,Ysabella Jayne %A Miller,Vicky %A Jacobs,Brenda %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K child %K parenting %K qualitative %K Indigenous health %K support programs %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting support programs enhance parents’ health and their child’s development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents’ experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents’ experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. %M 39576680 %R 10.2196/64994 %U https://pediatrics.jmir.org/2024/1/e64994 %U https://doi.org/10.2196/64994 %U http://www.ncbi.nlm.nih.gov/pubmed/39576680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55639 %T Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study %A Aldridge,Grace %A Wu,Ling %A Seguin,Joshua Paolo %A Robinson,Jennifer %A Battaglia,Elizabeth %A Olivier,Patrick %A Yap,Marie B H %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, 3800, Australia, 61 3 9905 0723, marie.yap@monash.edu %K co-design %K service design %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K health care services %K adverse childhood experience %K ACE %K mental disorder %K innovate %K social services %K community health %K evidence-based %K parenting intervention %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent’s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite’s design. Results: PaRK-Lite’s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents’ empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. %M 39576676 %R 10.2196/55639 %U https://formative.jmir.org/2024/1/e55639 %U https://doi.org/10.2196/55639 %U http://www.ncbi.nlm.nih.gov/pubmed/39576676 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51424 %T Psychometric Properties of Measuring Antiretroviral Therapy Adherence Among Young Latino Sexual Minority Men With HIV: Ecological Momentary Assessment and Electronic Pill Dispenser Study %A Sheehan,Diana M %A Gwanzura,Tendai %A Ibarra,Cynthia %A Ramirez-Ortiz,Daisy %A Swendeman,Dallas %A Duncan,Dustin T %A Muñoz-Laboy,Miguel %A Devieux,Jessy G %A Trepka,Mary Jo %K human immunodeficiency virus %K HIV %K MSM %K sexual minority %K antiretroviral therapy %K Latino %K Hispanic %K adherence %K psychometric %K ecological momentary assessment %K electronic pill dispenser %K validity %K acceptability %K compliance %K medication dispenser %K reminder %K alert %K digital health %K young adult %D 2024 %7 21.11.2024 %9 %J Online J Public Health Inform %G English %X Background: Increasing HIV rates among young Latino sexual minority men (YLSMM) warrant innovative and rigorous studies to assess prevention and treatment strategies. Ecological momentary assessments (EMAs) and electronic pill dispensers (EPDs) have been used to measure antiretroviral therapy (ART) adherence repeatedly in real time and in participants’ natural environments, but their psychometric properties among YLSMM are unknown. Objective: The study’s objective was to assess the concurrent validity, acceptability, compliance, and behavioral reactivity of EMAs and EPDs among YLSMM with HIV. Methods: A convenience sample of 56 YLSMM with HIV with suboptimal ART adherence, aged 18‐34 years, was recruited into a 28-consecutive-day EMA study. Concurrent validity was analyzed by comparing median ART adherence rates and calculating Spearman correlations between ART adherence measured by EMA, EPD, and baseline retrospective validated 3-item and single-item measures. Acceptability was assessed in exit interviews asking participants to rate EMA and EPD burden. Compliance was assessed by computing the percent lost to follow-up, the percent of EMAs missed, and the percentage of days the EPD was not opened that had corresponding EMA data self-reporting adherence to ARTs. Behavioral reactivity was assessed by computing the median change in ART adherence during the study period, using generalized mixed models to assess whether the cumulative number of EMAs completed and days of EPD use predicted ART adherence over time, and by asking participants to rate perceived reactivity using a Likert scale. Results: EMA ART adherence was significantly correlated with baseline validated 3-item (r=0.41, P=.003) and single-item (r=0.52, P<.001) measures, but correlations were only significant for participants that reported EMA was not burdensome. Correlations for EPD ART adherence were weaker but significant (r=0.36, P=.009; r=0.34, P=.01, respectively). Acceptability was high for EMAs (48/54, 89%) and EPDs (52/54, 96%) per self-report. Loss to follow-up was 4% (2/56), with the remaining participants completing 88.6% (1339/1512) of study-prompted EMAs. The percentage of missed EMA surveys increased from 5.8% (22/378) in week 1 of the study to 16.7% (63/378) in week 4. Of 260 days when EPDs were not opened, 68.8% (179) had a corresponding EMA survey self-reporting ART adherence. Reactivity inferred from the median change in ART adherence over time was 8.8% for EMAs and −0.8% for EPDs. Each completed EMA was associated with 1.03 odds (95% CI 1‐1.07) of EMA ART adherence over time, and each day of EPD use with 0.97 odds (95% CI 0.96‐0.99) of EPD ART adherence over time. Self-reported perceived behavioral reactivity was 39% for EMAs and 35% for EPDs. Conclusions: This study provides evidence of concurrent validity with retrospective validated measures for EMA- and EPD-measured ART adherence among YLSMM, when participant burden is carefully considered, without significant behavioral reactivity. While acceptability and compliance of EMAs and EPDs were high overall, noncompliance increased over time, suggesting respondent fatigue. %R 10.2196/51424 %U https://ojphi.jmir.org/2024/1/e51424 %U https://doi.org/10.2196/51424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50710 %T Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study %A Ahumada-Newhart,Veronica %A Wood,Taffeta %A Satake,Noriko %A Marcin,James P %K telehealth %K telewellness %K online fitness %K health equity %K community health %K group exercise %K mobile phone %K mobile device %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, many people lacked access to group fitness opportunities due to elevated risk of infection, lockdown, and closure of exercise facilities. Additionally, many people experienced higher than average rates of mental health burden (eg, anxiety and stress). To help address these needs, an existing in-person community exercise class, taught by a faculty member from an academic medical center, transitioned to an online synchronous (OS) physical fitness class via the Zoom (Zoom Video Communications) videoconferencing platform. As such, the instructor advertised the OS fitness classes through an existing email list of community members and university faculty, staff, students, or alumni email listservs. This telewellness intervention sought to create a sense of community, build social support, and promote physical and mental wellness during the COVID-19 pandemic. Objective: Our aim was to determine the perceived mental and physical health benefits of attending an OS fitness class for community members, including health care workers. We also assessed the use and functionality of related technologies necessary for delivering and attending the fitness classes. Methods: An online survey questionnaire was created and tested to collect quantitative and qualitative data for an exploratory study. Data were collected to evaluate the fitness class, motivation, perceived health benefits, and related technologies. A convenience sample of people who had participated in the OS fitness classes was recruited for this study via an emailed recruitment flyer. Results: A total of 51 participants accessed and completed the survey questionnaire. Survey participants consisted of 28 of 51 (55%) with a university affiliation, 17 of 51 (33%) with no university affiliation, and 6 of 51 (12%) who declined to state. The largest group of participants reporting full-time employment (18/51, 35%) also reported university affiliation with the academic medical center. In this group, 13 of 51 (25%) participants reported full-time employment, university affiliation, and doctoral degrees. High overall exercise class satisfaction was observed in the survey responses (mean 4.0, SD 1). Data analyses revealed significant perceived value of both mental and physical health benefits as motivating factors for participating in the OS fitness class. Challenges were identified as not being able to receive individual feedback from the instructor and the inability of some participants to see if they were in sync with the rest of the class. Conclusions: Results provide preliminary support for the use of online videoconferencing fitness platforms to promote wellness and facilitate group exercise in the community during times of high infection risk. Future studies should continue to explore perceived benefits, mental and physical wellness, best practices, and the design of related technologies. %R 10.2196/50710 %U https://formative.jmir.org/2024/1/e50710 %U https://doi.org/10.2196/50710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56553 %T An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study %A Marras,Carlos %A Labarga,María %A Ginard,Daniel %A Carrascosa,Jose Manuel %A Escudero-Contreras,Alejandro %A Collantes-Estevez,Eduardo %A de Mora,Fernando %A Robles,Tamara %A Romero,Elisa %A Martínez,Rafael %K consumer health information %K treatment switching %K biosimilar pharmaceuticals %K immune-mediated diseases %K education %K qualitative research %K training %K nocebo %K digital tool %K implementation %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. %R 10.2196/56553 %U https://formative.jmir.org/2024/1/e56553 %U https://doi.org/10.2196/56553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52883 %T Web-Based Intervention Using Self-Compassionate Writing to Induce Positive Mood in Family Caregivers of Older Adults: Quantitative Study %A Wiita,Farah %A Ho,Aileen K %A Weinstein,Netta %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Berkshire, RG6 6AL, United Kingdom, 44 7951506136, f.l.wiita@pgr.reading.ac.uk %K self-compassion %K caregivers %K mindfulness %K intervention %K writing %K experimental %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiver burden can impact the mental health of family caregivers, but self-compassion may help reduce this impact. Brief self-compassion interventions have been shown to be useful but have not been tested in family caregivers of older adults. Objective: This study aimed to test the effects of a brief self-compassion intervention and its components (self-kindness, common humanity, and mindfulness) on mental well-being and mood when reflecting on difficult family caregiving experiences. Methods: British caregivers were recruited through a web-based panel. Three experimental studies manipulated the self-compassion intervention. In study 1 (n=206) and study 2 (n=224), participants wrote about a difficult caregiving experience while focusing on 1 self-compassion component (self-kindness, common humanity, or mindfulness). In study 3 (n=222) participants focused on all components. Self-compassion, serenity, guilt, and sadness were measured. Results: In studies 1 and 2, condition effects showed mindfulness unexpectedly lowered mood. Inconsistent and modest benefits to affect were achieved by engagement in self-kindness and common humanity in study 1 (guilt [lowered]: P=.02 and sadness [lowered]: P=.04; serenity [nonsignificantly raised]: P=.20) and also in study 2 (sadness [nonsignificantly lowered]: P=.23 and guilt [nonsignificantly lowered]: P=.26; serenity [raised]: P=.33); significant benefits for self-compassion and mood were found in study 3 (serenity [raised]: P=.01, kindness [raised]: P=.003, and common humanity [raised]: P≤.001; guilt [lowered]: P<.001 and sadness [lowered]: P≤.001). More intensive efforts should be made to promote self-compassion in caregivers of older adults, with caution advised when relying primarily on mindfulness approaches. Conclusions: Self-compassionate writing may be beneficial for family caregivers, but more intensive interventions are needed. Further research is needed to determine the optimal dosage and content for achieving the greatest effects. %M 39571153 %R 10.2196/52883 %U https://formative.jmir.org/2024/1/e52883 %U https://doi.org/10.2196/52883 %U http://www.ncbi.nlm.nih.gov/pubmed/39571153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57109 %T Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial %A van Aubel,Evelyne %A Vaessen,Thomas %A Uyttebroek,Lotte %A Steinhart,Henrietta %A Beijer-Klippel,Annelie %A Batink,Tim %A van Winkel,Ruud %A de Haan,Lieuwe %A van der Gaag,Mark %A van Amelsvoort,Thérèse %A Marcelis,Machteld %A Schirmbeck,Frederike %A Reininghaus,Ulrich %A Myin-Germeys,Inez %+ Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Herestraat 49, ON5B bus 1029, Leuven, 3000, Belgium, 32 16 37 31 74, lotte.uyttebroek@kuleuven.be %K acceptance and commitment therapy %K ACT %K first episode of psychosis %K FEP %K ultrahigh risk for psychosis %K UHR %K ecological momentary intervention %K EMI %K mobile health %K mHealth %K blended care %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=–4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=–0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=–1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803 %M 39570655 %R 10.2196/57109 %U https://formative.jmir.org/2024/1/e57109 %U https://doi.org/10.2196/57109 %U http://www.ncbi.nlm.nih.gov/pubmed/39570655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56999 %T Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study %A Stone,Chris %A Essery,Rosie %A Matthews,Joe %A Naughton,Felix %A Munafo,Marcus %A Attwood,Angela %A Skinner,Andy %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 01174555910, chris.stone@bristol.ac.uk %K smoking %K smoking cessation %K passive detection %K just-in-time intervention %K JITAI %K relapse prevention %K relapse %K smartwatch %K wearable technology %K wearable %K mobile health %K mHealth %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the “StopWatch” intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch’s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants’ acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. %M 39570656 %R 10.2196/56999 %U https://formative.jmir.org/2024/1/e56999 %U https://doi.org/10.2196/56999 %U http://www.ncbi.nlm.nih.gov/pubmed/39570656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47311 %T Cybersecurity Interventions in Health Care Organizations in Low- and Middle-Income Countries: Scoping Review %A Hasegawa,Kaede %A O'Brien,Niki %A Prendergast,Mabel %A Ajah,Chris Agape %A Neves,Ana Luisa %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk %K computer security %K internet security %K network security %K digital health %K digital health technology %K cybersecurity %K health data %K global health %K security %K data science %K LMIC %K low income %K low resource %K scoping review %K review methodology %K implementation %K barrier %K facilitator %D 2024 %7 20.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. %M 39566062 %R 10.2196/47311 %U https://www.jmir.org/2024/1/e47311 %U https://doi.org/10.2196/47311 %U http://www.ncbi.nlm.nih.gov/pubmed/39566062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62725 %T Assessing Digital Phenotyping for App Recommendations and Sustained Engagement: Cohort Study %A Dwyer,Bridget %A Flathers,Matthew %A Burns,James %A Mikkelson,Jane %A Perlmutter,Elana %A Chen,Kelly %A Ram,Nanik %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02115, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K engagement %K mental health %K digital phenotype %K pilot study %K phenotyping %K smartphone sensors %K anxiety %K sleep %K fitness %K depression %K qualitative %K app recommendation %K app use %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Low engagement with mental health apps continues to limit their impact. New approaches to help match patients to the right app may increase engagement by ensuring the app they are using is best suited to their mental health needs. Objective: This study aims to pilot how digital phenotyping, using data from smartphone sensors to infer symptom, behavioral, and functional outcomes, could be used to match people to mental health apps and potentially increase engagement Methods: After 1 week of collecting digital phenotyping data with the mindLAMP app (Beth Israel Deaconess Medical Center), participants were randomly assigned to the digital phenotyping arm, receiving feedback and recommendations based on those data to select 1 of 4 predetermined mental health apps (related to mood, anxiety, sleep, and fitness), or the control arm, selecting the same apps but without any feedback or recommendations. All participants used their selected app for 4 weeks with numerous metrics of engagement recorded, including objective screentime measures, self-reported engagement measures, and Digital Working Alliance Inventory scores. Results: A total of 82 participants enrolled in the study; 17 (21%) dropped out of the digital phenotyping arm and 18 (22%) dropped out from the control arm. Across both groups, few participants chose or were recommended the insomnia or fitness app. The majority (39/47, 83%) used a depression or anxiety app. Engagement as measured by objective screen time and Digital Working Alliance Inventory scores were higher in the digital phenotyping arm. There was no correlation between self-reported and objective metrics of app use. Qualitative results highlighted the importance of habit formation in sustained app use. Conclusions: The results suggest that digital phenotyping app recommendation is feasible and may increase engagement. This approach is generalizable to other apps beyond the 4 apps selected for use in this pilot, and practical for real-world use given that the study was conducted without any compensation or external incentives that may have biased results. Advances in digital phenotyping will likely make this method of app recommendation more personalized and thus of even greater interest. %M 39560976 %R 10.2196/62725 %U https://formative.jmir.org/2024/1/e62725 %U https://doi.org/10.2196/62725 %U http://www.ncbi.nlm.nih.gov/pubmed/39560976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60865 %T Understanding Patients’ Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study %A Liu,Jianyi %A Giannone,Alyssa %A Wang,Hailing %A Wetherall,Lucy %A Juarascio,Adrienne %+ Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 2158951895, jl4528@drexel.edu %K bulimia nervosa %K binge eating %K digital intervention %K deterioration prevention %K eating disorder %K bulimia %K digital health %K deterioration %K maintenance %K mHealth %K mobile health app %K interviews %K qualitative %K user-centered design %K psychotherapy %K CBT %K cognitive behavioral therapy %K needs %K preferences %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients’ interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. %M 39556809 %R 10.2196/60865 %U https://formative.jmir.org/2024/1/e60865 %U https://doi.org/10.2196/60865 %U http://www.ncbi.nlm.nih.gov/pubmed/39556809 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57360 %T The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany %A Preiser,Christine %A Radionova,Natalia %A Ög,Eylem %A Koch,Roland %A Klemmt,Malte %A Müller,Regina %A Ranisch,Robert %A Joos,Stefanie %A Rieger,Monika A %+ Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, Tübingen, 72074, Germany, 49 70712984361, christine.preiser@med.uni-tuebingen.de %K symptom checker app %K qualitative interviews %K general practice %K perceived work-related psychosocial stress %K job satisfaction %K professional identity %K medical diagnosis %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the “unorganized stage” of patients’ searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients’ decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient’s next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients’ anxiety, was too risk-averse, or made patients more insistent on their own opinions. %M 39556813 %R 10.2196/57360 %U https://humanfactors.jmir.org/2024/1/e57360 %U https://doi.org/10.2196/57360 %U http://www.ncbi.nlm.nih.gov/pubmed/39556813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60966 %T Telemonitoring of Active Inflammatory Bowel Disease Using the App TECCU: Short-Term Results of a Multicenter Trial of GETECCU %A Aguas,Mariam %A Del Hoyo,Javier %A Vicente,Raquel %A Barreiro-de Acosta,Manuel %A Melcarne,Luigi %A Hernandez-Camba,Alejandro %A Madero,Lucía %A Arroyo,María Teresa %A Sicilia,Beatriz %A Chaparro,María %A Martin-Arranz,María Dolores %A Pajares,Ramón %A Mesonero,Francisco %A Mañosa,Miriam %A Martinez,Pilar %A Chacón,Silvia %A Tosca,Joan %A Marín,Sandra %A Sanroman,Luciano %A Calvo,Marta %A Monfort,David %A Saiz,Empar %A Zabana,Yamile %A Guerra,Ivan %A Varela,Pilar %A Baydal,Virginia %A Faubel,Raquel %A Corsino,Pilar %A Porto-Silva,Sol %A Brunet,Eduard %A González,Melodi %A Gutiérrez,Ana %A Nos,Pilar %+ Gastroenterology Department, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell, nº 106, Valencia, 46026, Spain, 34 34 96 124 4000, delhoyo_jav@gva.es %K clinical trial %K telemonitoring %K inflammatory bowel disease %K Crohn disease %K ulcerative colitis %K quality of life %K socioeconomical and psychological end points %K health outcomes %K remission time %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemonitoring for inflammatory bowel disease (IBD) has not consistently demonstrated superiority over standard care; however, noninferiority may be an acceptable outcome if remote care proves to be more efficient. Objective: This study aims to compare the remission time and quality of life of patients with active IBD managed through standard care versus the TECCU (Telemonitoring of Crohn Disease and Ulcerative Colitis) app. Methods: A 2-arm, randomized, multicenter trial with a noninferiority design was conducted across 24 hospitals in Spain. The study included adult patients with IBD who were starting immunosuppressive or biological therapy. Participants were randomized into 2 groups: the telemonitoring group (G_TECCU) and the standard care group (G_Control). The follow-up schedule for the telemonitoring group (G_TECCU) was based on contacts via the TECCU app, while the control group (G_Control) adhered to standard clinical practice, which included in-person visits and telephone calls. In both groups, treatment adjustments were made based on the progression of disease activity and medication adherence, assessed using specific indices and biological markers at each check-up. The primary outcome was the duration of remission after 12 weeks, while secondary outcomes included quality of life, medication adherence, adverse events, and patient satisfaction. Results: Of the 169 patients enrolled, 158 were randomized and 150 were analyzed per protocol: telemonitoring (n=71) and control (n=79). After 12 weeks, the time in clinical remission was not inferior in the telemonitoring group (mean 4.20, SD 3.73 weeks) compared with the control group (mean 4.32, SD 3.28 weeks), with a mean difference between arms of –0.12 weeks (95% CI –1.25 to 1.01; noninferiority P=.02). The mean reduction in C-reactive protein values was –15.40 mg/L (SD 90.15 mg/L; P=.19) in the G_TECCU group and –13.16 mg/L (SD 54.61 mg/L; P=.05) in the G_Control group, with no significant differences between the 2 arms (P=.73). Similarly, the mean improvement in fecal calprotectin levels was 832.3 mg/L (SD 1825.0 mg/L; P=.003) in the G_TECCU group and 1073.5 mg/L (SD 3105.7 mg/L; P=.03) in the G_Control group; however, the differences were not statistically significant (P=.96). Quality of life improved in both groups, with a mean increase in the 9-item Inflammatory Bowel Disease Questionnaire score of 13.44 points (SD 19.1 points; P<.001) in the G_TECCU group and 18.23 points (SD 22.9 points; P=.001) in the G_Control group. Additionally, the proportion of patients who adhered to their medication significantly increased from 35% (25/71) to 68% (48/71) in the G_TECCU group (P=.001) and from 46% (36/79) to 73% (58/79) in the G_Control group (P=.001). The satisfaction rate remained stable at around 90%, although noninferiority was not demonstrated for the secondary outcomes. Conclusions: Telemonitoring patients with active IBD is not inferior to standard care for achieving and maintaining short-term remission. The TECCU app may serve as a viable alternative follow-up tool, pending confirmation of improved health outcomes and cost-effectiveness over the long-term. Trial Registration: ClinicalTrials.gov NCT06031038; https://clinicaltrials.gov/ct2/show/NCT06031038 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9639 %M 39189160 %R 10.2196/60966 %U https://www.jmir.org/2024/1/e60966 %U https://doi.org/10.2196/60966 %U http://www.ncbi.nlm.nih.gov/pubmed/39189160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50959 %T Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study %A Zhou,Zhiheng %A Jin,Danian %A He,Jinghua %A Zhou,Shengqing %A Wu,Jiang %A Wang,Shuangxi %A Zhang,Yang %A Feng,Tianyuan %+ Pingshan Hospital of Southern Medical University, No. 16 Renmin Road, Pingshan District, Shenzhen, 518118, China, 86 13828493963, zhihengz@163.com %K information platform %K active health %K chronic disease management %K effectiveness %K community %K digital health %K health literacy %K cardio-cerebrovascular disease %K China %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents’ self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the “i Active Health” applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents’ risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents’ health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients’ BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. %M 39556830 %R 10.2196/50959 %U https://www.jmir.org/2024/1/e50959 %U https://doi.org/10.2196/50959 %U http://www.ncbi.nlm.nih.gov/pubmed/39556830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47754 %T Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study %A Fahr,Annina %A Kläy,Andrina %A Coka,Larissa S %A van Hedel,Hubertus J A %+ Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, Affoltern am Albis, 8910, Switzerland, 41 44 762 52 91, hubertus.vanhedel@kispi.uzh.ch %K neurorehabilitation %K single-case design %K interactive computer play %K cerebral palsy %K surface electromyography %K motor control %K mirror movements %K involuntary movements %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective: This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods: We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results: Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions: The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration: German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b %M 39556826 %R 10.2196/47754 %U https://formative.jmir.org/2024/1/e47754 %U https://doi.org/10.2196/47754 %U http://www.ncbi.nlm.nih.gov/pubmed/39556826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55088 %T An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study %A Yang,Lin %A Guo,Zhen %A Xu,Xiaowei %A Kang,Hongyu %A Lai,Jianqiang %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 3, Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K Chinese food data %K multimodal knowledge graph %K online platform %K population health promotion %K health promotion %K nutrients %K diet %K pregnant women %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. %M 39547662 %R 10.2196/55088 %U https://formative.jmir.org/2024/1/e55088 %U https://doi.org/10.2196/55088 %U http://www.ncbi.nlm.nih.gov/pubmed/39547662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58608 %T A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration %A Essop,Hafsa %A Kekana,Ramadimetja Mable %A Brosens,Jacques %A Smuts,Hanlie %+ Department of Radiography, University of Pretoria, 30 Bophelo Road, Gezina, Pretoria, 0008, South Africa, 27 0715897939, hafsa.essop@up.ac.za %K mobile app %K design science research %K usefulness %K pregnant radiographers %K fetal dosimetry %K occupational health and safety %K mobile phone %K maternal and child health %K PregiDose %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users’ perceptions of the app’s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users’ perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app’s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app’s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and “pregnancy brain,” were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. %M 39546780 %R 10.2196/58608 %U https://formative.jmir.org/2024/1/e58608 %U https://doi.org/10.2196/58608 %U http://www.ncbi.nlm.nih.gov/pubmed/39546780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63298 %T Cultural Adaptation and User Satisfaction of an Internet-Delivered Cognitive Behavioral Program for Depression and Anxiety Among College Students in Two Latin American Countries: Focus Group Study With Potential Users and a Cross-Sectional Questionnaire Study With Actual Users %A Albor,Yesica %A González,Noé %A Benjet,Corina %A Salamanca-Sanabria,Alicia %A Hernández-de la Rosa,Cristiny %A Eslava-Torres,Viridiana %A García-Alfaro,María Carolina %A Melchor-Audirac,Andrés %A Montoya-Montero,Laura Itzel %A Suárez,Karla %+ Center for Research in Global Mental Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, Mexico City, 14370, Mexico, 52 5541605332, cbenjet@gmail.com %K culturally competent care %K mental health %K digital health %K student health services %K Colombia %K Mexico %K SilverCloud %K anxiety %K depression %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To scale up mental health care in low-resource settings, digital interventions must consider cultural fit. Despite the findings that culturally adapted digital interventions have greater effectiveness, there is a lack of empirical evidence of interventions that have been culturally adapted or their adaptation documented. Objective: This study aimed to document the cultural adaptation of the SilverCloud Health Space from Depression and Anxiety program for university students in Colombia and Mexico and evaluate user satisfaction with the adapted program. Methods: A mixed methods process was based on Cultural Sensitivity and Ecological Validity frameworks. In phase 1, the research team added culturally relevant content (eg, expressions, personal stories, photos) for the target population to the intervention. In phase 2, potential users (9 university students) first evaluated the vignettes and photos used throughout the program. We calculated median and modal responses. They then participated in focus groups to evaluate and assess the cultural appropriateness of the materials. Their comments were coded into the 8 dimensions of the Ecological Validity Framework. Phase 3 consisted of choosing the vignettes most highly rated by the potential users and making modifications to the materials based on the student feedback. In the final phase, 765 actual users then engaged with the culturally adapted program and rated their satisfaction with the program. We calculated the percentage of users who agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them attain their goals. Results: The potential users perceived the original vignettes as moderately genuine, or true, which were given median scores between 2.5 and 3 (out of a possible 4) and somewhat identified with the situations presented in the vignettes given median scores between 1.5 and 3. The majority of comments or suggestions for modification concerned language (126/218, 57.5%), followed by concepts (50/218, 22.8%). Much less concerned methods (22/218, 10%), persons (9/218, 4.1%), context (5/218, 2.3%), or content (2/218, 0.9%). There were no comments about metaphors or goals. Intervention materials were modified based on these results. Of the actual users who engaged with the adapted version of the program, 87.7%-96.2% of them agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them to attain their goals. Conclusions: We conclude that the adapted version is satisfactory for this population based on the focus group discussions and the satisfaction scores. Conducting and documenting such cultural adaptations and involving the users in the cultural adaptation process will likely improve the effectiveness of digital mental health interventions in low- and middle-income countries and culturally diverse contexts. %M 39546799 %R 10.2196/63298 %U https://formative.jmir.org/2024/1/e63298 %U https://doi.org/10.2196/63298 %U http://www.ncbi.nlm.nih.gov/pubmed/39546799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53768 %T Use of Random Forest to Predict Adherence in an Online Intervention for Depression Using Baseline and Early Usage Data: Model Development and Validation on Retrospective Routine Care Log Data %A Wenger,Franziska %A Allenhof,Caroline %A Schreynemackers,Simon %A Hegerl,Ulrich %A Reich,Hanna %+ Clinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Heinrich-Hoffmann-Str. 10, Frankfurt am Main, 60528, Germany, 49 3412238744, franziska.wenger@deutsche-depressionshilfe.de %K depression %K adherence %K machine learning %K digital interventions %K random forest %K iFightDepression %K iFD %K online intervention %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online interventions, such as the iFightDepression (iFD) tool, are increasingly recognized as effective alternatives to traditional face-to-face psychotherapy or pharmacotherapy for treating depression. However, particularly when used outside of study settings, low adherence rates and the resulting diminished benefits of the intervention can limit their effectiveness. Understanding the factors that predict adherence would allow for early, tailored interventions for individuals at risk of nonadherence, thereby enhancing user engagement and optimizing therapeutic outcomes. Objective: This study aims to develop and evaluate a random forest model that predicts adherence to the iFD tool to identify users at risk of noncompletion. The model was based on characteristics collected during baseline and the first week of the intervention in patients with depression. Methods: Log data from 4187 adult patients who registered for the iFD tool between October 1, 2016, and May 5, 2022, and provided informed consent were statistically analyzed. The resulting data set was divided into training (2932/4187, 70%) and test (1255/4187, 30%) sets using a randomly stratified split. The training data set was utilized to train a random forest model aimed at predicting each user’s adherence at baseline, based on the hypothesized predictors: age, self-reported gender, expectations of the intervention, current or previous depression treatments, confirmed diagnosis of depression, baseline 9-item Patient Health Questionnaire (PHQ-9) score, accompanying guide profession, and usage behavior within the first week. After training, the random forest model was evaluated on the test data set to assess its predictive performance. The importance of each variable in predicting adherence was analyzed using mean decrease accuracy, mean decrease Gini, and Shapley Additive Explanations values. Results: Of the 4187 patients evaluated, 1019 (24.34%) were classified as adherent based on our predefined definition. An initial random forest model that relied solely on sociodemographic and clinical predictors collected at baseline did not yield a statistically significant adherence prediction. However, after incorporating each patient’s usage behavior during the first week, we achieved a significant prediction of adherence (P<.001). Within this prediction, the model achieved an accuracy of 0.82 (95% CI 0.79-0.84), an F1-score of 0.53, an area under the curve of 0.83, and a specificity of 0.94 for predicting nonadherent users. The key predictors of adherence included logs, word count on the first workshop’s worksheet, and time spent on the tool, all measured during the first week. Conclusions: Our results highlight that early engagement, particularly usage behavior during the first week of the online intervention, is a far greater predictor of adherence than any sociodemographic or clinical factors. Therefore, analyzing usage behavior within the first week and identifying nonadherers through the algorithm could be beneficial for tailoring interventions aimed at improving user adherence. This could include follow-up calls or face-to-face discussions, optimizing resource utilization in the process. %M 39546342 %R 10.2196/53768 %U https://formative.jmir.org/2024/1/e53768 %U https://doi.org/10.2196/53768 %U http://www.ncbi.nlm.nih.gov/pubmed/39546342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50963 %T Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial %A Jackson,Sarah %A Kale,Dimitra %A Beard,Emma %A Perski,Olga %A West,Robert %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 2076795634, s.e.jackson@ucl.ac.uk %K randomized controlled trial %K smartphone app %K smoking cessation %K digital intervention %K tobacco %K mobile phone %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. Objective: We aimed to evaluate the effectiveness of the offer of Smoke Free—an evidence-informed, widely used app—for smoking cessation versus no support. Methods: In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. Results: The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Conclusions: Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. Trial Registration: ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540 International Registered Report Identifier (IRRID): RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652 %M 39546331 %R 10.2196/50963 %U https://www.jmir.org/2024/1/e50963 %U https://doi.org/10.2196/50963 %U http://www.ncbi.nlm.nih.gov/pubmed/39546331 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57390 %T The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design %A Shojaei,Fereshtehossadat %A Shojaei,Fatemehalsadat %A Desai,Archita P %A Long,Emily %A Mehta,Jade %A Fowler,Nicole R %A Holden,Richard J %A Orman,Eric S %A Boustani,Malaz %+ Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 8128565754, fshojaei@iu.edu %K AgileNudge+ %K agile %K nudge strategy %K nudging interventions %K agile implementation %K human behavior %K software design %K human-computer interaction %K user experience design %K usability testing %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In today’s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. “AgileNudge+” (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of “AgileNudge+” for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software’s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science–based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software’s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool’s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project’s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users’ needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. %M 39302134 %R 10.2196/57390 %U https://formative.jmir.org/2024/1/e57390 %U https://doi.org/10.2196/57390 %U http://www.ncbi.nlm.nih.gov/pubmed/39302134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56158 %T Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study %A Barnes,Keely %A Sveistrup,Heidi %A Karimijashni,Motahareh %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Marshall,Shawn %+ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees Ave., Ottawa, ON, K1N 6N5, Canada, 1 6136126127, kbarn076@uottawa.ca %K remote care %K mild traumatic brain injury %K telehealth %K assessment %K workplace injury %K concussion %K telemedicine %K brain injury %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. Objective: This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Methods: Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants’ experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. Results: A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Conclusions: Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. International Registered Report Identifier (IRRID): RR2-10.2196/40446 %M 39536308 %R 10.2196/56158 %U https://www.jmir.org/2024/1/e56158 %U https://doi.org/10.2196/56158 %U http://www.ncbi.nlm.nih.gov/pubmed/39536308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54335 %T Early Identification of Cognitive Impairment in Community Environments Through Modeling Subtle Inconsistencies in Questionnaire Responses: Machine Learning Model Development and Validation %A Gao,Hongxin %A Schneider,Stefan %A Hernandez,Raymond %A Harris,Jenny %A Maupin,Danny %A Junghaenel,Doerte U %A Kapteyn,Arie %A Stone,Arthur %A Zelinski,Elizabeth %A Meijer,Erik %A Lee,Pey-Jiuan %A Orriens,Bart %A Jin,Haomiao %+ School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 7438534086, h.jin@surrey.ac.uk %K machine learning %K artificial intelligence %K cognitive impairments %K surveys and questionnaires %K community health services %K public health %K early identification %K elder care %K dementia %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The underdiagnosis of cognitive impairment hinders timely intervention of dementia. Health professionals working in the community play a critical role in the early detection of cognitive impairment, yet still face several challenges such as a lack of suitable tools, necessary training, and potential stigmatization. Objective: This study explored a novel application integrating psychometric methods with data science techniques to model subtle inconsistencies in questionnaire response data for early identification of cognitive impairment in community environments. Methods: This study analyzed questionnaire response data from participants aged 50 years and older in the Health and Retirement Study (waves 8-9, n=12,942). Predictors included low-quality response indices generated using the graded response model from four brief questionnaires (optimism, hopelessness, purpose in life, and life satisfaction) assessing aspects of overall well-being, a focus of health professionals in communities. The primary and supplemental predicted outcomes were current cognitive impairment derived from a validated criterion and dementia or mortality in the next ten years. Seven predictive models were trained, and the performance of these models was evaluated and compared. Results: The multilayer perceptron exhibited the best performance in predicting current cognitive impairment. In the selected four questionnaires, the area under curve values for identifying current cognitive impairment ranged from 0.63 to 0.66 and was improved to 0.71 to 0.74 when combining the low-quality response indices with age and gender for prediction. We set the threshold for assessing cognitive impairment risk in the tool based on the ratio of underdiagnosis costs to overdiagnosis costs, and a ratio of 4 was used as the default choice. Furthermore, the tool outperformed the efficiency of age or health-based screening strategies for identifying individuals at high risk for cognitive impairment, particularly in the 50- to 59-year and 60- to 69-year age groups. The tool is available on a portal website for the public to access freely. Conclusions: We developed a novel prediction tool that integrates psychometric methods with data science to facilitate “passive or backend” cognitive impairment assessments in community settings, aiming to promote early cognitive impairment detection. This tool simplifies the cognitive impairment assessment process, making it more adaptable and reducing burdens. Our approach also presents a new perspective for using questionnaire data: leveraging, rather than dismissing, low-quality data. %M 39536306 %R 10.2196/54335 %U https://formative.jmir.org/2024/1/e54335 %U https://doi.org/10.2196/54335 %U http://www.ncbi.nlm.nih.gov/pubmed/39536306 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55137 %T Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study %A Duran,Andrea T %A Cumella,Robin M %A Mendieta,Miguel %A Keener-Denoia,Adrianna %A López Veneros,David %A Farris,Samantha G %A Moise,Nathalie %A Kronish,Ian M %+ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, United States, 1 212 342 4491, atd2127@cumc.columbia.edu %K behavioral intervention development %K implementation science %K acute coronary syndrome %K exercise sensitivity %K interoceptive exposure %K digital health %K mobile phone %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ≥4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. %M 39531636 %R 10.2196/55137 %U https://formative.jmir.org/2024/1/e55137 %U https://doi.org/10.2196/55137 %U http://www.ncbi.nlm.nih.gov/pubmed/39531636 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52788 %T Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals %A Oudshoorn,Cathelijn %A Frielink,Noud %A Riper,Heleen %A Embregts,Petri %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, 5037 DB, Tilburg, Netherlands, 31 0134662969, c.e.m.oudshoorn@tilburguniversity.edu %K acceptance %K health care professionals %K intellectual disabilities %K eHealth %K disability %K psychological therapy %K support %K cross-sectional survey %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals’ acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants’ characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. %M 39531275 %R 10.2196/52788 %U https://formative.jmir.org/2024/1/e52788 %U https://doi.org/10.2196/52788 %U http://www.ncbi.nlm.nih.gov/pubmed/39531275 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e58663 %T Impact of Consumer Wearables Data on Pediatric Surgery Clinicians’ Management: Multi-Institutional Scenario-Based Usability Study %A Carter,Michela %A Linton,Samuel C %A Zeineddin,Suhail %A Pitt,J Benjamin %A De Boer,Christopher %A Figueroa,Angie %A Gosain,Ankush %A Lanning,David %A Lesher,Aaron %A Islam,Saleem %A Sathya,Chethan %A Holl,Jane L %A Ghomrawi,Hassan MK %A Abdullah,Fizan %+ Division of Pediatric Surgery, Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 63, Chicago, IL, 60611, United States, 1 312 227 4210, Fabdullah@luriechildrens.org %K postoperative care %K telehealth %K consultation %K remote %K appendectomy %K pediatric hospital %K children %K wearable device %K minimally invasive surgery %K pediatric surgery %K remote simulation study %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: At present, parents lack objective methods to evaluate their child’s postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent’s subjective assessment of the child’s health status and the child’s ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. Objective: This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians’ management. Methods: In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children’s hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. Results: In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. Conclusions: The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians’ remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use. %M 39531288 %R 10.2196/58663 %U https://periop.jmir.org/2024/1/e58663 %U https://doi.org/10.2196/58663 %U http://www.ncbi.nlm.nih.gov/pubmed/39531288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48664 %T Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study %A Gulzar,Saleema %A Rahim,Shirin %A Dossa,Khadija %A Saeed,Sana %A Agha,Insiyah %A Khoja,Shariq %A Karmaliani,Rozina %+ School of Nursing and Midwifery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3332356678, saleema.gulzar@aku.edu %K teleconsultation %K digital health %K school health %K child health %K information technology %K eConsultation %K telehealth %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Pakistan’s remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS’s cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. %M 39531262 %R 10.2196/48664 %U https://formative.jmir.org/2024/1/e48664 %U https://doi.org/10.2196/48664 %U http://www.ncbi.nlm.nih.gov/pubmed/39531262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59395 %T Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study %A Uemura,Kosuke %A Miyagami,Taiju %A Saita,Mizue %A Uchida,Takuro %A Yuasa,Shun %A Kondo,Keita %A Miura,Shun %A Matsushita,Mizuki %A Shirai,Yuka %A Misawa,Richard Baku %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan, 81 3 5802 1190, k.uemura.sh@juntendo.ac.jp %K exercise prescriptions %K sex %K age %K lifestyle %K internet search keywords %K infodemiology %K demographic %K physical activity %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective: This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods: Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results: The top-searched term was “Pilates” (266,000 queries). Male individuals showed higher interest in activities such as “running” (25,400/40,700, 62.4%), “muscle training” (65,800/111,000, 59.3%), and “hiking” (23,400/40,400, 57.9%) than female individuals. Female individuals exhibited higher interest in “Pilates” (199,000/266,000, 74.8%), “yoga” (86,200/117,000, 73.7%), and “tai chi” (45,300/65,900, 68.7%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms’ volume peaked for those in their 40s; “stretch” was most popular among those in their 50s; and “tai chi” and “radio calisthenics” had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of “tai chi,” which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions: Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change. %M 39527804 %R 10.2196/59395 %U https://formative.jmir.org/2024/1/e59395 %U https://doi.org/10.2196/59395 %U http://www.ncbi.nlm.nih.gov/pubmed/39527804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58363 %T A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study %A Oliveira,Ashleigh %A Wolff,John %A Alfouzan,Nouf %A Yu,Jin %A Yahya,Asma %A Lammy,Kayla %A Nakamura,Manabu T %+ Division of Nutritional Sciences, University of Illinois at Urbana Champaign, 905 S Goodwin Ave, Urbana, IL, 61801, United States, 1 217 333 1267, oliveira.ashleigh@gmail.com %K health application %K weight loss %K behavior change technique %K BCT %K online weight loss program %K weight monitoring %K meal planning %K sustainable weight loss %K dietary fiber %K mHealth %K mobile health %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. %M 39527795 %R 10.2196/58363 %U https://formative.jmir.org/2024/1/e58363 %U https://doi.org/10.2196/58363 %U http://www.ncbi.nlm.nih.gov/pubmed/39527795 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59908 %T A New Research Model for Artificial Intelligence–Based Well-Being Chatbot Engagement: Survey Study %A Yang,Yanrong %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, Lisboa, 1070-312, Portugal, 351 213 828 610, 20220021@NOVAIMS.UNL.PT %K artificial intelligence–based chatbot %K AI-based chatbot %K mental well-being %K intention to engage %K engagement behavior %K theoretical models %K mobile phone %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI)–based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals’ intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users’ AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. %M 39527812 %R 10.2196/59908 %U https://humanfactors.jmir.org/2024/1/e59908 %U https://doi.org/10.2196/59908 %U http://www.ncbi.nlm.nih.gov/pubmed/39527812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60673 %T Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study %A Scaramozza,Matthew %A Ruet,Aurélie %A Chiesa,Patrizia A %A Ahamada,Laïtissia %A Bartholomé,Emmanuel %A Carment,Loïc %A Charre-Morin,Julie %A Cosne,Gautier %A Diouf,Léa %A Guo,Christine C %A Juraver,Adrien %A Kanzler,Christoph M %A Karatsidis,Angelos %A Mazzà,Claudia %A Penalver-Andres,Joaquin %A Ruiz,Marta %A Saubusse,Aurore %A Simoneau,Gabrielle %A Scotland,Alf %A Sun,Zhaonan %A Tang,Minao %A van Beek,Johan %A Zajac,Lauren %A Belachew,Shibeshih %A Brochet,Bruno %A Campbell,Nolan %+ Biogen, 225 Binney St, Cambridge, MA, 02142, United States, 1 781 464 2000, matt.scaramozza@biogen.com %K multiple sclerosis %K sensor-derived measure %K smartphone %K cognitive function %K motor function %K digital biomarkers %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|<0.5) or were not correlated (|ρ|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. %M 39515815 %R 10.2196/60673 %U https://formative.jmir.org/2024/1/e60673 %U https://doi.org/10.2196/60673 %U http://www.ncbi.nlm.nih.gov/pubmed/39515815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53299 %T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study %A Perme,Natalie %A Reid,Endia %A Eluagu,Macdonald Chinwenwa %A Thompson,John %A Hebert,Courtney %A Gabbe,Steven %A Swoboda,Christine Marie %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu %K health resources %K pregnancy %K patient engagement %K mHealth %K maternal %K mobile health %K app %K focus group %K landscape analysis %K birth %K preterm %K premature %K mortality %K death %K pediatric %K infant %K neonatal %K design %K development %K obstetric %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. %M 39514852 %R 10.2196/53299 %U https://formative.jmir.org/2024/1/e53299 %U https://doi.org/10.2196/53299 %U http://www.ncbi.nlm.nih.gov/pubmed/39514852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e13723 %T Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process %A de Vette,Frederiek %A Ruiz-Rodriguez,Aurora %A Tabak,Monique %A Oude Nijeweme-d'Hollosy,Wendy %A Hermens,Hermie %A Vollenbroek-Hutten,Miriam %+ Biomechanical Engineering Group, Faculty of Engineering Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 5798, a.ruizrodriguez@utwente.nl %K game based %K gamification %K game %K eHealth %K telemedicine %K development %K design %K engagement %K game preferences %K older adults %K self-management %K prototyping %K evaluations %K creative %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform’s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game “Stranded!” The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. %M 39514861 %R 10.2196/13723 %U https://formative.jmir.org/2024/1/e13723 %U https://doi.org/10.2196/13723 %U http://www.ncbi.nlm.nih.gov/pubmed/39514861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64540 %T Preliminary Feasibility of a Novel Mind-Body Program to Prevent Persistent Concussion Symptoms Among Young Adults With Anxiety: Nonrandomized Open Pilot Study %A Becker,Molly Elizabeth %A Stratton Levey,Nadine %A Yeh,Gloria Y %A Giacino,Joseph %A Iverson,Grant %A Silverberg,Noah %A Parker,Robert A %A McKinnon,Ellen %A Siravo,Caitlin %A Shah,Priyanca %A Vranceanu,Ana-Maria %A Greenberg,Jonathan %+ Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 648, Boston, MA, 02114, United States, 1 6176439402, jgreenberg5@mgh.harvard.edu %K concussions %K mind-body %K preventions %K young adults %K feasibility %K persistence %K open pilot %K mind-body program %K preliminary feasibility %K mild traumatic brain injuries %K United States %K adults %K psychological factors %K mind-body interventions %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Concussions are common, particularly among young adults, and often are associated with persistent, debilitating, and hard-to-treat symptoms. Anxiety and concussion symptoms often amplify each other, and growing evidence indicates that anxiety plays a key role in symptoms persistence after concussion. Targeting anxiety early after concussion may be a promising means of helping prevent persistent concussion symptoms in this population. We developed the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program tailored for young adults with a recent concussion and anxiety, aiming to prevent persistent concussion symptoms. Objective: This study aims to conduct an open pilot of TOR-C to test preliminary feasibility, signal of change in measures, and treatment perceptions. Methods: Five young adults (aged 18-24 years) attended 4 weekly one-on-one live video sessions with a clinician. Participants completed questionnaires measuring treatment targets (ie, pain catastrophizing, mindfulness, fear avoidance, limiting behaviors, and all-or-nothing behaviors) and outcomes (ie, postconcussive symptoms, physical function, anxiety, depression, and pain) at baseline, immediately following the intervention, and 3 months after intervention completion. At the conclusion of the program, participants attended a qualitative interview and provided feedback about the program to help optimize study content and procedures. Results: Feasibility markers were excellent for credibility and expectancy (5/5, 100% of participants scored above the credibility and expectancy scale midpoint), client satisfaction (4/5, 80% of participants scored above the Client Satisfaction Questionnaire midpoint), therapist adherence (97% adherence), acceptability of treatment (5/5, 100% of participants attended 3 or more sessions), adherence to homework (87% home practice completion), and feasibility of assessments (no measures fully missing). The feasibility of recruitment was good (5/7, 71% of eligible participants agreed to participate). There were preliminary signals of improvements from pre-post comparisons in treatment targets (d=0.72-2.20) and outcomes (d=0.41-1.38), which were sustained after 3 months (d=0.38-2.74 and d=0.71-1.63 respectively). Exit interviews indicated overall positive perceptions of skills and highlighted barriers (eg, busyness) and facilitators (eg, accountability) to engagement. Conclusions: TOR-C shows preliminary feasibility, is associated with a signal of improvement in treatment targets and outcomes, and has the potential to support recovery from concussion. The quantitative findings along with the qualitative feedback obtained from the exit interviews will help optimize TOR-C in preparation for an upcoming randomized controlled trial of TOR-C versus an active control condition of health education for concussion recovery. International Registered Report Identifier (IRRID): RR2-10.2196/25746 %M 39514283 %R 10.2196/64540 %U https://formative.jmir.org/2024/1/e64540 %U https://doi.org/10.2196/64540 %U http://www.ncbi.nlm.nih.gov/pubmed/39514283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59158 %T A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study %A Straand,Ingjerd J %A Følstad,Asbjørn %A Wünsche,Burkhard C %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K web-based intervention %K positive psychology %K mental health %K user experience %K persuasive design %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users’ motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. %M 39514255 %R 10.2196/59158 %U https://formative.jmir.org/2024/1/e59158 %U https://doi.org/10.2196/59158 %U http://www.ncbi.nlm.nih.gov/pubmed/39514255 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56437 %T Virtual Coach–Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial %A Reilly,Erin D %A Kelly,Megan M %A Grigorian,Hannah L %A Waring,Molly E %A Quigley,Karen S %A Hogan,Timothy P %A Heapy,Alicia A %A Drebing,Charles E %A Volonte,Matias %A Kathawalla,Ummul-Kiram %A Robins,Hannah E %A Bernice,Katarina %A Bickmore,Timothy %+ Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K chronic pain %K randomized controlled trial %K usability %K acceptance and commitment therapy %K embodied conversational agent %K veterans %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach–guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain—chronic pain acceptance—after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 %M 39514264 %R 10.2196/56437 %U https://formative.jmir.org/2024/1/e56437 %U https://doi.org/10.2196/56437 %U http://www.ncbi.nlm.nih.gov/pubmed/39514264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51865 %T Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders %A Lange-Drenth,Lukas %A Schulz,Holger %A Suck,Isabell %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 07410 56811, l.lange-drenth@uke.de %K telerehabilitation %K rehabilitation %K eHealth development %K value specification %K stakeholder participation %K occupational injuries %K vocational rehabilitation %K aftercare %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients’ lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. %M 39514260 %R 10.2196/51865 %U https://formative.jmir.org/2024/1/e51865 %U https://doi.org/10.2196/51865 %U http://www.ncbi.nlm.nih.gov/pubmed/39514260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51832 %T Exploring Psychotherapists’ Attitudes on Internet- and Mobile-Based Interventions in Germany: Thematic Analysis %A Hildebrand,Anne Sophie %A Planert,Jari %A Machulska,Alla %A Margraf,Lena Maria %A Roesmann,Kati %A Klucken,Tim %+ Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, Siegen, 57072, Germany, 49 271 740 3688, Anne.Hildebrand@uni-siegen.de %K eHealth %K psychotherapy %K psychotherapists’ perspectives %K thematic analysis %K internet- and mobile-based intervention %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, internet- and mobile-based interventions (IMIs) have become increasingly relevant in mental health care and have sparked societal debates. Psychotherapists’ perspectives are essential for identifying potential opportunities for improvement, facilitating conditions, and barriers to the implementation of these interventions. Objective: This study aims to explore psychotherapists’ perspectives on opportunities for improvement, facilitating conditions, and barriers to using IMIs. Methods: The study used a qualitative research design, utilizing open-ended items in a cross-sectional survey. A total of 350 psychotherapists were asked to provide their written opinions on various aspects of IMIs. Thematic analysis was conducted to analyze the data and identify core themes. Results: The analysis revealed 11 core themes related to the use of IMIs, which were categorized into 4 superordinate categories: “Applicability,” “Treatment Resources,” “Technology,” and “Perceived Risks and Barriers.” While many psychotherapists viewed IMIs as a valuable support for conventional psychotherapy, they expressed skepticism about using IMIs as a substitute. Several factors were perceived as hindrances to the applicability of IMIs in clinical practice, including technological issues, subjective concerns about potential data protection risks, a lack of individualization due to the manualized nature of most IMIs, and the high time and financial costs for both psychotherapists and patients. They expressed a desire for easily accessible information on evidence and programs to reduce the time and effort required for training and advocated for this information to be integrated into the conceptualization of new IMIs. Conclusions: The findings of this study emphasize the importance of considering psychotherapists’ attitudes in the development, evaluation, and implementation of IMIs. This study revealed that psychotherapists recognized both the opportunities and risks associated with the use of IMIs, with most agreeing that IMIs serve as a tool to support traditional psychotherapy rather than as a substitute for it. Furthermore, it is essential to involve psychotherapists in discussions about IMIs specifically, as well as in the development of new methodologies in psychotherapy more broadly. Overall, this study can advance the use of IMIs in mental health care and contribute to the ongoing societal debate surrounding these interventions. %M 39510514 %R 10.2196/51832 %U https://formative.jmir.org/2024/1/e51832 %U https://doi.org/10.2196/51832 %U http://www.ncbi.nlm.nih.gov/pubmed/39510514 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e60190 %T Beyond Hemoglobin A1c—Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study %A Markowitz,Benjamin %A de Sequeira,Stephanie %A Najam,Adhiyat %A Pritlove,Cheryl %A Greenberg,Dana %A Greenberg,Marley %A Chan,Chee-Mei %A Lakhanpal,Gurpreet %A Jagadeesh,Samyukta %A Mukerji,Geetha %A Shulman,Rayzel %A Witteman,Holly O %A Yu,Catherine H %A Booth,Gillian L %A Parsons,Janet A %A , %+ Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1C9, Canada, 1 (416) 360 4000, stephanie.desequeira@unityhealth.to %K T1D self-management %K patient reported outcomes %K patient reported outcome measures %K virtual care %K mobile phone %K type 1 diabetes %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. Objective: This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. Methods: A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. Results: An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking “beyond A1c” toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre– and post–COVID-19 perspectives on virtual care. Conclusions: Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support. %M 39509700 %R 10.2196/60190 %U https://diabetes.jmir.org/2024/1/e60190 %U https://doi.org/10.2196/60190 %U http://www.ncbi.nlm.nih.gov/pubmed/39509700 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59897 %T Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach %A Berger,Mathilde %A Deblock-Bellamy,Anne %A Chèze,Laurence %A Robert,Thomas %A Desrosiers,Julie J %A Christe,Guillaume %A Bertrand,Anne Martine %+ Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL | HES-SO), Chemin des Abeilles 14, Lausanne, 1010, Switzerland, 41 (0)216510330, mathilde.berger@hetsl.ch %K chronic low back pain %K needs %K self-management %K physical activity %K mobile health %K mHealth %K user-centered design %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. %M 39509701 %R 10.2196/59897 %U https://humanfactors.jmir.org/2024/1/e59897 %U https://doi.org/10.2196/59897 %U http://www.ncbi.nlm.nih.gov/pubmed/39509701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53444 %T Remote Patient Monitoring and Digital Therapeutics Enhancing the Continuum of Care in Heart Failure: Nonrandomized Pilot Study %A Marier-Tétrault,Emmanuel %A Bebawi,Emmanuel %A Béchard,Stéphanie %A Brouillard,Philippe %A Zuchinali,Priccila %A Remillard,Emilie %A Carrier,Zoé %A Jean-Charles,Loyda %A Nguyen,John Nam Kha %A Lehoux,Pascale %A Pomey,Marie-Pascale %A Ribeiro,Paula A B %A Tournoux,François %+ Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC, H2X 0C1, Canada, 1 514 890 8000, emmanuel.marier-tetrault.chum@ssss.gouv.qc.ca %K heart failure %K remote patient management %K telemonitoring %K digital therapeutics %K digital health %K heart %K therapeutics %K pilot study %K patient care %K medical therapy %K vitals %K weight %K symptoms %K quality of life %K medication optimization %K mobile phone %D 2024 %7 6.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is the primary cause of hospitalization among Canadian patients aged ≥65 years. Care for HF requires regular clinical follow-ups to prevent readmissions and facilitate medical therapy optimization. Multiple barriers lead to therapeutic medical inertia including limited human resources and regional inequities. Remote patient monitoring (RPM) and digital therapeutics (DTx) solutions have been developed to improve HF management, but their adoption remains limited and underexplored. The Continuum project emerged as a collaborative initiative involving a health care center, a software start-up, and an industrial partner. Objective: We aimed to develop and test the feasibility of the Continuum intervention that seamlessly combined an RPM system with a DTx solution for HF within the same software. Methods: A 3-month pre-post pilot study was conducted from October 2020 to June 2021. Patients with HF who owned a smartphone or tablet (having remote patient monitoring [RPM+]), had (1) access to a self-care app where they could enter their vital signs, weight, and HF symptoms and view educational content; (2) daily monitoring of their data by a nurse; and (3) a DTx module with automated HF medication suggestions based on national guidelines, made available to their treating medical team. Bluetooth devices were offered to facilitate data recording. Nurses on RPM monitoring could call patients and arrange appointments with their medical team. Patients without a mobile device or unable to use the app were followed in another group (without remote patient monitoring [RPM–]). Results: In total, 52 patients were enrolled in this study (32 RPM+ and 20 RPM–). Among patients owning a mobile device, only 14% (5/37) could not use the app. In the RPM+ group, 47% (15/32) of the patients used the app for more than 80% (67 days) of the 12-week study period. The use of our digital solution was integrated into the regular nursing workday and only 34 calls had to be made by the nurse during the study period. Only 6% (2/32) of the patients in the RPM+ group experienced at least 1 all-cause hospitalization versus 35% (7/20) of the RPM– ones during the follow-up (6%, 2/32 vs 25%, 5/20 for HF hospitalization) and patients were more likely to have their HF therapy optimized if the DTx solution was available. Quality of life improved in patients compliant with the use of the mobile app (mean score variation +10.6, SD 14.7). Conclusions: This pilot study demonstrated the feasibility of implementing our digital solution, within the specific context of HF. The seamless integration of Continuum into nursing workflow, mobile app accessibility, and adoption by patients, were the 3 main key learning points of this study. Further investigation is required to assess the potential impacts on hospitalizations, drug optimization, and quality of life. Trial Registration: ClinicalTrials.gov NCT05377190; https://clinicaltrials.gov/study/NCT05377190 (pilot study #21.403) %M 39504548 %R 10.2196/53444 %U https://formative.jmir.org/2024/1/e53444 %U https://doi.org/10.2196/53444 %U http://www.ncbi.nlm.nih.gov/pubmed/39504548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50456 %T Codesigning a Digital Type 2 Diabetes Risk Communication Tool in Singapore: Qualitative Participatory Action Research Approach %A Hashim,Jumana %A Luna Puerta,Lidia %A Foong,Pin Sym %A Tai,E Shyong %A Yi,Huso %A Smith,Helen Elizabeth %+ Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, 117549, Singapore, 65 66012499, jhashim@nus.edu.sg %K type 2 diabetes %K risk perception %K co-design %K risk communication tool %K diabetes prevention %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a serious public health concern worldwide. Despite public health efforts encouraging early screening and improving knowledge of effective interventions for those at increased risk of type 2 diabetes (T2D), the incorporation of preventative behaviors into an individual’s daily life remains suboptimal. Successfully and accurately increasing risk perception has been demonstrated to increase behavioral intention. Objective: The study aims to codesign a T2D risk communication tool by engaging public participants to (1) identify key characteristics that contribute to an effective risk communication tool and (2) test and iterate to develop a culturally sensitive and meaningful risk communication tool that can motivate T2D preventative behaviors. Methods: We adopted a novel methodology, “Patient and Public Involvement (PPI) Hawkers,” where we approached patrons at hawker centers and public eateries frequented by all local residents to evaluate and test 3 prototypes for the tool. The three prototypes were (1) “Diabetes Onset”—estimated age of diabetes onset of T2D based on one’s risk factors, (2) “Relative Risk”—the relative risk of T2D is presented in a 1-10 scale indicating where one’s risk score lie in relation to others, and (3) “Metabolic Age”—the median age of the risk category based on one’s risk factors, presented to be compared against their chronological age. We gathered reactions and feedback through rapid testing and iteration to understand which risk result presentation would be received the best. All the collected data were revisited and analyzed using an inductive thematic analysis to identify the key characteristics contributing to an effective risk communication tool. Results: We engaged with 112 participants (female: n=59, 56%) across 6 hawker centers. The key characteristics that were important to participants emerged in four main themes: (1) appeal and user experience, in terms of format and readability; (2) trust and validity of the institution providing the tool and the accuracy of the risk result; (3) threat appraisal: salience of risk information, which influenced their risk perception; and (4) coping appraisal: facilitators for behavior change, which impacted their intention for implementing T2D preventative behaviors. The predictive nature of the prototype entitled “Diabetes Onset” was poorly received and removed after the first iteration. The Relative Risk prototype was valued for being straightforward but feared to be boring. The Metabolic Age prototype was anticipated to be more motivating for behavior change, but there were some concerns that the terminology may not be understood by everyone. Conclusions: Participants were divided on which of the 2 prototypes, “Metabolic Age” or “Relative Risk,” they would favor adopting. Further testing is now required to determine which prototype will be more effective in motivating behavior change. This study’s insights on the design process and valued characteristics of a risk communication tool will inform future development of such interventions. %M 39500495 %R 10.2196/50456 %U https://formative.jmir.org/2024/1/e50456 %U https://doi.org/10.2196/50456 %U http://www.ncbi.nlm.nih.gov/pubmed/39500495 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58776 %T A Deep Learning Model to Predict Breast Implant Texture Types Using Ultrasonography Images: Feasibility Development Study %A Kim,Ho Heon %A Jeong,Won Chan %A Pi,Kyungran %A Lee,Angela Soeun %A Kim,Min Soo %A Kim,Hye Jin %A Kim,Jae Hong %+ The W Clinic, 9F Kukdong B/D, 596 Gangnam-daero, Gangnam-gu, Seoul, 06038, Republic of Korea, 82 2 517 7617, stenkaracin@gmail.com %K breast implants %K mammoplasty %K ultrasonography: AI-assisted diagnosis %K cshell surface topography %K artificial intelligence %K deep learning %K machine learning %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast implants, including textured variants, have been widely used in aesthetic and reconstructive mammoplasty. However, the textured type, which is one of the shell texture types of breast implants, has been identified as a possible etiologic factor for lymphoma, specifically breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Identifying the shell texture type of the implant is critical to diagnosing BIA-ALCL. However, distinguishing the shell texture type can be difficult due to the loss of human memory and medical history. An alternative approach is to use ultrasonography, but this method also has limitations in quantitative assessment. Objective: This study aims to determine the feasibility of using a deep learning model to classify the shell texture type of breast implants and make robust predictions from ultrasonography images from heterogeneous sources. Methods: A total of 19,502 breast implant images were retrospectively collected from heterogeneous sources, including images captured from both Canon and GE devices, images of ruptured implants, and images without implants, as well as publicly available images. The Canon images were trained using ResNet-50. The model’s performance on the Canon dataset was evaluated using stratified 5-fold cross-validation. Additionally, external validation was conducted using the GE and publicly available datasets. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (PRAUC) were calculated based on the contribution of the pixels with Gradient-weighted Class Activation Mapping (Grad-CAM). To identify the significant pixels for classification, we masked the pixels that contributed less than 10%, up to a maximum of 100%. To assess the model’s robustness to uncertainty, Shannon entropy was calculated for 4 image groups: Canon, GE, ruptured implants, and without implants. Results: The deep learning model achieved an average AUROC of 0.98 and a PRAUC of 0.88 in the Canon dataset. The model achieved an AUROC of 0.985 and a PRAUC of 0.748 for images captured with GE devices. Additionally, the model predicted an AUROC of 0.909 and a PRAUC of 0.958 for the publicly available dataset. This model maintained the PRAUC values for quantitative validation when masking up to 90% of the least-contributing pixels and the remnant pixels in breast shell layers. Furthermore, the prediction uncertainty increased in the following order: Canon (0.066), GE (0072), ruptured implants (0.371), and no implants (0.777). Conclusions: We have demonstrated the feasibility of using deep learning to predict the shell texture type of breast implants. This approach quantifies the shell texture types of breast implants, supporting the first step in the diagnosis of BIA-ALCL. %M 39499915 %R 10.2196/58776 %U https://formative.jmir.org/2024/1/e58776 %U https://doi.org/10.2196/58776 %U http://www.ncbi.nlm.nih.gov/pubmed/39499915 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57117 %T Interprofessional Team Training With Virtual Reality: Acceptance, Learning Outcome, and Feasibility Evaluation Study %A Neher,Andrea N %A Wespi,Rafael %A Rapphold,Benjamin D %A Sauter,Thomas C %A Kämmer,Juliane E %A Birrenbach,Tanja %K medical education %K simulation %K virtual reality %K VR %K emergency medicine %K interprofessional team training %K nursing students %K medical students %K evaluation study %K assessment %K effectiveness %K patient care %K simulation-based training %K hemorrhage %K epileptic seizure %K headache %D 2024 %7 4.11.2024 %9 %J JMIR Serious Games %G English %X Background: Effective interprofessional teamwork is vital for ensuring high-quality patient care, especially in emergency medicine. However, interprofessional education often fails to facilitate meaningful interaction among health care disciplines. It is therefore imperative to afford early opportunities for cultivating interprofessional teamwork skills. While in-person simulation-based training has been shown to improve performance, this is resource-intensive, especially if it involves multiple professions. Virtual reality (VR)–based training is an innovative instructional approach that demands fewer resources and offers the flexibility of location-independent learning. Objective: This study aimed to develop and evaluate the acceptance, learning outcome, and feasibility of an interprofessional team (INTEAM) training course that included a VR simulation of a neurological emergency case. Methods: This 1-group study used a pre- and posttest design to evaluate the 2-hour INTEAM training course for nursing and medical students. The course included an e-learning part, VR simulation, and debriefing. The main learning objectives were derived from the entrustable professional activity 6, namely to handle a common problem in emergency medicine (headache due to subarachnoid hemorrhage and epileptic seizure) that requires interprofessional collaboration, including a structured handover. We used validated and self-constructed questionnaires, pre- and posttests, and open questions to assess the acceptance, learning outcome, and feasibility of the course. Results: The data of 42 students (21 nursing and 21 medical students) were analyzed and showed good usability in the System Usability Scale (median 72.5, IQR 65‐80). The perception of usefulness (median 6, IQR 5.8‐6.9) and ease of use (median 5.9, IQR 5.1‐6.3) was good among all students. There was a significant increase in the handover performance from pre- (median 8, IQR 6‐9) to posttraining (median 8, IQR 7‐9; z=−2.01; P=.045; r=0.33) and of the confidence in caring for patients with seizures (median 3, IQR 2‐3 and median 3.5, IQR 3‐4, respectively; z=−3.8; P<.001; r=0.60). In 67% (14/21) of the simulations, technical issues occurred, but all simulations could be carried out completely. Conclusions: The new INTEAM training course was well received by nursing and medical students. The handover skills and confidence in caring for patients with seizures were improved after the course. Despite technical challenges with the VR simulations, none required termination, and this demonstrates that our approach is feasible. These promising results encourage the use of VR simulations for team training in the education of nursing and medical students. %R 10.2196/57117 %U https://games.jmir.org/2024/1/e57117 %U https://doi.org/10.2196/57117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54565 %T User Views on Online Sexual Health Symptom Checker Tool: Qualitative Research %A King,Alicia Jean %A Bilardi,Jade Elissa %A Towns,Janet Mary %A Maddaford,Kate %A Fairley,Christopher Kincaid %A Chow,Eric P F %A Phillips,Tiffany Renee %+ School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 580 Swanston Street, Carlton, Melbourne, 3053, Australia, 61 93416266, aking@mshc.org.au %K sexual health %K sexually transmitted diseases %K risk assessment %K risk factors %K smartphone apps %K help-seeking behavior %K health literacy %K information seeking behavior %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delayed diagnosis and treatment of sexually transmitted infections (STIs) contributes to poorer health outcomes and onward transmission to sexual partners. Access to best-practice sexual health care may be limited by barriers such as cost, distance to care providers, sexual stigma, and trust in health care providers. Online assessments of risk offer a novel means of supporting access to evidence-based sexual health information, testing, and treatment by providing more individualized sexual health information based on user inputs. Objective: This developmental evaluation aims to find potential users’ views and experiences in relation to an online assessment of risk, called iSpySTI (Melbourne Sexual Health Center), including the likely impacts of use. Methods: Individuals presenting with urogenital symptoms to a specialist sexual health clinic were given the opportunity to trial a web-based, Bayesian-powered tool that provides a list of 2 to 4 potential causes of their symptoms based on inputs of known STI risk factors and symptoms. Those who tried the tool were invited to participate in a once-off, semistructured research interview. Descriptive, action, and emotion coding informed the comparative analysis of individual cases. Results: Findings from interviews with 14 people who had used the iSpySTI tool support the superiority of the online assessment of STI risk compared to existing sources of sexual health information (eg, internet search engines) in providing trusted and probabilistic information to users. Additionally, potential users reported benefits to their emotional well-being in the intervening period between noticing symptoms and being able to access care. Differences in current and imagined urgency of health care seeking and emotional impacts were found based on clinical diagnosis (eg, non-STI, curable and incurable but treatable STIs) and whether participants were born in Australia or elsewhere. Conclusions: Online assessments of risk provide users experiencing urogenital symptoms with more individualized and evidence-based health information that can improve their health care–seeking and provide reassurance in the period before they can access care. %R 10.2196/54565 %U https://formative.jmir.org/2024/1/e54565 %U https://doi.org/10.2196/54565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55614 %T Claims-Based Algorithm to Identify Pre-Exposure Prophylaxis Indications for Tenofovir Disoproxil Fumarate and Emtricitabine Prescriptions (2012-2014): Validation Study %A Sullivan,Patrick Sean %A Mera-Giler,Robertino M %A Bush,Staci %A Shvachko,Valentina %A Sarkodie,Eleanor %A O'Farrell,Daniel %A Dubose,Stephanie %A Magnuson,David %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 2005, Atlanta, GA, 30322, United States, 1 40421016039, pssulli@emory.edu %K pre-exposure prophylaxis %K PrEP %K classification %K electronic medical record %K EMR %K algorithm %K electronic health record %K EHR %K drug %K pharmacology %K pharmacotherapy %K pharmaceutical %K medication %K monotherapy %K HIV %K prevention %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To monitor the use of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and related medicines for pre-exposure prophylaxis (PrEP) as HIV prevention using commercial pharmacy data, it is necessary to determine whether TDF/FTC prescriptions are used for PrEP or for some other clinical indication. Objective: This study aimed to validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. Methods: An algorithm was developed to identify whether TDF/FTC prescriptions were for PrEP or for other indications from large-scale administrative databases. The algorithm identifies TDF/FTC prescriptions and then excludes patients with International Classification of Diseases (ICD)–9 diagnostic codes, medications, or procedures that suggest indications other than for PrEP (eg, documentation of HIV infection, chronic hepatitis B, or use of TDF/FTC for postexposure prophylaxis). For evaluation, we collected data by clinician assessment of medical records for patients with TDF/FTC prescriptions and compared the assessed indication identified by the clinician review with the assessed indication identified by the algorithm. The algorithm was then applied and evaluated in a large, urban, community-based sexual health clinic. Results: The PrEP algorithm demonstrated high sensitivity and moderate specificity (99.6% and 49.6%) in the electronic medical record database and high sensitivity and specificity (99% and 87%) in data from the urban community health clinic. Conclusions: The PrEP algorithm classified the indication for PrEP in most patients treated with TDF/FTC with sufficient accuracy to be useful for surveillance purposes. The methods described can serve as a basis for developing a robust and evolving case definition for antiretroviral prescriptions for HIV prevention purposes. %M 39141024 %R 10.2196/55614 %U https://formative.jmir.org/2024/1/e55614 %U https://doi.org/10.2196/55614 %U http://www.ncbi.nlm.nih.gov/pubmed/39141024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58622 %T Couple-Focused Smartphone Intervention to Reduce Problem Drinking: Pilot Randomized Control Trial %A Gustafson Sr,David H %A Gustafson Jr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Vjorn,Olivia J %A Curtin,John J %A Epstein,Elizabeth E %A Bailey,Genie L %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, Room 4127, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K alcohol use disorder %K AUD %K mHealth %K mobile health %K mobile phone %K smartphone %K couple therapy %K Comprehensive Health Enhancement Support System %K A-CHESS %K Alcohol Behavioral Couple Therapy %K ABCT %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. Objective: This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. Methods: A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients’ percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. Results: At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=–17.4, 95% CI –36.1 to 1.4; P=.07; Hedges g=–0.53), while the percentage of drinking days was relatively equal between patient groups (β=–2.1, 95% CI –24.8 to 20.7; P=.85; Hedges g=–0.12). Conclusions: Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial Registration: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549 %M 39486022 %R 10.2196/58622 %U https://formative.jmir.org/2024/1/e58622 %U https://doi.org/10.2196/58622 %U http://www.ncbi.nlm.nih.gov/pubmed/39486022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52729 %T Understanding Users’ Engagement in a Provider-Created Mobile App for Training to Advance Hepatitis C Care: Knowledge Assessment Survey Study %A Wegener,Maximilian %A Sims,Katarzyna %A Brooks,Ralph %A Nichols,Lisa %A Sideleau,Robert %A McKay,Sharen %A Villanueva,Merceditas %+ Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, United States, 1 2037857026, maximilian.wegener@yale.edu %K HIV %K HCV %K hepatitis C virus %K interactive digital interventions (IDI) %K education %K mobile application %K user engagement %K training %K awareness %K treatment %K testing %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization and the Centers for Disease Control and Prevention have set ambitious hepatitis C virus (HCV) elimination targets for 2030. Current estimates show that the United States is not on pace to meet elimination targets due to multiple patient, clinic, institutional, and societal level barriers that contribute to HCV testing and treatment gaps. Among these barriers are unawareness of testing and treatment needs, misinformation concerning adverse treatment reactions, need for substance use sobriety, and treatment efficacy. Strategies to improve viral hepatitis education are needed. Objective: We aim to provide a high-quality HCV educational app for patients and health care workers, particularly nonprescriber staff. The app was vetted by health care providers and designed to guide users through the HCV testing and treatment stages in a self-exploratory way to promote engagement and knowledge retention. The app is comprised of five learning modules: (1) Testing for Hep C (hepatitis C), (2) Tests for Hep C Positive Patients, (3) Treatments Available to You, (4) What to Expect During Treatment, and (5) What to Expect After Treatment. Methods: An HCV knowledge assessment survey was administered to providers and patients at the Yale School of Medicine and 11 Connecticut HIV clinics as part of a grant-funded activity. The survey findings and pilot testing feedback guided the app’s design and content development. Data on app usage from November 2019 to November 2022 were analyzed, focusing on user demographics, engagement metrics, and module usage patterns. Results: There were 561 app users; 216 (38.5%) accessed the training modules of which 151 (69.9%) used the app for up to 60 minutes. Of them, 65 (30.1%) users used it for >60 minutes with a median time spent of 5 (IQR 2-8) minutes; the median time between initial accession and last use was 39 (IQR 18-60) days. Users accessed one or more modules and followed a nonsequential pattern of use: module 1: 163 (75.4%) users; module 4: 82 (38%); module 5: 67 (31%); module 3: 49 (22.7%); module 2: 41 (19%). Conclusions: This app, created in an academic setting, is one of a few available in English and Spanish that provides content-vetted HCV education for patients and health care supportive staff. It offers the convenience of on-demand education, allowing users to access crucial information about HCV management and treatment in a self-directed fashion that acknowledges and promotes variable preferences in learning approaches. While app uptake was relatively limited, we propose that future efforts should focus on combined promotion efforts with marketing strategies experts aligned with academic experts. Incorporating ongoing user feedback and integrating personalized reminders and quizzes, will further enhance engagement, supporting the broader public health HCV elimination goals. %M 39486023 %R 10.2196/52729 %U https://formative.jmir.org/2024/1/e52729 %U https://doi.org/10.2196/52729 %U http://www.ncbi.nlm.nih.gov/pubmed/39486023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53744 %T Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study %A Paltell,Katherine C %A Duffecy,Jennifer %A Maki,Pauline M %A Edalatian Zakeri,Shiva %A Vujanovic,Anka A %A Berenz,Erin C %+ Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St, M/C 285, Chicago, IL, 60607, United States, 1 312 315 0808, kpaltell@uic.edu %K trauma %K posttraumatic stress disorder %K pregnancy %K perinatal %K web-based intervention %K stress %K postpartum %K depression %K child health %K treatment %K behavioral therapy %K SunnysideFlex %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. Objective: This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. Methods: The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). Results: All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Conclusions: Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period. %M 39485381 %R 10.2196/53744 %U https://formative.jmir.org/2024/1/e53744 %U https://doi.org/10.2196/53744 %U http://www.ncbi.nlm.nih.gov/pubmed/39485381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60317 %T Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation %A Ramirez,Ana %A Kramer,Justin %A Hazim,Katrina %A Roberge,Jason %+ Department of Anthropology, University of North Carolina at Chapel Hill, 207 E Cameron Aveue Chapel Hill, NC 27599-3115, Chapel Hill, NC, 27599, United States, 1 9199621243, ana_ramirez@unc.edu %K telemedicine %K telepsychiatry %K adolescents %K mental health %K psychiatry %K coaching %K qualitative assessment %K patient satisfaction %K family engagement %K depression %K anxiety %K suicidal ideation %D 2024 %7 31.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (“Youth and Family Engagement” [YFE] program). Objective: This study aims to explore patients’ and parents’ perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants’ preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program’s structure was often mentioned as promoting engagement, with telephone appointments and health coaches’ ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents’ nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches’ ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach–participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. %M 39481102 %R 10.2196/60317 %U https://formative.jmir.org/2024/1/e60317 %U https://doi.org/10.2196/60317 %U http://www.ncbi.nlm.nih.gov/pubmed/39481102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57514 %T Person-Centered Web-Based Mobile Health System (Symptoms) for Reporting Symptoms in COVID-19 Vaccinated Individuals: Observational Study of System, Users, and Symptoms %A Gustafson Hedov,Emelie %A Nyberg,Fredrik %A Gustafsson,Stefan %A Li,Huiqi %A Gisslén,Magnus %A Sundström,Johan %+ Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Entrance 40, 5th floor, Uppsala, 75185, Sweden, 46 018 471 00 00, emelie.gustafson@medsci.uu.se %K mHealth %K mobile health %K patient-reported outcomes %K apps %K COVID-19 %K vaccination side effects %K web-based symptom reporting %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The full spectrum of side effects from COVID-19 vaccinations and infections, including milder symptoms or health effects that do not lead to health care visits, remains unknown. Person-centered self-reporting of symptoms may offer a solution. Monitoring patient-reported outcomes over time will vary in importance for different patients. Individuals have unique needs and preferences, in terms of both communication methods and how the collected information is used to support care. Objective: This study aims to describe how Symptoms, a system for person-centered self-reporting of symptoms and health-related quality of life, was utilized in investigating COVID-19 vaccine side effects. We illustrate this by presenting data from the Symptoms system in newly vaccinated individuals from the RECOVAC (Register-based large-scale national population study to monitor COVID-19 vaccination effectiveness and safety) study. Methods: During the COVID-19 pandemic, newly vaccinated individuals were identified as the ideal population to query for milder symptoms related to COVID-19 vaccinations and infections. To this end, we used posters in observation areas at 150 vaccination sites across the Västra Götaland region of Sweden, inviting newly vaccinated individuals to use a novel digital system, Symptoms. In the Symptoms system, users can track their symptoms, functioning, and quality of life as often as they wish, using evidence-based patient-reported outcome measures and short numeric rating scales. These scales cover a prespecified list of symptoms based on common COVID-19 symptoms and previously reported vaccine side effects. Participants could also use numeric rating scales for self-defined symptoms if their symptom was not included on the prespecified list. Results: A total of 731 people created user accounts and consented to share data for research between July 21, 2021, and September 27, 2022. The majority of users were female (444/731, 60.7%), with a median age of 38 (IQR 30-47) years. Most participants (498/702, 70.9%) did not report any of the comorbidities included in the questionnaire. Of the 731 participants, 563 (77.0%) reported experiencing 1 or more symptoms. The most common symptom was pain at the injection site (486/563, 86.3%), followed by fatigue (181/563, 32.1%) and headache (169/563, 30.0%). In total, 143 unique symptoms were reported. Of these, 29 were from the prespecified list, while the remaining 114 (79.7%) were self-defined entries in the symptom field. This suggests that the flexibility of the self-directed system—allowing individuals to decide which symptoms they consider worth tracking—may be an important feature. Conclusions: Self-reported symptoms in the Symptoms system appeared to align with previously observed post–COVID-19 vaccination symptoms. The system was relatively easy to use and successfully captured broad, longitudinal data. Its person-centered and self-directed design seemed crucial in capturing the full burden of symptoms experienced by users. %M 39476854 %R 10.2196/57514 %U https://formative.jmir.org/2024/1/e57514 %U https://doi.org/10.2196/57514 %U http://www.ncbi.nlm.nih.gov/pubmed/39476854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53491 %T Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey %A Robertson,Noah %A Syed,Maryam J %A Song,Bowen %A Kaur,Arshdeep %A Patel,Janaki G %A Marawar,Rohit %A Basha,Maysaa %A Zutshi,Deepti %+ Department of Neurology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, United States, 1 (313) 577 1245, dzutshi@med.wayne.edu %K telemedicine %K telehealth %K neurology %K eHealth %K teleneurology %K patient experience %K patient satisfaction %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. %M 39476368 %R 10.2196/53491 %U https://formative.jmir.org/2024/1/e53491 %U https://doi.org/10.2196/53491 %U http://www.ncbi.nlm.nih.gov/pubmed/39476368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59811 %T Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of Māori Views %A Jayamini,Widana Kankanamge Darsha %A Mirza,Farhaan %A Bidois-Putt,Marie-Claire %A Naeem,M Asif %A Chan,Amy Hai Yan %+ Department of Computer Science, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Building WZ, Level 8, 6th St Paul Street, Auckland, 1010, New Zealand, 64 210504680, darsha.jayamini@autuni.ac.nz %K asthma risk prediction %K artificial intelligence %K machine learning %K māori perceptions %K health system development %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting Māori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including artificial intelligence (AI) and machine learning (ML) models, are increasingly popular for asthma risk prediction. However, these AI models may underrepresent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aimed to explore the views and perceptions that Māori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and ensure Māori are represented in ML models without worsening existing health inequities. Methods: Semistructured interviews were conducted with 20 Māori participants with asthma, 3 male and 17 female, aged 18-76 years. All the interviews were conducted one-on-one, except for 1 interview, which was conducted with 2 participants. Altogether, 10 web-based interviews were conducted, while the rest were kanohi ki te kanohi (face-to-face). A thematic analysis was conducted to identify the themes. Further, sentiment analysis was carried out to identify the sentiments using a pretrained Bidirectional Encoder Representations from Transformers model. Results: We identified four key themes: (1) concerns about AI use, (2) interest in using technology to support asthma, (3) desired characteristics of AI-based systems, and (4) experience with asthma management and opportunities for technology to improve care. AI was relatively unfamiliar to many participants, and some of them expressed concerns about whether AI technology could be trusted, kanohi ki te kanohi interaction, and inadequate knowledge of AI and technology. These concerns are exacerbated by the Māori experience of colonization. Most of the participants were interested in using technology to support their asthma management, and we gained insights into user preferences regarding computer-based health care applications. Participants discussed their experiences, highlighting problems with health care quality and limited access to resources. They also mentioned the factors that trigger their asthma control level. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for Māori communities and a need to address trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for Indigenous populations in New Zealand. %M 39475765 %R 10.2196/59811 %U https://formative.jmir.org/2024/1/e59811 %U https://doi.org/10.2196/59811 %U http://www.ncbi.nlm.nih.gov/pubmed/39475765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56390 %T An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use %A Preuhs,Katharina %A Bussink-Voorend,Daphne %A van Keulen,Hilde M %A Wildeman,Ilona %A Hautvast,Jeannine %A Hulscher,Marlies %A van Empelen,Pepijn %+ Netherlands Organization for Applied Scientific Research (TNO), Expertise Group Child Health, PO Box 2215, Leiden, 2301 CE, Netherlands, 31 615597505, katharina.preuhs@tno.nl %K COVID-19 %K COVID-19 vaccination %K informed decision-making %K user-centered design %K low literacy %K eHealth %K tailored decision aid %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one’s attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. %M 39475719 %R 10.2196/56390 %U https://formative.jmir.org/2024/1/e56390 %U https://doi.org/10.2196/56390 %U http://www.ncbi.nlm.nih.gov/pubmed/39475719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64412 %T Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study %A Hernandez,Belinda %A Shegog,Ross %A Markham,Christine %A Emery,Susan %A Baumler,Elizabeth %A Thormaehlen,Laura %A Andina Teixeira,Rejane %A Rivera,Yanneth %A Pertuit,Olive %A Kanipe,Chelsey %A Witherspoon,Iraina %A Doss,Janis %A Jones,Victor %A Peskin,Melissa %+ Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, United States, 1 210 276 9021, belinda.hernandez@uth.tmc.edu %K sexual assault prevention %K sexual harassment prevention %K healthy relationships %K military %K technology-based interventions %K intervention mapping %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program’s goal is to increase Airmen’s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen’s overall well-being and mission readiness. Objective: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods: Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results: After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions: The findings from this study demonstrate X-CoRe’s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe’s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants. %M 39471370 %R 10.2196/64412 %U https://formative.jmir.org/2024/1/e64412 %U https://doi.org/10.2196/64412 %U http://www.ncbi.nlm.nih.gov/pubmed/39471370 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59016 %T Development of the Happy Hands Self-Management App for People with Hand Osteoarthritis: Feasibility Study %A Tveter,Anne Therese %A Varsi,Cecilie %A Maarnes,Marit Kristin %A Pedersen,Stein Jarle %A Christensen,Barbara S %A Blanck,Thale Beate %A Nyheim,Sissel B %A Pelle,Tim %A Kjeken,Ingvild %+ Health Service Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0319, Norway, 47 22451500, a.t.tveter@medisin.uio.no %K Osteoarthritis %K hand exercises %K home exercise %K first-line treatment %K mHealth %K eHealth %K self-management %K app development %K design %K usefulness %K satisfaction %K activity performance %K social cognitive theory %K behavior change %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education, hand exercises, and the use of assistive devices are recommended as first-line treatments for individuals with hand osteoarthritis (OA). However, the quality of care services for this patient group is suboptimal in primary care. Objective: The overarching goal was to develop and evaluate feasibility of an app-based self-management intervention for people with hand OA. This feasibility study aims to assess self-reported usability and satisfaction, change in outcomes and quality-of-care, exercise adherence and patients’ experiences using the app. Methods: The development and feasibility testing followed the first 2 phases of the Medical Research Council framework for the development and evaluation of complex interventions and were conducted in close collaboration with patient research partners (PRPs). A 3-month pre-post mixed methods design was used to evaluate feasibility. Men and women over 40 years of age diagnosed with painful, symptomatic hand OA were recruited. Usability was assessed using the System Usability Scale (0-100), while satisfaction, usefulness, pain, and stiffness were evaluated using a numeric rating scale (NRS score from 0 to 10). The activity performance of the hand was measured using the Measure of Activity Performance of the Hand (MAP-Hand) (1-4), grip strength was assessed with a Jamar dynamometer (kg), and self-reported quality of care was evaluated using the Osteoarthritis Quality Indicator questionnaire (0-100). Participants were deemed adherent if they completed at least 2 exercise sessions per week for a minimum of 8 weeks. Focus groups were conducted to explore participants’ experiences using the app. Changes were analyzed using a paired sample t test (mean change and 95% CI), with the significance level set at P<.05. Results: The first version of the Happy Hands app was developed based on the needs and requirements of the PRPs, evidence-based treatment recommendations, and the experiences of individuals living with hand OA. The app was designed to guide participants through a series of informational videos, exercise videos, questionnaires, quizzes, and customized feedback over a 3-month period. The feasibility study included 71 participants (mean age 64 years, SD 8; n=61, 86%, women), of whom 57 (80%) completed the assessment after 3 months. Usability (mean 91.5 points, SD 9.2 points), usefulness (median 8, IQR 7-10), and satisfaction (median 8, IQR 7-10) were high. Significant improvements were observed in self-reported quality of care (36.4 points, 95% CI 29.7-43.1, P<.001), grip strength (right: 2.9 kg, 95% CI 1.7-4.1; left: 3.2 kg, 95% CI 1.9-4.6, P<.001), activity performance (0.18 points, 95% CI 0.11-0.25, P<.001), pain (1.7 points, 95% CI 1.2-2.2, P<.001), and stiffness (1.9 points, 95% CI 1.3-2.4, P=.001) after 3 months. Of the 71 participants, 53 (75%) were adherent to the exercise program. The focus groups supported these results and led to the implementation of several enhancements in the second version of the app. Conclusions: The app-based self-management intervention was deemed highly usable and useful by patients. The results further indicated that the intervention may improve quality of care, grip strength, activity performance, pain, and stiffness. However, definitive conclusions need to be confirmed in a powered randomized controlled trial. Trial Registration: NCT05150171 %M 39470716 %R 10.2196/59016 %U https://formative.jmir.org/2024/1/e59016 %U https://doi.org/10.2196/59016 %U http://www.ncbi.nlm.nih.gov/pubmed/39470716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56898 %T Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study %A Mustafa,Noor Khairiyah %A Ibrahim,Roszita %A Aizuddin,Azimatun Noor %A Aljunid,Syed Mohamed %A Awang,Zainudin %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Pre-Clinical Block, Cheras, 56000, Malaysia, 60 391455887 ext 5888, roszita@ppukm.ukm.edu.my %K critical success factors %K exploratory factor analysis %K Casemix system %K acceptance %K Total Hospital Information System %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved. Objective: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health’s Total Hospital Information System (THIS). Methods: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study’s minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach α assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp). Results: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07% of the total variance, surpassing the minimum requirement of 60%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach α ranged from 0.914 to 0.969, demonstrating high reliability. Conclusions: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals. %M 39470697 %R 10.2196/56898 %U https://formative.jmir.org/2024/1/e56898 %U https://doi.org/10.2196/56898 %U http://www.ncbi.nlm.nih.gov/pubmed/39470697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58048 %T Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial %A Lin,Yu-Chih %A Wu,Chen-Ching %A Sung,Wan-Yu %A Yen,Jeng-Hsien %A Lin,Yi-Ching %+ Department of Laboratory Medicine, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist, Kaohsiung, 80756, Taiwan, 886 7 3121101 ext 7233, winterjeanne@gmail.com %K ankylosing spondylitis %K galvanic response %K home medical device %K rehabilitation %K transcutaneous electrical stimulation %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. Objective: This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. Methods: The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. Results: A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference –0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference –0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). Conclusions: The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients’ physical functions and spinal flexibility. %M 39467549 %R 10.2196/58048 %U https://formative.jmir.org/2024/1/e58048 %U https://doi.org/10.2196/58048 %U http://www.ncbi.nlm.nih.gov/pubmed/39467549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57376 %T Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St, Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K app %K digital health %K mobile health %K mHealth %K mobile apps %K smartphone %K vaping %K vaping cessation %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. %M 39331522 %R 10.2196/57376 %U https://formative.jmir.org/2024/1/e57376 %U https://doi.org/10.2196/57376 %U http://www.ncbi.nlm.nih.gov/pubmed/39331522 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51753 %T Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design %A Le Roux,Enora %A Ursino,Moreno %A Milovanovic,Ivana %A Picq,Paul %A Haignere,Jeremie %A Rault,Gilles %A Pougheon Bertrand,Dominique %A Alberti,Corinne %+ Inserm, Hôpital Universitaire Robert Debré, Assistance publique – Hôpitaux de Paris.Nord - Université Paris Cité, 48 Boulevard Serurier, Paris, 75019, France, 33 679690998, enora.leroux@aphp.fr %K connected devices %K cystic fibrosis %K patient education %K self-management %K medical device %K home monitoring %K remote monitoring %K statistical process control %K connected health %K alerts %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control—the cumulative sum control chart (CUSUM)—was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 %M 39467550 %R 10.2196/51753 %U https://formative.jmir.org/2024/1/e51753 %U https://doi.org/10.2196/51753 %U http://www.ncbi.nlm.nih.gov/pubmed/39467550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57219 %T Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study %A Strandberg,Susanna %A Ekstedt,Mirjam %A Fagerström,Cecilia %A Backåberg,Sofia %+ Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 35195, Sweden, 46 725673309, susanna.strandberg@lnu.se %K chronic illness %K eHealth %K experience-based co-design %K older adults %K self-care %K video feedback %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, “Breathing exercises” and “Picking up from the floor,” revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. %M 39466305 %R 10.2196/57219 %U https://formative.jmir.org/2024/1/e57219 %U https://doi.org/10.2196/57219 %U http://www.ncbi.nlm.nih.gov/pubmed/39466305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59087 %T eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study %A Kim,Youlim %A Lee,Hyeonkyeong %A Park,Jeongok %A Kim,Yong-Chan %A Kim,Dong Hee %A Lee,Young-Me %+ College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3373, hlee39@yuhs.ac %K cervical cancer %K human papillomavirus %K vaccines %K health communication %K chatbot %K artificial intelligence %K adolescent %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes “cues to action” that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. Objective: This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. Methods: The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. Results: A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts’ chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Conclusions: Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention. %M 39466304 %R 10.2196/59087 %U https://formative.jmir.org/2024/1/e59087 %U https://doi.org/10.2196/59087 %U http://www.ncbi.nlm.nih.gov/pubmed/39466304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64454 %T Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study %A Price,Jill AB %A Gregory,Julia %A McCall,Hugh C %A Landry,Caeleigh A %A Beahm,Janine D %A Hadjistavropoulos,Heather D %+ Canadian Institute for Public Safety Research and Treatment, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada, 1 3063378418, jill.price@uregina.ca %K internet-delivered cognitive behavioral therapy %K case stories %K public safety personnel %K public safety %K mental health %K internet interventions %K digital mental health interventions %K first responders %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)—a group that experiences elevated rates of mental health concerns and barriers to mental health care—a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET’s first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients’ perceptions of the case stories in this course. Objective: This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP’s perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course. Methods: This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview. Results: Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution. Conclusions: Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP. Trial Registration: ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032 %M 39453705 %R 10.2196/64454 %U https://formative.jmir.org/2024/1/e64454 %U https://doi.org/10.2196/64454 %U http://www.ncbi.nlm.nih.gov/pubmed/39453705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59501 %T Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study %A Dana,Zara %A Nagra,Harpreet %A Kilby,Kimberly %+ Supportiv, 2222 Harold Way, Berkeley, CA, 94704, United States, 1 800 845 0015, harpreet@supportiv.com %K digital peer support %K social loneliness %K chat-based interactions %K older adults %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users’ autonomy, competence, and relatedness. Objective: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. Methods: Participants were each prompted with a single question: “What’s your struggle?” Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. Results: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. Conclusions: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options. %M 39453688 %R 10.2196/59501 %U https://formative.jmir.org/2024/1/e59501 %U https://doi.org/10.2196/59501 %U http://www.ncbi.nlm.nih.gov/pubmed/39453688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58583 %T Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study %A Kim,Jae Heon %A Lee,Ui Cheol %A Jeong,Byeong Hun %A Kang,Byeong Uk %A Shim,Sung Ryul %A Jeong,In Gab %+ Department of Biomedical Informatics, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea, 82 6008661, sungryul.shim@gmail.com %K smart diaper %K urinary incontinence %K medical device %K voided volume %K urine output %K nursing home %K older adults %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. Objective: The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user’s movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. Results: The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was –0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Conclusions: Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications. %M 39447169 %R 10.2196/58583 %U https://formative.jmir.org/2024/1/e58583 %U https://doi.org/10.2196/58583 %U http://www.ncbi.nlm.nih.gov/pubmed/39447169 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56376 %T Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study %A Hayashi,Kosuke %A Imai,Hiromitsu %A Oikawa,Ichiro %A Ishihara,Yugo %A Wakuda,Hirokazu %A Miura,Iori %A Uenohara,Shingo %A Kuwae,Asuka %A Kai,Megumi %A Furuya,Ken'ichi %A Uemura,Naoto %+ Department of Clinical Pharmacology and Therapeutics, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, 8795593, Japan, 81 975865952, khayashi@oita-u.ac.jp %K physical activity %K behavioral economics %K pedometer %K arm %K cadence %K app %K public health %K walk %K Google Fit %K heart points %K exercise %K mobile phone %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for “intensity” and “duration,” making it challenging to efficiently increase people’s moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met. Objective: This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users’ daily MVPA. Methods: A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily “heart points” as measured by Google Fit, a publicly available app that measures users’ daily MVPA. Results: The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by “heart points” collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02). Conclusions: Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users’ daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants. Trial Registration: UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057420 %M 39447165 %R 10.2196/56376 %U https://formative.jmir.org/2024/1/e56376 %U https://doi.org/10.2196/56376 %U http://www.ncbi.nlm.nih.gov/pubmed/39447165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55706 %T Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study %A Li,Lan %A Wood,Caroline E %A Kostkova,Patty %+ Centre for Digital Public Health in Emergencies, Department for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E6BT, United Kingdom, 44 7529917633, lan.li.19@ucl.ac.uk %K influenza vaccination %K intervention study %K social media %K students %K health promotion %K mixed methods %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. Objective: This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. Methods: A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Results: Our study included 596 students, of which 303 (50.8%) were in the intervention group and 293 (49.2%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8%) compared to the control group (54/293, 18.4%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. Conclusions: This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations. %M 39447171 %R 10.2196/55706 %U https://formative.jmir.org/2024/1/e55706 %U https://doi.org/10.2196/55706 %U http://www.ncbi.nlm.nih.gov/pubmed/39447171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50131 %T Optimizing the Measurement of Information on the Context of Alcohol Consumption Within the Drink Less App Among People Drinking at Increasing and Higher Risk Levels: Mixed-Methods Usability Study %A Stevely,Abigail K %A Garnett,Claire %A Holmes,John %A Jones,Andrew %A Dinu,Larisa %A Oldham,Melissa %+ Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 552, a.stevely@sheffield.ac.uk %K alcohol use disorder %K substance use disorder %K alcohol consumption %K mobile app %K mHealth %K mobile health %K diary %K health behavior change %K usability %K user engagement %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing public health evidence base focused on understanding the links between drinking contexts and alcohol consumption. However, the potential value of developing context-based interventions to help people drinking at increasing and higher risk levels to cut down remains underexplored. Digital interventions, such as apps, offer significant potential for delivering context-based interventions as they can collect contextual information and flexibly deliver personalized interventions while addressing barriers associated with face-to-face interventions, such as time constraints. Objective: This early phase study aimed to identify the best method for collecting information on the contexts of alcohol consumption among users of an alcohol reduction app by comparing 2 alternative drinking diaries in terms of user engagement, data quality, usability, and acceptability. Methods: Participants were recruited using the online platform Prolific and were randomly assigned to use 1 of the 2 adapted versions of the Drink Less app for 14 days. Tags (n=31) included tags for location, motivation, and company that participants added to drink records. Occasion type (n=31) included a list of occasion types that participants selected from when adding drink records. We assessed engagement and data quality with app data, usability with a validated questionnaire, and acceptability with semistructured interviews. Results: Quantitative findings on engagement, data quality, and app usability were good overall, with participants using the app on most days (tags: mean 12.23, SD 2.46 days; occasion type: mean 12.39, SD 2.12 days). However, around 40% of drinking records in tags did not include company and motivation tags. Mean usability scores were similar across app versions (tags: mean 72.39, SD 8.10; occasion type: mean 74.23, SD 6.76). Qualitative analysis found that both versions were acceptable to users and were relevant to their drinking occasions, and participants reported increased awareness of their drinking contexts. Several participants reported that the diary helped them to reduce alcohol consumption in some contexts (eg, home or lone drinking) more than others (eg, social drinking) and suggested that they felt less negative affect recording social drinking contexts out of their home. Participants also suggested the inclusion of “work drinks” in both versions and “habit” as a motivation in the tags version. Conclusions: There was no clearly better method for collecting data on alcohol consumption as both methods had good user engagement, usability, acceptability, and data quality. Participants recorded sufficient data on their drinking contexts to suggest that an adapted version of Drink Less could be used as the basis for context-specific interventions. The occasion type version may be preferable owing to lower participant burden. A more general consideration is to ensure that context-specific interventions are designed to minimize the risk of unintended positive reinforcement of drinking occasions that are seen as sociable by users. %M 39446464 %R 10.2196/50131 %U https://formative.jmir.org/2024/1/e50131 %U https://doi.org/10.2196/50131 %U http://www.ncbi.nlm.nih.gov/pubmed/39446464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55481 %T Exploring the Impact of an Interactive Electronic Pegboard on Manual Dexterity and Cognitive Skills of Patients With Stroke: Preliminary Analysis %A Chien,Shih-Ying %A Wu,Ching-Yi %A Wong,Alice May-Kuen %A Chen,Chih-Kuang %A Beckman,Sara L %+ Department of Industrial Design, Chang Gung University, No 259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, 886 3 211 8800 ext 5669, shihying@mail.cgu.edu.tw %K interactive electronic pegboard %K stroke %K hand dexterity %K cognitive rehabilitation %K system %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals. Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke. Methods: We explored the pegboard’s clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback. Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality. Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool. %M 39446480 %R 10.2196/55481 %U https://formative.jmir.org/2024/1/e55481 %U https://doi.org/10.2196/55481 %U http://www.ncbi.nlm.nih.gov/pubmed/39446480 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51322 %T A Person-Based Web-Based Sleep Intervention Aimed at Adolescents (SleepWise): Randomized Controlled Feasibility Study %A Moghadam,Shokraneh %A Husted,Margaret %A Aznar,Ana %A Gray,Debra %+ Department of Psychology, University of Winchester, Sparkford Rd, Winchester, SO22 4NR, United Kingdom, 44 01392 72 5950, s.oftadeh-moghadam@exeter.ac.uk %K web-based health interventions %K sleep %K adolescence %K behavior change %K person-based approach %K sleep intervention %K detrimental health outcome %K SleepWise %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents are advised to sleep 8-10 hours per night; however, most do not sleep for this recommended amount. Poor adolescent sleep is associated with detrimental health outcomes, including reduced physical activity, risk-taking behaviors, and increased depression and anxiety levels, making this an important public health concern. Existing interventions targeting adolescent sleep are often unsuccessful or their effectiveness unclear, as they are frequently noninteractive, time-consuming, and lack a strong theoretical foundation; highlighting an urgent need for innovative interventions deemed acceptable by adolescents. Objective: The main objective of this study was to determine the acceptability, feasibility, and preliminary impact of a web-based person-based sleep intervention (SleepWise) on adolescent sleep quality. Participant incentivization was also explored to understand its impact on engagement, acceptability, and sleep quality. Methods: A feasibility trial was conducted to test the feasibility, acceptability, and preliminary impact of SleepWise on adolescent sleep quality, developed based on the person-based approach to intervention development. In total, 90 participants (aged 13-17 years) from further education institutions and secondary schools were recruited for two 2-arm randomized controlled trials. One trial (trial 1) was incentivized to understand the impact of incentivization. Acceptability and sleep quality were assessed via questionnaires, and a mixed methods process evaluation was undertaken to assess participant engagement and experience with SleepWise. Engagement was automatically tracked by SleepWise, which collected data on the date and time, pages viewed, and the number of goals and sleep logs completed per participant. Semistructured interviews were carried out to gain participant feedback. Results: Participants in both trials reported high levels of acceptability (trial 1: mean 21.00, SD 2.74; trial 2: mean 20.82, SD 2.48) and demonstrated similar levels of engagement with SleepWise. Participants in trial 1 viewed slightly more pages of the intervention, and those in trial 2 achieved their set goals more frequently. Improvements in sleep quality were found in both trials 1 and 2, with medium (trial 1) and large (trial 2) effect sizes. A larger effect size for improvement in sleep quality was found in the nonincentivized trial (d=0.87), suggesting that incentivization may not impact engagement or sleep quality. Both trials achieved acceptable recruitment (trial 1, N=48; trial 2, N=42), and retention at 5 weeks (trial 1: N=30; trial 2: N=30). Qualitative findings showed that adolescents lead busy lifestyles, which may hinder engagement; however, participants deemed SleepWise acceptable in length and content, and made attempts at behavior change. Conclusions: SleepWise is an acceptable and potentially efficacious web-based sleep intervention aimed at adolescents. Findings from this study showed that incentivization did not greatly impact engagement, acceptability, or sleep quality. Subject to a full trial, SleepWise has the potential to address the urgent need for innovative, personalized, and acceptable sleep interventions for adolescents. Trial Registration: OSF Registries osf.io/yanb2; https://osf.io/yanb2 %M 39442165 %R 10.2196/51322 %U https://formative.jmir.org/2024/1/e51322 %U https://doi.org/10.2196/51322 %U http://www.ncbi.nlm.nih.gov/pubmed/39442165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60491 %T Exploring Contactless Vital Signs Collection in Video Telehealth Visits Among Veterans Affairs Providers and Patients: Pilot Usability Study %A Garvin,Lynn %A Richardson,Eric %A Heyworth,Leonie %A McInnes,D Keith %+ Center for Healthcare Optimization and Implementation Research, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, United States, 1 617 390 4315, Lynn.Garvin@va.gov %K veteran %K provider %K video-based care %K vital statistics %K telemonitoring %K usability %K mobile health app %K telemedicine %K health care access %K vital sign %K video %K telehealth %K patient %K Veterans Affairs %K telehealth platform %K photoplethysmography %K camera %K web-based survey %K electronic medical record %K home-based biometric devices %K mHealth %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To expand veterans’ access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called “Vitals” on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans’ smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient. Objective: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals. Methods: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey. Results: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals “useful” and “easy to use,” and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals’ flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation. Conclusions: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients’ vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients. %M 39441645 %R 10.2196/60491 %U https://formative.jmir.org/2024/1/e60491 %U https://doi.org/10.2196/60491 %U http://www.ncbi.nlm.nih.gov/pubmed/39441645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56704 %T Influence of Avatar Identification on the Attraction of Virtual Reality Games: Survey Study %A Li,PengFei %A Qi,Fa %A Ye,Zhihai %+ Art College, Jinan University, No. 601 Huangpu Avenue West, Tianhe District, Guangzhou City, Guangdong Province, Guangzhou, 510632, China, 86 198 3289 9510, tlipengfei@jnu.edu.cn %K avatar identification %K self-differentiation theory %K immersion %K attractiveness %K virtual reality games %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In gaming, the embodied interaction experience of avatars serves as a key to emotional sublimation in artistic creation. This presents the emotional expression of art in a more vivid form, which is a critical factor in the high attractiveness of virtual reality (VR) games to players. Intertwined with players’ physiological and psychological responses, immersion is an essential element for enhancing gaming attractiveness. Objective: This study aims to explore how to help players establish a sense of identity with their embodied avatars in VR game environments and enhance the attractiveness of games to players through the mediating effect of immersion. Methods: We conducted a structured questionnaire survey refined through repeated validation. A total of 402 VR users were publicly recruited through the internet from March 22, 2024, to April 13, 2024. Statistical analysis was conducted using the SPSS and Amos tools, including correlation analysis, regression analysis, and mediation effect verification. We divided the self-differentiation theory into 4 dimensions to validate their impact on avatar identification. Subsequently, we correlated the effects of avatar identification, game immersion, and game attractiveness and proposed a hypothetical mediating model. Results: Regression analysis of the predictor variables and the dependent variable indicated a significant positive predictive effect (P<.001); the variance inflation factor values for each independent variable were all <5. In the hypothesis testing of the mediating effect, the total mediating effect was significant (P<.001). Regarding the direct impact, both the effect of avatar identification on immersion and the effect of immersion on game attractiveness were significant (P<.001). However, the direct effect of avatar identification on game attractiveness was not significant (P=.28). Regarding the indirect impact, the effect of avatar identification on game attractiveness was significant (P<.001). The results indicate a significant positive correlation between different dimensions of the self-differentiation theory and identification with avatars. Moreover, immersion in the game fully mediated the relationship between identification with avatars and game attractiveness. Conclusions: This study underscores that the embodiment of avatar identification is influenced by dimensions of self-differentiation, and the impact of identification with avatars on game attractiveness is contingent upon full mediation by immersion. These findings deepen our understanding of the role of avatar identification in VR gaming. %M 39437383 %R 10.2196/56704 %U https://formative.jmir.org/2024/1/e56704 %U https://doi.org/10.2196/56704 %U http://www.ncbi.nlm.nih.gov/pubmed/39437383 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55679 %T Virtual Reality–Based Exposure With 360° Environments for Social Anxiety Disorder: Usability and Feasibility Study %A Ernst,Mathias %A Bouchard,Stéphane %A Andersen,Tonny %A Orskov,Per Trads %A Tarp,Kristine %A Lichtenstein,Mia Beck %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 26218846, mlichtenstein@health.sdu.dk %K anxiety %K exposure therapy %K social anxiety disorder %K virtual reality %K 360° %K mixed methods %K interactive %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist’s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)–based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective: This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods: A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results: Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions: VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful. %M 39432344 %R 10.2196/55679 %U https://formative.jmir.org/2024/1/e55679 %U https://doi.org/10.2196/55679 %U http://www.ncbi.nlm.nih.gov/pubmed/39432344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54827 %T The Online Health Information–Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study %A Clancy,Brigid %A Bonevski,Billie %A English,Coralie %A Guillaumier,Ashleigh %+ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4055 3222, brigid.clancy@newcastle.edu.au %K stroke %K online health information seeking %K information-seeking behavior %K consumer health information %K digital health %K eHealth %K long-term care %K health-risk behaviors %K qualitative research %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. Objective: This study aims to explore the online health information–seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Methods: Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive–deductive approach. In the deductive analysis, responses were mapped to an online health information–seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. Results: A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information–seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants’ online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. Conclusions: People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support. %M 39423365 %R 10.2196/54827 %U https://formative.jmir.org/2024/1/e54827 %U https://doi.org/10.2196/54827 %U http://www.ncbi.nlm.nih.gov/pubmed/39423365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60925 %T Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study %A Pojednic,Rachele %A Welch,Amy %A Thornton,Margaret %A Garvey,Meghan %A Grogan,Tara %A Roberts,Walter %A Ash,Garrett %+ Stanford Lifestyle Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94303, United States, 1 617 833 7372, rpojedni@stanford.edu %K biomarker %K biometric %K heart rate variability %K saliva %K feasibility %K warfighter %K field training %K acceptability %K wearable biosensors %K real-time %K data collection %K physiological stress %K training exercise %K pilot study %K sweat sensors %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. Objective: This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). Methods: A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. Results: A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. Conclusions: This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery. %M 39422988 %R 10.2196/60925 %U https://formative.jmir.org/2024/1/e60925 %U https://doi.org/10.2196/60925 %U http://www.ncbi.nlm.nih.gov/pubmed/39422988 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63823 %T Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study %A Follong,Berit %A Haliburton,Caitlin %A Mackay,Sally %A Maiquez,Maria %A Grey,Jacqueline %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599, berit.follong@auckland.ac.nz %K public health %K nutrition %K dietary assessment methods %K digital tools %K user experience %K qualitative data %K survey %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool’s usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool. Objective: This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected. Methods: We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey. Results: A total of 37 participants aged ≥11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38% and women and girls: 23/37, 62%; Māori: 10/37, 27% and non-Māori: 27/37, 73%). Although most (31/37, 84%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?). Conclusions: This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users. %M 39422998 %R 10.2196/63823 %U https://formative.jmir.org/2024/1/e63823 %U https://doi.org/10.2196/63823 %U http://www.ncbi.nlm.nih.gov/pubmed/39422998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47814 %T Fine-Tuned Bidirectional Encoder Representations From Transformers Versus ChatGPT for Text-Based Outpatient Department Recommendation: Comparative Study %A Jo,Eunbeen %A Yoo,Hakje %A Kim,Jong-Ho %A Kim,Young-Min %A Song,Sanghoun %A Joo,Hyung Joon %+ Department of Medical Informatics, Korea University College of Medicine, 73, Inchon-ro, Seoul, 02841, Republic of Korea, 82 2 920 5445, drjoohj@gmail.com %K natural language processing %K bidirectional encoder representations from transformers %K large language model %K generative pretrained transformer %K medical specialty prediction %K quality of care %K health care application %K ChatGPT %K BERT %K AI technology %K conversational agent %K AI %K artificial intelligence %K chatbot %K application %K health care %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients often struggle with determining which outpatient specialist to consult based on their symptoms. Natural language processing models in health care offer the potential to assist patients in making these decisions before visiting a hospital. Objective: This study aimed to evaluate the performance of ChatGPT in recommending medical specialties for medical questions. Methods: We used a dataset of 31,482 medical questions, each answered by doctors and labeled with the appropriate medical specialty from the health consultation board of NAVER (NAVER Corp), a major Korean portal. This dataset includes 27 distinct medical specialty labels. We compared the performance of the fine-tuned Korean Medical bidirectional encoder representations from transformers (KM-BERT) and ChatGPT models by analyzing their ability to accurately recommend medical specialties. We categorized responses from ChatGPT into those matching the 27 predefined specialties and those that did not. Both models were evaluated using performance metrics of accuracy, precision, recall, and F1-score. Results: ChatGPT demonstrated an answer avoidance rate of 6.2% but provided accurate medical specialty recommendations with explanations that elucidated the underlying pathophysiology of the patient’s symptoms. It achieved an accuracy of 0.939, precision of 0.219, recall of 0.168, and an F1-score of 0.134. In contrast, the KM-BERT model, fine-tuned for the same task, outperformed ChatGPT with an accuracy of 0.977, precision of 0.570, recall of 0.652, and an F1-score of 0.587. Conclusions: Although ChatGPT did not surpass the fine-tuned KM-BERT model in recommending the correct medical specialties, it showcased notable advantages as a conversational artificial intelligence model. By providing detailed, contextually appropriate explanations, ChatGPT has the potential to significantly enhance patient comprehension of medical information, thereby improving the medical referral process. %M 39423004 %R 10.2196/47814 %U https://formative.jmir.org/2024/1/e47814 %U https://doi.org/10.2196/47814 %U http://www.ncbi.nlm.nih.gov/pubmed/39423004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54916 %T Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework %A Pack,Allison P %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %+ Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0274, allison.pack@northwestern.edu %K older adults %K polypharmacy %K medication adherence %K intervention development %K qualitative research %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. %M 39418094 %R 10.2196/54916 %U https://formative.jmir.org/2024/1/e54916 %U https://doi.org/10.2196/54916 %U http://www.ncbi.nlm.nih.gov/pubmed/39418094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62762 %T WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice %A Fabens,Isabella %A Makhele,Calsile %A Igaba,Nelson Kibiribiri %A Hlongwane,Sizwe %A Phohole,Motshana %A Waweru,Evelyn %A Oni,Femi %A Khwepeya,Madalitso %A Sardini,Maria %A Moyo,Khumbulani %A Tweya,Hannock %A Wafula,Mourice Barasa %A Pienaar,Jacqueline %A Ndebele,Felex %A Setswe,Geoffrey %A Dong,Tracy Qi %A Feldacker,Caryl %+ International Training and Education Center for Health (I-TECH), Departments of Global Health and Medicine, University of Washington, 13th Floor, 908 Jefferson Street, Seattle, WA, 98104, United States, 1 206 221 4970, cfeld@uw.edu %K 2-way texting %K text messages %K WhatsApp %K digital health innovations %K male circumcision %K South Africa %K quality improvement %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period—from August to October, 2023—337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. %M 39412842 %R 10.2196/62762 %U https://formative.jmir.org/2024/1/e62762 %U https://doi.org/10.2196/62762 %U http://www.ncbi.nlm.nih.gov/pubmed/39412842 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57294 %T A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial %A Debrot,Anik %A Efinger,Liliane %A Kheyar,Maya %A Pomini,Valentino %A Berthoud,Laurent %+ Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Géopolis, Rue de la Mouline 11, Lausanne, 1015, Switzerland, 41 216923239, anik.debrot@unil.ch %K web-based interventions %K randomized controlled trial %K grief %K bereavement %K separation %K guidance %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms. Objective: This study aimed to compare the efficacy and adherence rates of 2 WBIs for prolonged grief symptoms following the loss of a loved one through death or romantic separation. Methods: LIVIA 2.0 was developed relying on theoretical and empirical findings on bereavement processes and WBIs, and is compared with LIVIA 1, which has already demonstrated its efficacy. We conducted a randomized controlled trial and provided on-demand guidance to participants. Outcomes were assessed through web-based questionnaires before the intervention, after the intervention (12 weeks later), and at follow-up (24 weeks later). Primary outcomes were grief symptoms, depressive symptoms, and well-being. Secondary outcomes were anxiety symptoms, grief coping strategies, aspects related to self-identity, and program satisfaction. Results: In total, 62 participants were randomized (intent-to-treat [ITT] sample), 29 (47%) in LIVIA 2.0 (active arm) and 33 (53%) in LIVIA 1 (control arm). The dropout rate was 40% (37/62), and 10 participants were removed due to exclusion criteria, leading to a final per-protocol sample of 27 (44%) completers who differed from noncompleters only based on reporting fewer anxiety symptoms (t60=3.03; P=.004). Participants who are separated reported more grief symptoms (t60=2.22; P=.03) and attachment anxiety (t60=2.26; P=.03), compared to participants who are bereaved. There were pre-post within-group differences for both programs in the ITT sample, with significant reductions in grief (Cohen d=−0.90), depressive symptoms (Cohen d=−0.31), and centrality of the loss (Cohen d=−0.45). The same pattern was observed in the per-protocol sample, with the exception that anxiety symptoms also significantly diminished (Cohen d=−0.45). No difference was found in efficacy between the 2 programs (all P>.33). Participants (ITT sample) reported overall high levels of program satisfaction (mean 3.18, SD 0.54; over a maximum of 4). Effect stability was confirmed at the 6-month follow-up for all outcomes, with an improvement in self-concept clarity. Conclusions: The 2 grief-related WBIs were effective in reducing grief, depressive and anxiety symptoms for participants who are bereaved or separated. The analyses did not reveal any pre-post between-group differences, suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome. However, caution is warranted with the interpretation of the results given the limited power of the sample, which only allows the detection of medium effect sizes. Trial Registration: ClinicalTrials.gov NCT05219760; https://clinicaltrials.gov/study/NCT05219760 International Registered Report Identifier (IRRID): RR2-10.2196/39026 %M 39412869 %R 10.2196/57294 %U https://formative.jmir.org/2024/1/e57294 %U https://doi.org/10.2196/57294 %U http://www.ncbi.nlm.nih.gov/pubmed/39412869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60434 %T Intention to Use a Mental Health App for Menopause: Health Belief Model Approach %A Martin-Key,Nayra A %A Funnell,Erin L %A Benacek,Jiri %A Spadaro,Benedetta %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K menopause %K menopause transition %K mental health %K perimenopause %K women’s health %K psychological framework %K symptom tracking %K app usage %K app %K Health Belief Model %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users’ intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals’ health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach α value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler–scaled fit statistics indicated a good fit for the model (χ2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (β=.48, P<.001). This was followed by perceived barriers (β=–.25, P<.001), perceived susceptibility (β=.15, P<.001), and perceived benefits (β=.13, P<.001). Perceived severity (β=.01, P=.869) and self-efficacy (β=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. %M 39412868 %R 10.2196/60434 %U https://formative.jmir.org/2024/1/e60434 %U https://doi.org/10.2196/60434 %U http://www.ncbi.nlm.nih.gov/pubmed/39412868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55234 %T Examining the Effects of Cognitive Behavioral Therapy With a Virtual Agent on User Motivation and Improvement in Psychological Distress and Anxiety: Two-Session Experimental Study %A Frischholz,Katja %A Tanaka,Hiroki %A Shidara,Kazuhiro %A Onishi,Kazuyo %A Nakamura,Satoshi %+ Department of Psychology, University of Regensburg, Universitätsstraße 31, Regensburg, 93053, Germany, 49 941 943 4413, katja.frischholz@psychologie.uni-regensburg.de %K cognitive behavioral therapy %K cognitive restructuring %K motivation %K virtual agent %K automatic negative thoughts %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is a valuable treatment for mood disorders and anxiety. CBT methods, such as cognitive restructuring, are employed to change automatic negative thoughts to more realistic ones. Objective: This study extends on previous research conducted by the authors, focused on the process of correcting automatic negative thoughts to realistic ones and reducing distress and anxiety via CBT with a virtual agent. It was aimed to investigate whether the previously applied virtual agent would achieve changes in automatic negative thoughts when modifications to the previous experimental paradigm are applied and when user motivation is taken into consideration. Furthermore, the potential effects of existing participant knowledge concerning CBT or automatic thoughts were explored. Methods: A single-group, 2-session experiment was conducted using a within-group design. The study recruited 35 participants from May 15, 2023, to June 2, 2023, via Inter Group Corporation, with data collection following from June 5 to June 20, 2023, at Nara Institute of Science and Technology, Japan. There were 19 male and 16 female participants (age range: 18-50 years; mean 33.66, SD 10.77 years). Participants answered multiple questionnaires covering depressive symptomatology and other cognitive variables before and after a CBT session. CBT was carried out using a virtual agent, who participants conversed with using a CBT dialogue scenario on the topic of automatic negative thoughts. Session 2 of the experiment took place 1 week after session 1. Changes in distress and state anxiety were analyzed using a Wilcoxon signed-rank test and t-test for paired samples. The relationships of motivation with cognitive changes and distress or anxiety changes were investigated via correlation analysis. Multiple linear regression was used to analyze the potential predictive qualities of previous knowledge of CBT and automatic negative thoughts regarding outcome measures. Results: Significant reductions in distress (all P<.001) and state anxiety (all P<.003) emerged throughout the first and second experimental sessions. The CBT intervention increased participants’ recognition of their negative thinking and their intention to change it, namely their motivation to change it. However, no clear correlations of motivation with changes in distress or anxiety were found (all P>.04). Participants reported moderate subjective changes in their cognition, which were in part positively correlated with their motivation (all P<.007). Lastly, existing knowledge of CBT did not predict reductions in distress during the first session of the experiment (P=.02). Conclusions: CBT using a virtual agent and a CBT dialogue scenario was successful in reducing distress and anxiety when talking about automatic negative thoughts. The promotion of client motivation needs to be critically considered when designing interventions using CBT with a virtual agent, and further experimental investigations on the causal influences between motivation and outcome measures need to be conducted. %M 39405101 %R 10.2196/55234 %U https://formative.jmir.org/2024/1/e55234 %U https://doi.org/10.2196/55234 %U http://www.ncbi.nlm.nih.gov/pubmed/39405101 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47251 %T Intervention to Improve Well-Being, Nutrition, and Physical Activity in Adults: Experimental Study %A Aubert,Morghane %A Clavel,Céline %A Le Scanff,Christine %A Martin,Jean-Claude %+ Laboratoire Interdisciplinaire des Sciences du Numérique, Campus Universitaire bâtiment 507, Rue du Belvédère, Orsay, 91400, France, 33 684216205, jean-claude.martin@lisn.fr %K mindfulness %K well-being %K affects %K nutrition %K physical activity %K intervention %K lifestyle habits %K mindfulness exercises %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindfulness improves well-being, improves emotional regulation, reduces impulses to eat, and is linked to increased physical activity. Mindfulness interventions usually focus on 1 aspect but do not offer an approach to holistically improving lifestyle. Objective: This study aims to address this gap by designing and evaluating a holistic mindfulness intervention. Methods: Committing to a 12-week intervention with 2-hour sessions without knowing whether you will enjoy it can be a hindrance for someone completely unfamiliar with mindfulness. For this reason, we decided to design a mindfulness intervention with short sessions over a reduced number of weeks. The aim is to enable novices to discover different aspects of mindfulness while at the same time offering a satisfactory practice for people who are already practicing mindfulness. We designed and evaluated a web-based mindfulness intervention in 5 sessions of 5 to 10 minutes each on well-being, diet, and physical activity to support a healthier lifestyle. The first 2 sessions focus on formal mindfulness meditation to enable novices to discover mindfulness and its main principles. Then there are 2 sessions about food. The first session about food aims to develop a sense of satisfaction with the food we eat and to focus our attention on new sensations. The second session about food aims to develop the ability to resist the lure of unhealthy foods. Finally, there is a session on physical activity. The aim is to develop a particular awareness of the body during movement, to increase satisfaction with physical activity, and to develop regular exercise. Results: In total, 32 participants completed the intervention. After the intervention, we observed decreases in negative affect, anxiety, and emotional distress, and an increase in dispositional mindfulness. There was no effect on reported healthy eating habits and physical activity habits. Few participants repeated the exercises as recommended. The majority of our participants were new to mindfulness. The majority of our participants reported being satisfied with the different sessions. A few minor difficulties were mentioned, mainly related to the environment in which the participants carried out the sessions. Only 1 session was less satisfactory for one-third of the participants. The session on resistance to unhealthy foods was formulated too strictly and the idea of banning certain foods was a hindrance for one-third of the participants. A reformulation is needed. Conclusions: The mindfulness exercises were well accepted and promoted a state of mindfulness. It would be interesting to provide easier technical access to the exercises via a mobile app so that they can be repeated easily. %M 39405102 %R 10.2196/47251 %U https://formative.jmir.org/2024/1/e47251 %U https://doi.org/10.2196/47251 %U http://www.ncbi.nlm.nih.gov/pubmed/39405102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57939 %T Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation %A Folk,Johanna B %A Valencia-Ayala,Cynthia %A Holloway,Evan D %A Anvar,Sarah %A Czopp,Alison %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 5, 7M8, San Francisco, CA, 94110, United States, 1 4156029521, Johanna.folk@ucsf.edu %K family-based intervention %K affect management %K child welfare system %K telehealth %K formative evaluation %K trauma exposure %K substance misuse %K adverse childhood experiences %K trauma-informed care %K adolescent health %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 %M 39405104 %R 10.2196/57939 %U https://formative.jmir.org/2024/1/e57939 %U https://doi.org/10.2196/57939 %U http://www.ncbi.nlm.nih.gov/pubmed/39405104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60712 %T Leveraging Chatbots to Combat Health Misinformation for Older Adults: Participatory Design Study %A Peng,Wei %A Lee,Hee Rin %A Lim,Sue %+ Department of Media and Information, Michigan State University, 404 Wilson Room 409, East Lansing, MI, 48824, United States, 1 5174328235, pengwei@msu.edu %K chatbot %K conversational agent %K older adults %K health misinformation %K participatory design %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults, a population particularly susceptible to misinformation, may experience attempts at health-related scams or defrauding, and they may unknowingly spread misinformation. Previous research has investigated managing misinformation through media literacy education or supporting users by fact-checking information and cautioning for potential misinformation content, yet studies focusing on older adults are limited. Chatbots have the potential to educate and support older adults in misinformation management. However, many studies focusing on designing technology for older adults use the needs-based approach and consider aging as a deficit, leading to issues in technology adoption. Instead, we adopted the asset-based approach, inviting older adults to be active collaborators in envisioning how intelligent technologies can enhance their misinformation management practices. Objective: This study aims to understand how older adults may use chatbots’ capabilities for misinformation management. Methods: We conducted 5 participatory design workshops with a total of 17 older adult participants to ideate ways in which chatbots can help them manage misinformation. The workshops included 3 stages: developing scenarios reflecting older adults’ encounters with misinformation in their lives, understanding existing chatbot platforms, and envisioning how chatbots can help intervene in the scenarios from stage 1. Results: We found that issues with older adults’ misinformation management arose more from interpersonal relationships than individuals’ ability to detect misinformation in pieces of information. This finding underscored the importance of chatbots to act as mediators that facilitate communication and help resolve conflict. In addition, participants emphasized the importance of autonomy. They desired chatbots to teach them to navigate the information landscape and come to conclusions about misinformation on their own. Finally, we found that older adults’ distrust in IT companies and governments’ ability to regulate the IT industry affected their trust in chatbots. Thus, chatbot designers should consider using well-trusted sources and practicing transparency to increase older adults’ trust in the chatbot-based tools. Overall, our results highlight the need for chatbot-based misinformation tools to go beyond fact checking. Conclusions: This study provides insights for how chatbots can be designed as part of technological systems for misinformation management among older adults. Our study underscores the importance of inviting older adults to be active co-designers of chatbot-based interventions. %M 39393065 %R 10.2196/60712 %U https://formative.jmir.org/2024/1/e60712 %U https://doi.org/10.2196/60712 %U http://www.ncbi.nlm.nih.gov/pubmed/39393065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57348 %T Decision Support Tool to Improve Decision-Making for HIV Pre-Exposure Prophylaxis (PrEP): Development Process and Alpha Testing %A Ajiboye,Wale %A Yusuf,Abban %A Pedersen,Cheryl %A Brown,Rebecca %A Dzonsons,Kristaps %A Nelson,LaRon %+ MAP Center for Urban Health Solution, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B1C9, Canada, 1 4165873178, wale.ajiboye@unityhealth.to %K HIV PrEP in black patients %K pre-exposure prophylaxis %K decision support tool to increase PrEP uptake and adherence %K HIV prevention in Black communities %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: African, Caribbean, and Black (Black) communities in Canada are disproportionately affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP) is a highly effective option for the prevention of HIV. However, the use of PrEP for HIV prevention among eligible Black clients in Canada remains far below the thresholds necessary to achieve the goal of zero new HIV infections. In a recent study in Toronto, PrEP-eligible Black clients were found to have decisional conflict and unmet decisional needs, which affected the quality of their decision-making process regarding the initiation and adherence to PrEP. There is evidence that decision support tools (DSTs) can improve the quality of a decision, the quality of the decision-making process, the implementation or continuation of the chosen option, and the appropriate use of health services. Despite these benefits, there is currently no DST for PrEP-eligible Black clients being asked to consider PrEP for HIV prevention. Objective: Our study aimed to develop a DST to improve PrEP decision-making for Black clients and to evaluate the tool’s acceptability and usability. Methods: We developed and evaluated the PrEP DST for Black patients using the 7-step process outlined in the Ottawa Decision Support Group Guideline for the development and evaluation of DST. To facilitate the implementation of the Ottawa Decision Support Group guideline, we assembled a multidisciplinary team of primary health care providers, researchers, community members with lived experiences, and digital content designers to serve as the steering committee. First, we assessed patients’ and primary health care providers’ views on decisional support needs, after which we determined the content, design, and distribution plan for the DST. Subsequently, we conducted evidence synthesis, reviews, and appraisal before developing the PrEP DST prototype. The final tool was reviewed by steering committee members for completeness before acceptability and usability testing with potential Black clients and PrEP providers. Results: The web-based DST yielded 27 pages divided into 6 distinct sections. The six sections include (1) an introduction of the DST, (2) clarify your decision, (3) knowledge, (4) a value clarification exercise, (5) support system, and (6) next steps. Both Black clients and PrEP providers reported ease of task performance, general satisfaction, and usefulness of the tool to support decision-making for Black clients. Feedback on usability centered on the need to add a user guide to increase usability. All feedback was incorporated into the final tool. Conclusions: A PrEP DST for Black clients developed using a systematic process and a multidisciplinary steering committee was acceptable and usable by both Black clients and PrEP providers. Further study (eg, randomized controlled trials) may be needed to evaluate the efficacy of the PrEP DST. %M 39393055 %R 10.2196/57348 %U https://formative.jmir.org/2024/1/e57348 %U https://doi.org/10.2196/57348 %U http://www.ncbi.nlm.nih.gov/pubmed/39393055 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53465 %T Automated Detection of Neurodevelopmental Disorders Using Face-to-Face Mobile Technology Among Typically Developing Greek Children: Randomized Controlled Trial %A Toki,Eugenia I %A Zakopoulou,Victoria %A Tatsis,Giorgos %A Pange,Jenny %+ Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Panepistimioupoli B, Rm 148, Ioannina, 45500, Greece, 30 2651050720, toki@uoi.gr %K main principles %K automated detection %K neurodevelopmental disorders %K principal component analysis %K early screening %K early intervention %K detection %K screening %K assessment %K digital tool %K serious game %K child %K Greece %K speech %K psychomotor %K cognitive %K psychoemotional %K hearing %K machine learning %K apps %K predictions %K screening %K prognosis %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurodevelopmental disorders (NDs) are characterized by heterogeneity, complexity, and interactions among multiple domains with long-lasting effects in adulthood. Early and accurate identification of children at risk for NDs is crucial for timely intervention, yet many cases remain undiagnosed, leading to missed opportunities for effective interventions. Digital tools can help clinicians assist and identify NDs. The concept of using serious games to enhance health care has gained attention among a growing group of scientists, entrepreneurs, and clinicians. Objective: This study aims to explore the core principles of automated mobile detection of NDs in typically developing Greek children, using a serious game developed within the SmartSpeech project, designed to evaluate multiple developmental domains through principal component analysis (PCA). Methods: A total of 229 typically developing children aged 4 to 12 years participated in the study. The recruitment process involved open calls through public and private health and educational institutions across Greece. Parents were thoroughly informed about the study’s objectives and procedures, and written consent was obtained. Children engaged under the clinician’s face-to-face supervision with the serious game “Apsou,” which assesses 18 developmental domains, including speech, language, psychomotor, cognitive, psychoemotional, and hearing abilities. Data from the children’s interactions were analyzed using PCA to identify key components and underlying principles of ND detection. Results: A sample of 229 typically developing preschoolers and early school-aged children played the Apsou mobile serious game for automated detection of NDs. Performing a PCA, the findings identified 5 main components accounting for about 80% of the data variability that potentially have significant prognostic implications for a safe diagnosis of NDs. Varimax rotation explained 61.44% of the total variance. The results underscore key theoretical principles crucial for the automated detection of NDs. These principles encompass communication skills, speech and language development, vocal processing, cognitive skills and sensory functions, and visual-spatial skills. These components align with the theoretical principles of child development and provide a robust framework for automated ND detection. Conclusions: The study highlights the feasibility and effectiveness of using serious games for early ND detection in children. The identified principal components offer valuable insights into critical developmental domains, paving the way for the development of advanced machine learning applications to support highly accurate predictions and classifications for automated screening, diagnosis, prognosis, or intervention planning in ND clinical decision-making. Future research should focus on validating these findings across diverse populations integrating additional features such as biometric data and longitudinal tracking to enhance the accuracy and reliability of automated detection systems. Trial Registration: ClinicalTrials.gov NCT06633874; https://clinicaltrials.gov/study/NCT06633874 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.3390/signals4020021 %M 39393054 %R 10.2196/53465 %U https://formative.jmir.org/2024/1/e53465 %U https://doi.org/10.2196/53465 %U http://www.ncbi.nlm.nih.gov/pubmed/39393054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58221 %T Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke %A Wakeman,Michael %A Tesfaye,Lydia %A Gregory,Tim %A Leahy,Erin %A Kendrick,Brandon %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K smoking cessation %K social determinants of health %K mhealth %K apps %K qualitative research %K young adults %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users’ perceptions are important determinants of the adoption and use of new technologies. However, little is known about users’ perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. Objective: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. Methods: In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Results: Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants’ limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). Conclusions: The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management. %M 39392684 %R 10.2196/58221 %U https://formative.jmir.org/2024/1/e58221 %U https://doi.org/10.2196/58221 %U http://www.ncbi.nlm.nih.gov/pubmed/39392684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58356 %T Intervention for the Management of Neuropsychiatric Symptoms to Reduce Caregiver Stress: Protocol for the Mindful and Self-Compassion Care Intervention for Caregivers of Persons Living With Dementia %A Travis,Aniyah %A O’Donnell,Arden %A Giraldo-Santiago,Natalia %A Stone,Sarah M %A Torres,Daniel %A Adler,Shelley R %A Vranceanu,Ana-Maria %A Ritchie,Christine S %+ Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, United States, 1 617 726 1382, csritchie@mgh.harvard.edu %K mindfulness %K caregiver %K self-compassion %K ADRD %K Alzheimer’s disease and related dementias %K mental health %D 2024 %7 11.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress related to Alzheimer disease and related dementias (ADRD) is common, particularly among those who care for persons with challenging behaviors and personality or mood changes. Mindfulness and self-compassion programs are efficacious for managing stress. The skills of mindfulness and self-compassion, however, must be integrated with behavioral management skills in order to effectively improve caregiver stress. Objective: In this study, we aimed to describe the development of the Mindful and Self-Compassionate Care (MASC) program, the first program that combines mindfulness and self-compassion with behavioral management skills to decrease caregiver stress, and its evaluation in the Supporting Our Caregivers in ADRD Learning (SOCIAL) study. Methods: Using the National Institutes of Health (NIH) stage model, we describe 3 phases of work encompassing NIH Stages 1A and 1B. In phase 1, we conducted 5 focus groups (N=28) of stressed individuals caring for persons with ADRD and challenging behaviors. Rapid data analysis informed the development of a 6-week online intervention. Phase 2 (NIH stage 1A) includes an open pilot (N>10) with optional exit interviews. Phase 3 (NIH stage 1B) is a feasibility randomized controlled trial of the intervention versus the Health Education Program control. Primary outcomes focus on feasibility with secondary outcomes encompassing acceptability, credibility, fidelity, and signals of preliminary efficacy. Phase 1 follows traditional recommendations for qualitative analyses (at the point of thematic saturation) which was achieved after 5 focus groups (N=28). For the phase 2 open pilot, up to 12 participants will be recruited. For the phase 3 feasibility study, recruitment of 80 caregivers will allow the assessment of feasibility benchmarks. Data for phase 1 included 5 focus groups. In phases 2 and 3, data collection will occur through REDCap (Research Electronic Data Capture; Vanderbilt University) surveys and an optional qualitative exit interview. Analyses will include hybrid inductive-deductive analyses for qualitative data and assessment of changes in our intervention targets and outcomes using t tests and correlation analyses. Results: In phase 1, caregivers reported interest in a brief, online stress management program. Participants held misconceptions about mindfulness and self-compassion, but after detailed explanation thoughts, these skills could be helpful when directly linked to implementation during caregiving routines. Phases 2 and 3 will be completed by the end of 2025. Conclusions: We describe the protocol for the Supporting Our Caregivers in ADRD Learning study, as well as the development and feasibility testing of the Mindful and Self-Compassionate Care intervention. Future work will include a fully powered efficacy-effectiveness randomized controlled trial. Trial Registration: ClinicalTrials NCT05847153; https://clinicaltrials.gov/study/NCT05847153; and ClinicalTrials.gov NCT06276023; https://clinicaltrials.gov/study/NCT06276023 International Registered Report Identifier (IRRID): DERR1-10.2196/58356 %M 39392675 %R 10.2196/58356 %U https://www.researchprotocols.org/2024/1/e58356 %U https://doi.org/10.2196/58356 %U http://www.ncbi.nlm.nih.gov/pubmed/39392675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60147 %T Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study %A Polivka,Barbara %A Krueger,Kathryn %A Bimbi,Olivia %A Huntington-Moskos,Luz %A Nyenhuis,Sharmilee %A Cramer,Emily %A Eldeirawi,Kamal %+ School of Nursing, University of Kansas, 3901 Rainbow Blvd., School of Nursing, Kansas City, KS, 66160, United States, 1 9135881630, bpolivka@kumc.edu %K indoor air quality %K asthma %K real-time assessment %K EMA %K ecological momentary assessment %K mobile phone %K monitoring %K air quality %K real time %K spirometry %K acceptability %K usability %K residential toxins %K volatile organic compounds %K VOC %K adult %K female %K women %K college student %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. %M 39388233 %R 10.2196/60147 %U https://formative.jmir.org/2024/1/e60147 %U https://doi.org/10.2196/60147 %U http://www.ncbi.nlm.nih.gov/pubmed/39388233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56674 %T Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study %A Trò,Rosella %A Orecchia,Angelica %A Disma,Nicola %A Uva,Paolo %A Cavanna,Roberto %A Zanardi,Nicolò %A Torre,Michele %A Fato,Marco Massimo %+ Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Via all'Opera Pia 13, Genoa, 16145, Italy, 39 3408716911, rosella.tro@edu.unige.it %K pectus excavatum %K pain assessment %K web platform %K health care informatics %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. Objective: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children’s Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. Methods: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Results: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. Conclusions: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality. %M 39378419 %R 10.2196/56674 %U https://formative.jmir.org/2024/1/e56674 %U https://doi.org/10.2196/56674 %U http://www.ncbi.nlm.nih.gov/pubmed/39378419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45461 %T Impact of a Self-Autonomous Evaluation Station and Personalized Training Algorithm on Quality of Life and Physical Capacities in Sedentary Adults: Randomized Controlled Trial %A Le Mat,Yann %A Casali,Corentin %A Le Mat,Franck %A Féasson,Léonard %A Foschia,Clément %A Géry,Mathias %A Rossi,Jérémy %A Millet,Guillaume Y %+ Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023, 10 rue de Tréfilerie, Saint Etienne, 42100, France, 33 0477421875, yann.lemat@univ-st-etienne.fr %K physical activity %K sedentary behavior %K quality of life %K mobile health %K health-related interventions %K mobile app %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is a major risk factor for noncommunicable diseases and a leading cause of premature death. The World Health Organization (WHO) recommends at least 150 minutes of moderate intensity physical activity (PA) weekly, regardless of age, gender, or personal habits. However, in both sports performance and clinical settings, personalized training (PT) regimens have shown superior efficacy over general guidelines. Objective: We hypothesized that an automatic PT program, informed by initial physical evaluations, would increase overall quality of life, quality of sleep, and physical capabilities and reduce fatigue and depression compared with adherence to WHO recommendations. Methods: This 5-month, randomized, single-blinded controlled trial involved 112 sedentary or minimally active participants, divided randomly into PT and free training (FT) groups. Physical capabilities and subjective measures such as quality of life, sleep, depression, and fatigue were evaluated for both groups. After 1 month, both groups were asked to perform 150 minutes of PA per week for 4 months; the PT group could either follow a “virtual coach” on a mobile app to follow some personalized PA or do what they would like, while the FT group was to follow the general PA recommendations of the WHO. Results: We did not find any group×time interaction for PA duration or intensity, physical qualities, and subjective measures. However, considering both groups together, there was a significant pretest and posttest time effect for duration of PA (18.2 vs 24.5 min/d of PA; P<.001), intensity (2.36 vs 3.11; P<.001), and workload (46.8 vs 80.5; P<.001). Almost all physical qualities were increased pretest and posttest (ie, estimated VO2max 26.8 vs 29 mL min–1 kg–1; P<.001; flexibility 25.9 vs 26.9 cm; P=.049; lower limb isometric forces 328 vs 347 N m; P=.002; reaction time 0.680 vs 0.633 s; P<.001; power output on cyclo-ergometer 7.63 vs 7.82 W; P<.003; and balance for the left and right leg 215 vs 163 mm2; P<.003 and 186 vs 162 mm2; P=.048, respectively). Finally, still considering the PT and FT groups together, there were significant pretest to posttest improvements in the mental component of quality of life using the 12-item Short Form Health Survey (41.9 vs 46.0; P<.006), well-being using the Warwick-Edinburgh Mental Well-Being Scale (48.3 vs 51.7; P<.002), depression using the Center for Epidemiologic Studies Depression Scale (15.5 vs 11.5; P=.02), and fatigue using the Functional Assessment of Chronic Illness Therapy–Fatigue (37.1 vs 39.5; P=.048). Conclusions: The individualized training was not more effective than the general recommendations. A slight increase in PA (from 18 to 24 min/d) in sedentary or poorly active people is enough for a significant increase in physical capabilities and a significant improvement in quality of life, well-being, depression, and fatigue. Trial Registration: ClinicalTrials.gov NCT04998266; https://clinicaltrials.gov/study/NCT04998266 %M 39365990 %R 10.2196/45461 %U https://formative.jmir.org/2024/1/e45461 %U https://doi.org/10.2196/45461 %U http://www.ncbi.nlm.nih.gov/pubmed/39365990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55921 %T Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment %A Vomhof,Markus %A Bau,Jessica Tabea %A Hüter,Pia %A Stehl,Stefan %A Haastert,Burkhard %A Loerbroks,Adrian %A Icks,Andrea %A Calo,Stella Teresa %A Schuster,Luca %A Pischke,Claudia R %A Kairies-Schwarz,Nadja %A Angerer,Peter %A Apolinário-Hagen,Jennifer %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 211 8106557, jessica.bau@hhu.de %K preferences %K digital mental health %K medical students %K innovation diffusion %K technology acceptance %K health information %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students’ information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students’ interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. %M 39365652 %R 10.2196/55921 %U https://formative.jmir.org/2024/1/e55921 %U https://doi.org/10.2196/55921 %U http://www.ncbi.nlm.nih.gov/pubmed/39365652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56606 %T Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study %A Herrijgers,Corinne %A Verboon,Peter %A Florence,Eric %A Vandebosch,Heidi %A Poels,Karolien %A Platteau,Tom %+ Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen, 2000, Belgium, 32 033455656, cherrijgers@itg.be %K mobile health %K chemsex %K men who have sex with men %K MSM %K harm reduction %K behavioral change %K self-efficacy %K risk behavior %K sexual health %K digital intervention %K health education %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. Objective: This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. Methods: The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. Results: The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app’s features an average of 50 times during the study. Conclusions: The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms. %M 39365642 %R 10.2196/56606 %U https://formative.jmir.org/2024/1/e56606 %U https://doi.org/10.2196/56606 %U http://www.ncbi.nlm.nih.gov/pubmed/39365642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55815 %T A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach %A Chernick,Lauren S. %A Bugaighis,Mona %A Daylor,Victoria %A Hochster,Daniel %A Rosen,Evan %A Schnall,Rebecca %A Stockwell,Melissa S %A Bell,David L. %+ Columbia University Irving Medical Center, 3959 Broadway, New York, NY, United States, 1 2123059825, lc2243@cumc.columbia.edu %K sexual health %K adolescent health %K sex education %K emergency medicine %K health planning %K sexual behavior %K SMS text messaging %K mHealth %K mobile app %K condom use %K user-centered design %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric’s content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen’s heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. %M 39365657 %R 10.2196/55815 %U https://formative.jmir.org/2024/1/e55815 %U https://doi.org/10.2196/55815 %U http://www.ncbi.nlm.nih.gov/pubmed/39365657 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60604 %T Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial %A Horita,Hideki %A Seki,Yoichi %A Yamaguchi,Takumi %A Shiko,Yuki %A Kawasaki,Yohei %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 inohana, Chiba City, 2608670, Japan, 81 476207779, horitah@iuhw.ac.jp %K internet addiction %K adolescents %K parents %K cognitive behavioral therapy %K digital health %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent’s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents’ hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 %M 39361415 %R 10.2196/60604 %U https://pediatrics.jmir.org/2024/1/e60604 %U https://doi.org/10.2196/60604 %U http://www.ncbi.nlm.nih.gov/pubmed/39361415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57936 %T The WeThrive App and Its Impact on Adolescents Who Menstruate: Qualitative Study %A MacNeil,Nora %A Price,Victoria %A Pike,Meghan %+ Division of Hematology/Oncology, Department of Pediatrics, Izaak Walton Killam Health Centre, PO Box 9700, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024708643, meghan.pike@iwk.nshealth.ca %K heavy menstrual bleeding %K adolescents %K menorrhagia %K quality of life %K mobile applications %K mobile health application %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Without recognition, HMB can lead to other medical conditions resulting in diminished health-related quality of life. WeThrive, a new mobile health (mHealth) app, implements the pictorial bleeding assessment chart to identify HMB, and the adolescent Menstrual Bleeding Questionnaire to measure the effects of HMB on adolescents’ health-related quality of life. If HMB is identified, WeThrive will connect users to local clinics for further assessment of their menstrual bleeding with a health care provider. Objective: This study aimed to describe adolescents’ experiences using WeThrive app. Methods: This qualitative study was approved by the local Research Ethics Board in Halifax, Nova Scotia, and informed consent was provided by all participants. Individual semistructured interviews were held via videoconference with adolescents younger than 18 years, who had at least 1 menstrual period and had used WeThrive at least once. Interview transcripts were thematically analyzed by 2 investigators (MP and NMN) independently, and the κ statistic was calculated to determine the strength of correlation in themes. Results: Five adolescents (mean age 15.5, range 13-18 years), participated in the interviews. All participants stated that WeThrive helps them better understand their menstrual periods by predicting period onset, recognizing menstrual symptoms, and identifying HMB. Four themes were identified: (1) the importance of visual features and usability, (2) newly obtained knowledge using WeThrive, (3) feature use depends on menstrual health, and (4) trustworthiness. There was substantial agreement on the identified themes (κ=0.73). Conclusions: WeThrive is visually appealing, and trustworthy, and helps users better understand their menstrual periods, including identifying HMB. By identifying HMB early, WeThrive has the potential to improve the recognition of bleeding disorders and iron deficiency in adolescents. WeThrive is a useful tool to help adolescents better understand their menstrual periods. %M 39361373 %R 10.2196/57936 %U https://formative.jmir.org/2024/1/e57936 %U https://doi.org/10.2196/57936 %U http://www.ncbi.nlm.nih.gov/pubmed/39361373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51383 %T Optimizing ChatGPT’s Interpretation and Reporting of Delirium Assessment Outcomes: Exploratory Study %A Choi,Yong K %A Lin,Shih-Yin %A Fick,Donna Marie %A Shulman,Richard W %A Lee,Sangil %A Shrestha,Priyanka %A Santoso,Kate %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6051B Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 624 6442, yong.choi@pitt.edu %K generative artificial intelligence %K generative AI %K large language models %K ChatGPT %K delirium detection %K Sour Seven Questionnaire %K prompt engineering %K clinical vignettes %K medical education %K caregiver education %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Generative artificial intelligence (AI) and large language models, such as OpenAI’s ChatGPT, have shown promising potential in supporting medical education and clinical decision-making, given their vast knowledge base and natural language processing capabilities. As a general purpose AI system, ChatGPT can complete a wide range of tasks, including differential diagnosis without additional training. However, the specific application of ChatGPT in learning and applying a series of specialized, context-specific tasks mimicking the workflow of a human assessor, such as administering a standardized assessment questionnaire, followed by inputting assessment results in a standardized form, and interpretating assessment results strictly following credible, published scoring criteria, have not been thoroughly studied. Objective: This exploratory study aims to evaluate and optimize ChatGPT’s capabilities in administering and interpreting the Sour Seven Questionnaire, an informant-based delirium assessment tool. Specifically, the objectives were to train ChatGPT-3.5 and ChatGPT-4 to understand and correctly apply the Sour Seven Questionnaire to clinical vignettes using prompt engineering, assess the performance of these AI models in identifying and scoring delirium symptoms against scores from human experts, and refine and enhance the models’ interpretation and reporting accuracy through iterative prompt optimization. Methods: We used prompt engineering to train ChatGPT-3.5 and ChatGPT-4 models on the Sour Seven Questionnaire, a tool for assessing delirium through caregiver input. Prompt engineering is a methodology used to enhance the AI’s processing of inputs by meticulously structuring the prompts to improve accuracy and consistency in outputs. In this study, prompt engineering involved creating specific, structured commands that guided the AI models in understanding and applying the assessment tool’s criteria accurately to clinical vignettes. This approach also included designing prompts to explicitly instruct the AI on how to format its responses, ensuring they were consistent with clinical documentation standards. Results: Both ChatGPT models demonstrated promising proficiency in applying the Sour Seven Questionnaire to the vignettes, despite initial inconsistencies and errors. Performance notably improved through iterative prompt engineering, enhancing the models’ capacity to detect delirium symptoms and assign scores. Prompt optimizations included adjusting the scoring methodology to accept only definitive “Yes” or “No” responses, revising the evaluation prompt to mandate responses in a tabular format, and guiding the models to adhere to the 2 recommended actions specified in the Sour Seven Questionnaire. Conclusions: Our findings provide preliminary evidence supporting the potential utility of AI models such as ChatGPT in administering standardized clinical assessment tools. The results highlight the significance of context-specific training and prompt engineering in harnessing the full potential of these AI models for health care applications. Despite the encouraging results, broader generalizability and further validation in real-world settings warrant additional research. %M 39353189 %R 10.2196/51383 %U https://formative.jmir.org/2024/1/e51383 %U https://doi.org/10.2196/51383 %U http://www.ncbi.nlm.nih.gov/pubmed/39353189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51198 %T Harnessing the Power of Complementarity Between Smart Tracking Technology and Associated Health Information Technologies: Longitudinal Study %A Tao,Youyou %A Zhu,Ruilin %A Wu,Dezhi %+ Department of Management Science, Lancaster University, Bailrigg, Lancaster, LA1 4YX, United Kingdom, 44 1524592938, ruilin.zhu@lancaster.ac.uk %K health IT %K smart tracking technology %K mobile IT %K health information exchange %K electronic health record %K readmission risk %K complementarity effects %K mobile phone %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smart tracking technology (STT) that was applied for clinical use has the potential to reduce 30-day all-cause readmission risk through streamlining clinical workflows with improved accuracy, mobility, and efficiency. However, previously published literature has inadequately addressed the joint effects of STT for clinical use and its complementary health ITs (HITs) in this context. Furthermore, while previous studies have discussed the symbiotic and pooled complementarity effects among different HITs, there is a lack of evidence-based research specifically examining the complementarity effects between STT for clinical use and other relevant HITs. Objective: Through a complementarity theory lens, this study aims to examine the joint effects of STT for clinical use and 3 relevant HITs on 30-day all-cause readmission risk. These HITs are STT for supply chain management, mobile IT, and health information exchange (HIE). Specifically, this study examines whether the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and whether symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Methods: This study uses a longitudinal in-patient dataset, including 879,122 in-patient hospital admissions for 347,949 patients in 61 hospitals located in Florida and New York in the United States, from 2014 to 2015. Logistic regression was applied to assess the effect of HITs on readmission risks. Time and hospital fixed effects were controlled in the regression model. Robust standard errors (SEs) were used to account for potential heteroskedasticity. These errors were further clustered at the patient level to consider possible correlations within the patient groups. Results: The interaction between STT for clinical use and STT for supply chain management, mobile IT, and HIE was negatively associated with 30-day readmission risk, with coefficients of –0.0352 (P=.003), –0.0520 (P<.001), and –0.0216 (P=.04), respectively. These results indicate that the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Furthermore, the joint effects of these HITs varied depending on the hospital affiliation and patients’ disease types. Conclusions: Our results reveal that while individual HIT implementations have varying impacts on 30-day readmission risk, their joint effects are often associated with a reduction in 30-day readmission risk. This study substantially contributes to HIT value literature by quantifying the complementarity effects among 4 different types of HITs: STT for clinical use, STT for supply chain management, mobile IT, and HIE. It further offers practical implications for hospitals to maximize the benefits of their complementary HITs in reducing the 30-day readmission risk in their respective care scenarios. %M 39353192 %R 10.2196/51198 %U https://formative.jmir.org/2024/1/e51198 %U https://doi.org/10.2196/51198 %U http://www.ncbi.nlm.nih.gov/pubmed/39353192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58241 %T Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study %A Liu,Yuhan %A Fang,Anna %A Moriarty,Glen %A Firman,Cristopher %A Kraut,Robert E %A Zhu,Haiyi %+ Human-Computer Interaction Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 (412) 268 2000, annadfang@gmail.com %K agent-based modeling %K mental health %K algorithmic matching %K social computing %K online communities %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. Objective: In this study, we collaborated with one of the world’s largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. Methods: We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a “sandbox” to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. Results: Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker–counselor matches occurred using a “first come, first served” protocol, whereas relatively fewer matches occurred using a “last come, first served” protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities—underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a “filter”-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (–12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using “topic” as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups—specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. Conclusions: Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities. %M 39352736 %R 10.2196/58241 %U https://formative.jmir.org/2024/1/e58241 %U https://doi.org/10.2196/58241 %U http://www.ncbi.nlm.nih.gov/pubmed/39352736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56162 %T mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users %A Muehlensiepen,Felix %A Bruch,Dunja %A Seifert,Frances %A Wengemuth,Eileen %A Heinze,Martin %A Spethmann,Sebastian %A May,Susann %+ Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 151 191260 24, Felix.Muehlensiepen@mhb-fontane.de %K hypertension %K mobile health %K mHealth apps %K digital health %K patient perspective %K qualitative study %K cardiology %D 2024 %7 27.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users’ perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users’ hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s %M 39331954 %R 10.2196/56162 %U https://formative.jmir.org/2024/1/e56162 %U https://doi.org/10.2196/56162 %U http://www.ncbi.nlm.nih.gov/pubmed/39331954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56878 %T Ascertaining Out-of-Pocket Costs of Dementia Care: Feasibility Study of a Web-Based Weekly Survey %A Dawson,Walter D %A Mattek,Nora %A Gothard,Sarah %A Kaye,Jeffrey %A Lindauer,Allison %+ Oregon Alzheimer’s Disease Research Center, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR131, Portland, OR, 97239, United States, 1 5034946976, dawsonw@ohsu.edu %K Alzheimer disease %K caregiving %K out-of-pocket costs %K behavioral and psychological symptoms of dementia %K technological interventions %K clinical trials %K dementias %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caring for a family member living with dementia is costly. A major contributor to care demands, and therefore to the costs, are the behavioral symptoms of dementia. Here, we examine the feasibility of ascertaining costs related to caregiving from weekly web-based surveys collected during a telehealth-based behavioral intervention study—Support via Technology: Living and Learning with Advancing Alzheimer Disease. Objective: This study aims to determine the feasibility and acceptability of using a web-based weekly survey to capture real-time data on out-of-pocket caregiving expenses and time commitments associated with dementia care. To examine relationships between behavioral symptoms, care partner reactivity, burden, and out-of-pocket dementia care costs. Methods: Feasibility was measured by accrual, retention, and data completion by participating care partners. Behavioral symptoms, care partner reactivity, and burden were collected before and after the intervention from 13 care partners. Weekly web-based surveys queried Support via Technology: Living and Learning with Advancing Alzheimer Disease care partners about their out-of-pocket costs associated with care-related activities. The surveys included questions on out-of-pocket costs care partners incurred from hospitalizations and emergency department use, primary care provider visits, use of paid in-home care or respite services, use of prescription medications, and use of over-the-counter medications. The surveys also queried the amount of time care partners devoted to these specific care–related activities. Results: Out-of-pocket costs of dementia care were collected via a web-based weekly survey for up to 18 months. In-home assistance was the most frequently reported type of out-of-pocket care expense and the costliest. care partners who paid for in-home assistance or respite reported more behavioral and psychological symptoms of dementia behaviors, higher reactivity, and higher burden than those who did not. Conclusions: This novel web-based weekly survey–based approach offers lessons for designing and implementing future cost-focused studies and care partner–supportive telehealth-based interventions for Alzheimer disease and related dementias (ADRD). The results correspond with the existing understanding of ADRD in that high family-related out-of-pocket costs are a typical part of the caregiving experience, and those costs likely increase with dementia severity. The results may also offer potential insights to health systems and policy makers as they seek to implement telehealth-based and related interventions that seek to better support people living with ADRD and their family care partners. Trial Registration: ClinicalTrials.gov NCT04335110; https://clinicaltrials.gov/ct2/show/NCT04335110 %M 39321453 %R 10.2196/56878 %U https://formative.jmir.org/2024/1/e56878 %U https://doi.org/10.2196/56878 %U http://www.ncbi.nlm.nih.gov/pubmed/39321453 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53224 %T The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing %A Savage,Leah C %A Soto-Cossio,Luz Estefhany %A Minardi,Francesca %A Beyrouty,Matthew %A Schoonover,Julie %A Musella,Jay %A Frazier,Michaela %A Villagra,Cristina N %A Sly,Jamilia R %A Erblich,Joel %A Itzkowitz,Steven H %A Jandorf,Lina H %A Calman,Neil S %A Atreja,Ashish %A Miller,Sarah J %+ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Box 1077, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 2128247783, sarah.miller@mssm.edu %K digital navigation %K digital health %K Federally Qualified Health Center %K colorectal cancer %K cancer screening %K mobile phone %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. %M 39321451 %R 10.2196/53224 %U https://formative.jmir.org/2024/1/e53224 %U https://doi.org/10.2196/53224 %U http://www.ncbi.nlm.nih.gov/pubmed/39321451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53759 %T Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation %A Okamoto,Masumi %A Saito,Yoshinobu %A Nakamura,Sho %A Nagasawa,Makoto %A Shibuya,Megumi %A Nagasaka,Go %A Narimatsu,Hiroto %+ Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building Tonomachi 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki, 210-0821, Japan, 81 44 589 8100, hiroto-narimatsu@umin.org %K digital health %K mhealth %K ehealth %K smartphone app %K smartphone application %K peer support %K digital peer support %K social support %K group intervention %K physical activity %K health promotion %K behavior change %K apps %K step counting %K workplace health %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. Objective: This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. Methods: The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Results: Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)–hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). Conclusions: This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. Trial Registration: UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z %M 39316793 %R 10.2196/53759 %U https://formative.jmir.org/2024/1/e53759 %U https://doi.org/10.2196/53759 %U http://www.ncbi.nlm.nih.gov/pubmed/39316793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53034 %T Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of ‘Zvatinoda!’ (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework %A Mackworth-Young,Constance Ruth Sina %A Charashika,Privillage %A , %A Larsson,Leyla %A Wilding-Davies,Olivia Jane %A Simpson,Nikita %A Kydd,Anna Sorrel %A Chinyanga,Theonevus Tinashe %A Ferrand,Rashida Abbas %A Mangombe,Aveneni %A Webb,Karen %A Doyle,Aoife Margaret %+ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 20 7636 8636, constance.mackworth-young1@lshtm.ac.uk %K adolescents %K young people %K digital health %K mobile intervention %K HIV %K sexual and reproductive health %K Zimbabwe %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone–based discussion groups, complemented by “ask the expert” sessions. Peer facilitators, supported by an “Auntie,” led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators’ debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable “Auntie,” and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people’s knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. %M 39316784 %R 10.2196/53034 %U https://formative.jmir.org/2024/1/e53034 %U https://doi.org/10.2196/53034 %U http://www.ncbi.nlm.nih.gov/pubmed/39316784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60411 %T Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners %A Beccia,Chiara %A Hunter,Barbara %A Manski-Nankervis,Jo-Anne %A White,Mary %+ Department of General Practice and Primary Care, The University of Melbourne, Medical Building (181), , Melbourne, 3010, Australia, 61 0468480327, cbeccia@student.unimelb.edu.au %K type 1 diabetes %K digital health innovation %K clinical decision support tool %K diabetes %K acceptability %K feasibility %K diagnosis %K child %K children %K youth %K qualitative and simulation study %K hospital %K diabetic ketoacidosis %K diagnostic delay %K Australian %K Australia %K video recorded %K audio recorded %K screen recorded %K video %K videos %K patient %K patients %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay. Objective: In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context. Methods: In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework. Results: Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting—time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs’ needs regarding DIRECT-T1DM; (2) inner setting—DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation—design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets. Conclusions: End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its “real-time” nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting. %M 39312767 %R 10.2196/60411 %U https://formative.jmir.org/2024/1/e60411 %U https://doi.org/10.2196/60411 %U http://www.ncbi.nlm.nih.gov/pubmed/39312767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53314 %T Creation of an Automated and Comprehensive Resident Progress System for Residents and to Save Hours of Faculty Time: Mixed Methods Study %A Perotte,Rimma %A Berns,Alyssa %A Shaker,Lana %A Ophaswongse,Chayapol %A Underwood,Joseph %A Hajicharalambous,Christina %+ Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ, 07601, United States, 1 5519962470, rimma.perotte@hmhn.org %K progress dashboard %K informatics in medical education %K residency learning management system %K residency progress system %K residency education system %K summarization %K administrative burden %K medical education %K resident %K residency %K resident data %K longitudinal %K pilot study %K competency %K dashboards %K dashboard %K faculty %K residents %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It is vital for residents to have a longitudinal view of their educational progression, and it is crucial for the medical education team to have a clear way to track resident progress over time. Current tools for aggregating resident data are difficult to use and do not provide a comprehensive way to evaluate and display resident educational advancement. Objective: This study aims to describe the creation and assessment of a system designed to improve the longitudinal presentation, quality, and synthesis of educational progress for trainees. We created a new system for residency progress management with 3 goals in mind, that are (1) a long-term and centralized location for residency education data, (2) a clear and intuitive interface that is easy to access for both the residents and faculty involved in medical education, and (3) automated data input, transformation, and analysis. We present evaluations regarding whether residents find the system useful, and whether faculty like the system and perceive that it helps them save time with administrative duties. Methods: The system was created using a suite of Google Workspace tools including Forms, Sheets, Gmail, and a collection of Apps Scripts triggered at various times and events. To assess whether the system had an effect on the residents, we surveyed and asked them to self-report on how often they accessed the system and interviewed them as to whether they found it useful. To understand what the faculty thought of the system, we conducted a 14-person focus group and asked the faculty to self-report their time spent preparing for residency progress meetings before and after the system debut. Results: The system went live in February 2022 as a quality improvement project, evolving through multiple iterations of feedback. The authors found that the system was accessed differently by different postgraduate years (PGY), with the most usage reported in the PGY1 class (weekly), and the least amount of usage in the PGY3 class (once or twice). However, all of the residents reported finding the system useful, specifically for aggregating all of their evaluations in the same place. Faculty members felt that the system enabled a more high-quality biannual clinical competency committee meeting and they reported a combined time savings of 8 hours in preparation for each clinical competency committee as a result of reviewing resident data through the system. Conclusions: Our study reports on the creation of an automated, instantaneous, and comprehensive resident progress management system. The system has been shown to be well-liked by both residents and faculty. Younger PGY classes reported more frequent system usage than older PGY classes. Faculty reported that it helped facilitate more meaningful discussion of training progression and reduced the administrative burden by 8 hours per biannual session. %M 39312292 %R 10.2196/53314 %U https://formative.jmir.org/2024/1/e53314 %U https://doi.org/10.2196/53314 %U http://www.ncbi.nlm.nih.gov/pubmed/39312292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58335 %T Patterns of Use and Withdrawal Syndrome in Dual Cannabis and Tobacco Users (DuCATA_GAM-CAT): Protocol for a Mixed Methods Study %A Saura,Judith %A Feliu,Ariadna %A Enríquez-Mestre,Marta %A Fu,Marcela %A Ballbè,Montse %A Castellano,Yolanda %A Pla,Margarida %A Rosa,Nathalia %A Radeva,Petia %A Maestre-González,Elena %A Cabezas,Carmen %A Colom,Joan %A Suelves,Josep M %A Mondon,Silvia %A Barrio,Pablo %A Andreu,Magalí %A Raich,Antònia %A Bernabeu,Jordi %A Vilaplana,Jordi %A Roca Tutusaus,Xavier %A Guydish,Joseph %A Fernández,Esteve %A Martínez,Cristina %+ Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d’Oncologia, WHO Collaborating Center On Tobacco Control, Avinguda de la Granvia de l’Hospitalet 199, L'Hospitalet de Llobregat, Barcelona, 08908, Spain, 34 932607733, efernandez@iconcologia.net %K cannabis %K tobacco %K substance abuse %K withdrawal symptoms %K mobile phone %K protocol %K addiction %K pattern use %K withdrawal syndrome %K mixed method %K participatory %K qualitative study %K focus groups %K cannabis use disorder %K clinicians %K researchers %K predictive analysis %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users. Objective: The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs. Methods: The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants’ experiences during their CUD treatment. Results: By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total. Conclusions: All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research. Trial Registration: ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091 International Registered Report Identifier (IRRID): DERR1-10.2196/58335 %M 39298750 %R 10.2196/58335 %U https://www.researchprotocols.org/2024/1/e58335 %U https://doi.org/10.2196/58335 %U http://www.ncbi.nlm.nih.gov/pubmed/39298750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57185 %T Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study %A Grube,Lara %A Petit,Pascal %A Vuillerme,Nicolas %A Nitschke,Marlies %A Nwosu,Obioma Bertrand %A Knitza,Johannes %A Krusche,Martin %A Seifer,Ann-Kristin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3- Rheumatology & Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318543023, harriet.morf@uk-erlangen.de %K DTx %K DHA %K usability %K Yoga %K YogiTherapy %K ankylosing spondylitis %K axial spondylarthritis %K digital health application %K eHealth %K self-assessment %K physical exercise %K patient acceptance %K therapy %K home exercise %K exercise %K patients %K patient %K spondyloarthritis %K usability study %K app %K apps %K rheumatic disease %K chronic %K spine %K adjacent joints %K joints %K joint %K correlation analysis %K digital therapeutics %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is –26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=–0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. %M 39298754 %R 10.2196/57185 %U https://formative.jmir.org/2024/1/e57185 %U https://doi.org/10.2196/57185 %U http://www.ncbi.nlm.nih.gov/pubmed/39298754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41093 %T Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study %A Yoo,In-jin %A Park,Do-Hyung %A Lee,Othelia EunKyoung %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte, 9201 University City Boulevard, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 7046878668, al.park@uncc.edu %K socially assistive robot %K older adults %K robot use pattern %K time series clustering %K profiling analysis %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. %M 39298762 %R 10.2196/41093 %U https://formative.jmir.org/2024/1/e41093 %U https://doi.org/10.2196/41093 %U http://www.ncbi.nlm.nih.gov/pubmed/39298762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56559 %T Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment %A Staras,Stephanie A S %A Tauscher,Justin %A Vinson,Michelle %A Thompson,Lindsay A %A Gerend,Mary A %A Shenkman,Elizabeth A %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Road, Room 7005, Gainesville, FL, 32611, United States, 1 (352)294 8299, sstaras@ufl.edu %K participatory design %K think-aloud %K implementation science %K adolescent vaccination %K human papillomavirus vaccine %K usability %K eHealth %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents’ vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app’s usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child’s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents’ children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. %M 39298761 %R 10.2196/56559 %U https://formative.jmir.org/2024/1/e56559 %U https://doi.org/10.2196/56559 %U http://www.ncbi.nlm.nih.gov/pubmed/39298761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56370 %T A Behavior-Based Model to Validate Electronic Systems Designed to Collect Patient-Reported Outcomes: Model Development and Application %A Attamimi,Sultan %A Marshman,Zoe %A Deery,Christopher %A Radley,Stephen %A Gilchrist,Fiona %+ Academic Unit of Oral Health Dentistry and Society, University of Sheffield, 19 Claremont Cres, Broomhall, Sheffield, S10 2TA, United Kingdom, 44 0114 2717990, su.altamimi@uoh.edu.sa %K patient-reported outcome %K PRO %K electronic PRO %K user acceptance testing %K system validation %K patient-reported outcomes %K electronic PROs %K user acceptance %K validation model %K paediatric dentistry %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The merits of technology have been adopted in capturing patient-reported outcomes (PROs) by incorporating PROs into electronic systems. Following the development of an electronic system, evaluation of system performance is crucial to ensuring the collection of meaningful data. In contemporary PRO literature, electronic system validation is overlooked, and evidence on validation methods is lacking. Objective: This study aims to introduce a generalized concept to guide electronic patient-reported outcome (ePRO) providers in planning for system-specific validation methods. Methods: Since electronic systems are essentially products of software engineering endeavors, electronic systems used to collect PRO should be viewed from a computer science perspective with consideration to the health care environment. On this basis, a testing model was blueprinted and applied to a newly developed ePRO system designed for clinical use in pediatric dentistry (electronic Personal Assessment Questionnaire-Paediatric Dentistry) to investigate its thoroughness. Results: A behavior-based model of ePRO system validation was developed based on the principles of user acceptance testing and patient-centered care. The model allows systematic inspection of system specifications and identification of technical errors through simulated positive and negative usage pathways in open and closed environments. The model was able to detect 15 positive errors with 1 unfavorable response when applied to electronic Personal Assessment Questionnaire-Paediatric Dentistry system testing. Conclusions: The application of the behavior-based model to a newly developed ePRO system showed a high ability for technical error detection in a systematic fashion. The proposed model will increase confidence in the validity of ePRO systems as data collection tools in future research and clinical practice. %M 39288407 %R 10.2196/56370 %U https://formative.jmir.org/2024/1/e56370 %U https://doi.org/10.2196/56370 %U http://www.ncbi.nlm.nih.gov/pubmed/39288407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52293 %T A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety %A Dimeff,Linda A %A Koerner,Kelly %A Heard,Kandi %A Ruork,Allison K %A Kelley-Brimer,Angela %A Witterholt,Suzanne T %A Lardizabal,Mary Beth %A Clubb,Joseph R %A McComish,Julie %A Waghray,Arpan %A Dowdy,Roger %A Asad-Pursley,Sara %A Ilac,Maria %A Lawrence,Hannah %A Zhou,Frank %A Beadnell,Blair %+ Evidence-Based Practice Institute, 9450 SW Gemini Dr, PMB 68735, Beaverton, OR, 97008-7105, United States, 1 253 765 0455, linda.dimeff@jasprhealth.com %K suicide %K emergency department %K ED %K digital technology %K suicide prevention best practices %K individual %K particular %K suicide prevention %K evidence-based intervention %K Emergency department %K hospital %K vulnerable population %K Jaspr Health %K psychiatric %K psychiatrist %K care %K safety %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr’s use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. %M 39283664 %R 10.2196/52293 %U https://formative.jmir.org/2024/1/e52293 %U https://doi.org/10.2196/52293 %U http://www.ncbi.nlm.nih.gov/pubmed/39283664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57108 %T The Potential Use and Value of a Wearable Monitoring Bracelet for Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study Investigating the Patient and Health Care Professional Perspectives %A Debeij,Suzanne M %A Aardoom,Jiska J %A Haaksma,Miriam L %A Stoop,Wieteke A M %A van Dam van Isselt,Eléonore F %A Kasteleyn,Marise J %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 651306514, s.m.debeij@lumc.nl %K eHealth %K Chronic Obstructive Pulmonary Disease %K COPD %K wearable %K exacerbation %K self-management %K monitoring bracelet %K remote monitoring %K mobile phone %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders’ perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. Objective: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. Methods: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. Results: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. Conclusions: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD. %M 39270210 %R 10.2196/57108 %U https://formative.jmir.org/2024/1/e57108 %U https://doi.org/10.2196/57108 %U http://www.ncbi.nlm.nih.gov/pubmed/39270210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53455 %T Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study %A Po,Hui-Wen %A Chu,Ying-Chien %A Tsai,Hui-Chen %A Lin,Chen-Liang %A Chen,Chung-Yu %A Ma,Matthew Huei-Ming %+ Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579. Sec 2,, Yunlin Rd, Douliou, Yunlin, 640, Taiwan, 886 055323911, c8101147@ms16.hinet.net %K telemonitoring %K discharge planning %K case manager %K hospital readmission %K telehealth %K remote healthcare %K high-risk %K post-discharge %K respiratory disease %K respiratory diseases %K cardiovascular disease %K cardiovascular diseases %K case management %K patient education %K readmission %K health status tracking %K care guidance %K medical advice %K male %K men %K older adult %K older adults %K elder %K elderly %K older person %K older people %K home monitoring %K physiological signal %K physiological signals %K mobile phone %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. %M 39269747 %R 10.2196/53455 %U https://formative.jmir.org/2024/1/e53455 %U https://doi.org/10.2196/53455 %U http://www.ncbi.nlm.nih.gov/pubmed/39269747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56797 %T ChatGPT Use Among Pediatric Health Care Providers: Cross-Sectional Survey Study %A Kisvarday,Susannah %A Yan,Adam %A Yarahuan,Julia %A Kats,Daniel J %A Ray,Mondira %A Kim,Eugene %A Hong,Peter %A Spector,Jacob %A Bickel,Jonathan %A Parsons,Chase %A Rabbani,Naveed %A Hron,Jonathan D %+ Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 5704283137, susannah.kisvarday@childrens.harvard.edu %K ChatGPT %K machine learning %K surveys and questionnaires %K medical informatics applications %K OpenAI %K large language model %K LLM %K machine learning %K pediatric %K chatbot %K artificial intelligence %K AI %K digital tools %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The public launch of OpenAI’s ChatGPT platform generated immediate interest in the use of large language models (LLMs). Health care institutions are now grappling with establishing policies and guidelines for the use of these technologies, yet little is known about how health care providers view LLMs in medical settings. Moreover, there are no studies assessing how pediatric providers are adopting these readily accessible tools. Objective: The aim of this study was to determine how pediatric providers are currently using LLMs in their work as well as their interest in using a Health Insurance Portability and Accountability Act (HIPAA)–compliant version of ChatGPT in the future. Methods: A survey instrument consisting of structured and unstructured questions was iteratively developed by a team of informaticians from various pediatric specialties. The survey was sent via Research Electronic Data Capture (REDCap) to all Boston Children’s Hospital pediatric providers. Participation was voluntary and uncompensated, and all survey responses were anonymous.  Results: Surveys were completed by 390 pediatric providers. Approximately 50% (197/390) of respondents had used an LLM; of these, almost 75% (142/197) were already using an LLM for nonclinical work and 27% (52/195) for clinical work. Providers detailed the various ways they are currently using an LLM in their clinical and nonclinical work. Only 29% (n=105) of 362 respondents indicated that ChatGPT should be used for patient care in its present state; however, 73.8% (273/368) reported they would use a HIPAA-compliant version of ChatGPT if one were available. Providers’ proposed future uses of LLMs in health care are described. Conclusions: Despite significant concerns and barriers to LLM use in health care, pediatric providers are already using LLMs at work. This study will give policy makers needed information about how providers are using LLMs clinically. %M 39265163 %R 10.2196/56797 %U https://formative.jmir.org/2024/1/e56797 %U https://doi.org/10.2196/56797 %U http://www.ncbi.nlm.nih.gov/pubmed/39265163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58791 %T Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation %A Kang,Boyoung %A Hong,Munpyo %+ Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 2 740 1770, bykang2015@gmail.com %K loneliness %K depression %K digital interventions %K college students %K mental health %K mixed methods evaluation %K Woebot %K Happify %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot (Woebot Health, Inc) and Happify (Twill Inc), have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed methods approach was used over 4 months. A total of 63 participants aged 18 to 27 years from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with an inclusion criterion of University of California, Los Angeles (UCLA) Loneliness Scale score ≥34. The final sample consisted of 27 participants due to attrition. Participants were randomly assigned to Woebot (15/27, 55%); Happify (9/27, 33%); or a control group using Bondee (Metadream), a metaverse social network messenger app (3/27, 11%). Quantitative measures (UCLA Loneliness Scale and Patient Health Questionnaire-9) and qualitative assessments (user feedback and focused interviews) were used. Results: Although mean decreases in loneliness and depression were observed in the control and intervention groups after the intervention, the differences between the control and intervention groups were not statistically significant (UCLA Loneliness: P=.67; Patient Health Questionnaire-9: P=.35). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, this study highlights the potential of well-designed digital interventions in alleviating college students’ loneliness and depression. The findings contribute to the growing body of research on accessible digital mental health tools and underscore the importance of comprehensive support systems. Further research with larger and more diverse samples is needed to better understand the effectiveness and optimization of such interventions. Trial Registration: Clinical Research Information Service KCT0009449; https://bit.ly/4d2e4Bu %M 39264705 %R 10.2196/58791 %U https://formative.jmir.org/2024/1/e58791 %U https://doi.org/10.2196/58791 %U http://www.ncbi.nlm.nih.gov/pubmed/39264705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48453 %T Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study %A Metz,Gido %A Thielmann,Rosa R L C %A Roosjen,Hanneke %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882435, g.metz@maastrichtuniversity.nl %K web-based intervention %K eHealth %K engagement %K potential impact %K mixed methods %K evaluation %K acyclic behavior change diagram %K web analytics %K think-aloud method %K web-based %K user %K chlamydia %K behavior change %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. Objective: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. Methods: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page’s aim of promoting STI testing, a relatively small percentage (n=4948, 14%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. Results: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. Conclusions: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general. %M 39259573 %R 10.2196/48453 %U https://formative.jmir.org/2024/1/e48453 %U https://doi.org/10.2196/48453 %U http://www.ncbi.nlm.nih.gov/pubmed/39259573 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57367 %T Overdose Detection Among High-Risk Opioid Users Via a Wearable Chest Sensor in a Supervised Injecting Facility: Protocol for an Observational Study %A Tas,Basak %A Lawn,Will %A Jauncey,Marianne %A Bartlett,Mark %A Dietze,Paul %A O'Keefe,Daniel %A Clark,Nico %A Henderson,Bruce %A Cowan,Catriona %A Meredith,Osian %A Strang,John %+ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences Building, London, SE5 8BB, United Kingdom, 44 2078480438, john.strang@kcl.ac.uk %K wearable sensor %K overdose %K opioid-related deaths %K injecting opioid use %K medically supervised injection center %K opioid induced respiratory depression %K mobile phone %K opioid overdose %K drug overdose %K Australia %K United States %K chest biosensor %K biosensor %K wearable device %K respiratory depression %K algorithm %K detection algorithm %K observational design %K illicit drugs %K safe injecting facilities %K naloxone %K wearable %D 2024 %7 10.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities. Objective: The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants’ acceptability of the chest biosensor. Methods: The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor’s ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study. Results: As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing. Conclusions: This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor’s potential step forward in real-time intervention strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/57367 %M 39255471 %R 10.2196/57367 %U https://www.researchprotocols.org/2024/1/e57367 %U https://doi.org/10.2196/57367 %U http://www.ncbi.nlm.nih.gov/pubmed/39255471 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51061 %T A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability %A Jin,William %A Montoya,Christopher %A Rich,Benjamin James %A Taswell,Crystal Seldon %A Noy,Miguel %A Kwon,Deukwoo %A Spieler,Benjamin %A Mahal,Brandon %A Abramowitz,Matthew %A Yechieli,Raphael %A Pollack,Alan %A Dal Pra,Alan %+ Department of Radiation Oncology, Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, United States, 1 3055851111, willhjin@gmail.com %K digital therapeutics %K behavioral intervention %K digital health %K prostate cancer %K radiation %K smart water bottle %K companion app %K oncology %K prostate %K privacy %K radiation therapy %K bladder %K compliance %K smartphone-based behavioral intervention %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Objective: Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. Methods: In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75% of the simulation’s volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80% (15/18) of patients used the device >50% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. Results: QLC was 100% in 375 out of 398 (94.2%) total treatments, while QNC was 88.9% in 341 out of 398 (85.7%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83% (15/18) of patients used the SBI on >50% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). Conclusions: This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. Trial Registration: ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214 %M 39255484 %R 10.2196/51061 %U https://cancer.jmir.org/2024/1/e51061 %U https://doi.org/10.2196/51061 %U http://www.ncbi.nlm.nih.gov/pubmed/39255484 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50356 %T Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study %A Abdul Aziz,Amani Fadzlina %A Ong,Tiffanie %+ Naluri Hidup Sdn Bhd, 22, Persiaran Damansara Endah, Bukit Damansara, Kuala Lumpur, 50490, Malaysia, 60 123072922, tiffanie@naluri.life %K digital behavioral coaching %K chronic disease management %K digital health %K mHealth %K workplace interventions %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=–0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=–11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. %M 39255013 %R 10.2196/50356 %U https://mhealth.jmir.org/2024/1/e50356 %U https://doi.org/10.2196/50356 %U http://www.ncbi.nlm.nih.gov/pubmed/39255013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46901 %T User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation %A Anderson,Ekaterina %A Moldestad,Megan %A Brunner,Julian %A Ball,Sherry %A Helfrich,Christian %A Orlander,Jay %A Rinne,Seppo %A Sayre,George %+ Center for Health Optimization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 7816874936, Ekaterina.Anderson@va.gov %K electronic health records %K United States Department of Veterans Affairs %K Veterans Affairs %K organizational change %K delivery of health care %K integrated %K medical informatics %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Department of Veterans Affairs (VA), the largest nationally integrated health system in the United States, is transitioning from its homegrown electronic health record (EHR) to a new vendor-based EHR, Oracle Cerner. Experiences of the first VA site to transition have been widely discussed in the media, but in-depth accounts based on rigorous research are lacking. Objective: We sought to explore employee perspectives on the rationale for, and value of, transitioning from a VA-tailored EHR to a vendor-based product. Methods: As part of a larger mixed methods, multisite, formative evaluation of VA clinician and staff experiences with the EHR transition, we conducted semistructured interviews at the Mann-Grandstaff VA Medical Center before, during, and after going live in October 2020. In total, we completed 122 interviews with 26 participants across multiple departments. Results: Before the new vendor-based EHR went live, participants initially expressed cautious optimism about the transition. However, in subsequent interviews following the go-live, participants increasingly critiqued the vendor’s understanding of VA’s needs, values, and workflows, as well as what they perceived as an inadequate fit between the functionalities of the new vendor-based EHR system and VA’s characteristic approach to care. As much as a year after going live, participants reiterated these concerns while also expressing a desire for substantive changes to the transition process, with some questioning the value of continuing with the transition. Conclusions: VA’s transition from a homegrown EHR to a vendor-based EHR system has presented substantial challenges, both practical and cultural in nature. Consequently, it is a valuable case study for understanding the sociotechnical dimension of EHR-to-EHR transitions. These findings have implications for both VA leadership and the broader community of policy makers, vendors, informaticists, and others involved in large-scale health information technology implementations. %M 39255006 %R 10.2196/46901 %U https://formative.jmir.org/2024/1/e46901 %U https://doi.org/10.2196/46901 %U http://www.ncbi.nlm.nih.gov/pubmed/39255006 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58347 %T Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics %A Wunderlich,Maximilian Markus %A Frey,Nicolas %A Amende-Wolf,Sandro %A Hinrichs,Carl %A Balzer,Felix %A Poncette,Akira-Sebastian %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Invalidenstraße 90, Berlin, 10115 Berlin, Germany, 49 030 450 581 018, akira-sebastian.poncette@charite.de %K patient monitoring %K intensive care unit %K ICU %K alarm fatigue %K alarm management %K patient safety %K alarm system %K alarm system quality %K medical devices %K clinical alarms %K COVID-19 %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue. Objective: We aimed to compare alarm situations between provisional COVID-19 ICUs and non–COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff. Methods: Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non–COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel. Results: COVID-19 ICUs had significantly more alarms per bed per day than non–COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19–specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04). Conclusions: Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings. %M 39250783 %R 10.2196/58347 %U https://medinform.jmir.org/2024/1/e58347 %U https://doi.org/10.2196/58347 %U http://www.ncbi.nlm.nih.gov/pubmed/39250783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59003 %T Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial %A Adu,Medard K %A Eboreime,Oghenekome %A Shalaby,Reham %A Eboreime,Ejemai %A Agyapong,Belinda %A da Luz Dias,Raquel %A Sapara,Adegboyega O %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 17802157771, vn602367@dal.ca %K major depressive disorder %K Text4Support %K SMS text messaging %K email messaging %K digital health %K mental health %K mobile phone %K depressive disorder %K health communication %K global health %K treatments %K patient %K text messaging-based %K cognitive behavioral therapy %K communication %K effectiveness %K mental health support %K digital intervention %K digital interventions %K mental health care %K well-being %K depression symptoms %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging–based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. Objective: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. Methods: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Results: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded “No” to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: –1.90, 95% CI –6.53 to 2.74; 5.78, 95% CI –1.94 to 13.50; and 11.85, 95% CI –3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. Conclusions: The study’s findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. Trial Registration: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/ %M 39250182 %R 10.2196/59003 %U https://formative.jmir.org/2024/1/e59003 %U https://doi.org/10.2196/59003 %U http://www.ncbi.nlm.nih.gov/pubmed/39250182 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58739 %T Problematic Social Media Use Among Italian Midadolescents: Protocol and Rationale of the SMART Project %A Donisi,Valeria %A Salerno,Laura %A Delvecchio,Elisa %A Brugnera,Agostino %+ Department of Philosophy, Social Sciences and Education, University of Perugia, Piazza Ermini 1, Perugia, 06123, Italy, 39 0755854943, elisa.delvecchio@unipg.it %K adolescents %K social media %K problematic social media use %K psychological distress %K wellbeing promotion %K eHealth interventions %K co-creation %K qualitative research %K biomarkers %D 2024 %7 9.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Social media (SM) use constitutes a large portion of midadolescents’ daily lives as a way of peer interaction. A significant percentage of adolescents experience intense or problematic social media use (PSMU), an etiologically complex behavior potentially associated with psychological distress. To date, studies longitudinally testing for risk or protective factors of PSMU, and collecting qualitative data are still scarce among midadolescents. Self-help interventions specifically targeting PSMU in this population and involving midadolescents in co-creation are needed. Objective: The 2-year SMART multicenter project aims to (1) advance knowledge on PSMU; (2) co-design an unguided self-help app for promoting awareness and functional SM use; and (3) test feasibility and provide preliminary findings on its effectiveness to further improve and adapt the app. Methods: The SMART project is organized in 3 phases: phase 1 will focus on knowledge advancement on PSMU and its risk and protective factors using a longitudinal design; phase 2 will explore adolescents perspectives using qualitative approach and will co-design an unguided self-help app for reducing PSMU, which will be evaluated and adapted in phase 3. Around 1500 midadolescents (aged 14-18 years) will be recruited in northern, central, and southern Italy to investigate the potential intra- and interpersonal psychological risk and protective factors for PSMU and define specific PSMU profiles and test for its association with psychological distress. Subjective (self-report) PSMU’s psychosocial risk or protective factors will be assessed at 3 different time points and Ecological Momentary Assessment (EMA) will be used. Moreover, focus groups will be performed in a subsample of midadolescents to collect the adolescents’ unique point of view on PSMU and experiences with SM. Those previous results will inform the self-help app, which will be co-designed through working groups with adolescents. Subsequently, the SMART app will be deployed and adapted, after testing its feasibility and potential effectiveness in a pilot study. Results: The project is funded by the Italian Ministry of University and Research as part of a national grant (PRIN, “Progetti di Rilevante Interesse Nazionale”). The research team received an official notice of research funding approval in July 2023 (Project Code 2022LC4FT7). The project was preregistered on Open Science Framework, while the ethics approval was obtained in November 2023. We started the enrollments in December 2023, with the final follow-up data to be collected within May 2025. Conclusions: The innovative aspects of the SMART project will deepen the conceptualization of PSMU and of its biopsychosocial antecedents among midadolescents, with relevant scientific, technological, and socioeconomic impacts. The advancement of knowledge and the developed self-help app for PSMU will timely respond to midadolescents’ increased loneliness and psychological burden due to COVID-19 pandemic and humanitarian crisis. Trial Registration: OSF Registries; https://osf.io/2ucnk/ International Registered Report Identifier (IRRID): DERR1-10.2196/58739 %M 39248403 %R 10.2196/58739 %U https://www.researchprotocols.org/2024/1/e58739 %U https://doi.org/10.2196/58739 %U http://www.ncbi.nlm.nih.gov/pubmed/39248403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57588 %T Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study %A Gehringer,James E %A Woodruff Jameson,Anne %A Boyer,Hailey %A Konieczny,Jennifer %A Thomas,Ryan %A Pierce III,James %A Cunha,Andrea B %A Willett,Sandra %+ Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, 985450 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025592562, james.gehringer@unmc.edu %K cerebral palsy %K HABIT %K home intervention %K virtual reality %K rehabilitation %K VR %K case study %K hand %K hands %K arm %K arms %K intensive training %K feasibility %K game %K games %K gaming %K hand arm bimanual intensive training %K motor %K movement %K home setting %K home-based %K child %K children %K male %K males %K men %K quasi-experimental %K parent %K parents %K intervention %K interventions %D 2024 %7 6.9.2024 %9 Case Report %J JMIR Form Res %G English %X This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting. %M 39241226 %R 10.2196/57588 %U https://formative.jmir.org/2024/1/e57588 %U https://doi.org/10.2196/57588 %U http://www.ncbi.nlm.nih.gov/pubmed/39241226 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54909 %T Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability %A Heinert,Sara W %A Guzman-Baez,Kelvin %A Aamir,Affan %A Penugonda,Ananya %A Crabtree,Benjamin F %A Greene,Kathryn %A Heckman,Carolyn J %A Levy,Phillip %A Strickland,Pamela Ohman %A Hudson,Shawna V %+ Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ, 08901, United States, 1 732 235 7872, sara.heinert@rutgers.edu %K hypertension %K adolescents %K adults %K emergency department %K digital health intervention %K dyad intervention %K intervention development %K qualitative research %K youth %K adolescent %K teen %K teens %K teenager %K teenagers %K adult %K youth-led %K digital health %K health education %K refinement %K acceptability %K USA %K United States %K care navigation %K effectiveness %K formative study %K prototype %K self-guided %K online module %K online modules %K engagement %K blood pressure %K health knowledge %K health promotion %K nutrition education %K support intervention %K support %K supports %D 2024 %7 6.9.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention’s concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. %M 39240662 %R 10.2196/54909 %U https://formative.jmir.org/2024/1/e54909 %U https://doi.org/10.2196/54909 %U http://www.ncbi.nlm.nih.gov/pubmed/39240662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59690 %T Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study %A Dougherty,Kylie %A Gebremariam,Abebe %A Biza,Heran %A Belew,Mulusew %A Benda,Natalie %A Tesfaye,Yihenew %A Cranmer,John %A Bakken,Suzanne %+ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, kylie.dougherty@northwestern.edu %K basic emergency obstetric care needs %K BEmOC %K supply chain %K Ethiopia %K Sociotechnical Model %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)—the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the “Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems” to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study’s findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. %M 39235860 %R 10.2196/59690 %U https://formative.jmir.org/2024/1/e59690 %U https://doi.org/10.2196/59690 %U http://www.ncbi.nlm.nih.gov/pubmed/39235860 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54051 %T The Relationship Between Symptom Change and Use of a Web-Based Self-Help Intervention for Parents of Children With Externalizing Behavior Disorders: Exploratory Study %A Wähnke,Laura %A Dose,Christina %A Klemp,Marie-Theres %A Mühlenmeister,Judith %A Plück,Julia %A Döpfner,Manfred %+ School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Pohligstr 9, Cologne, 50969, Germany, 49 47887774, laura.waehnke@uni-koeln.de %K web-based self-help %K eHealth %K parent management training %K externalizing symptom %K ADHD %K attention-deficit hyperactivity disorder %K self-help %K use %K child %K children %K parent %K parents %K management %K management training %K symptom %K symptoms %K caregiver %K ODD %K oppositional defiant disorder %K treatment %K web-based %K caregivers %K longitudinal data %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers’ use of WASH and symptom changes of child externalizing behaviors is lacking. Objective: This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children’s externalizing behavior symptoms. Methods: Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers’ use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers’ use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling). Results: Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms. Conclusions: The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers’ use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors). Trial Registration: German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-2481-0 %M 39231431 %R 10.2196/54051 %U https://pediatrics.jmir.org/2024/1/e54051 %U https://doi.org/10.2196/54051 %U http://www.ncbi.nlm.nih.gov/pubmed/39231431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57860 %T Evaluation of the Continuing Education Training “Beratende für Digitale Gesundheitsversorgung” (“Consultant for Digital Healthcare”): Protocol for an Effectiveness Study %A Kraft,Bernhard %A Kuscher,Thomas %A Zawatzki,Susann %A Hofstetter,Sebastian %A Jahn,Patrick %+ Health Service Research Working Group | Acute Care, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-str. 40, Halle (Saale), 06120, Germany, 49 345 557 4149, Bernhard.Kraft@uk-halle.de %K digitization %K digital-assistive technologies %K nursing and health care professionals %K further training program %K digital competence %K digital healthcare %K digital health %K effectiveness study %K training program %K nursing %K nursings %K health professional %K health professionals %K transfer of learning %K satisfaction %K mixed-method %K self-assessment %K Teaching Analysis Poll %K technology %K technologies %K innovation %K exploratory %K intervention %D 2024 %7 4.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The digital transformation in health care requires training nursing and health professionals in the digitally competent use of digital assistive technologies (DAT). The continuing education training “Beratende für digitale Gesundheitsversorgung” (“Consultant for Digital Healthcare”) was developed to fill this gap. The effectiveness of the training program will be assessed in this study. Objective: The primary objective is to record and measure the participants’ learning success. We will assess whether the previously defined teaching intentions, learning objectives, competencies, and participants’ expectations have been achieved and whether a transfer of learning occurred. The secondary objective is participant satisfaction and feasibility of the training. The tertiary objective is the successful transfer of DAT by participants in their institutions. Methods: Approximately 65 nursing and health care professionals will participate in the pilot phase of the further training and evaluation process, which is planned in a mixed methods design in a nonsequential manner. The different methods will be combined in the interpretation of the results to achieve a synaptic view of the training program. We plan to conduct pre-post surveys in the form of participant self-assessments about dealing with DAT and content-related knowledge levels. Exploratory individual interviews will also be conducted to build theory, to examine whether and to what extent competence (cognition) has increased, and whether dealing (affect) with DAT has changed. Furthermore, an interim evaluation within the framework of the Teaching Analysis Poll (TAP) will occur. The knowledge thereby gained will be used to revise and adapt the modules for future courses. To assess the transfer success, the participants create a practical project, which is carried out within the training framework, observed by the lecturers, and subsequently evaluated and adapted. Results: We expect that the learning objectives for the continuing education training will be met. The attendees are expected to increase their level of digital competence in different skills areas: (1) theoretical knowledge, (2) hands-on skills for planning the application and practical use of DAT, (3) reflective skills and applying ethical and legal considerations in their use, (4) applying all that in a structured process of technology implementation within their practical sphere of work. Conclusions: The aim of this study and appropriate further training program are to educate nursing and health care professionals in the use of DAT, thereby empowering them for a structured change process toward digitally aided care. This focus gives rise to the following research questions: First, how should further training programs be developed, and which focus is appropriate for addressee-appropriate learning goals, course structure, and general curriculum? Second, how should a training program with this specific content and area be evaluated? Third, what are the conditions to offer a continued program? International Registered Report Identifier (IRRID): PRR1-10.2196/57860 %M 39231424 %R 10.2196/57860 %U https://www.researchprotocols.org/2024/1/e57860 %U https://doi.org/10.2196/57860 %U http://www.ncbi.nlm.nih.gov/pubmed/39231424 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55852 %T Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study %A Pohl,Petra %A Klerfors,Karoline %A Kjörk,Emma K %+ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rehabiliteringsmedicin, Vita stråket 12, vån 4, Sahlgrenska universitetssjukhuset, Gothenburg, 41345, Sweden, 46 31 3422391, emma.kjork@neuro.gu.se %K e-health %K stroke %K Strokehälsa %K follow-up %K previsit %K person-centred care %K health literacy %K digital tool %K shared decision-making %K survey %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool “Strokehealth” was developed for patients to fill out in advance. The concept Strokehälsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. Objective: The study’s primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Methods: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. Results: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73% (58/80; 39 men). The majority (48/58, 83%) reported using the internet daily. Most respondents (56/58, 97%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. Conclusions: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Trial Registration: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135 %M 39226546 %R 10.2196/55852 %U https://humanfactors.jmir.org/2024/1/e55852 %U https://doi.org/10.2196/55852 %U http://www.ncbi.nlm.nih.gov/pubmed/39226546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57335 %T The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study %A Shetty,Shishir %A Mubarak,Auwalu Saleh %A R David,Leena %A Al Jouhari,Mhd Omar %A Talaat,Wael %A Al-Rawi,Natheer %A AlKawas,Sausan %A Shetty,Sunaina %A Uzun Ozsahin,Dilber %+ Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Building M31, Sharjah, 27272, United Arab Emirates, 971 556491740, dozsahin@sharjah.ac.ae %K convolutional neural networks %K nasal septal deviation %K cone beam computed tomography %K tomographic %K tomography %K nasal %K nose %K face %K facial %K image %K images %K imagery %K artificial intelligence %K CNN %K neural network %K neural networks %K ResNet %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. Objective: This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Methods: Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones—ResNet50, ResNet101, and MobileNet—were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. Results: The best-performing model—CEH-ResNet101—achieved a mean average precision of 0.911, with an area under the curve of 0.921. Conclusions: The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images. %M 39226096 %R 10.2196/57335 %U https://formative.jmir.org/2024/1/e57335 %U https://doi.org/10.2196/57335 %U http://www.ncbi.nlm.nih.gov/pubmed/39226096 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59088 %T Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study %A Mogk,Jessica %A Idu,Abisola E %A Bobb,Jennifer F %A Key,Dustin %A Wong,Edwin S %A Palazzo,Lorella %A Stefanik-Guizlo,Kelsey %A King,Deborah %A Beatty,Tara %A Dorsey,Caitlin N %A Caldeiro,Ryan M %A Garza McWethy,Angela %A Glass,Joseph E %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1360, Seattle, WA, 98101, United States, 1 206 287 2900, jessica.m.mogk@kp.org %K implementation %K digital therapeutics %K substance use disorder %K practice facilitation %K health coaching %K primary care %K mobile phone %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. Objective: This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. Methods: From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. Results: Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. Conclusions: The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. Trial Registration: ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045 %M 39222348 %R 10.2196/59088 %U https://formative.jmir.org/2024/1/e59088 %U https://doi.org/10.2196/59088 %U http://www.ncbi.nlm.nih.gov/pubmed/39222348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47246 %T Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Marshall,Shawn %+ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada, 1 6136126127, kbarn076@uottawa.ca %K telehealth %K remote care %K concussion %K mTBI %K mild traumatic brain injury %K assessment %K examination %K telemedicine %K remote care %K TBI %K traumatic brain injury %K brain injury %K Delphi %K measure %K measures %K measurement %K mobile phone %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. Objective: This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. Methods: The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. Results: In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Conclusions: Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. International Registered Report Identifier (IRRID): RR2-10.2196/40446 %M 39222352 %R 10.2196/47246 %U https://formative.jmir.org/2024/1/e47246 %U https://doi.org/10.2196/47246 %U http://www.ncbi.nlm.nih.gov/pubmed/39222352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56962 %T A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study %A Ayyaswami,Varun %A Subramanian,Jeevarathna %A Nickerson,Jenna %A Erban,Stephen %A Rosano,Nina %A McManus,David D %A Gerber,Ben S %A Faro,Jamie M %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3898 ext 63898, varun.ayyaswami@umassmed.edu %K remote patient monitoring %K physical activity %K electronic health record %K wearable device %K patient monitoring %K health monitoring %K health monitor %K patient monitor %K remote patient monitor %K exercise %K exercises %K electronic health records %K patient record %K health record %K health records %K wearable devices %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. Objective: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)–integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. Methods: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. Results: In total, 3 themes were identified from provider interviews: (1) providers’ knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. Conclusions: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting. %M 39221852 %R 10.2196/56962 %U https://formative.jmir.org/2024/1/e56962 %U https://doi.org/10.2196/56962 %U http://www.ncbi.nlm.nih.gov/pubmed/39221852 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e52631 %T Objective Comparison of the First-Person–View Live Streaming Method Versus Face-to-Face Teaching Method in Improving Wound Suturing Skills for Skin Closure in Surgical Clerkship Students: Randomized Controlled Trial %A Halim,Freda %A Widysanto,Allen %A Wahjoepramono,Petra Octavian Perdana %A Candrawinata,Valeska Siulinda %A Budihardja,Andi Setiawan %A Irawan,Andry %A Sudirman,Taufik %A Christina,Natalia %A Koerniawan,Heru Sutanto %A Tobing,Jephtah Furano Lumban %A Sungono,Veli %A Marlina,Mona %A Wahjoepramono,Eka Julianta %K teaching method %K live streaming %K first-person view %K face-to-face %K simple wound suturing %D 2024 %7 30.8.2024 %9 %J JMIR Med Educ %G English %X Background: The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person–view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills. Objective: This study aims to objectively assess the effectiveness of the first-person–view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students. Methods: A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed. Results: A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant’s pre-experiment and postexperiment DOPS scores revealed that the LS method’s outcome is comparable to the FTF method’s outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students’ surgical skills. Conclusions: First-person–view LS training sessions could enhance students’ ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method. Trial Registration: ClinicalTrials.gov NCT06221917; https://clinicaltrials.gov/study/NCT06221917 %R 10.2196/52631 %U https://mededu.jmir.org/2024/1/e52631 %U https://doi.org/10.2196/52631 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54252 %T Examining a Fully Automated Mobile-Based Behavioral Activation Intervention in Depression: Randomized Controlled Trial %A Santopetro,Nicholas %A Jones,Danielle %A Garron,Andrew %A Meyer,Alexandria %A Joyner,Keanan %A Hajcak,Greg %K digital intervention %K digital health %K digital application %K digital applications %K mobile health %K mHealth %K automation %K automate %K automated %K behavioral activation %K BA %K BA intervention %K depression %K depressed %K depressive %K depressive symptoms %K anhedonia %K anhedonia symptoms %K anxiety %K anxious %K anxiety symptoms %K adults %K adult %K psychiatry %K psych %K psychology %K major depressive disorder %K MDD %D 2024 %7 30.8.2024 %9 %J JMIR Ment Health %G English %X Background: Despite significant progress in our understanding of depression, prevalence rates have substantially increased in recent years. Thus, there is an imperative need for more cost-effective and scalable mental health treatment options, including digital interventions that minimize therapist burden. Objective: This study focuses on a fully automated digital implementation of behavioral activation (BA)—a core behavioral component of cognitive behavioral therapy for depression. We examine the efficacy of a 1-month fully automated SMS text message–based BA intervention for reducing depressive symptoms and anhedonia. Methods: To this end, adults reporting at least moderate current depressive symptoms (8-item Patient Health Questionnaire score ≥10) were recruited online across the United States and randomized to one of three conditions: enjoyable activities (ie, BA), healthy activities (ie, an active control condition), and passive control (ie, no contact). Participants randomized to enjoyable and healthy activities received daily SMS text messages prompting them to complete 2 activities per day; participants also provided a daily report on the number and enjoyment of activities completed the prior day. Results: A total of 126 adults (mean age 32.46, SD 7.41 years) with current moderate depressive symptoms (mean score 16.53, SD 3.90) were recruited. Participants in the enjoyable activities condition (BA; n=39) experienced significantly greater reductions in depressive symptoms compared to participants in the passive condition (n=46). Participants in both active conditions—enjoyable activities and healthy activities (n=41)—reported reduced symptoms of anxiety compared to those in the control condition. Conclusions: These findings provide preliminary evidence regarding the efficacy of a fully automated digital BA intervention for depression and anxiety symptoms. Moreover, reminders to complete healthy activities may be a promising intervention for reducing anxiety symptoms. Trial Registration: ClincalTrials.gov NCT06492824; https://clinicaltrials.gov/study/NCT06492824 %R 10.2196/54252 %U https://mental.jmir.org/2024/1/e54252 %U https://doi.org/10.2196/54252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54800 %T Assessing the Feasibility and Acceptability of Smart Speakers in Behavioral Intervention Research With Older Adults: Mixed Methods Study %A Quinn,Kelly %A Leiser Ransom,Sarah %A O'Connell,Carrie %A Muramatsu,Naoko %A Marquez,David X %A Chin,Jessie %+ Department of Communication, University of Illinois Chicago, 1007 W Harrison St, 1140 BSB, MC 132, Chicago, IL, 60607, United States, 1 312 996 3187, kquinn8@uic.edu %K smart speakers %K physical activity %K older adults %K behavioral health %K intervention %K smart device %K smart devices %K conversational agent %K physical activities %K behavioral intervention %K intervention research %D 2024 %7 30.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smart speakers, such as Amazon’s Echo and Google’s Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. Objective: This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. Methods: Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. Results: Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. Conclusions: Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention. %R 10.2196/54800 %U https://www.jmir.org/2024/1/e54800 %U https://doi.org/10.2196/54800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56332 %T Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions %A Naimark,Jody %A Tinetti,Mary E %A Delbanco,Tom %A Dong,Zhiyong %A Harcourt,Kendall %A Esterson,Jessica %A Charpentier,Peter %A Walker,Jan %+ Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, HVMA Annex, Suite 2200, Boston, MA, 02215, United States, 1 6177541416, jwalker1@bidmc.harvard.edu %K electronic pre-visit questionnaire %K patient portal %K multimorbidity %K care priorities %K goal %K goals %K priority %K priorities %K care plan %K care plans %K questionnaire %K questionnaires %K previsit %K pre-visit %K portal %K portals %K electronic health record %K EHR %K records %K record %K engagement %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %D 2024 %7 29.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients’ priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. Objective: The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. Methods: The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website’s questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. Results: In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. Conclusions: Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care. %M 39207829 %R 10.2196/56332 %U https://formative.jmir.org/2024/1/e56332 %U https://doi.org/10.2196/56332 %U http://www.ncbi.nlm.nih.gov/pubmed/39207829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51690 %T Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study %A Vakili,Negar %A Curran,Janet A %A Walls,Roisin %A Phillips,Debbie %A Miller,Alanna %A Cassidy,Christine %A Wozney,Lori %+ Mental Health and Addictions, IWK Health, 5850/5980 University Avenue, Halifax, NS, PO Box 9700, Canada, 1 902 719 9285, lori.wozney@iwk.nshealth.ca %K patient satisfaction %K satisfaction %K cross-sectional %K survey %K surveys %K engagement %K usage %K technology use %K transitional %K transition %K coordinated care %K service %K services %K feature %K features %K need %K needs %K transitional care %K information science %K human-computer interaction %K health behavior %K text-messaging %K messaging %K text messages %K text message %K SMS %K mental health %K persuasive system design %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message–based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. Results: A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. %M 39190437 %R 10.2196/51690 %U https://formative.jmir.org/2024/1/e51690 %U https://doi.org/10.2196/51690 %U http://www.ncbi.nlm.nih.gov/pubmed/39190437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55476 %T Recognition of Forward Head Posture Through 3D Human Pose Estimation With a Graph Convolutional Network: Development and Feasibility Study %A Lee,Haedeun %A Oh,Bumjo %A Kim,Seung-Chan %+ Machine Learning Systems Laboratory, School of Sports Science, Sungkyunkwan University, Seoburo 2066, Suwon, Gyunggi-do, 16419, Republic of Korea, 82 31 299 6918, seungchan@ieee.org %K posture correction %K injury prediction %K human pose estimation %K forward head posture %K machine learning %K graph convolutional networks %K posture %K graph neural network %K graph %K pose %K postural %K deep learning %K neural network %K neural networks %K upper %K algorithms %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prolonged improper posture can lead to forward head posture (FHP), causing headaches, impaired respiratory function, and fatigue. This is especially relevant in sedentary scenarios, where individuals often maintain static postures for extended periods—a significant part of daily life for many. The development of a system capable of detecting FHP is crucial, as it would not only alert users to correct their posture but also serve the broader goal of contributing to public health by preventing the progression of chronic injuries associated with this condition. However, despite significant advancements in estimating human poses from standard 2D images, most computational pose models do not include measurements of the craniovertebral angle, which involves the C7 vertebra, crucial for diagnosing FHP. Objective: Accurate diagnosis of FHP typically requires dedicated devices, such as clinical postural assessments or specialized imaging equipment, but their use is impractical for continuous, real-time monitoring in everyday settings. Therefore, developing an accessible, efficient method for regular posture assessment that can be easily integrated into daily activities, providing real-time feedback, and promoting corrective action, is necessary. Methods: The system sequentially estimates 2D and 3D human anatomical key points from a provided 2D image, using the Detectron2D and VideoPose3D algorithms, respectively. It then uses a graph convolutional network (GCN), explicitly crafted to analyze the spatial configuration and alignment of the upper body’s anatomical key points in 3D space. This GCN aims to implicitly learn the intricate relationship between the estimated 3D key points and the correct posture, specifically to identify FHP. Results: The test accuracy was 78.27% when inputs included all joints corresponding to the upper body key points. The GCN model demonstrated slightly superior balanced performance across classes with an F1-score (macro) of 77.54%, compared to the baseline feedforward neural network (FFNN) model’s 75.88%. Specifically, the GCN model showed a more balanced precision and recall between the classes, suggesting its potential for better generalization in FHP detection across diverse postures. Meanwhile, the baseline FFNN model demonstrates a higher precision for FHP cases but at the cost of lower recall, indicating that while it is more accurate in confirming FHP when detected, it misses a significant number of actual FHP instances. This assertion is further substantiated by the examination of the latent feature space using t-distributed stochastic neighbor embedding, where the GCN model presented an isotropic distribution, unlike the FFNN model, which showed an anisotropic distribution. Conclusions: Based on 2D image input using 3D human pose estimation joint inputs, it was found that it is possible to learn FHP-related features using the proposed GCN-based network to develop a posture correction system. We conclude the paper by addressing the limitations of our current system and proposing potential avenues for future work in this area. %M 39186772 %R 10.2196/55476 %U https://formative.jmir.org/2024/1/e55476 %U https://doi.org/10.2196/55476 %U http://www.ncbi.nlm.nih.gov/pubmed/39186772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58121 %T Beta Test of a Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FaithCore): Development and Usability Study %A Sharma,Pravesh %A Tranby,Brianna %A Kamath,Celia %A Brockman,Tabetha A %A Lenhart,Ned %A Quade,Brian %A Abuan,Nate %A Halom,Martin %A Staples,Jamie %A Young,Colleen %A Brewer,LaPrincess %A Patten,Christi %+ Department of Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple St, Eau Claire, WI, 54703, United States, 1 715 838 5369, sharma.pravesh@mayo.edu %K social media %K Facebook %K rural %K smoking %K cessation %K quitline %K community-based participatory research %K CBPR %K FaithCore %K mobile phone %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living in rural communities experience substantial geographic and infrastructure barriers to attaining health equity in accessing tobacco use cessation treatment. Social media and other digital platforms offer promising avenues to improve access and overcome engagement challenges in tobacco cessation efforts. Research has also shown a positive correlation between faith-based involvement and a lower likelihood of smoking, which can be used to engage rural communities in these interventions. Objective: This study aimed to develop and beta test a social intervention prototype using a Facebook (Meta Platforms, Inc) group specifically designed for rural smokers seeking evidence-based smoking cessation resources. Methods: We designed a culturally aligned and faith-aligned Facebook group intervention, FaithCore, tailored to engage rural people who smoke in smoking cessation resources. Both intervention content and engagement strategies were guided by community-based participatory research principles. Given the intervention’s focus on end users, that is, rural people who smoked, we conducted a beta test to assess any technical or usability issues of this intervention before any future trials for large-scale implementation. Results: No critical beta test technical and usability issues were noted. Besides, the FaithCore intervention was helpful, easy to understand, and achieved its intended goals. Notably, 90% (9/10) of the participants reported that they tried quitting smoking, while 90% (9/10) reported using or seeking cessation resources discussed within the group. Conclusions: This study shows that social media platform with culturally aligned and faith-aligned content and engagement strategies delivered by trained moderators are promising for smoking cessation interventions in rural communities. Our future step is to conduct a large pilot trial to evaluate the intervention’s effectiveness on smoking cessation outcomes. %M 39186365 %R 10.2196/58121 %U https://formative.jmir.org/2024/1/e58121 %U https://doi.org/10.2196/58121 %U http://www.ncbi.nlm.nih.gov/pubmed/39186365 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50944 %T Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study %A Chambers,Laura C %A Malyuta,Yelena %A Goedel,William C %A Chan,Philip A %A Sutten Coats,Cassandra %A Allen,Ken %A Nunn,Amy S %K social marketing %K sexually transmitted infection %K HIV %K sexual and gender minorities %K sexual health %K gay %K MSM %K men who have sex with men %K STI %K testing %K digital marketing %K digital %K campaign %K promote %K treatment %K prevention %K bisexual %K advertisement %K Google display %K Grindr %K Facebook %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective: We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods: We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results: Overall, Google Search yielded the highest click-through rate (7.1%) and conversion rate (7.0%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4%‐3.3%; conversion rates=0%‐0.03%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion—which measures the number of people intending to attend the clinic for services—was substantially lower for Google Search (US $48.19 vs US $3120.42-US $3436.03). Conclusions: Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches. %R 10.2196/50944 %U https://publichealth.jmir.org/2024/1/e50944 %U https://doi.org/10.2196/50944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56380 %T Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study %A Miki,Takahiro %A Yamada,Junya %A Ishida,Shinpei %A Sakui,Daisuke %A Kanai,Masashi %A Hagiwara,Yuta %+ PREVENT Inc, 1 Aoi, Higashi-ku, IKKO Shinsakae Building 9F, Aichi, 461-0004, Japan, 81 8092149725, miki.takahiro@prevent.co.jp %K mobile health %K chronic ischemic heart disease %K disease management program %K mobile phone %K behavior change %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. %M 39173150 %R 10.2196/56380 %U https://formative.jmir.org/2024/1/e56380 %U https://doi.org/10.2196/56380 %U http://www.ncbi.nlm.nih.gov/pubmed/39173150 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e57990 %T Assessing Predictive Factors of Attitudes Toward Peer-Supported Mental Health Interventions in the Metaverse: Mixed Methods Study %A Ramos,Francisco Nicolas %A Bernstein,Rachel A %A Ezawa,Iony D %+ Department of Psychology, University of Southern California, 3620 S McClintock Ave, Los Angeles, CA, 90089, United States, 1 (213) 740 2203, ezawa@usc.edu %K metaverse %K mental health intervention %K consumer attitude %K digital mental health intervention %K virtual world %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: The metaverse is a promising avenue for accessible, effective digital mental health treatments. However, general attitudes toward peer-supported metaverse mental health interventions (MMHIs) remain largely unexplored. Objective: This study examined the relation of sociodemographic, mental health, and technology factors in predicting attitudes toward MMHIs. Methods: We used a mixed methods design with a self-report online survey (N=545 participants) to assess participant attitudes toward MMHIs and sociodemographic, mental health, and technology factors. Ordinal logistic regression was used to examine predictors of general interest in peer-supported MMHIs and binary logistic regression to examine predictors of preference for MMHIs versus face-to-face interventions. Inductive content analysis was performed on 483 open-ended responses regarding intervention preference. Results: Older age (odds ratio [OR] 1.03, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.44, 95% CI 1.25-1.66; P<.001), more positive mental help–seeking attitudes (OR 1.22, 95% CI 1.06-1.42; P=.007), more online video game use (OR 1.26, 95% CI 1.09-1.44; P=.001), and greater virtual reality experience (OR 1.55, 95% CI 1.28-1.90; P<.001) were associated with greater odds of reporting more interest in MMHIs. Internet access was associated with greater odds of reporting less interest in MMHIs (OR 0.50, 95% CI 0.30-0.84; P=.01). Hispanic ethnicity (OR 1.81, 95% CI 1.13-2.90; P=.01), older age (OR 1.04, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.28, 95% CI 1.09-1.51; P=.003), smartphone access (OR 10.46, 95% CI 2.87-50.71; P<.001), higher self-reported video game use (OR 1.25, 95% CI 1.05-1.48; P=.01), and more positive computer attitudes (OR 1.05, 95% CI 1.01-1.10; P=.02) predicted greater odds of preference for MMHIs (versus face-to-face interventions), whereas the male gender (OR 0.43, 95% CI 0.28-0.68; P<.001), internet access (OR 0.12, 95% CI 0.02-0.40; P=.002), more positive mental help–seeking attitudes (OR 0.76, 95% CI 0.62-0.92; P=.005), and moderately severe (OR 0.20, 95% CI 0.07-0.51; P=.001) and severe (OR 0.26, 95% CI 0.08-0.79; P=.02) levels of depression symptoms predicted lower odds of preference for MMHIs. Qualitative analysis revealed 14 themes describing reasons for intervention preference. Anonymity (133/483, 27.5%), social aversion (38/483, 7.9%), ease of use and accessibility (35/483, 7.2%), anxiety (28/483, 5.8%), and comfort (26/483, 5.4%) tended to be endorsed by those preferring MMHIs. Ecological validity of social interactions (99/483, 20.5%), ecological validity of interventions (75/483, 15.5%), aversion/distrust toward technology (42/483, 8.7%), impersonal quality (31/483, 6.4%), and immersion/engagement (11/483, 2.3%) tended to be endorsed by those who preferred face-to-face interventions. Mental health attitudes (28/483, 5.8%), privacy (19/483, 3.9%), and miscellaneous reasons (46/483, 9.5%) were endorsed equally between preferences. Novelty (21/483, 4.3%) was most cited by those who expressed no preference. Conclusions: This study identified several factors associated with attitudes toward peer-supported MMHIs, which may be leveraged to inform mental health outreach to interested populations. %R 10.2196/57990 %U https://xr.jmir.org/2024/1/e57990 %U https://doi.org/10.2196/57990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50128 %T Live Streaming of the Professor’s Ward Rounds in Undergraduate Neurology Education: Usability Study %A Sekiguchi,Kenji %A Kawano,Seiji %A Chihara,Norio %A Satomi-Kobayashi,Seimi %A Maeda,Eiichi %A Matsumoto,Riki %+ Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, 6500017, Japan, 81 783825885, sekiguch@med.kobe-u.ac.jp %K live streaming %K ward round %K web conferencing software %K neurological examination %K undergraduate education %K medical student %K medical education %K rounds %K remote education %K video-conferencing %K residents %K live-stream %K neurology %K neuroscience %K web conferencing %K distance education %K technology enhanced learning %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients’ personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants’ satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. %M 39172503 %R 10.2196/50128 %U https://formative.jmir.org/2024/1/e50128 %U https://doi.org/10.2196/50128 %U http://www.ncbi.nlm.nih.gov/pubmed/39172503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50580 %T Capturing Patients’ and Clinicians’ Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis %A Shaker,Ali Abbas %A Simonsen,Erik %A Tarp,Kristine %A Borisov,Radoslav Aleksandrov %A Sørensen,John Aasted %A Bechmann,Henrik %A Austin,Stephen F %+ Psychiatric Research Unit, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K telemedicine %K telepsychiatry %K video consultation %K mobile health %K mHealth %K COVID-19 %K synchronous technology %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. Objective: The aim of this study was to investigate patients’ and clinicians’ experiences and attitudes toward using VCs in clinical practice. Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians’ experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients’ and clinicians’ perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions. %M 39167796 %R 10.2196/50580 %U https://formative.jmir.org/2024/1/e50580 %U https://doi.org/10.2196/50580 %U http://www.ncbi.nlm.nih.gov/pubmed/39167796 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e54724 %T Use of Immersive Virtual Reality in Nursing Homes for People With Dementia: Feasibility Study to Assess Cognitive, Motor, and Emotional Responses %A Prinz,Alexander %A Buerger,Dan %A Krafft,Jelena %A Bergmann,Matteo %A Woll,Alexander %A Barisch-Fritz,Bettina %A Witte,Kerstin %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 49049244, bettina.barisch-fritz@kit.edu %K persons with dementia %K virtual reality %K VR %K immersive virtual reality %K iVR %K head-mounted display %K HMD %K physical performance %K physical activity %K physical function %K motor performance %K Alzheimer’s disease %K Alzheimer’s %K Alzheimer’s treatment %K Alzheimer’s care %K Alzheimer’s symptom control %K dementia %K dementia therapy %K dementia care %K cognitive decline %K cognitive impairment %K cognitive impairments %K neurocognition %K neurology %K neurologist %K neurologists %K nursing home %K nursing homes %K nursing facility %K senior home %K long-term care center %K long-term care facility %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Physical activity interventions for people with dementia have shown promising effects in improving cognition and physical function or slowing disease-related decline. Immersive virtual reality (iVR), using head-mounted displays, facilitates realistic experiences by blurring the boundaries between VR and the real world. The use of iVR for people with dementia offers the potential to increase active time and improve dementia therapy and care through exercise interventions. However, the feasibility of using VR use in people with dementia, considering changes in motor, cognitive, psychological, and physiological parameters, remains insufficiently investigated. Objective: This study aims to investigate the feasibility of using iVR in people with dementia or mild cognitive impairment in nursing homes. Specifically, we examined changes in motor performance (balance and mobility), cognitive performance (global cognition and executive functions), emotional responses, and fear of falling using iVR. Methods: Utilizing a pre-post design, this study recruited 35 participants with mild-to-moderate dementia, assessed by the Mini-Mental State Examination (MMSE). Participants underwent a single session involving iVR exposure, with pre- and postexposure assessments and a feedback form, to exclude negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance. The use of iVR involved 4 scenes, with a total length of 8 minutes. These scenes depicted a park with short and rather passive impressions presented as a 360° video in a head-mounted display. Before and after using the iVR, cognitive parameters were assessed using the Trail-Making Test A (TMT-A), motor parameters were assessed using the FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques-4) and Timed-Up-and-Go (TUG) tests, and psychological parameters were assessed using the Dementia Mood Picture Test, State-Trait Anxiety Inventory, and Short Falls Efficacy Scale-International (Short FES-I). The Emotion Rating Scale and the duration of use were recorded during use, and a feedback questionnaire was completed afterward in addition to the posttests. Paired t tests and Wilcoxon tests were used to examine pre-post differences. Results: Of the 35 initial participants, 33 completed the study, which corresponds to a dropout rate of 6%. All 33 participants, who had a mean of 83.71 (SD 5.01) years, had dementia. They showed no statistically significant difference in cognitive and motor performance before and after iVR use. Thus, no negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance were observed. The emotion rating scale also showed that 72% (n=24) felt joy and fun during iVR use, 100% (n=33) showed no emotions such as fear, sadness, or anger, and 93% (n=31) were attentive during iVR use. Conclusions: The feasibility of using iVR for people with dementia can be rated positively. There were no changes in motor, cognitive, or emotional parameters that would increase the risk of falls or other negative emotional reactions during or after iVR use. Further studies are needed to investigate prolonged use in a more stimulating computer-generated environment and possible physical and cognitive tasks for people with dementia in nursing homes. Trial Registration: German Clinical Trials Register DRKS00030616; https://drks.de/search/de/trial/DRKS00030616 %R 10.2196/54724 %U https://xr.jmir.org/2024/1/e54724 %U https://doi.org/10.2196/54724 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59963 %T Development of an mHealth App by Experts for Queer Individuals’ Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study %A Seretlo,Raikane James %A Smuts,Hanlie %A Mokgatle,Mathildah Mpata %+ Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, Tshwane, 0208, South Africa, 27 012 521 4111, Raikane.seretlo@smu.ac.za %K experts %K mobile health app %K mHealth app %K digital health care %K telemedicine %K digital innovation %K sexual-reproductive health care services and needs %K lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities %K LBQTQIA+ %K queer individuals %K nominal group technique %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. %M 39167434 %R 10.2196/59963 %U https://formative.jmir.org/2024/1/e59963 %U https://doi.org/10.2196/59963 %U http://www.ncbi.nlm.nih.gov/pubmed/39167434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54097 %T Machine Learning Model for Anesthetic Risk Stratification for Gynecologic and Obstetric Patients: Cross-Sectional Study Outlining a Novel Approach for Early Detection %A Tsai,Feng-Fang %A Chang,Yung-Chun %A Chiu,Yu-Wen %A Sheu,Bor-Ching %A Hsu,Min-Huei %A Yeh,Huei-Ming %+ Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung Shan South Road (Zhongshan South Road), Zhongzheng District, Taipei, 100225, Taiwan, 886 223123456 ext 2662158, y.y.hhmm@hotmail.com %K gradient boosting machine %K comorbidity %K gynecological and obstetric procedure %K ASA classification %K American Society of Anesthesiologists %K preoperative evaluation %K machine learning %K machine learning model %K gynecology %K obstetrics %K early detection %K artificial intelligence %K physiological %K gestational %K anesthetic risk %K clinical laboratory data %K laboratory data %K risk %K risk classification %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Preoperative evaluation is important, and this study explored the application of machine learning methods for anesthetic risk classification and the evaluation of the contributions of various factors. To minimize the effects of confounding variables during model training, we used a homogenous group with similar physiological states and ages undergoing similar pelvic organ–related procedures not involving malignancies. Objective: Data on women of reproductive age (age 20-50 years) who underwent gestational or gynecological surgery between January 1, 2017, and December 31, 2021, were obtained from the National Taiwan University Hospital Integrated Medical Database. Methods: We first performed an exploratory analysis and selected key features. We then performed data preprocessing to acquire relevant features related to preoperative examination. To further enhance predictive performance, we used the log-likelihood ratio algorithm to generate comorbidity patterns. Finally, we input the processed features into the light gradient boosting machine (LightGBM) model for training and subsequent prediction. Results: A total of 10,892 patients were included. Within this data set, 9893 patients were classified as having low anesthetic risk (American Society of Anesthesiologists physical status score of 1-2), and 999 patients were classified as having high anesthetic risk (American Society of Anesthesiologists physical status score of >2). The area under the receiver operating characteristic curve of the proposed model was 0.6831. Conclusions: By combining comorbidity information and clinical laboratory data, our methodology based on the LightGBM model provides more accurate predictions for anesthetic risk classification. Trial Registration: Research Ethics Committee of the National Taiwan University Hospital 202204010RINB; https://www.ntuh.gov.tw/RECO/Index.action %M 38991090 %R 10.2196/54097 %U https://formative.jmir.org/2024/1/e54097 %U https://doi.org/10.2196/54097 %U http://www.ncbi.nlm.nih.gov/pubmed/38991090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55641 %T Comparing the Output of an Artificial Intelligence Algorithm in Detecting Radiological Signs of Pulmonary Tuberculosis in Digital Chest X-Rays and Their Smartphone-Captured Photos of X-Ray Films: Retrospective Study %A Ridhi,Smriti %A Robert,Dennis %A Soren,Pitamber %A Kumar,Manish %A Pawar,Saniya %A Reddy,Bhargava %+ Qure.ai, 2nd floor, Prestige Summit, Halasuru, Bangalore, 560042, India, 91 9611981003, dennis.robert.nm@gmail.com %K artificial intelligence %K AI %K deep learning %K early detection %K tuberculosis %K TB %K computer-aided detection %K diagnostic accuracy %K chest x-ray %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) based computer-aided detection devices are recommended for screening and triaging of pulmonary tuberculosis (TB) using digital chest x-ray (CXR) images (soft copies). Most AI algorithms are trained using input data from digital CXR Digital Imaging and Communications in Medicine (DICOM) files. There can be scenarios when only digital CXR films (hard copies) are available for interpretation. A smartphone-captured photo of the digital CXR film may be used for AI to process in such a scenario. There is a gap in the literature investigating if there is a significant difference in the performance of AI algorithms when digital CXR DICOM files are used as input for AI to process as opposed to photos of the digital CXR films being used as input. Objective: The primary objective was to compare the agreement of AI in detecting radiological signs of TB when using DICOM files (denoted as CXRd) as input versus when using smartphone-captured photos of digital CXR films (denoted as CXRp) with human readers. Methods: Pairs of CXRd and CXRp images were obtained retrospectively from patients screened for TB. AI results were obtained using both the CXRd and CXRp files. The majority consensus on the presence or absence of TB in CXR pairs was obtained from a panel of 3 independent radiologists. The positive and negative percent agreement of AI in detecting radiological signs of TB in CXRd and CXRp were estimated by comparing with the majority consensus. The distribution of AI probability scores was also compared. Results: A total of 1278 CXR pairs were analyzed. The positive percent agreement of AI was found to be 92.22% (95% CI 89.94-94.12) and 90.75% (95% CI 88.32-92.82), respectively, for CXRd and CXRp images (P=.09). The negative percent agreement of AI was 82.08% (95% CI 78.76-85.07) and 79.23% (95% CI 75.75-82.42), respectively, for CXRd and CXRp images (P=.06). The median of the AI probability score was 0.72 (IQR 0.11-0.97) in CXRd and 0.72 (IQR 0.14-0.96) in CXRp images (P=.75). Conclusions: We did not observe any statistically significant differences in the output of AI in digital CXRs and photos of digital CXR films. %M 39167435 %R 10.2196/55641 %U https://formative.jmir.org/2024/1/e55641 %U https://doi.org/10.2196/55641 %U http://www.ncbi.nlm.nih.gov/pubmed/39167435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49589 %T Effect of the Implementation of a Multiple-Behavior Self-Monitoring Intervention on Dietary Intake in Type 2 Diabetes: Secondary Data Analysis %A Ko,Jisook %A Wang,Jing %A Mbue,Ngozi %A Schembre,Susan %A Cron,Stanley %+ Florida State University, 98 Varsity Way, Tallahassee, FL, FL32306, United States, 1 850 644 3299, jingwang@nursing.fsu.edu %K electronic diary %K technology-assisted self-monitoring %K multiple-behavior intervention %K type 2 diabetes %K diabetes %K self-monitoring %K monitoring %K dietary intake %K monitor %K carbohydrate intake %K calories %K education %K diabetic %K e-diary %K e diary %K self-care %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An electronic diary embedded in a mobile device to monitor lifestyle can be as effective as traditional methods. However, the efficacy of self-monitoring multiple behaviors for dietary intake has not been well studied in people with diabetes. Objective: This study aimed to compare the effect of using technology-assisted self-monitoring versus paper diaries on changes in dietary intake. Methods: This is a secondary analysis of data collected from 39 people with type 2 diabetes as part of a 3-month pilot clinical trial. Changes in energy intake and the contribution of total fat intake and total carbohydrate intake to total calories (%) from baseline to after intervention (3 months) were evaluated. Results: In total, 26 (67%) of the 39 participants preferred mobile diaries over paper diaries. Participants in the mobile diary group showed slightly higher self-monitoring adherence. Linear mixed modeling results indicated a significant overall decrease in total energy intake (P=.005), dietary fat intake (P=.01), and carbohydrate intake (P=.08) from baseline to 3 months. No significant group differences were detected (P>.05). Conclusions: The implementation of a 3-month, multiple-behavior, self-monitoring intervention in Diabetes Self-Management Education programs has resulted in successful reduction in dietary intake (energy, fat, and carbohydrate), whichever self-monitoring method is chosen by participants according to their preferences. Long-term studies are needed to confirm our findings on dietary intake and examine other behavioral and disease outcomes that require monitoring. %M 39163595 %R 10.2196/49589 %U https://formative.jmir.org/2024/1/e49589 %U https://doi.org/10.2196/49589 %U http://www.ncbi.nlm.nih.gov/pubmed/39163595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56921 %T Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study %A Klassen,Stephen A %A Jabbar,Jesica %A Osborne,Jenna %A Iannarelli,Nathaniel J %A Kirby,Emerson S %A O'Leary,Deborah D %A Locke,Sean %+ Faculty of Applied Health Sciences, Brock University, 1812 Sir Issac Brock Way, St. Catharines, ON, L2S 3A1, Canada, 1 9056885550, slocke@brocku.ca %K pulse interval %K mobile app %K validation %K mHealth %K mHealth app %K app mobile device %K mobile device app %K pulse %K heart %K heart rate %K validation study %K biomarker %K psychological %K physiological %K pulse rate %K young adults %K youth %K linear correlation %K heart rate variability %K examining %K examine %K validity %K psychological health %K physiological health %K interval data %K mobile phone %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers’ ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (–1.56, SD 1.86; 95% CI –5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant’s beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. %M 39163099 %R 10.2196/56921 %U https://formative.jmir.org/2024/1/e56921 %U https://doi.org/10.2196/56921 %U http://www.ncbi.nlm.nih.gov/pubmed/39163099 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56319 %T Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach %A Franco,Pamela %A Olhaberry,Marcia %A Muzard,Antonia %A Harismendy,Ángeles %A Kelders,Saskia %+ Centre for eHealth & Well-being Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0 534899180, s.m.kelders@utwente.nl %K internet-based intervention %K postpartum depression %K user-centered development %K perinatal mental health %K user-centered design %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders’ openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype’s final version. The resulting intervention, named Mamá, te entiendo (“Mom, I get you”), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. %M 39159447 %R 10.2196/56319 %U https://formative.jmir.org/2024/1/e56319 %U https://doi.org/10.2196/56319 %U http://www.ncbi.nlm.nih.gov/pubmed/39159447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49794 %T The Dual Task Ball Balancing Test and Its Association With Cognitive Function: Algorithm Development and Validation %A Greene,Barry %A Tobyne,Sean %A Jannati,Ali %A McManus,Killian %A Gomes Osman,Joyce %A Banks,Russell %A Kher,Ranjit %A Showalter,John %A Bates,David %A Pascual-Leone,Alvaro %+ Linus Health, 280 Summer St, Boston, MA, 02210, United States, 1 851682046, kmcmanus@linus.health %K cognitive function %K dual task %K inertial sensors %K mHealth %K tablet %K MCI %K Alzheimer %K dementia %K motor %K older adults %K cognitive impairment %K balance
 %D 2024 %7 19.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Dual task paradigms are thought to offer a quantitative means to assess cognitive reserve and the brain’s capacity to allocate resources in the face of competing cognitive demands. The most common dual task paradigms examine the interplay between gait or balance control and cognitive function. However, gait and balance tasks can be physically challenging for older adults and may pose a risk of falls. Objective: We introduce a novel, digital dual-task assessment that combines a motor-control task (the “ball balancing” test), which challenges an individual to maintain a virtual ball within a designated zone, with a concurrent cognitive task (the backward digit span task [BDST]). Methods: The task was administered on a touchscreen tablet, performance was measured using the inertial sensors embedded in the tablet, conducted under both single- and dual-task conditions. The clinical use of the task was evaluated on a sample of 375 older adult participants (n=210 female; aged 73.0, SD 6.5 years). Results: All older adults, including those with mild cognitive impairment (MCI) and Alzheimer disease–related dementia (ADRD), and those with poor balance and gait problems due to diabetes, osteoarthritis, peripheral neuropathy, and other causes, were able to complete the task comfortably and safely while seated. As expected, task performance significantly decreased under dual task conditions compared to single task conditions. We show that performance was significantly associated with cognitive impairment; significant differences were found among healthy participants, those with MCI, and those with ADRD. Task results were significantly associated with functional impairment, independent of diagnosis, degree of cognitive impairment (as indicated by the Mini Mental State Examination [MMSE] score), and age. Finally, we found that cognitive status could be classified with >70% accuracy using a range of classifier models trained on 3 different cognitive function outcome variables (consensus clinical judgment, Rey Auditory Verbal Learning Test [RAVLT], and MMSE). Conclusions: Our results suggest that the dual task ball balancing test could be used as a digital cognitive assessment of cognitive reserve. The portability, simplicity, and intuitiveness of the task suggest that it may be suitable for unsupervised home assessment of cognitive function. %M 39158963 %R 10.2196/49794 %U https://www.jmir.org/2024/1/e49794 %U https://doi.org/10.2196/49794 %U http://www.ncbi.nlm.nih.gov/pubmed/39158963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54816 %T Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn Brenna %A McAlister,Kelsey %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health, Inc, Ste 200, 821 E Washington Ave, Madison, WI, 53703, United States, 1 8005160975, darian.lawrence@bendhealth.com %K suicide %K self-harm %K collaborative care %K behavioral health %K telehealth %K telemedicine %K eHealth %K collaborative %K collaboration %K suicidal %K self-injury %K crisis %K crises %K mental health %K self-injurious %K anxiety %K depression %K pediatric %K pediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K mobile phone %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=–0.08; P=.99) symptoms. Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents. %M 39151166 %R 10.2196/54816 %U https://formative.jmir.org/2024/1/e54816 %U https://doi.org/10.2196/54816 %U http://www.ncbi.nlm.nih.gov/pubmed/39151166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56189 %T The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke %A Barcheus,Ida-Maria %A Ranner,Maria %A Månsson Lexell,Eva %A Jacobsson,Lars %A Larsson-Lund,Maria %+ Division of Health, Medicine and Rehabilitation-Occupational Therapy, Department of Health, Education and Technology, Luleå University of Technology, Luleå tekniska universitet, Luleå, 97187, Sweden, 46 0733379375, ida.maria.barcheus@ltu.se %K internet-based rehabilitation %K occupational therapy intervention %K rehabilitation %K self-management %K stroke %K active everyday life %K activity-based intervention %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients’ experiences during the intervention process. Objective: This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods: Overall, 9 clients with stroke who received SEE participated in the study—4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results: The participants’ experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions: SEE has the potential to support clients’ development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants’ self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions. %M 39146535 %R 10.2196/56189 %U https://formative.jmir.org/2024/1/e56189 %U https://doi.org/10.2196/56189 %U http://www.ncbi.nlm.nih.gov/pubmed/39146535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56043 %T Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study %A Burke,Meghan %A Li,Chak %A Cheung,Waifong Catherine %A Terol,Adriana Kaori %A Johnston,Amanda %A Schueller,Stephen M %+ Department of Special Education, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, United States, 1 6155851420, meghan.burke@vanderbilt.edu %K human-centered design %K autism %K service access %K families %K digital support %K autistic children %K autistic %K children %K child %K app %K apps %K application %K applications %K digital tool %K tool %K tools %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. Objective: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. Methods: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. Results: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). Conclusions: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app. %M 39141412 %R 10.2196/56043 %U https://formative.jmir.org/2024/1/e56043 %U https://doi.org/10.2196/56043 %U http://www.ncbi.nlm.nih.gov/pubmed/39141412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58653 %T A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study %A Mancinelli,Elisa %A Magnolini,Simone %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K chatbot prototype %K co-design %K pregnancy %K prevention %K behavioral activation %K multiple case study %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. Objective: Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women’s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. Methods: Using a multiple–case study design, the research aims to uncover similarities and differences in participants’ perceptions of the chatbot while also exploring women’s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. Results: Similarities and differences have emerged regarding women’s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot’s limitations. Conclusions: Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring. %M 39140593 %R 10.2196/58653 %U https://formative.jmir.org/2024/1/e58653 %U https://doi.org/10.2196/58653 %U http://www.ncbi.nlm.nih.gov/pubmed/39140593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56250 %T Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study %A Gautam,Kamal %A Shrestha,Roman %A Dlamini,Sihlelelwe %A Razali,Belle %A Paudel,Kiran %A Azwa,Iskandar %A Saifi,Rumana %A Toh,YuHang %A Justin Lim,Hazriq %A Sutherland,Ryan %A Restar,Arjee %A Phanuphak,Nittaya %A Wickersham,Jeffrey A %+ Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, United States, 1 2037374158, jeffrey.wickersham@yale.edu %K HIV %K AIDS %K pre-exposure prophylaxis %K PrEP %K mobile health %K mHealth %K transgender women %K Malaysia %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women’s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women’s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. %M 39137407 %R 10.2196/56250 %U https://formative.jmir.org/2024/1/e56250 %U https://doi.org/10.2196/56250 %U http://www.ncbi.nlm.nih.gov/pubmed/39137407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39554 %T Exploring the Impact of a Sleep App on Sleep Quality in a General Population Sample: Pilot Randomized Controlled Trial %A Armitage,Bianca Tanya %A Potts,Henry W W %A Irwin,Michael R %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1722, abigail.fisher@ucl.ac.uk %K sleep %K mobile app %K app optimization %K intervention %K smartphone %K general population %K mindfulness %K cognitive behavioral therapy %K CBT %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. Objective: We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. Methods: This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. Results: A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI –2.0 to 3.8), with was no significant effect of group (P=.91). App users’ engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. Conclusions: In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. Trial Registration: ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483 %M 39137016 %R 10.2196/39554 %U https://formative.jmir.org/2024/1/e39554 %U https://doi.org/10.2196/39554 %U http://www.ncbi.nlm.nih.gov/pubmed/39137016 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54819 %T Charting Health Challenges for Digital Preventive Interventions Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: National Long-Term Follow-Up Survey of Self-Rated Health Outcomes %A Nygren,Jens M %A Aili,Katarina %A Arvidsson,Susann %A Olsson,Maria %A Jarfelt,Marianne %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K digital preventive interventions %K long-term follow-up %K self-rated health outcomes %K adult survivors %K childhood acute lymphoblastic leukemia %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ≥18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. %M 39133918 %R 10.2196/54819 %U https://formative.jmir.org/2024/1/e54819 %U https://doi.org/10.2196/54819 %U http://www.ncbi.nlm.nih.gov/pubmed/39133918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52884 %T Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method %A Maar,Marion %A Bourdon,Caleigh %A Berti,Joahnna %A Bisaillon,Emma %A Boesch,Lisa %A Boston,Alicia %A Chapdelaine,Justin %A Humphrey,Alison %A Kumar,Sandeep %A Maar-Jackson,Benjamin %A Martell,Robert %A Naokwegijig,Bruce %A Preet Kaur,Davinder %A Rice,Sarah %A Rickaby,Barbara %A Sutherland,Mariette %A Reade,Maurianne %+ Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K ATKC consensus method %K community-based participatory research %K COVID-19 vaccines %K cultural competency %K electronic survey development %K Indigenous Peoples %K vaccine confidence %K vaccine hesitancy %K youth %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants’ vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. Objective:  To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. Methods:  Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. Results:  The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants’ connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. Conclusions:  Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities. %M 39133917 %R 10.2196/52884 %U https://formative.jmir.org/2024/1/e52884 %U https://doi.org/10.2196/52884 %U http://www.ncbi.nlm.nih.gov/pubmed/39133917 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e62842 %T Immersive Virtual Reality Use in Medical Intensive Care: Mixed Methods Feasibility Study %A Locke,Brian W %A Tsai,Te-yi %A Reategui-Rivera,C Mahony %A Gabriel,Aileen S %A Smiley,Aref %A Finkelstein,Joseph %+ Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 30 N Mario Capecchi Dr, Salt Lake City, UT, 84112, United States, 1 801 581 7606, brian.locke@imail.org %K immersive virtual reality %K intensive care unit %K distraction therapy %K virtual reality %K mixed methods %K feasibility study %K semistructured interview %K therapy %K therapist %K critical illness %K critically ill %K adult %K patient acceptance %K user experience %K games for health %K serious games %K gamification %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Immersive virtual reality (VR) is a promising therapy to improve the experience of patients with critical illness and may help avoid postdischarge functional impairments. However, the determinants of interest and usability may vary locally and reports of uptake in the literature are variable. Objective: The aim of this mixed methods feasibility study was to assess the acceptability and potential utility of immersive VR in critically ill patients at a single institution. Methods: Adults without delirium who were admitted to 1 of 2 intensive care units were offered the opportunity to participate in 5-15 minutes of immersive VR delivered by a VR headset. Patient vital signs, heart rate variability, mood, and pain were assessed before and after the VR experience. Pre-post comparisons were performed using paired 2-sided t tests. A semistructured interview was administered after the VR experience. Patient descriptions of the experience, issues, and potential uses were summarized with thematic analysis. Results: Of the 35 patients offered the chance to participate, 20 (57%) agreed to partake in the immersive VR experience, with no difference in participation rate by age. Improvements were observed in overall mood (mean difference 1.8 points, 95% CI 0.6-3.0; P=.002), anxiety (difference of 1.7 points, 95% CI 0.8-2.7; P=.001), and pain (difference of 1.3 points, 95% CI 0.5-2.1; P=.003) assessed on 1-10 scales. The heart rate changed by a mean of –1.1 (95% CI –0.3 to –1.9; P=.008) beats per minute (bpm) from a baseline of 86.1 (SD 11.8) bpm and heart rate variability, assessed by the stress index (SI), changed by a mean of –5.0 (95% CI –1.5 to –8.5; P=.004) seconds–2 from a baseline SI of 40.0 (SD 23) seconds–2. Patients commented on the potential for the therapy to address pain, lessen anxiety, and facilitate calmness. Technical challenges were minimal and there were no adverse effects observed. Conclusions: Patient acceptance of immersive VR was high in a mostly medical intensive care population with little prior VR experience. Patients commented on the potential of immersive VR to ameliorate cognitive and emotional symptoms. Investigators can consider integrating minimally modified commercial VR headsets into the existing intensive care unit workflow to further assess VR’s efficacy for a variety of endpoints. %M 39046869 %R 10.2196/62842 %U https://games.jmir.org/2024/1/e62842 %U https://doi.org/10.2196/62842 %U http://www.ncbi.nlm.nih.gov/pubmed/39046869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52428 %T Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial %A Dawson,Jacqueline Kiwata %A Ede,Alison %A Phan,Madeleine %A Sequeira,Alec %A Teng,Hsiang-Ling %A Donlin,Ayla %+ Department of Physical Therapy, California State University, Long Beach, ET-130, 1250 Bellflower Boulevard, Long Beach, CA, 90840, United States, 1 5629857139, jacqueline.dawson@csulb.edu %K digital health %K physical activity %K user experience %K heart rate monitor %K group exercise %K mHealth %K wearable %K group exercise %K feasibility %K acceptability %K mobile health %K mobile health exercise %K exercise %K adults %K randomized controlled trial %K exercise program %K support %K wearables %K screening %K effectiveness %K videoconference %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear. Objective: This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes. Methods: Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention. Results: Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention. Conclusions: Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence. Trial Registration: ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421 %R 10.2196/52428 %U https://formative.jmir.org/2024/1/e52428 %U https://doi.org/10.2196/52428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57038 %T Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study %A Campos,Susana %A Nuñez,Daniel %A Pérez,J Carola %A Robinson,Jo %+ Center of Cognitive Sciences, Faculty of Psychology, University of Talca, Avenida Lircay s/n, Talca, 3460000, Chile, 56 712201782, dnunez@utalca.cl %K web-based screening %K adolescents %K psychopathology %K suicidal ideation %K early detection %K detection %K screening %K teens %K youths %K suicide %K mental health %K screening tool %K Latin American %K Latino %K psychiatric %K psychiatric symptoms %K psychological risk %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health–related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. Objective: The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. Methods: A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Results: Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles—one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. Conclusions: WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions. %M 39116425 %R 10.2196/57038 %U https://formative.jmir.org/2024/1/e57038 %U https://doi.org/10.2196/57038 %U http://www.ncbi.nlm.nih.gov/pubmed/39116425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53508 %T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study %A Bilal,Ayesha-Mae %A Pagoni,Konstantina %A Iliadis,Stavros I %A Papadopoulos,Fotios C %A Skalkidou,Alkistis %A Öster,Caisa %+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se %K digital phenotyping %K smartphone app %K mHealth %K mobile health %K qualitative study %K user experience %K usability %K perinatal depression %K depression %K app %K user %K users %K qualitative %K perinatal %K mobile app %K clinical research %K acceptability %K behavioral data %K depressive symptoms %K interview %K pregnant %K postpartum %K women %K thematic analysis %K well-being %K monitor %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. %M 39115893 %R 10.2196/53508 %U https://formative.jmir.org/2024/1/e53508 %U https://doi.org/10.2196/53508 %U http://www.ncbi.nlm.nih.gov/pubmed/39115893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46800 %T Assessing ChatGPT’s Capability for Multiple Choice Questions Using RaschOnline: Observational Study %A Chow,Julie Chi %A Cheng,Teng Yun %A Chien,Tsair-Wei %A Chou,Willy %+ Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, No. 901, Chung Hwa Road, Yung Kung District, Tainan, 710, Taiwan, 886 937399106, smilewilly@mail.chimei.org.tw %K RaschOnline %K ChatGPT %K multiple choice questions %K differential item functioning %K Wright map %K KIDMAP %K website tool %K evaluation tool %K tool %K application %K artificial intelligence %K scoring %K testing %K college %K students %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: ChatGPT (OpenAI), a state-of-the-art large language model, has exhibited remarkable performance in various specialized applications. Despite the growing popularity and efficacy of artificial intelligence, there is a scarcity of studies that assess ChatGPT’s competence in addressing multiple-choice questions (MCQs) using KIDMAP of Rasch analysis—a website tool used to evaluate ChatGPT’s performance in MCQ answering. Objective: This study aims to (1) showcase the utility of the website (Rasch analysis, specifically RaschOnline), and (2) determine the grade achieved by ChatGPT when compared to a normal sample. Methods: The capability of ChatGPT was evaluated using 10 items from the English tests conducted for Taiwan college entrance examinations in 2023. Under a Rasch model, 300 simulated students with normal distributions were simulated to compete with ChatGPT’s responses. RaschOnline was used to generate 5 visual presentations, including item difficulties, differential item functioning, item characteristic curve, Wright map, and KIDMAP, to address the research objectives. Results: The findings revealed the following: (1) the difficulty of the 10 items increased in a monotonous pattern from easier to harder, represented by logits (–2.43, –1.78, –1.48, –0.64, –0.1, 0.33, 0.59, 1.34, 1.7, and 2.47); (2) evidence of differential item functioning was observed between gender groups for item 5 (P=.04); (3) item 5 displayed a good fit to the Rasch model (P=.61); (4) all items demonstrated a satisfactory fit to the Rasch model, indicated by Infit mean square errors below the threshold of 1.5; (5) no significant difference was found in the measures obtained between gender groups (P=.83); (6) a significant difference was observed among ability grades (P<.001); and (7) ChatGPT’s capability was graded as A, surpassing grades B to E. Conclusions: By using RaschOnline, this study provides evidence that ChatGPT possesses the ability to achieve a grade A when compared to a normal sample. It exhibits excellent proficiency in answering MCQs from the English tests conducted in 2023 for the Taiwan college entrance examinations. %M 39115919 %R 10.2196/46800 %U https://formative.jmir.org/2024/1/e46800 %U https://doi.org/10.2196/46800 %U http://www.ncbi.nlm.nih.gov/pubmed/39115919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46823 %T Using Discrete-Event Simulation to Model Web-Based Crisis Counseling Service Operation: Evaluation Study %A Chiang,Byron %A Law,Yik Wa %A Yip,Paul Siu Fai %+ Centre of Suicide Research and Prevention, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Rd, Pokfulam, Hong Kong, China (Hong Kong), 852 2831 5232, sfpyip@hku.hk %K discrete-event simulation %K community operational research %K queuing %K web-based counseling %K service management %K repeat users %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the Organisation for Economic Co-operation and Development, its member states experienced worsening mental health during the COVID-19 pandemic, leading to an increase of 60% to 1000% in digital counseling access. Hong Kong, too, witnessed a surge in demand for crisis intervention services during the pandemic, attracting both nonrepeat and repeat service users during the process. As a result of the continuing demand, platforms offering short-term emotional support are facing an efficiency challenge in managing caller responses. Objective: This aim of this paper was to assess the queuing performance of a 24-hour text-based web-based crisis counseling platform using a Python-based discrete-event simulation (DES) model. The model evaluates the staff combinations needed to meet demand and informs service priority decisions. It is able to account for unbalanced and overlapping shifts, unequal simultaneous serving capacities among custom worker types, time-dependent user arrivals, and the influence of user type (nonrepeat users vs repeat users) and suicide risk on service durations. Methods: Use and queue statistics by user type and staffing conditions were tabulated from past counseling platform database records. After calculating the data distributions, key parameters were incorporated into the DES model to determine the supply-demand equilibrium and identify potential service bottlenecks. An unobserved-components time-series model was fitted to make 30-day forecasts of the arrival rate, with the results piped back to the DES model to estimate the number of workers needed to staff each work shift, as well as the number of repeat service users encountered during a service operation. Results: The results showed a marked increase (from 3401/9202, 36.96% to 5042/9199, 54.81%) in the overall conversion rate after the strategic deployment of human resources according to the values set in the simulations, with an 85% chance of queuing users receiving counseling service within 10 minutes and releasing an extra 39.57% (3631/9175) capacity to serve nonrepeat users at potential risk. Conclusions: By exploiting scientifically informed data models with DES, nonprofit web-based counseling platforms, even those with limited resources, can optimize service capacity strategically to manage service bottlenecks and increase service uptake. %M 39110974 %R 10.2196/46823 %U https://formative.jmir.org/2024/1/e46823 %U https://doi.org/10.2196/46823 %U http://www.ncbi.nlm.nih.gov/pubmed/39110974 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51872 %T Effects of a Digital Care Pathway for Multiple Sclerosis: Observational Study %A Vesinurm,Märt %A Maunula,Anna %A Olli,Päivi %A Lillrank,Paul %A Ijäs,Petra %A Torkki,Paulus %A Mäkitie,Laura %A Laakso,Sini M %+ Institute of Healthcare Engineering and Management, Department of Industrial Engineering and Management, Aalto University School of Science, Maarintie 8, Espoo, 02150, Finland, 358 503228815, mart.vesinurm@aalto.fi %K digital care pathway %K multiple sclerosis %K patient satisfaction %K outcome %K patient reported outcome measures %K resource usage %K telemedicine %K digital care %K outpatient clinic %K quality of life %K quality of care %K communication %K caregiver %K chronic condition %K strategy %K long-term %K patient engagement %K digital health service %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction. Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months. Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors’ appointments, remote doctors’ contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark. Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups. %M 39110966 %R 10.2196/51872 %U https://humanfactors.jmir.org/2024/1/e51872 %U https://doi.org/10.2196/51872 %U http://www.ncbi.nlm.nih.gov/pubmed/39110966 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51716 %T Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial %A Chan,Wai Sze %A Cheng,Wing Yee %A Lok,Samson Hoi Chun %A Cheah,Amanda Kah Mun %A Lee,Anna Kai Win %A Ng,Albe Sin Ying %A Kowatsch,Tobias %+ Department of Psychology, The University of Hong Kong, Room 627, the Jockey Club Tower, Pokfulam, Hong Kong, Hong Kong, China (Hong Kong), 852 39172295, chanwais@hku.hk %K insomnia %K cognitive behavioral therapy %K digital intervention %K mobile health %K mHealth %K chatbot-based coaching %K human support %K mobile phone %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. Objective: This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. Methods: Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. Results: Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=–0.28), depressive symptoms (P<.001; d=–0.62), anxiety (P=.01; d=–0.40), fatigue (P=.02; d=–0.35), dysfunctional beliefs about sleep (P<.001; d=–0.53), and safety behaviors related to sleep (P=.001; d=–0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=–0.33) and sleep-related safety behaviors (P=.05; d=–0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. Conclusions: Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. Trial Registration: ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638 %M 39110971 %R 10.2196/51716 %U https://mental.jmir.org/2024/1/e51716 %U https://doi.org/10.2196/51716 %U http://www.ncbi.nlm.nih.gov/pubmed/39110971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55650 %T Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study %A Idalski Carcone,April %A Holtz,Bree E %A Reardon,Madeleine %A Vesey,Dariane %A Ellis,Deborah A %A Parks,Michael %+ Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, 3128 Integrative Biosciences Bldg, 6135 Woodward, Detroit, MI, 48202, United States, 1 3135771057, acarcone@med.wayne.edu %K emerging adults %K type 1 diabetes %K intervention %K qualitative %K mHealth %K mobile phone %K smartphone %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs’ experiences living in a rural community with T1D and discussed EAs’ impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (“everyone knows”) and community members’ lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs’ needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial %M 39110496 %R 10.2196/55650 %U https://formative.jmir.org/2024/1/e55650 %U https://doi.org/10.2196/55650 %U http://www.ncbi.nlm.nih.gov/pubmed/39110496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59434 %T Use of Generative AI for Improving Health Literacy in Reproductive Health: Case Study %A Burns,Christina %A Bakaj,Angela %A Berishaj,Amonda %A Hristidis,Vagelis %A Deak,Pamela %A Equils,Ozlem %+ MiOra, 17328 Ventura Boulevard Number 190, Encino, CA, 91316, United States, 1 3105954094, oequils@yahoo.com %K ChatGPT %K chatGPT %K chat-GPT %K chatbots %K chat-bot %K chat-bots %K artificial intelligence %K AI %K machine learning %K ML %K large language model %K large language models %K LLM %K LLMs %K natural language processing %K NLP %K deep learning %K chatbot %K Google Search %K internet %K communication %K English proficiency %K readability %K health literacy %K health information %K health education %K health related questions %K health information seeking %K health access %K reproductive health %K oral contraceptive %K birth control %K emergency contraceptive %K comparison %K clinical %K patients %D 2024 %7 6.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally. Objective: A pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill. Methods: A sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, “what should I do if I missed a day of my oral contraception birth control?” alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information. Results: The ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text. Conclusions: ChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed. %M 38986153 %R 10.2196/59434 %U https://formative.jmir.org/2024/1/e59434 %U https://doi.org/10.2196/59434 %U http://www.ncbi.nlm.nih.gov/pubmed/38986153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55759 %T The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey %A Campos-Castillo,Celeste %A Tamla Rai,Vijaya %A Laestadius,Linnea I %+ Department of Media and Information, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48823, United States, 1 5174325912, camposca@msu.edu %K mental health %K school modality %K race and ethnicity %K confidants %K sleep %K equity %K remote learning %K virtual learning %K racial justice %K anxiety %K depression %K depressive %K student %K students %K school %K schools %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K race %K racial %K eLearning %K online learning %K education %K equality %K inequality %K inequity %K disparity %K disparities %K teaching %K ethnic %K ethnicities %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. Objective: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. Methods: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. Results: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (β=–.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (β=–.121; P=.01) and depression (β=–.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (β=–.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (β=.601; P<.001) and depression (β=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. Conclusions: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic’s impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports. %M 39102274 %R 10.2196/55759 %U https://formative.jmir.org/2024/1/e55759 %U https://doi.org/10.2196/55759 %U http://www.ncbi.nlm.nih.gov/pubmed/39102274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54999 %T A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study %A LaVine,Danielle %A Greer,Zara %A Kim,Jiyun %A Kumar,Santosh %A Belin,Thomas %A Shetty,Vivek %+ Section of Oral & Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, 23-009 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1668, United States, 1 3108255170, vshetty@g.ucla.edu %K dental disease %K underserved populations %K mHealth %K usability testing %K feasibility testing, mobile phone %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Preventative self-care can reduce dental disease that disproportionately burdens vulnerable populations. Personalized digital oral self-care behavioral interventions offer a promising solution. However, the success of these digital interventions depends on toothbrushing data collection e-platforms attuned to the needs and preferences of vulnerable communities. Objective: The aim of this study is to assess the usability and feasibility of the Remote Oral Behaviors Assessment System (ROBAS), which has been adapted to address the unique requirements of socioeconomically disadvantaged minority individuals. Methods: A cohort of 53 community-clinic participants, including 31 (58%) Latino and 22 (42%) Black individuals with no prior experience using electric toothbrushes, were recruited to use ROBAS, with planned assessments at baseline, 2 months, and 4 months. Beyond evaluating ROBAS’s technical performance, extensive feedback was gathered to gauge users’ experiences, viewpoints, and overall contentment. The System Usability Scale (SUS) served as a primary metric for assessing user satisfaction and acceptability. Results: ROBAS exhibited largely reliable and consistent data-gathering capabilities. SUS scores (mean 75.6, SD 14.5) reflected participant contentment within a range of values for other commonly used digital devices and technologies. Among participants who answered questions about willingness to pay for ROBAS, 97% (30/31) indicated that they were willing to pay for ROBAS either as a one-time payment or as a subscription-based service. Additionally, 87.5% of participants expressed that they would endorse it to acquaintances. Most participants expressed no reservations about privacy; among those who expressed privacy concerns (n=20, 50%), the concerns included exposure of information (n=18, 45%), monitoring of brushing habits (n=12, 30%), and collection of information (n=14, 35%), although these concerns did not significantly correlate with specific participant traits. In qualitative terms, users valued ROBAS's ability to monitor brushing habits but called for refinements, especially in Wi-Fi and application connectivity. Recommendations for system improvements encompassed enhanced app functionality, individualized coaching, more comprehensive brushing data, and the addition of flossing activity tracking. Conclusions: The research highlights ROBAS's promise as a digital platform for unobtrusively tracking daily oral self-care activities in marginalized communities. The system proved to be both feasible, as evidenced by its stable and accurate data capture of brushing behaviors, and user-friendly, as reflected by strong SUS scores and positive user feedback. Influential factors for its uptake included ease of learning and operation, and the feedback provided. %M 39094107 %R 10.2196/54999 %U https://formative.jmir.org/2024/1/e54999 %U https://doi.org/10.2196/54999 %U http://www.ncbi.nlm.nih.gov/pubmed/39094107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54009 %T An App for Navigating Patient Transportation and Acute Stroke Care in Northwestern Ontario Using Machine Learning: Retrospective Study %A Hassan,Ayman %A Benlamri,Rachid %A Diner,Trina %A Cristofaro,Keli %A Dillistone,Lucas %A Khallouki,Hajar %A Ahghari,Mahvareh %A Littlefield,Shalyn %A Siddiqui,Rabail %A MacDonald,Russell %A Savage,David W %+ Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON, P7B 6Z6, Canada, 1 8076847580, rabail.siddiqui@tbh.net %K stroke care %K acute stroke %K northwestern %K Ontario %K prediction %K models %K machine learning %K stroke %K cardiovascular %K brain %K neuroscience %K TIA %K transient ischemic attack %K coordinated care %K navigation %K navigating %K mHealth %K mobile health %K app %K apps %K applications %K geomapping %K geography %K geographical %K location %K spatial %K predict %K predictions %K predictive %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A coordinated care system helps provide timely access to treatment for suspected acute stroke. In Northwestern Ontario (NWO), Canada, communities are widespread with several hospitals offering various diagnostic equipment and services. Thus, resources are limited, and health care providers must often transfer patients with stroke to different hospital locations to ensure the most appropriate care access within recommended time frames. However, health care providers frequently situated temporarily (locum) in NWO or providing care remotely from other areas of Ontario may lack sufficient information and experience in the region to access care for a patient with a time-sensitive condition. Suboptimal decision-making may lead to multiple transfers before definitive stroke care is obtained, resulting in poor outcomes and additional health care system costs. Objective: We aimed to develop a tool to inform and assist NWO health care providers in determining the best transfer options for patients with stroke to provide the most efficient care access. We aimed to develop an app using a comprehensive geomapping navigation and estimation system based on machine learning algorithms. This app uses key stroke-related timelines including the last time the patient was known to be well, patient location, treatment options, and imaging availability at different health care facilities. Methods: Using historical data (2008-2020), an accurate prediction model using machine learning methods was developed and incorporated into a mobile app. These data contained parameters regarding air (Ornge) and land medical transport (3 services), which were preprocessed and cleaned. For cases in which Ornge air services and land ambulance medical transport were both involved in a patient transport process, data were merged and time intervals of the transport journey were determined. The data were distributed for training (35%), testing (35%), and validation (30%) of the prediction model. Results: In total, 70,623 records were collected in the data set from Ornge and land medical transport services to develop a prediction model. Various learning models were analyzed; all learning models perform better than the simple average of all points in predicting output variables. The decision tree model provided more accurate results than the other models. The decision tree model performed remarkably well, with the values from testing, validation, and the model within a close range. This model was used to develop the “NWO Navigate Stroke” system. The system provides accurate results and demonstrates that a mobile app can be a significant tool for health care providers navigating stroke care in NWO, potentially impacting patient care and outcomes. Conclusions: The NWO Navigate Stroke system uses a data-driven, reliable, accurate prediction model while considering all variations and is simultaneously linked to all required acute stroke management pathways and tools. It was tested using historical data, and the next step will to involve usability testing with end users. %R 10.2196/54009 %U https://formative.jmir.org/2024/1/e54009 %U https://doi.org/10.2196/54009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56594 %T Quality of Chronic Obstructive Pulmonary Disease Information on the Chinese Internet: Website Evaluation Study %A Wang,Qinqin %A Liu,Lingjun %A Li,Hong %A Zhang,Qiao %A Ma,Qianli %+ Chronic Respiratory Disease Management and Rehabilitation Center, SongShan General Hospital, D Building, 1st FIoor, Chongqing, 401120, China, 86 19112955805, cqmql@163.com %K chronic obstructive pulmonary disease %K internet %K information quality %K DISCERN %K websites %K health information %K DISCERN instrument %K pulmonary disease %K chronic pulmonary disease %K cross-sectional study %K website information %K treatment %K COPD %K China %K evaluation %K pulmonary %K chronic %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of internet technology has greatly increased the ability of patients with chronic obstructive pulmonary disease (COPD) to obtain health information, giving patients more initiative in the patient-physician decision-making process. However, concerns about the quality of website health information will affect the enthusiasm of patients’ website search behavior. Therefore, it is necessary to evaluate the current situation of Chinese internet information on COPD. Objective: This study aims to evaluate the quality of COPD treatment information on the Chinese internet. Methods: Using the standard disease name “慢性阻塞性肺疾病” (“chronic obstructive pulmonary disease” in Chinese) and the commonly used public search terms “慢阻肺” (“COPD”) and “肺气肿” (“emphysema”) combined with the keyword “治疗” (“treatment”), we searched the PC client web page of Baidu, Sogou, and 360 search engines and screened the first 50 links of the website from July to August 2021. The language was restricted to Chinese for all the websites. The DISCERN tool was used to evaluate the websites. Results: A total of 96 websites were included and analyzed. The mean overall DISCERN score for all websites was 30.4 (SD 10.3; range 17.3-58.7; low quality), no website reached the maximum DISCERN score of 75, and the mean score for each item was 2.0 (SD 0.7; range 1.2-3.9). There were significant differences in mean DISCERN scores between terms, with “chronic obstructive pulmonary disease” having the highest mean score. Conclusions: The quality of COPD information on the Chinese internet is poor, which is mainly reflected in the low reliability and relevance of COPD treatment information, which can easily lead consumers to make inappropriate treatment choices. The term “chronic obstructive pulmonary disease” has the highest DISCERN score among commonly used disease search terms. It is recommended that consumers use standard disease names when searching for website information, as the information obtained is relatively reliable. %M 39088820 %R 10.2196/56594 %U https://formative.jmir.org/2024/1/e56594 %U https://doi.org/10.2196/56594 %U http://www.ncbi.nlm.nih.gov/pubmed/39088820 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57101 %T Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study %A Imai,Ayu %A Matsuoka,Teruyuki %A Nakayama,Chikara %A Hashimoto,Nana %A Sano,Mutsuo %A Narumoto,Jin %+ Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, 81 075 251 5612, tmms2004@koto.kpu-m.ac.jp %K loneliness %K virtual reality %K VR %K Alzheimer disease %K predementia %K intervention %K subjective cognitive decline %K mild cognitive impairment %K dementia %K older adult %K geriatric %K depression %K cognitive impairments %D 2024 %7 1.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective: This study aims to assess the impact of a virtual reality (VR)–based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR’s impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID): DERR1-10.2196/57101 %M 39088243 %R 10.2196/57101 %U https://www.researchprotocols.org/2024/1/e57101 %U https://doi.org/10.2196/57101 %U http://www.ncbi.nlm.nih.gov/pubmed/39088243 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 5 %N %P e48213 %T Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study %A Haq,Zaeem Ul %A Naeem,Ayesha %A Zaeem,Durayya %A Sohail,Mohina %A Pervaiz,Noor ul Ain %K primary health care %K mother and child health %K community health worker %K slums %K digital applications %K health communication. %D 2024 %7 31.7.2024 %9 %J JMIRx Med %G English %X Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers’ self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. %R 10.2196/48213 %U https://xmed.jmir.org/2024/1/e48213 %U https://doi.org/10.2196/48213 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57653 %T Use of Transdermal Alcohol Sensors in Conjunction With Contingency Management to Reduce Alcohol Consumption in People With Alcohol Dependence Attending Alcohol Treatment Services: Protocol for a Pilot Feasibility Randomized Controlled Trial %A Brobbin,Eileen %A Deluca,Paolo %A Parkin,Stephen %A Drummond,Colin %+ Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K accuracy %K addiction %K alcohol %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensors %K wearables %K mobile phone %K transdermal %K TAS %K wearable technology %K alcohol use disorders %K AUD %K RCT %K randomized controlled trial %K abstinence %K community-based %K residential rehabilitation %K consumption %K alcohol consumption %K low-risk consumption %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable technology for objective, continuous, and reliable alcohol monitoring has been developed. These are known as transdermal alcohol sensors (TASs). They can be worn on the wrist or ankle with the sensor pressed against the skin and can measure sweat vapors being emitted from the skin, to record transdermal alcohol concentration (TAC). Previous studies have investigated the accuracy and acceptability of the available TAS brands, but there has been little research into their use in people with alcohol use disorders (AUD). Objective: This feasibility randomized controlled trial aims to explore the feasibility, strengths, and limitations of using a TAS to monitor alcohol consumption in individuals in treatment for AUD with or without contingency management (CM) to promote abstinence or low-level alcohol consumption. Methods: The target sample size is 30 (15 randomized to each group). Participants will be recruited through poster adverts at alcohol services. Both groups (control and CM) will wear the TAS (BACtrack Skyn) for 2 weeks in the context of their usual treatment, meeting with the researcher every other weekday. In the last meeting, the participants will complete a postwear survey on their experience of wearing the TAS. The CM group will also receive small financial incentives for low or no alcohol consumption, as measured by the TAS. On days where the TAC peak is below a set threshold (<115.660 g/L), CM group participants will be rewarded with a £5 (US $6.38) voucher. There are financial bonuses if this target is achieved on consecutive days. The researcher will monitor TAC for each day of the study at each research visit and allocate financial incentives to participants according to a set reinforcement schedule. Results: The first participant was enrolled in June 2023, and the last in December 2023. Data analysis is underway and is estimated to be completed by June 2024. A total of 32 participants were enrolled. Conclusions: Most TAS brands have had limited application in clinical settings, and most studies have included healthy adults rather than people with AUD. TAS has the potential to enhance treatment outcomes in clinical alcohol treatment. The accuracy, acceptability, and feasibility of TAS for people with AUD in clinical settings need to be investigated. This is the first study to use TAS in specialized alcohol services with diagnosed AUD individuals currently receiving treatment from a south London alcohol service. Trial Registration: ISRCTN Registry ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 International Registered Report Identifier (IRRID): DERR1-10.2196/57653 %M 39083798 %R 10.2196/57653 %U https://www.researchprotocols.org/2024/1/e57653 %U https://doi.org/10.2196/57653 %U http://www.ncbi.nlm.nih.gov/pubmed/39083798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54599 %T The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial %A Johnson,Joshua K. %A Longhurst,Jason K %A Gevertzman,Michael %A Jefferson,Corey %A Linder,Susan M %A Bethoux,Francois %A Stilphen,Mary %+ Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code M83-13, Cleveland, OH, 44915, United States, 1 2169030621, johnsoj8@ccf.org %K rehabilitation %K physical therapy %K PT %K physiotherapy %K telehealth %K Parkinson disease %K tele-rehabilitation %K telerehabilitation %K TR %K exercise %K physical activity %K exercise therapy %K tele-health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K Parkinson’s disease %K Parkinson %K Parkinsons %K Parkinsonism %K PD %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non–study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as “good” or “very good” across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 %M 39083792 %R 10.2196/54599 %U https://formative.jmir.org/2024/1/e54599 %U https://doi.org/10.2196/54599 %U http://www.ncbi.nlm.nih.gov/pubmed/39083792 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56758 %T Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial %A Ferguson,IreLee %A George,Grace %A Narine,Kevin O %A Turner,Amari %A McGhee,Zelda %A Bajwa,Harris %A Hart,Frances G %A Carter,Sierra %A Beard,Courtney %+ Department of Psychiatry, McLean Hospital/Harvard Medical School, 115 Mill St, Belmont, MA, 02478, United States, 1 617 855 3557, cbeard@mclean.harvard.edu %K interpretation bias %K anxiety %K depression %K Black %K Latinx %K smartphone %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials’ samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. %M 39083330 %R 10.2196/56758 %U https://mental.jmir.org/2024/1/e56758 %U https://doi.org/10.2196/56758 %U http://www.ncbi.nlm.nih.gov/pubmed/39083330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54723 %T Impact of a Health Coach–Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study %A Sacher,Paul M %A Fulton,Emily %A Rogers,Victoria %A Wilson,Julia %A Gramatica,Marco %A Dent,Jennifer E %A Aarts,Edo O %A Eccleston,David %A Greve,Jan Willem %A Palm-Meinders,Inge %A Chuttani,Ram %+ Allurion Technologies Inc, 11 Huron Dr, Natick, MA, 01760, United States, 1 508 647 4000, psacher@icloud.com %K intragastric balloon %K obesity %K behavior change %K health coaching %K digital health %K weight management %K well-being %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. Objective: This study aims to assess whether a health coach–led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. Methods: This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life–Lite–Clinical Trials Version, Loss of Control Over Eating Scale–Brief, Weight Efficacy Lifestyle Questionnaire–Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Results: Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. Conclusions: This study provides evidence that the health coach–led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Trial Registration: ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606 %M 39083340 %R 10.2196/54723 %U https://formative.jmir.org/2024/1/e54723 %U https://doi.org/10.2196/54723 %U http://www.ncbi.nlm.nih.gov/pubmed/39083340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54633 %T A Reliable and Accessible Caregiving Language Model (CaLM) to Support Tools for Caregivers: Development and Evaluation Study %A Parmanto,Bambang %A Aryoyudanta,Bayu %A Soekinto,Timothius Wilbert %A Setiawan,I Made Agus %A Wang,Yuhan %A Hu,Haomin %A Saptono,Andi %A Choi,Yong Kyung %+ Department of Health Information Management, University of Pittsburgh, 6052 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K large language model %K caregiving %K caregiver %K informal care %K carer %K GPT %K language model %K LLM %K elderly %K aging %K ChatGPT %K machine learning %K natural language processing %K NLP %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, 1 in 5 adults currently serves as a family caregiver for an individual with a serious illness or disability. Unlike professional caregivers, family caregivers often assume this role without formal preparation or training. Thus, there is an urgent need to enhance the capacity of family caregivers to provide quality care. Leveraging technology as an educational tool or an adjunct to care is a promising approach that has the potential to enhance the learning and caregiving capabilities of family caregivers. Large language models (LLMs) can potentially be used as a foundation technology for supporting caregivers. An LLM can be categorized as a foundation model (FM), which is a large-scale model trained on a broad data set that can be adapted to a range of different domain tasks. Despite their potential, FMs have the critical weakness of “hallucination,” where the models generate information that can be misleading or inaccurate. Information reliability is essential when language models are deployed as front-line help tools for caregivers. Objective: This study aimed to (1) develop a reliable caregiving language model (CaLM) by using FMs and a caregiving knowledge base, (2) develop an accessible CaLM using a small FM that requires fewer computing resources, and (3) evaluate the model’s performance compared with a large FM. Methods: We developed a CaLM using the retrieval augmented generation (RAG) framework combined with FM fine-tuning for improving the quality of FM answers by grounding the model on a caregiving knowledge base. The key components of the CaLM are the caregiving knowledge base, a fine-tuned FM, and a retriever module. We used 2 small FMs as candidates for the foundation of the CaLM (LLaMA [large language model Meta AI] 2 and Falcon with 7 billion parameters) and adopted a large FM (GPT-3.5 with an estimated 175 billion parameters) as a benchmark. We developed the caregiving knowledge base by gathering various types of documents from the internet. We focused on caregivers of individuals with Alzheimer disease and related dementias. We evaluated the models’ performances using the benchmark metrics commonly used in evaluating language models and their reliability for providing accurate references with their answers. Results: The RAG framework improved the performance of all FMs used in this study across all measures. As expected, the large FM performed better than the small FMs across all metrics. Interestingly, the small fine-tuned FMs with RAG performed significantly better than GPT 3.5 across all metrics. The fine-tuned LLaMA 2 with a small FM performed better than GPT 3.5 (even with RAG) in returning references with the answers. Conclusions: The study shows that a reliable and accessible CaLM can be developed using small FMs with a knowledge base specific to the caregiving domain. %M 39083337 %R 10.2196/54633 %U https://formative.jmir.org/2024/1/e54633 %U https://doi.org/10.2196/54633 %U http://www.ncbi.nlm.nih.gov/pubmed/39083337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56715 %T Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial %A Lowe,Cabella %A Sephton,Ruth %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Road, London, E1 4DG, United Kingdom, 44 7976315105, c.lowe@qmul.ac.uk %K mHealth %K eHealth %K digital health %K digital technology %K digital triage %K musculoskeletal %K triage %K physiotherapy triage %K validation %K acceptability %K physiotherapy %K primary care %K randomized controlled trial %K usability %K assess %K assessment %K triaging %K referrals %K crossover %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials—considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. Objective: The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. Methods: A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Results: Over 8 weeks, 129 patients were invited to participate. Of these, 92% (119/129) proceeded to eligibility assessment, with 60% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41% (32/78; 95% CI 22-45), intraclass correlation coefficient 0.37 (95% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78% (61/78; 95% CI 47-78) and an intraclass correlation coefficient of 0.57 (95% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90% CI +2.94 to –2.94), equating to an “excellent” system. There were no study incidents, and the trial burden was acceptable. Conclusions: Physiotherapist-DART agreement of 78%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): RR2-10.2196/31541 %M 39078682 %R 10.2196/56715 %U https://formative.jmir.org/2024/1/e56715 %U https://doi.org/10.2196/56715 %U http://www.ncbi.nlm.nih.gov/pubmed/39078682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46319 %T Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study %A Chen,Wenfei %A Chen,Jiana %A Jiang,Shaojun %A Wang,Chunhua %A Zhang,Jinhua %+ Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China, 86 13306912381, pollyzhang2006@126.com %K warfarin %K telemedicine %K smart phone application %K anti-coagulation management %K management %K cohort study %K application %K chronic disease %K support %K effectiveness %K online model %K patient management %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non–web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non–web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non–web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non–web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non–web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non–web-based management group was significantly higher than that in the web-based management group (12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non–web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Conclusions: Compared with traditional non–web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. %M 39073869 %R 10.2196/46319 %U https://www.jmir.org/2024/1/e46319 %U https://doi.org/10.2196/46319 %U http://www.ncbi.nlm.nih.gov/pubmed/39073869 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43894 %T Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery %A Sides,Teresa %A Kbaier,Dhouha %+ The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, United Kingdom, 44 0300 303 5303, Teresa.Sides@open.ac.uk %K National Health Service %K primary care %K SMS text messaging %K SMS reminders %K missed appointments %K quantitative research %K Kruskal-Wallis test %K Mann-Whitney test %D 2024 %7 29.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. Objective: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. Methods: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom’s most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Results: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). Conclusions: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings. %M 39073855 %R 10.2196/43894 %U https://www.jmir.org/2024/1/e43894 %U https://doi.org/10.2196/43894 %U http://www.ncbi.nlm.nih.gov/pubmed/39073855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54577 %T Use of Machine Learning Models to Differentiate Neurodevelopment Conditions Through Digitally Collected Data: Cross-Sectional Questionnaire Study %A Grazioli,Silvia %A Crippa,Alessandro %A Buo,Noemi %A Busti Ceccarelli,Silvia %A Molteni,Massimo %A Nobile,Maria %A Salandi,Antonio %A Trabattoni,Sara %A Caselli,Gabriele %A Colombo,Paola %+ Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Via Don Luigi Monza, 20, Bosisio Parini, 23842, Italy, 39 031877593, alessandro.crippa@lanostrafamiglia.it %K digital-aided clinical assessment %K machine learning %K random forest %K logistic regression %K computational psychometrics %K telemedicine %K neurodevelopmental conditions %K parent-report questionnaires %K attention-deficit/hyperactivity disorder %K autism spectrum disorder %K ASD %K autism %K autistic %K attention deficit %K hyperactivity %K classification %D 2024 %7 29.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diagnosis of child and adolescent psychopathologies involves a multifaceted approach, integrating clinical observations, behavioral assessments, medical history, cognitive testing, and familial context information. Digital technologies, especially internet-based platforms for administering caregiver-rated questionnaires, are increasingly used in this field, particularly during the screening phase. The ascent of digital platforms for data collection has propelled advanced psychopathology classification methods such as supervised machine learning (ML) into the forefront of both research and clinical environments. This shift, recently called psycho-informatics, has been facilitated by gradually incorporating computational devices into clinical workflows. However, an actual integration between telemedicine and the ML approach has yet to be fulfilled. Objective: Under these premises, exploring the potential of ML applications for analyzing digitally collected data may have significant implications for supporting the clinical practice of diagnosing early psychopathology. The purpose of this study was, therefore, to exploit ML models for the classification of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using internet-based parent-reported socio-anamnestic data, aiming at obtaining accurate predictive models for new help-seeking families. Methods: In this retrospective, single-center observational study, socio-anamnestic data were collected from 1688 children and adolescents referred for suspected neurodevelopmental conditions. The data included sociodemographic, clinical, environmental, and developmental factors, collected remotely through the first Italian internet-based screening tool for neurodevelopmental disorders, the Medea Information and Clinical Assessment On-Line (MedicalBIT). Random forest (RF), decision tree, and logistic regression models were developed and evaluated using classification accuracy, sensitivity, specificity, and importance of independent variables. Results: The RF model demonstrated robust accuracy, achieving 84% (95% CI 82-85; P<.001) for ADHD and 86% (95% CI 84-87; P<.001) for ASD classifications. Sensitivities were also high, with 93% for ADHD and 95% for ASD. In contrast, the DT and LR models exhibited lower accuracy (DT 74%, 95% CI 71-77; P<.001 for ADHD; DT 79%, 95% CI 77-82; P<.001 for ASD; LR 61%, 95% CI 57-64; P<.001 for ADHD; LR 63%, 95% CI 60-67; P<.001 for ASD) and sensitivities (DT: 82% for ADHD and 88% for ASD; LR: 62% for ADHD and 68% for ASD). The independent variables considered for classification differed in importance between the 2 models, reflecting the distinct characteristics of the 3 ML approaches. Conclusions: This study highlights the potential of ML models, particularly RF, in enhancing the diagnostic process of child and adolescent psychopathology. Altogether, the current findings underscore the significance of leveraging digital platforms and computational techniques in the diagnostic process. While interpretability remains crucial, the developed approach might provide valuable screening tools for clinicians, highlighting the significance of embedding computational techniques in the diagnostic process. %M 39073858 %R 10.2196/54577 %U https://formative.jmir.org/2024/1/e54577 %U https://doi.org/10.2196/54577 %U http://www.ncbi.nlm.nih.gov/pubmed/39073858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54458 %T Complex Hospital-Based Electronic Prescribing–Based Intervention to Support Antimicrobial Stewardship: Qualitative Study %A Cresswell,Kathrin %A Hinder,Susan %A Sheikh,Aziz %A Watson,Neil %A Price,David %A Heed,Andrew %A Pontefract,Sarah Katie %A Coleman,Jamie %A Beggs,Jillian %A Chuter,Antony %A Slee,Ann %A Williams,Robin %+ Usher Institute, University of Edinburgh, Usher Building, 5‒7 Little France Road, Edinburgh, EH16 4UX, United Kingdom, 44 (0)131 651 4151, Kathrin.Cresswell@ed.ac.uk %K antimicrobial stewardship %K electronic prescribing %K evaluation %K healthcare %K qualitative study %K hospital-based %K electronic prescribing %K e-prescribing %K prescribing %K prescription %K ePAMS+ %K antimicrobial resistance %K AMR %K complex intervention %K complex interventions %K educational %K behavioral %K technological %K public health %K implementation %K AMS %K hospital %K hospitals %K development %K in-depth %K interview %K interviews %K observation %K observations %K prescriber %K prescribers %K nurse %K nurses %K pharmacist %K pharmacists %K microbiologist %K microbiologists %K thematic analysis %K antimicrobial %K antimicrobials %D 2024 %7 26.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Antimicrobial resistance (AMR) represents a growing concern for public health. Objective: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals. Methods: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12. Results: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions). Conclusions: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings. %M 39059001 %R 10.2196/54458 %U https://formative.jmir.org/2024/1/e54458 %U https://doi.org/10.2196/54458 %U http://www.ncbi.nlm.nih.gov/pubmed/39059001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43119 %T Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation %A Unlu,Ozan %A Pikcilingis,Aaron %A Letourneau,Jonathan %A Landman,Adam %A Patel,Rajesh %A Shenoy,Erica S %A Hashimoto,Dean %A Kim,Marvel %A Pellecer,Johnny %A Zhang,Haipeng %+ Division of Cardiovascular Medicine, Brigham and Women's Hospital, 70 Francis St, Boston, MA, 02115, United States, 1 857 407 4561, ounlu@bwh.harvard.edu %K chatbot %K return to work %K employee %K health care personnel %K COVID-19 %K conversational agent %K occupational health %K support service %K health care delivery %K agile methodology %K digital intervention %K digital support %K work policy %K hospital staff %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients’ and employees’ queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. %M 39052994 %R 10.2196/43119 %U https://formative.jmir.org/2024/1/e43119 %U https://doi.org/10.2196/43119 %U http://www.ncbi.nlm.nih.gov/pubmed/39052994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57938 %T Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors %A Bisby,Madelyne %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Sydney, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K anxiety %K depression %K daily actions %K treatments %K personalization %K mental health %K digital treatment %K analysis %K clinical factors %K questionnaire %K depression symptoms %K anxiety symptoms %K patients %K Australian %K Australia %K digital psychology service %K psychology %K symptom severity %K severity %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety. Objective: This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics. Methods: Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Results: The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment. Conclusions: The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health. %M 39052998 %R 10.2196/57938 %U https://formative.jmir.org/2024/1/e57938 %U https://doi.org/10.2196/57938 %U http://www.ncbi.nlm.nih.gov/pubmed/39052998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52878 %T Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game %A Noroozi,Mohammad %A St John,Ace %A Masino,Caterina %A Laplante,Simon %A Hunter,Jaryd %A Brudno,Michael %A Madani,Amin %A Kersten-Oertel,Marta %+ Applied Perception Lab, Department of Computer Science and Software Engineering, Concordia University, 2155 Guy Street ER923, Montreal, QC, H3G 1M8, Canada, 1 8482424 ext 5830, marta.kersten@concordia.ca %K gamification %K serious games %K surgery %K education %K laparoscopic cholecystectomy %K artificial intelligence %K AI %K laparoscope %K gallbladder %K cholecystectomy %K mobile game %K gamify %K educational game %K interactive %K decision-making %K mobile phone %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. Objective:  To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. Methods:  LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Results:  Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. Conclusions:  LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees. %M 39052314 %R 10.2196/52878 %U https://formative.jmir.org/2024/1/e52878 %U https://doi.org/10.2196/52878 %U http://www.ncbi.nlm.nih.gov/pubmed/39052314 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52734 %T Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link %A Avanceña,Anton L V %A Brody,Carinne %A Chhoun,Pheak %A Tuot,Sovannary %A Yi,Siyan %+ Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave, PHR 2.112, Austin, TX, 78712, United States, 1 5124713146, antonlv@utexas.edu %K female entertainment workers %K Cambodia %K mHealth %K mobile health %K economic evaluation %K stigmatized populations %K women's health %K sexual health %K STI %K sexually transmitted infection %K STD %K sexually transmitted disease %K economic %K cost %K costs %K affordable %K affordability %K budget %K finance %K financial %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Link is a mobile phone–based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. Objective: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. Methods: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link’s messaging and outreach services to 70% of female entertainment workers in 5 years. Results: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval –0.088 to 0.126) DALYs averted, Mobile Link’s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. Conclusions: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial Registration: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842 %M 39052328 %R 10.2196/52734 %U https://formative.jmir.org/2024/1/e52734 %U https://doi.org/10.2196/52734 %U http://www.ncbi.nlm.nih.gov/pubmed/39052328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58263 %T Digitally Enabled Peer Support and Social Health Platform for Vulnerable Adults With Loneliness and Symptomatic Mental Illness: Cohort Analysis %A Bravata,Dena %A Russell,Daniel %A Fellows,Annette %A Goldman,Ron %A Pace,Elizabeth %+ Center for Primary Care and Outcomes Research, Stanford University, 1840 Lexington Av, San Mateo, CA, 94402, United States, 1 4157065829, dbravata@gmail.com %K peer support %K social isolation %K loneliness %K depression %K depressive %K mental health %K anxiety %K quality of life %K isolation %K isolated %K online support %K digital health %K vulnerable %K race %K racial ethnic %K ethnicity %K gender %K socioeconomic %K demographic %D 2024 %7 24.7.2024 %9 Research Letter %J JMIR Form Res %G English %X This study prospectively evaluated the effects of digitally enabled peer support on mental health outcomes and estimated medical cost reductions among vulnerable adults with symptomatic depression, anxiety, and significant loneliness to address the mental health crisis in the United States. %M 38941568 %R 10.2196/58263 %U https://formative.jmir.org/2024/1/e58263 %U https://doi.org/10.2196/58263 %U http://www.ncbi.nlm.nih.gov/pubmed/38941568 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54272 %T Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial %A Rabbani,Fauziah %A Nafis,Javeria %A Akhtar,Samina %A Khan,Muhammad Shahid %A Sayani,Saleem %A Siddiqui,Amna %A Siddiqi,Sameen %A Merali,Zul %+ Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 3500, Pakistan, 92 2134864864, fauziah.Rabbani@aku.edu %K anxiety %K depression %K feasibility %K mental health %K health workers %K mPareshan app %K implementation research %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective: The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Methods: Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app–based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization’s Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs’ routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. Results: At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. Conclusions: This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z International Registered Report Identifier (IRRID): DERR1-10.2196/54272 %M 39042878 %R 10.2196/54272 %U https://www.researchprotocols.org/2024/1/e54272 %U https://doi.org/10.2196/54272 %U http://www.ncbi.nlm.nih.gov/pubmed/39042878 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e39779 %T Design, Develop, and Pilot-Test a Digital Platform to Enhance Student Well-Being: Protocol for a Mixed-Methods Study %A Joshi,Ashish %A Kaur,Kamalpreet %A Bhatt,Ashruti %A Surapaneni,Krishna Mohan %A Grover,Ashoo %A Pandya,Apurva Kumar %+ School of Public Health, University of Memphis, 236 Robison Hall, Memphis, TN, 38152, United States, 1 443 570 6018, ashish1875@gmail.com %K well-being %K students %K digital interventions %K social support %K family demands %K mental well-being %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Well-being is a multidimensional concept and has been extended to many areas. Student well-being has garnered attention over the last decade due to concerns that have been raised. Digital health interventions have the potential to enhance and improve student well-being. Objective: The objective of the study is to design, develop, and pilot-test a digital health platform to enhance student well-being. Methods: A sample size of 5000 participants will be recruited across Gujarat and Tamil Nadu, India. Students will be enrolled from Parul University in Vadodara, Gujarat, as well as Panimalar Medical College Hospital and Research Institute, Panimalar Engineering College, Panimalar Institute of Technology, and Panimalar College of Nursing in Chennai, Tamil Nadu. Current undergraduate and graduate students consenting to participate will be recruited using convenience sampling from these institutes. The study will collect baseline data to construct the student well-being index. Based on the risk profile, a random subset of the population will be provided access to the digital health intervention, which will deliver tailored interactive messages addressing the various dimensions of well-being among undergraduate and graduate students. The eligible study participants will be aged 18 years and older, enrolled in these institutes, and willing to give their consent to participate in the study. Results: The proposed research is an unfunded study. The enrollment of the individuals in the study began in October 2022. Data gathered will be analyzed using SAS (version 9.3; SAS Institute) and results will be reported as 95% CIs and P values. Conclusions: The proposed study will help to determine the factors affecting well-being among college students and help in designing digital health interventions to improve the well-being of undergraduate and graduate students. International Registered Report Identifier (IRRID): PRR1-10.2196/39779 %M 39042879 %R 10.2196/39779 %U https://www.researchprotocols.org/2024/1/e39779 %U https://doi.org/10.2196/39779 %U http://www.ncbi.nlm.nih.gov/pubmed/39042879 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54951 %T Probing the Role of Digital Payment Solutions in Gambling Behavior: Preliminary Results From an Exploratory Focus Group Session With Problem Gamblers %A Lakew,Nathan %A Jonsson,Jakob %A Lindner,Philip %+ Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, Stockholm, 113 64, Sweden, 46 852483391, nathan.lakew@ki.se %K digital payment solutions %K online gambling behavior %K sociotechnical %K subjective experience %K focus group %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology has significantly reshaped the landscape and accessibility of gambling, creating uncharted territory for researchers and policy makers involved in the responsible gambling (RG) agenda. Digital payment solutions (DPS) are the latest addition of technology-based services in gambling and are now prominently used for deposit and win withdrawal. The seamless collaboration between online gambling operators and DPS, however, has raised concerns regarding the potential role of DPS platforms in facilitating harmful behavior. Objective: Using a focus group session with problem gamblers, this study describes a preliminary investigation of the role of DPS in the online gambling context and its influence on players’ gambling habits, financial behavior, choices of gambling environment, and the overall outcome of gambling subjective experiences. Methods: A total of 6 problem gamblers participated in a one-and-half-hour focus group session to discuss how DPSs are integrated into their everyday gambling habits, what motivates them to use DPS, and what shifts they observe in their gambling behavior. Thematic analysis was used to analyze the empirical evidence with a mix of inductive and deductive research approaches as a knowledge claim strategy. Results: Our initial findings revealed that the influence of DPSs in online gambling is multifaced where, on the one hand, their ability to integrate with players’ existing habits seamlessly underscores the facilitating role they play in potentially maximizing harm. On the other hand, we find preliminary evidence that DPSs can have a direct influence on gambling outcomes in both subtle and pervasive ways—nudging, institutionalizing, constraining, or triggering players’ gambling activities. This study also highlights the increasingly interdisciplinary nature of online gambling, and it proposes a preliminary conceptual framework to illustrate the sociotechnical interplay between DPS and gambling habits that ultimately capture the outcome of gambling’s subjective experience. Conclusions: Disguised as a passive payment enabler, the role of DPS has so far received scant attention; however, this exploratory qualitative study demonstrates that given the technological advantage and access to customer financial data, DPS can become a potent platform to enable and at times trigger harmful gambling. In addition, DPS’s bird’s-eye view of cross-operator gambling behavior can open up an opportunity for researchers and policy makers to explore harm reduction measures that can be implemented at the digital payment level for gambling customers. Finally, more interdisciplinary studies are needed to formulate the sociotechnical nature of online gambling and holistic harm minimization strategy. %M 39042438 %R 10.2196/54951 %U https://humanfactors.jmir.org/2024/1/e54951 %U https://doi.org/10.2196/54951 %U http://www.ncbi.nlm.nih.gov/pubmed/39042438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54817 %T Adding Virtual Reality Mindful Exposure Therapy to a Cancer Center’s Tobacco Treatment Offerings: Feasibility and Acceptability Single-Group Pilot Study %A Jackson,Riley Walton %A Cao-Nasalga,Ann %A Chieng,Amy %A Pirkl,Amy %A Jagielo,Annemarie D %A Xu,Cindy %A Goldenhersch,Emilio %A Rosencovich,Nicolas %A Waitman,Cristian %A Prochaska,Judith J %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 650 724 3608, jpro@stanford.edu %K tobacco cessation %K virtual reality %K exposure therapy %K cancer care %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability of a virtual reality (VR) mindful exposure therapy app for quitting smoking called MindCotine. Objective: The objective of this study was to determine the feasibility and acceptability of offering 6 weeks of MindCotine treatment as a part of Stanford’s Tobacco Treatment Services for patients seen for cancer care. Methods: As part of a single-group pilot study, the MindCotine VR program was offered to English- or Spanish-speaking patients interested in quitting smoking. Given the visual interface, epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a digital environment with audiovisual content guiding mindfulness exercises (eg, breathing techniques, body awareness, and thought recognition), text-based coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to use the app for 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. Results: Of the 357 patients reached by the tobacco treatment specialist, 62 (17.3%) were ineligible, 190 (53.2%) were not interested in tobacco treatment services, and 78 (21.8%) preferred other tobacco treatment services. Among the 105 eligible and interested in assistance with quitting, 27 (25.7%) were interested in MindCotine, of whom 20 completed the informed consent, 9 used the program, and 8 completed their end-of-treatment survey. Participants using MindCotine completed, on average, 13 (SD 20.2) program activities, 19 (SD 26) journal records, and 11 (SD 12.3) coaching engagements. Of the 9 participants who used MindCotine, 4 (44%) reported some dizziness with app use that resolved and 7 (78%) would recommend MindCotine to a friend. In total, 2 participants quit tobacco (22.2% reporting, 10% overall), 2 others reduced their smoking by 50% or more, and 2 quit for 24 hours and then relapsed. Conclusions: In a feasibility and acceptability pilot study of a novel VR tobacco treatment app offered to patients at a cancer center, 4 of 9 (44%) reporting and 4 of 20 (20%) overall substantially reduced or quit using tobacco after 6 weeks and most would recommend the app to others. Further testing on a larger sample is warranted. Trial Registration: ClinicalTrials.gov NCT05220254; https://clinicaltrials.gov/study/NCT05220254 %M 39042439 %R 10.2196/54817 %U https://formative.jmir.org/2024/1/e54817 %U https://doi.org/10.2196/54817 %U http://www.ncbi.nlm.nih.gov/pubmed/39042439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57316 %T Piloting a Clinical Decision Support Tool to Identify Patients With Social Needs and Provide Navigation Services and Referral to Community-Based Organizations: Protocol for a Randomized Controlled Trial %A Hatef,Elham %A Richards,Thomas %A Topel,Kristin %A Hail,Sofia %A Kitchen,Christopher %A Shaw,Katherine %A Zhang,Talan %A Lasser,Elyse C %A Weiner,Jonathan P %+ Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 1 4109788006, ehatef1@jhu.edu %K social needs %K social determinants of health %K clinical decision support tool %K electronic health records %K randomized controlled trial %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social needs and social determinants of health (SDOH) significantly outrank medical care when considering the impact on a person’s length and quality of life, resulting in poor health outcomes and worsening life expectancy. Integrating social needs and SDOH data along with clinical risk information within operational clinical decision support (CDS) systems built into electronic health records (EHRs) is an effective approach to addressing health-related social needs. To achieve this goal, applied research is needed to develop EHR-integrated CDS tools and closed-loop referral systems and implement and test them in the digital and clinical workflows at health care systems and collaborating community-based organizations (CBOs). Objective: This study aims to describe the protocol for a mixed methods study including a randomized controlled trial and a qualitative phase assessing the feasibility, acceptability, and effectiveness of an EHR-integrated digital platform to identify patients with social needs and provide navigation services and closed-loop referrals to CBOs to address their social needs. Methods: The randomized controlled trial will enroll and randomize adult patients living in socioeconomically challenged neighborhoods in Baltimore City receiving care at a single academic health care institution in the 3-month intervention (using the digital platform) or the 3-month control (standard-of-care assessment and addressing of social needs) arms (n=295 per arm). To evaluate the feasibility and acceptability of the digital platform and its impact on the clinical and digital workflow and patient care, we will conduct focus groups with the care teams in the health care system (eg, clinical providers, social workers, and care managers) and collaborating CBOs. The outcomes will be the acceptability, feasibility, and effectiveness of the CDS tool and closed-loop referral system. Results: This clinical trial opened to enrollment in June 2023 and will be completed in March 2025. Initial results are expected to be published in spring 2025. We will report feasibility outcome measures as weekly use rates of the digital platform. The acceptability outcome measure will be the provider’s and patient’s responses to the truthfulness of a statement indicating a willingness to use the platform in the future. Effectiveness will be measured by tracking a 3-month change in identified social needs and provided navigation services as well as clinical outcomes such as hospitalization and emergency department visits. Conclusions: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of such interventions in digital and clinical workflows to enhance the health care system and CBO ability related to social needs assessment and intervention. These results may inform the construction of a future multi-institutional trial designed to test the effectiveness of this intervention across different health care systems and care settings. Trial Registration: ClinicalTrials.gov NCT05574699; https://clinicaltrials.gov/study/NCT05574699 International Registered Report Identifier (IRRID): DERR1-10.2196/57316 %M 39042426 %R 10.2196/57316 %U https://www.researchprotocols.org/2024/1/e57316 %U https://doi.org/10.2196/57316 %U http://www.ncbi.nlm.nih.gov/pubmed/39042426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51400 %T Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis %A Myers,Jennifer Rae %A Bryk,Kelsey N %A Madero,Erica N %A McFarlane,Jacob %A Campitelli,Anthony %A Gills,Joshua %A Jones,Megan %A Paulson,Sally %A Gray,Michelle %A Glenn,Jordan M %+ Neurotrack Technologies, 399 Bradford St #101, Redwood City, CA, 94063, United States, 1 6505498566, jennifer.r.myers@outlook.com %K Alzheimer disease %K cognition %K intervention %K rural issues %K digital health %K geriatric %K geriatrics %K elder %K elderly %K diabetes %K diabetes mellitus %K dementia %K digital cognitive health coaching %K rural %K countryside %K qualitative study %K thematic analysis %K mHealth %K telehealth %K health informatics %K mental health %K behavioral change %K healthy lifestyle %K coach support %K self-awareness %K prevention %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. Objective: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. Methods: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant’s goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, “What were your top 1 or 2 takeaways from your recent Health Coaching session?” and “Is there anything you would change about our Health Coaching sessions?” A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). Results: The following four themes emerged from participants’ feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Conclusions: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): RR2-10.2196/31841 %M 39038282 %R 10.2196/51400 %U https://formative.jmir.org/2024/1/e51400 %U https://doi.org/10.2196/51400 %U http://www.ncbi.nlm.nih.gov/pubmed/39038282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57529 %T Measuring Engagement in Provider-Guided Digital Health Interventions With a Conceptual and Analytical Framework Using Nurse WRITE as an Exemplar: Exploratory Study With an Iterative Approach %A Wang,Yan %A DeVito Dabbs,Annette %A Thomas,Teresa Hagan %A Campbell,Grace %A Donovan,Heidi %+ Department of Health & Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building, Pittsburgh, PA, 15261, United States, 1 14126261172, yaw75@pitt.edu %K engagement %K digital health intervention %K framework %K symptom management %K eHealth %K gynecological cancer %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement. Objective: This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework’s ability to describe and categorize engagement using Nurse WRITE as an example. Methods: A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients' posts, we created 2 socio-affective engagement measures—total count of socio-affective engagement classes (eg, sharing personal experience) and total word count—and 2 cognitive engagement measures—total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data—the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions. Results: On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses' inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses’ queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews. Conclusions: This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants’ engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy. %M 39037757 %R 10.2196/57529 %U https://formative.jmir.org/2024/1/e57529 %U https://doi.org/10.2196/57529 %U http://www.ncbi.nlm.nih.gov/pubmed/39037757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56312 %T Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination %A Meltzer,Ellen %A Wilshusen,Laurie %A Abdulwadood,Isra %A Yee,Claire %A Sherman,Amy %A Strader,Kelli %A Thomley,Barbara %A Millstine,Denise %A Tilburt,Jon %A Fields,Heather %A Bergstrom,Larry %A Patchett,David %A Camoriano,John %A Bauer,Brent %+ Division of General Internal Medicine, Department of Medicine, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, United States, 1 4803016200, meltzer.ellen@mayo.edu %K telemedicine %K TELE %K patient experience %K communication skills %K integrative medicine %K face-to-face %K F2F %K encounters %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage “top box” scores (ie, the percentage of respondents who selected the most positive response category on the survey, “very good”), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine. %M 39037767 %R 10.2196/56312 %U https://formative.jmir.org/2024/1/e56312 %U https://doi.org/10.2196/56312 %U http://www.ncbi.nlm.nih.gov/pubmed/39037767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52212 %T Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking %A Banakou,Domna %A Johnston,Tania %A Beacco,Alejandro %A Senel,Gizem %A Slater,Mel %+ Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Campus de Mundet Edifici CAVE, Passeig de la Vall d'Hebron 171, Barcelona, 08035, Spain, 34 93 403 ext 9618, melslater@ub.edu %K exposure therapy %K virtual reality %K gradual exposure %K fear of public speaking %K anxiety %K change blindness %K public speaking %K desensitization %K anxiety disorder %K feasibility study %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. Objective: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. Methods: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. Results: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. Conclusions: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients. %M 39037760 %R 10.2196/52212 %U https://formative.jmir.org/2024/1/e52212 %U https://doi.org/10.2196/52212 %U http://www.ncbi.nlm.nih.gov/pubmed/39037760 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57114 %T Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study %A Sezgin,Emre %A Kocaballi,A Baki %A Dolce,Millie %A Skeens,Micah %A Militello,Lisa %A Huang,Yungui %A Stevens,Jack %A Kemper,Alex R %+ Nationwide Children's Hospital, 700 Children's dr, Columbus, OH, 43205, United States, 1 6147223179, emre.sezgin@nationwidechildrens.org %K social determinants of health %K social needs %K chatbot %K conversational agent %K primary care %K digital health %K iterative design %K implementation %K evaluation %K usability %K feasibility %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. Objective: This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. Methods: This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot’s design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. Results: Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot’s capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. Conclusions: Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs. %M 39028995 %R 10.2196/57114 %U https://humanfactors.jmir.org/2024/1/e57114 %U https://doi.org/10.2196/57114 %U http://www.ncbi.nlm.nih.gov/pubmed/39028995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51943 %T Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study %A Smith,Amy M %A Marin,Anna %A DeCaro,Renee E %A Feinn,Richard %A Wack,Audrey %A Hughes,Gregory I %A Rivard,Nathaniel %A Umashankar,Akshay %A Turk,Katherine W %A Budson,Andrew E %+ Blank Slate Technologies, LLC, 4075 Wilson Blvd, Arlington, VA, 22203, United States, 1 2034018923, smitham192@gmail.com %K Alzheimer disease %K spaced retrieval %K mobile app %K assistive technology %K episodic memory %K semantic memory %K mobile phone %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD. Objective: This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user’s rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting. Methods: In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied. Results: After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app’s automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it. Conclusions: These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations. %M 39028554 %R 10.2196/51943 %U https://formative.jmir.org/2024/1/e51943 %U https://doi.org/10.2196/51943 %U http://www.ncbi.nlm.nih.gov/pubmed/39028554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55575 %T Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers %A Xu,Qidi %A Kim,Yejin %A Chung,Karen %A Schulz,Paul %A Gottlieb,Assaf %+ McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 7135003698, assaf.gottlieb@uth.tmc.edu %K mild cognitive impairment %K Fitbits %K fitness trackers %K sleep %K physical activity %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI). Objective: This study aimed to use data collected from fitness trackers to predict MCI status. Methods: In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status. Results: Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time. Conclusions: Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies. %M 39024003 %R 10.2196/55575 %U https://formative.jmir.org/2024/1/e55575 %U https://doi.org/10.2196/55575 %U http://www.ncbi.nlm.nih.gov/pubmed/39024003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53716 %T Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study %A Esmaeilpour,Zeinab %A Natarajan,Aravind %A Su,Hao-Wei %A Faranesh,Anthony %A Friel,Ciaran %A Zanos,Theodoros P %A D’Angelo,Stefani %A Heneghan,Conor %+ Google LLC, 199 Fremont Street, San Francisco, CA, 94105, United States, 1 9293047065, znb.esmailpoor@gmail.com %K COVID detection %K wearable %K respiratory virus detection %K algorithm %K respiratory infection %K respiratory virus %K COVID-19 %K wearable device %K well-being %K health %K physiology %K health care worker %K prediction %K infection %K physical stress %K emotional stress %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. Objective: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. Methods: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. Results: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2%, and the positive-predictive value ranged from 4% to 10% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. Conclusions: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures. %M 39018555 %R 10.2196/53716 %U https://formative.jmir.org/2024/1/e53716 %U https://doi.org/10.2196/53716 %U http://www.ncbi.nlm.nih.gov/pubmed/39018555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52842 %T Adaptation and Reach of a Pre-Exposure Prophylaxis Social Marketing Campaign for Latino, Latina, and Latinx Populations: Development Study %A Shah,Harita S %A Serrano,Pedro Alonso %A Phillips II,Gregory %+ Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC 3051, Chicago, IL, 60637, United States, 1 773 702 4581, harita@uchicago.edu %K Latino %K Latinx %K Latina %K social marketing %K social media %K PrEP %K pre-exposure prophylaxis %K HIV prevention %K community %K CBPR %K community-based participatory research %K campaign %K transgender %K MSM %K reach %K HIV %K prevention %K formative research %K men who have sex with men %K treatment %K intervention %K biomedical %K awareness %K Latino/x/a %K Latina/x/o %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women. Objective: This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign. Methods: We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate (“Be PrEPared”) campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics. Results: The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education–related content. In the first year, there were 5006 visitors to the website. Conclusions: Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations. %M 39018099 %R 10.2196/52842 %U https://formative.jmir.org/2024/1/e52842 %U https://doi.org/10.2196/52842 %U http://www.ncbi.nlm.nih.gov/pubmed/39018099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56608 %T Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial %A Miura,Kumi Watanabe %A Kudo,Takashi %A Otake-Matsuura,Mihoko %+ Center for Advanced Intelligence Project, RIKEN, Nihonbashi 1-chome Mitsui Building, 15th floor 1-4-1 Nihonbashi, Tokyo, 103-0027, Japan, 81 3 6225 2482, mihoko.otake@riken.jp %K randomized controlled trial %K web-based intervention %K communication technology %K cognitive health %K neural blood markers %K social isolation %K well-being %D 2024 %7 11.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. Objective: This study will examine the effects of “Photo-Integrated Conversation Moderated by Application version 2” (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. Methods: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. Results: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. Conclusions: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. Trial Registration: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66 International Registered Report Identifier (IRRID): DERR1-10.2196/56608 %M 38990615 %R 10.2196/56608 %U https://www.researchprotocols.org/2024/1/e56608 %U https://doi.org/10.2196/56608 %U http://www.ncbi.nlm.nih.gov/pubmed/38990615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54044 %T Predictive Model for Extended-Spectrum β-Lactamase–Producing Bacterial Infections Using Natural Language Processing Technique and Open Data in Intensive Care Unit Environment: Retrospective Observational Study %A Ito,Genta %A Yada,Shuntaro %A Wakamiya,Shoko %A Aramaki,Eiji %+ Department of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma City, 8916-5, Japan, 81 0743725204, aramaki@is.naist.jp %K predictive modeling %K MIMIC-3 dataset %K natural language processing %K NLP %K QuickUMLS %K named entity recognition %K ESBL-producing bacterial infections %D 2024 %7 10.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning has advanced medical event prediction, mostly using private data. The public MIMIC-3 (Medical Information Mart for Intensive Care III) data set, which contains detailed data on over 40,000 intensive care unit patients, stands out as it can help develop better models including structured and textual data. Objective: This study aimed to build and test a machine learning model using the MIMIC-3 data set to determine the effectiveness of information extracted from electronic medical record text using a named entity recognition, specifically QuickUMLS, for predicting important medical events. Using the prediction of extended-spectrum β-lactamase (ESBL)–producing bacterial infections as an example, this study shows how open data sources and simple technology can be useful for making clinically meaningful predictions. Methods: The MIMIC-3 data set, including demographics, vital signs, laboratory results, and textual data, such as discharge summaries, was used. This study specifically targeted patients diagnosed with Klebsiella pneumoniae or Escherichia coli infection. Predictions were based on ESBL-producing bacterial standards and the minimum inhibitory concentration criteria. Both the structured data and extracted patient histories were used as predictors. In total, 2 models, an L1-regularized logistic regression model and a LightGBM model, were evaluated using the receiver operating characteristic area under the curve (ROC-AUC) and the precision-recall curve area under the curve (PR-AUC). Results: Of 46,520 MIMIC-3 patients, 4046 were identified with bacterial cultures, indicating the presence of K pneumoniae or E coli. After excluding patients who lacked discharge summary text, 3614 patients remained. The L1-penalized model, with variables from only the structured data, displayed a ROC-AUC of 0.646 and a PR-AUC of 0.307. The LightGBM model, combining structured and textual data, achieved a ROC-AUC of 0.707 and a PR-AUC of 0.369. Key contributors to the LightGBM model included patient age, duration since hospital admission, and specific medical history such as diabetes. The structured data-based model showed improved performance compared to the reference models. Performance was further improved when textual medical history was included. Compared to other models predicting drug-resistant bacteria, the results of this study ranked in the middle. Some misidentifications, potentially due to the limitations of QuickUMLS, may have affected the accuracy of the model. Conclusions: This study successfully developed a predictive model for ESBL-producing bacterial infections using the MIMIC-3 data set, yielding results consistent with existing literature. This model stands out for its transparency and reliance on open data and open-named entity recognition technology. The performance of the model was enhanced using textual information. With advancements in natural language processing tools such as BERT and GPT, the extraction of medical data from text holds substantial potential for future model optimization. %M 38986131 %R 10.2196/54044 %U https://formative.jmir.org/2024/1/e54044 %U https://doi.org/10.2196/54044 %U http://www.ncbi.nlm.nih.gov/pubmed/38986131 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e49703 %T Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial %A Baik,Sharon H %A Clark,Karen %A Sanchez,Marisol %A Loscalzo,Matthew %A Celis,Ashley %A Razavi,Marianne %A Yang,Dershung %A Dale,William %A Haas,Niina %+ Department of Supportive Care Medicine, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, United States, 1 626 256 4673, shbaik@coh.org %K cancer %K distress screening %K eHealth %K supportive care %K mobile phone %D 2024 %7 10.7.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient’s needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. Objective: This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. Methods: For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. Results: Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, “help request” function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference −2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). Conclusions: Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406 %M 38986134 %R 10.2196/49703 %U https://cancer.jmir.org/2024/1/e49703 %U https://doi.org/10.2196/49703 %U http://www.ncbi.nlm.nih.gov/pubmed/38986134 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47785 %T Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis %A Ortiz,Fernanda %A Grasberger,Juulia %A Ekstrand,Agneta %A Helanterä,Ilkka %A Giunti,Guido %+ Abdominal Center–Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00130, Finland, 358 504270795, fernanda.ortiz@hus.fi %K eHealth %K kidney living donor %K informed consent %K telemedicine %K process standardization %K kidney %K donor %K tool %K usability %K psychological impact %K utility %K smartphone %K coping %K surgery %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors’ lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users’ ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 %M 38981119 %R 10.2196/47785 %U https://formative.jmir.org/2024/1/e47785 %U https://doi.org/10.2196/47785 %U http://www.ncbi.nlm.nih.gov/pubmed/38981119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55732 %T Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design %A Gunn,Rose %A Watkins,Shelby L %A Boston,Dave %A Rosales,A Gabriela %A Massimino,Stefan %A Navale,Suparna %A Fitzpatrick,Stephanie L %A Dickerson,John %A Gold,Rachel %A Lee,George %A McMullen,Carmit K %+ OCHIN, Inc, PO Box 5426, Portland, OR, 97228, United States, 1 503 943 2500, gunnr@ochin.org %K Patient-generated health data %K telemedicine %K telehealth %K diabetes mellitus %K hypertension %K self-management %K patient portal %K implementation science %K COVID-19: pandemic %K community health center %K chronic condition %K remote patient monitoring %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. Objective: The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. Methods: This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC’s implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record–extracted health outcomes data and semistructured interviews with the CHC’s staff and patients participating in the RPM program. Results: The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. Conclusions: While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance. %M 38980716 %R 10.2196/55732 %U https://formative.jmir.org/2024/1/e55732 %U https://doi.org/10.2196/55732 %U http://www.ncbi.nlm.nih.gov/pubmed/38980716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56110 %T ChatGPT With GPT-4 Outperforms Emergency Department Physicians in Diagnostic Accuracy: Retrospective Analysis %A Hoppe,John Michael %A Auer,Matthias K %A Strüven,Anna %A Massberg,Steffen %A Stremmel,Christopher %+ Department of Medicine I, LMU University Hospital, Marchioninistr 15, Munich, 81377, Germany, 49 89 4400 712622, christopher.stremmel@med.uni-muenchen.de %K emergency department %K diagnosis %K accuracy %K artificial intelligence %K ChatGPT %K internal medicine %K AI %K natural language processing %K NLP %K emergency medicine triage %K triage %K physicians %K physician %K diagnostic accuracy %K OpenAI %D 2024 %7 8.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: OpenAI’s ChatGPT is a pioneering artificial intelligence (AI) in the field of natural language processing, and it holds significant potential in medicine for providing treatment advice. Additionally, recent studies have demonstrated promising results using ChatGPT for emergency medicine triage. However, its diagnostic accuracy in the emergency department (ED) has not yet been evaluated. Objective: This study compares the diagnostic accuracy of ChatGPT with GPT-3.5 and GPT-4 and primary treating resident physicians in an ED setting. Methods: Among 100 adults admitted to our ED in January 2023 with internal medicine issues, the diagnostic accuracy was assessed by comparing the diagnoses made by ED resident physicians and those made by ChatGPT with GPT-3.5 or GPT-4 against the final hospital discharge diagnosis, using a point system for grading accuracy. Results: The study enrolled 100 patients with a median age of 72 (IQR 58.5-82.0) years who were admitted to our internal medicine ED primarily for cardiovascular, endocrine, gastrointestinal, or infectious diseases. GPT-4 outperformed both GPT-3.5 (P<.001) and ED resident physicians (P=.01) in diagnostic accuracy for internal medicine emergencies. Furthermore, across various disease subgroups, GPT-4 consistently outperformed GPT-3.5 and resident physicians. It demonstrated significant superiority in cardiovascular (GPT-4 vs ED physicians: P=.03) and endocrine or gastrointestinal diseases (GPT-4 vs GPT-3.5: P=.01). However, in other categories, the differences were not statistically significant. Conclusions: In this study, which compared the diagnostic accuracy of GPT-3.5, GPT-4, and ED resident physicians against a discharge diagnosis gold standard, GPT-4 outperformed both the resident physicians and its predecessor, GPT-3.5. Despite the retrospective design of the study and its limited sample size, the results underscore the potential of AI as a supportive diagnostic tool in ED settings. %M 38976865 %R 10.2196/56110 %U https://www.jmir.org/2024/1/e56110 %U https://doi.org/10.2196/56110 %U http://www.ncbi.nlm.nih.gov/pubmed/38976865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58063 %T A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study %A McClure,Jennifer B %A Heffner,Jaimee L %A Krakauer,Chloe %A Mun,Sophia %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K HIV %K tobacco %K nicotine %K smoking cessation %K mobile health %K mHealth %K motivation %K ambivalence %K app %K mobile phone %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. Objective: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. Methods: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Results: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. Conclusions: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health–based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. Trial Registration: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659 %M 38976321 %R 10.2196/58063 %U https://formative.jmir.org/2024/1/e58063 %U https://doi.org/10.2196/58063 %U http://www.ncbi.nlm.nih.gov/pubmed/38976321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55834 %T Novel Methodology for Identifying the Occurrence of Ovulation by Estimating Core Body Temperature During Sleeping: Validity and Effectiveness Study %A Sato,Daisuke %A Ikarashi,Koyuki %A Nakajima,Fumiko %A Fujimoto,Tomomi %+ Sports Physiology Laboratory, Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan, 81 25 257 4624, daisuke@nuhw.ac.jp %K menstrual cycle %K ovulation %K biphasic temperature shift %K estimation method %K women %D 2024 %7 5.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Body temperature is the most-used noninvasive biomarker to determine menstrual cycle and ovulation. However, issues related to its low accuracy are still under discussion. Objective: This study aimed to improve the accuracy of identifying the presence or absence of ovulation within a menstrual cycle. We investigated whether core body temperature (CBT) estimation can improve the accuracy of temperature biphasic shift discrimination in the menstrual cycle. The study consisted of 2 parts: experiment 1 assessed the validity of the CBT estimation method, while experiment 2 focused on the effectiveness of the method in discriminating biphasic temperature shifts. Methods: In experiment 1, healthy women aged between 18 and 40 years had their true CBT measured using an ingestible thermometer and their CBT estimated from skin temperature and ambient temperature measured during sleep in both the follicular and luteal phases of their menstrual cycles. This study analyzed the differences between these 2 measurements, the variations in temperature between the 2 phases, and the repeated measures correlation between the true and estimated CBT. Experiment 2 followed a similar methodology, but focused on evaluating the diagnostic accuracy of these 2 temperature measurement approaches (estimated CBT and traditional oral basal body temperature [BBT]) for identifying ovulatory cycles. This was performed using urine luteinizing hormone (LH) as the reference standard. Menstrual cycles were categorized based on the results of the LH tests, and a temperature shift was identified using a specific criterion called the “three-over-six rule.” This rule and the nested design of the study facilitated the assessment of diagnostic measures, such as sensitivity and specificity. Results: The main findings showed that CBT estimated from skin temperature and ambient temperature during sleep was consistently lower than directly measured CBT in both the follicular and luteal phases of the menstrual cycle. Despite this, the pattern of temperature variation between these phases was comparable for both the estimated and true CBT measurements, suggesting that the estimated CBT accurately reflected the cyclical variations in the true CBT. Significantly, the CBT estimation method showed higher sensitivity and specificity for detecting the occurrence of ovulation than traditional oral BBT measurements, highlighting its potential as an effective tool for reproductive health monitoring. The current method for estimating the CBT provides a practical and noninvasive method for monitoring CBT, which is essential for identifying biphasic shifts in the BBT throughout the menstrual cycle. Conclusions: This study demonstrated that the estimated CBT derived from skin temperature and ambient temperature during sleep accurately captures variations in true CBT and is more accurate in determining the presence or absence of ovulation than traditional oral BBT measurements. This method holds promise for improving reproductive health monitoring and understanding of menstrual cycle dynamics. %M 38967967 %R 10.2196/55834 %U https://formative.jmir.org/2024/1/e55834 %U https://doi.org/10.2196/55834 %U http://www.ncbi.nlm.nih.gov/pubmed/38967967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53289 %T Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design %A Tennant,Ryan %A Allana,Sana %A Mercer,Kate %A Burns,Catherine M %+ Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, drtennan@uwaterloo.ca %K aged %K caregivers %K patient safety %K communication %K patient care team %K information management %K digital technology %K human-centered design %K mobile phone %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. Objective: The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. Methods: The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19–related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. Results: Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. Conclusions: This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles. %M 38963695 %R 10.2196/53289 %U https://formative.jmir.org/2024/1/e53289 %U https://doi.org/10.2196/53289 %U http://www.ncbi.nlm.nih.gov/pubmed/38963695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55342 %T A Deep Learning–Based Rotten Food Recognition App for Older Adults: Development and Usability Study %A Chun,Minki %A Yu,Ha-Jin %A Jung,Hyunggu %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K digital health %K mobile health %K mHealth %K app %K apps %K application %K applications %K smartphone %K smartphones %K classification %K digital sensor %K deep learning %K artificial intelligence %K machine learning %K food %K foods %K fruit %K fruits %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K camera %K image %K imaging %K photo %K photos %K photograph %K photographs %K recognition %K picture %K pictures %K sensor %K sensors %K develop %K development %K design %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items. Objective: This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app. Methods: We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7%, males and n=11, 42.3%, females) as participants. We evaluated the usability of the app and the participants’ perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses. Results: The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants’ perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory. Conclusions: This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains. %M 38959501 %R 10.2196/55342 %U https://formative.jmir.org/2024/1/e55342 %U https://doi.org/10.2196/55342 %U http://www.ncbi.nlm.nih.gov/pubmed/38959501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56118 %T Motivational Variables as Moderating Effects of a Web-Based Mental Health Program for University Students: Secondary Analysis of a Randomized Controlled Trial %A Hanano,Maria %A Rith-Najarian,Leslie %A Gong-Guy,Elizabeth %A Chavira,Denise %+ University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095, United States, 1 9493501523, mariahanano@g.ucla.edu %K web-based intervention %K internal motivation %K depression %K anxiety %K self-determination theory %K mental health %K university students %K university %K students %K web-based %K analysis %K randomized controlled trial %K self-guided %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. Objective: This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). Methods: Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. Results: Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=–2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=–2.28; P=.02 and t1507=–4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. Conclusions: The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045 %M 38959024 %R 10.2196/56118 %U https://formative.jmir.org/2024/1/e56118 %U https://doi.org/10.2196/56118 %U http://www.ncbi.nlm.nih.gov/pubmed/38959024 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e54532 %T A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study %A Syed,Toufeeq Ahmed %A Thompson,Erika L %A Johnson,Jason %A Latif,Zainab %A Kennedy,Nan %A Javier,Damaris %A Stinson,Katie %A Vishwanatha,Jamboor K %K diversity %K mentoring %K health workforce %K underrepresented groups %K online platform %K user-computer interface %K A/B testing %K split testing %K recommendation algorithm %K network of mentors %K groups %K enrollment %D 2024 %7 2.7.2024 %9 %J JMIR Hum Factors %G English %X Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health–funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform—MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3% (784/1368) with the legacy form to 74.5% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN’s membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. %R 10.2196/54532 %U https://humanfactors.jmir.org/2024/1/e54532 %U https://doi.org/10.2196/54532 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e57674 %T Data Set and Benchmark (MedGPTEval) to Evaluate Responses From Large Language Models in Medicine: Evaluation Development and Validation %A Xu,Jie %A Lu,Lu %A Peng,Xinwei %A Pang,Jiali %A Ding,Jinru %A Yang,Lingrui %A Song,Huan %A Li,Kang %A Sun,Xin %A Zhang,Shaoting %K ChatGPT %K LLM %K assessment %K data set %K benchmark %K medicine %D 2024 %7 28.6.2024 %9 %J JMIR Med Inform %G English %X Background: Large language models (LLMs) have achieved great progress in natural language processing tasks and demonstrated the potential for use in clinical applications. Despite their capabilities, LLMs in the medical domain are prone to generating hallucinations (not fully reliable responses). Hallucinations in LLMs’ responses create substantial risks, potentially threatening patients’ physical safety. Thus, to perceive and prevent this safety risk, it is essential to evaluate LLMs in the medical domain and build a systematic evaluation. Objective: We developed a comprehensive evaluation system, MedGPTEval, composed of criteria, medical data sets in Chinese, and publicly available benchmarks. Methods: First, a set of evaluation criteria was designed based on a comprehensive literature review. Second, existing candidate criteria were optimized by using a Delphi method with 5 experts in medicine and engineering. Third, 3 clinical experts designed medical data sets to interact with LLMs. Finally, benchmarking experiments were conducted on the data sets. The responses generated by chatbots based on LLMs were recorded for blind evaluations by 5 licensed medical experts. The evaluation criteria that were obtained covered medical professional capabilities, social comprehensive capabilities, contextual capabilities, and computational robustness, with 16 detailed indicators. The medical data sets include 27 medical dialogues and 7 case reports in Chinese. Three chatbots were evaluated: ChatGPT by OpenAI; ERNIE Bot by Baidu, Inc; and Doctor PuJiang (Dr PJ) by Shanghai Artificial Intelligence Laboratory. Results: Dr PJ outperformed ChatGPT and ERNIE Bot in the multiple-turn medical dialogues and case report scenarios. Dr PJ also outperformed ChatGPT in the semantic consistency rate and complete error rate category, indicating better robustness. However, Dr PJ had slightly lower scores in medical professional capabilities compared with ChatGPT in the multiple-turn dialogue scenario. Conclusions: MedGPTEval provides comprehensive criteria to evaluate chatbots by LLMs in the medical domain, open-source data sets, and benchmarks assessing 3 LLMs. Experimental results demonstrate that Dr PJ outperforms ChatGPT and ERNIE Bot in social and professional contexts. Therefore, such an assessment system can be easily adopted by researchers in this community to augment an open-source data set. %R 10.2196/57674 %U https://medinform.jmir.org/2024/1/e57674 %U https://doi.org/10.2196/57674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55361 %T The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study %A Gerald Dcruz,Julian %A Yeh,Paichang %+ Docsun Biomedical Holdings, Inc, 6763 32ND Ave N, Saint Petersburg, FL, 33710, United States, 1 (813) 4380045, jan.yeh@docsun.health %K medical devices %K mHealth %K vital signs %K measurements validity %K validation %K validity %K device %K devices %K vital %K vitals %K accuracy %K pulse %K oxygen %K saturation %K heart rate %K blood pressure %K respiration %K respiratory %K telehealth %K telemedicine %K eHealth %K e-health %K self-check %K self-checker %K breathing %K portal %K portals %K self-checking %K self-monitor %K self-monitoring %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. Objective: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. Methods: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant’s facial features are detected and screened for the extraction of necessary readings. Results: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within ±10% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within ±10% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was ±3%. The mean absolute percentage difference was 0.59%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81% and diastolic BP with an accuracy of 95.71%. Conclusions: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines. %M 38598698 %R 10.2196/55361 %U https://formative.jmir.org/2024/1/e55361 %U https://doi.org/10.2196/55361 %U http://www.ncbi.nlm.nih.gov/pubmed/38598698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55013 %T Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation %A Liu,Chuchu %A Holme,Petter %A Lehmann,Sune %A Yang,Wenchuan %A Lu,Xin %+ College of Systems Engineering, National University of Defense Technology, No 137 Yanwachi Street, Changsha, 410073, China, 86 18627561577, xin.lu.lab@outlook.com %K human mobility %K data representativeness %K population composition %K COVID-19 %K epidemiological modeling %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near–real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic’s importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. %M 38941609 %R 10.2196/55013 %U https://formative.jmir.org/2024/1/e55013 %U https://doi.org/10.2196/55013 %U http://www.ncbi.nlm.nih.gov/pubmed/38941609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54892 %T A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology %A Hodson,Nathan %A Woods,Peter %A Sobolev,Michael %A Giacco,Domenico %+ Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, United States, 1 2133480086, nathan.hodson@warwick.ac.uk %K parenting %K child behavior %K mental health %K app development %K digital %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non–English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. %M 38941594 %R 10.2196/54892 %U https://formative.jmir.org/2024/1/e54892 %U https://doi.org/10.2196/54892 %U http://www.ncbi.nlm.nih.gov/pubmed/38941594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54587 %T Availability of Alcohol on an Online Third-Party Delivery Platform Across London Boroughs, England: Exploratory Cross-Sectional Study %A Sharpe,Casey %A Bhuptani,Saloni %A Jecks,Mike %A Sheron,Nick %A Henn,Clive %A Burton,Robyn %+ Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, United Kingdom, 44 7595 417304, robyn.burton@stir.ac.uk %K alcohol %K availability %K online %K third-party delivery platforms %K England %K cross-sectional study %K exploratory %K licensing %K public health %K policy %D 2024 %7 28.6.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Higher availability of alcohol is associated with higher levels of alcohol consumption and harm. Alcohol is increasingly accessible online, with rapid delivery often offered by a third-party driver. Remote delivery and online availability are important from a public health perspective, but to date, relatively little research has explored the availability of alcohol offered by online platforms. Objective: This cross-sectional exploratory study describes the availability of alcohol on the third-party platform Deliveroo within London, England. Methods: We extracted the number of outlets offering alcohol on Deliveroo for each London borough and converted these into crude rates per 1000 population (18-64 years). Outlets were grouped as outlets exclusively selling alcohol, off-licenses, and premium. We calculated Pearson correlation coefficients to explore the association between borough’s crude rate of outlets per 1000 population and average Indices of Multiple Deprivation (IMD) 2019 scores. We extracted the number of outlets also selling tobacco or e-cigarettes and used non-Deliveroo drivers. We searched addresses of the top 20 outlets delivering to the most boroughs by outlet type (60 total) to determine their associated premise. Results: We identified 4277 total Deliveroo-based outlets offering alcohol across London, including outlets delivering in multiple boroughs. The crude rate of outlets per 1000 population aged 18-64 years was 0.73 and ranged from 0.22 to 2.29 per borough. Most outlets exclusively sold alcohol (3086/4277, 72.2%), followed by off-licenses (770/4277, 18.0%) and premium (421/4277, 9.8%). The majority of outlets exclusively selling alcohol sold tobacco or e-cigarettes (2951/3086, 95.6%) as did off-licenses to a lesser extent (588/770, 76.4%). Most outlets exclusively offering alcohol used drivers not employed by Deliveroo (2887/3086, 93.6%), and the inverse was true for premium outlets (50/421, 11.9%) and off-licenses (73/770, 9.5%). There were 1049 unique outlets, of which 396 (37.8%) were exclusively offering alcohol—these outlets tended to deliver across multiple boroughs unlike off-licenses and premium outlets. Of outlets with confirmed addresses, self-storage units were listed as the associated premise for 85% (17/20) of outlets exclusively offering alcohol, 11% (2/19) of off-licenses, and 12% (2/17) of premium outlets. We found no significant relationship between borough IMD scores and crude rate of outlets per 1000 population overall (P=.87) or by any outlet type: exclusively alcohol (P=.41), off-license (P=.58), and premium (P=.18). Conclusions: London-based Deliveroo outlets offering alcohol are common and are sometimes operating from self-storage units that have policies prohibiting alcohol storage. This and the potential for increased alcohol accessibility online have implications for public health given the relationship between alcohol’s availability and consumption or harm. There is a need to ensure that regulations for delivery are adequate for protecting children and vulnerable adults. The Licensing Act 2003 may require modernization in the digital age. Future research must explore a relationship between online alcohol availability and deprivation. %M 38941596 %R 10.2196/54587 %U https://formative.jmir.org/2024/1/e54587 %U https://doi.org/10.2196/54587 %U http://www.ncbi.nlm.nih.gov/pubmed/38941596 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57699 %T mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial %A Carey,Rachel L %A Le,Ha %A Coffman,Donna L %A Nahum-Shani,Inbal %A Thirumalai,Mohanraj %A Hagen,Cole %A Baehr,Laura A %A Schmidt-Read,Mary %A Lamboy,Marlyn S R %A Kolakowsky-Hayner,Stephanie A %A Marino,Ralph J %A Intille,Stephen S %A Hiremath,Shivayogi V %+ Department of Health and Rehabilitation Sciences, Temple University, Pearson Hall 40, 1800 North Broad Street, Philadelphia, PA, 19121, United States, 1 215 204 0496, Shiv.Hiremath@temple.edu %K spinal cord injury %K physical activity %K just-in-time adaptive intervention %K mobile health %K randomized controlled trial %K microrandomized trial %K wearable sensors %K ecological momentary assessment %K community %K mobile phone %D 2024 %7 28.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels. Objective: The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt. Methods: Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ≥12 hours for the duration of the study. Results: Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection. Conclusions: The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person’s actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability. Trial Registration: ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832 International Registered Report Identifier (IRRID): DERR1-10.2196/57699 %M 38941145 %R 10.2196/57699 %U https://www.researchprotocols.org/2024/1/e57699 %U https://doi.org/10.2196/57699 %U http://www.ncbi.nlm.nih.gov/pubmed/38941145 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56123 %T Effects of a Patient Portal Intervention to Address Diabetes Care Gaps: Protocol for a Pragmatic Randomized Controlled Trial %A Hackstadt,Amber J %A Elasy,Tom A %A Gangaputra,Sapna %A Harper,Kryseana J %A Mayberry,Lindsay S %A Nelson,Lyndsay A %A Peterson,Neeraja B %A Rosenbloom,S Trent %A Yu,Zhihong %A Martinez,William %+ Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, United States, 1 615 322 5000, william.martinez@vumc.org %K patient portals %K self-management %K self-efficacy %K diabetes mellitus %K health literacy %K attitudes %D 2024 %7 28.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months). Objective: This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes. Methods: We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A1c, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used. Results: This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy. Conclusions: The study directly tests the hypothesis that a patient portal intervention—alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care—will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention. Trial Registration: ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903 International Registered Report Identifier (IRRID): DERR1-10.2196/56123 %M 38941148 %R 10.2196/56123 %U https://www.researchprotocols.org/2024/1/e56123 %U https://doi.org/10.2196/56123 %U http://www.ncbi.nlm.nih.gov/pubmed/38941148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58551 %T Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design %A Hall,Evelyn %A Keyser,Laura %A McKinney,Jessica %A Pulliam,Samantha %A Weinstein,Milena %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Ste 400, San Francisco, CA, 94158, United States, 1 866 657 5382, laura.keyser@ucsf.edu %K urinary incontinence %K digital health %K pelvic floor muscle training %K real-world %K evidence %K user-centered design %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women’s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. %R 10.2196/58551 %U https://formative.jmir.org/2024/1/e58551 %U https://doi.org/10.2196/58551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58503 %T Clinicians’ Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study %A LoCastro,Marissa %A Wang,Ying %A Yu,Tristan %A Mortaz-Hedjri,Soroush %A Mendler,Jason %A Norton,Sally %A Bernacki,Rachelle %A Carroll,Thomas %A Klepin,Heidi %A Wedow,Lucy %A Goonan,Sean %A Erdos,Hannah %A Bagnato,Brenda %A Liesveld,Jane %A Huselton,Eric %A Kluger,Benzi %A Loh,Kah Poh %+ Division of Hematology Oncology, Department of Medicine, James P. Wilmot Cancer Institute, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, United States, 1 585 276 4353, Kahpoh_Loh@urmc.rochester.edu %K serious illness conversations %K serious illness conversation %K SIC %K Serious Illness Care Program %K SICP %K hematologic malignancy %K geriatric oncology %K acute myeloid leukemia %K AML %K myelodysplastic syndrome %K MDS %K cancer %K oncology %K oncologist %K oncologists %K metastases %K telemedicine %K telehealth %K tele-medicine %K tele-health %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician’s perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients’ values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 %M 38935428 %R 10.2196/58503 %U https://formative.jmir.org/2024/1/e58503 %U https://doi.org/10.2196/58503 %U http://www.ncbi.nlm.nih.gov/pubmed/38935428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55855 %T Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study %A Schaffert,Daniel %A Bibi,Igor %A Blauth,Mara %A Lull,Christian %A von Ahnen,Jan Alwin %A Gross,Georg %A Schulze-Hagen,Theresa %A Knitza,Johannes %A Kuhn,Sebastian %A Benecke,Johannes %A Schmieder,Astrid %A Leipe,Jan %A Olsavszky,Victor %+ Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 2280, victor.olsavszky@medma.uni-heidelberg.de %K psoriasis vulgaris %K psoriatic arthritis %K automated machine learning %K therapy change %K Psoriasis Area and Severity Index %K PASI score change %K Bath Ankylosing Spondylitis Disease Activity Index %K BASDAI classification %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. Objective: This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Methods: Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. Results: Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. Conclusions: The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes. %M 38738977 %R 10.2196/55855 %U https://formative.jmir.org/2024/1/e55855 %U https://doi.org/10.2196/55855 %U http://www.ncbi.nlm.nih.gov/pubmed/38738977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58501 %T Improving the Acceptability and Implementation of Information and Communication Technology–Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders %A Ahmed,Mona %A Marín,Mayca %A Gangas,Pilar %A Bentlage,Ellen %A Louro,Claudia %A Brach,Michael %+ Institute of Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 8334812, mona.ahmad@uni-muenster.de %K acceptability %K implementation %K neurodegenerative diseases %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K older people %K stakeholders %K information and communication technology %K ICT %K user-centered design %K co-design %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union–funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users’ needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 38935424 %R 10.2196/58501 %U https://formative.jmir.org/2024/1/e58501 %U https://doi.org/10.2196/58501 %U http://www.ncbi.nlm.nih.gov/pubmed/38935424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59267 %T Evaluating ChatGPT-4’s Accuracy in Identifying Final Diagnoses Within Differential Diagnoses Compared With Those of Physicians: Experimental Study for Diagnostic Cases %A Hirosawa,Takanobu %A Harada,Yukinori %A Mizuta,Kazuya %A Sakamoto,Tetsu %A Tokumasu,Kazuki %A Shimizu,Taro %+ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-cho, Shimotsuga, Tochigi, 321-0293, Japan, 81 282861111, hirosawa@dokkyomed.ac.jp %K decision support system %K diagnostic errors %K diagnostic excellence %K diagnosis %K large language model %K LLM %K natural language processing %K GPT-4 %K ChatGPT %K diagnoses %K physicians %K artificial intelligence %K AI %K chatbots %K medical diagnosis %K assessment %K decision-making support %K application %K applications %K app %K apps %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of artificial intelligence (AI) chatbots, particularly ChatGPT with GPT-4 (OpenAI), in assisting with medical diagnosis is an emerging research area. However, it is not yet clear how well AI chatbots can evaluate whether the final diagnosis is included in differential diagnosis lists. Objective: This study aims to assess the capability of GPT-4 in identifying the final diagnosis from differential-diagnosis lists and to compare its performance with that of physicians for case report series. Methods: We used a database of differential-diagnosis lists from case reports in the American Journal of Case Reports, corresponding to final diagnoses. These lists were generated by 3 AI systems: GPT-4, Google Bard (currently Google Gemini), and Large Language Models by Meta AI 2 (LLaMA2). The primary outcome was focused on whether GPT-4’s evaluations identified the final diagnosis within these lists. None of these AIs received additional medical training or reinforcement. For comparison, 2 independent physicians also evaluated the lists, with any inconsistencies resolved by another physician. Results: The 3 AIs generated a total of 1176 differential diagnosis lists from 392 case descriptions. GPT-4’s evaluations concurred with those of the physicians in 966 out of 1176 lists (82.1%). The Cohen κ coefficient was 0.63 (95% CI 0.56-0.69), indicating a fair to good agreement between GPT-4 and the physicians’ evaluations. Conclusions: GPT-4 demonstrated a fair to good agreement in identifying the final diagnosis from differential-diagnosis lists, comparable to physicians for case report series. Its ability to compare differential diagnosis lists with final diagnoses suggests its potential to aid clinical decision-making support through diagnostic feedback. While GPT-4 showed a fair to good agreement for evaluation, its application in real-world scenarios and further validation in diverse clinical environments are essential to fully understand its utility in the diagnostic process. %M 38924784 %R 10.2196/59267 %U https://formative.jmir.org/2024/1/e59267 %U https://doi.org/10.2196/59267 %U http://www.ncbi.nlm.nih.gov/pubmed/38924784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57519 %T The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial %A Bratches,Reed W R %A Cohen,Jeffrey %A Carpenter-Song,Elizabeth %A Mistler,Lisa %A Barr,Paul J %+ School of Nursing, University of Alabama at Birmingham, 1720 University Boulevard, Birmingham, AL, 35222, United States, 1 2059316655, rbratches@gmail.com %K feasibility %K acceptability %K amyotrophic lateral sclerosis %K digital intervention %K ALS %K video recording %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 %M 38924779 %R 10.2196/57519 %U https://formative.jmir.org/2024/1/e57519 %U https://doi.org/10.2196/57519 %U http://www.ncbi.nlm.nih.gov/pubmed/38924779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55722 %T Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study %A Hooker,Stephanie A %A Crain,A Lauren %A Muegge,Jule %A Rossom,Rebecca C %A Pronk,Nicolaas P %A Pasumarthi,Dhavan Prasad %A Kunisetty,Gopikrishna %A Masters,Kevin S %+ Division of Research and Evaluation, HealthPartners Institute, 8170 33rd Ave S MS21112R, Minneapolis, MN, 55425, United States, 1 9529675056, stephanie.a.hooker@healthpartners.com %K physical activity %K midlife %K digital health %K SMS text messaging %K theory-based %K meaning in life %K mobile phone %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (−4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. %M 38917457 %R 10.2196/55722 %U https://formative.jmir.org/2024/1/e55722 %U https://doi.org/10.2196/55722 %U http://www.ncbi.nlm.nih.gov/pubmed/38917457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56241 %T Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study %A O'Driscoll,Fiona %A O'Brien,Niki %A Guo,Chaohui %A Prime,Matthew %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035, Queen Elizabeth Queen Mother Wing, St Mary's Campus, South Wharf Road, London, W2 1NY, United Kingdom, 44 020 7594 1419, saira.ghafur13@imperial.ac.uk %K digital health technology %K software as a medical device %K clinical simulation %K Delphi study %K eDelphi study %K artificial intelligence %K digital health %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. Objective: The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. Methods: An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as “not important” or “not important at all” and >60% “important” or “very important.” Results: In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains—background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. Conclusions: This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges. %M 38917454 %R 10.2196/56241 %U https://formative.jmir.org/2024/1/e56241 %U https://doi.org/10.2196/56241 %U http://www.ncbi.nlm.nih.gov/pubmed/38917454 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52248 %T User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study %A Adam,Esmee %A Meiland,Franka %A Frielink,Noud %A Meinders,Erwin %A Smits,Reon %A Embregts,Petri %A Smaling,Hanneke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 071 526 84 44, e.adam@lumc.nl %K stress detection %K sensor system %K garment integrated %K wearable %K user requirements %K dementia %K intellectual disability %K intellectual disabilities %K long-term care %K perceptions %K wearables %K qualitative study %K residents %K communication impairment %K impairments %K garment sensor %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. %R 10.2196/52248 %U https://formative.jmir.org/2024/1/e52248 %U https://doi.org/10.2196/52248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56894 %T Parents’ Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot—A Digital Healthcare Assistant): Qualitative Process Evaluation %A Chua,Joelle Yan Xin %A Choolani,Mahesh %A Chee,Cornelia Yin Ing %A Yi,Huso %A Chan,Yiong Huak %A Lalor,Joan Gabrielle %A Chong,Yap Seng %A Shorey,Shefaly %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K perinatal %K parents %K mobile app %K chatbot %K qualitative study %K interviews %K experiences %K mobile phone %D 2024 %7 21.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents experience many challenges during the perinatal period. Mobile app–based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. Objective: This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app–based intervention with an in-built chatbot titled Parentbot—a Digital Healthcare Assistant (PDA). Methods: A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. Results: Three themes with 10 subthemes describing parents’ perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. Conclusions: Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users’ experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents. %M 38905628 %R 10.2196/56894 %U https://www.jmir.org/2024/1/e56894 %U https://doi.org/10.2196/56894 %U http://www.ncbi.nlm.nih.gov/pubmed/38905628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56074 %T Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study %A Podda,Jessica %A Tacchino,Andrea %A Ponzio,Michela %A Di Antonio,Federica %A Susini,Alessia %A Pedullà,Ludovico %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713306, jessica.podda@aism.it %K cognitive assessment %K cognitive impairment %K digital health %K mHealth app %K multiple sclerosis %K self-management %K usability %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app’s reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. %M 38900535 %R 10.2196/56074 %U https://formative.jmir.org/2024/1/e56074 %U https://doi.org/10.2196/56074 %U http://www.ncbi.nlm.nih.gov/pubmed/38900535 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52494 %T Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study %A Pinto,Bernardine M %A Patel,Ashwin %A Ostendorf,Danielle M %A Huebschmann,Amy G %A Dunsiger,Shira I %A Kindred,Madison M %+ College of Nursing, University of South Carolina, 1601 Greene Street, Rm 302B, Columbia, SC, 29208, United States, 1 8037779272, Pintob@mailbox.sc.edu %K physical activity adoption %K web platform %K breast cancer survivors %K design %K implementation %K cost-effectiveness %K mobile phone %D 2024 %7 19.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494 %M 38896452 %R 10.2196/52494 %U https://www.researchprotocols.org/2024/1/e52494 %U https://doi.org/10.2196/52494 %U http://www.ncbi.nlm.nih.gov/pubmed/38896452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55751 %T Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study %A Porta,Xènia %A Nieto,Rubén %A Serrat,Mayte %A Bourdin Kreitz,Pierre %+ eHealthLab, Faculty of Psychology and Education, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933263538, xeniaporta@uoc.edu %K fibromyalgia %K chronic pain %K pain management %K information and communication technologies %K use %K satisfaction %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. %M 38888943 %R 10.2196/55751 %U https://formative.jmir.org/2024/1/e55751 %U https://doi.org/10.2196/55751 %U http://www.ncbi.nlm.nih.gov/pubmed/38888943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50452 %T Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study %A Siste,Kristiana %A Ophinni,Youdiil %A Hanafi,Enjeline %A Yamada,Chika %A Novalino,Reza %A Limawan,Albert P %A Beatrice,Evania %A Rafelia,Vania %A Alison,Peter %A Matsumoto,Toshihiko %A Sakamoto,Ryota %+ Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8304, Japan, 81 757537351, chika128@cseas.kyoto-u.ac.jp %K substance use disorder %K cognitive behavioral therapy %K telemedicine %K peer involvement %K Indonesia %K substance use disorders %K digital intervention %K COVID-19 %K psychotherapy %K drug %K mobile phone %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. %M 38888959 %R 10.2196/50452 %U https://formative.jmir.org/2024/1/e50452 %U https://doi.org/10.2196/50452 %U http://www.ncbi.nlm.nih.gov/pubmed/38888959 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53966 %T Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial %A Hooshmand Zaferanieh,Mohammad %A Shi,Lu %A Jindal,Meenu %A Chen,Liwei %A Zhang,Lingling %A Lopes,Snehal %A Jones,Karyn %A Wang,Yucheng %A Meggett,Kinsey %A Walker,Cari Beth %A Falgoust,Grace %A Zinzow,Heidi %+ University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, United States, 1 864 455 7992, hooshmam@email.sc.edu %K mindfulness-based cognitive therapy %K MBCT %K mindfulness-based interventions %K depression %K depressive symptoms %K virtual delivery %K mindfulness %K mental health %K depressive %K distress %K stress %K remote %K randomized %K controlled trial %K controlled trials %K RCT %K psychotherapy %K cognitive therapy %D 2024 %7 18.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. Objective: This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. Methods: To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. Results: This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. Conclusions: This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT’s efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. Trial Registration: ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719 International Registered Report Identifier (IRRID): DERR1-10.2196/53966 %M 38888958 %R 10.2196/53966 %U https://www.researchprotocols.org/2024/1/e53966 %U https://doi.org/10.2196/53966 %U http://www.ncbi.nlm.nih.gov/pubmed/38888958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56687 %T The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis %A Wang,Ye %A Shi,Changjing %A Wang,Xinyun %A Meng,Hua %A Chen,Junqiang %+ Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Qingxiu District, Nanning, 530021, China, 86 07715347234, chenjunqiang@gxmu.edu.cn %K static characteristics of physicians %K internet hospitals %K telemedicine %K statistical analysis %K online consultation %K web-based consultation %K teleconsultation %K physician %K patient %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor’s clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor’s credentials and accomplishments patients prioritize during their selection process. Objective: Our primary aim is to delve deeper into the correlation between physicians’ static characteristics—such as their qualifications, experiences, and profiles on the internet—and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. Methods: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors’ internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. Results: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Conclusions: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction. %M 38885498 %R 10.2196/56687 %U https://formative.jmir.org/2024/1/e56687 %U https://doi.org/10.2196/56687 %U http://www.ncbi.nlm.nih.gov/pubmed/38885498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55000 %T Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study %A Casella Jean-Baptiste,Meredith %A Vital Julmiste,Thamar Monide %A Ball,Ellen %+ Hôpital Universitaire de Mirebalais, Sante Fanm, Rue Chatulee, Mirebalais, HT 5210, Haiti, 509 4892 3626, mjeanbaptiste@pih.org %K maternal health %K health informatics %K quality improvement %K Plan-Do-Study-Act %K PDSA %K maternal %K neonatal %K data collection %K prenatal %K outpatient %K electronic data %K nursing %K nursing staff %K nursing leadership %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. %M 38875702 %R 10.2196/55000 %U https://formative.jmir.org/2024/1/e55000 %U https://doi.org/10.2196/55000 %U http://www.ncbi.nlm.nih.gov/pubmed/38875702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50557 %T Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study %A Li,Catherine Yan Hei %A Platkin,Charles %A Chin,Jonathan %A Khan,Asia %A Bennett,Jaleel %A Speck,Anna %A Nielsen,Annette %A Leung,May May %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 3676, maymay.leung@tufts.edu %K SNAP %K SNAP eligibility screening %K food insecurity %K college students %K web-based tool %K think-aloud %K system usability %K user experience %K student %K college %K chronic health %K stress %K anxiety %K barrier %K technology %K tool %K Supplemental Nutrition Assistance Program %K usability %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. %M 38869926 %R 10.2196/50557 %U https://formative.jmir.org/2024/1/e50557 %U https://doi.org/10.2196/50557 %U http://www.ncbi.nlm.nih.gov/pubmed/38869926 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48605 %T Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach %A Shen,Hongxia %A van der Kleij,Rianne %A van der Boog,Paul J M %A Chavannes,Niels H %+ School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, 510000, China, 86 13937118104, H.Shen@lumc.nl %K eHealth %K self-management %K intervention mapping %K chronic kidney disease %K intervention development %K mobile phone %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR–Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including “knowledge and beliefs” in the domain “individual characteristics,” “quality and advantage of eHealth intervention” in the domain “intervention characteristics,” “compatibility” in the domain “inner setting,” and “cultural context” in the domain “outer setting.” To ensure the effectiveness of the Dutch MD–based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention’s appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, our study’s research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 %M 38869943 %R 10.2196/48605 %U https://formative.jmir.org/2024/1/e48605 %U https://doi.org/10.2196/48605 %U http://www.ncbi.nlm.nih.gov/pubmed/38869943 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59315 %T Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet’s Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study %A Lancioni,Giulio E %A Singh,Nirbhay N %A O’Reilly,Mark F %A Sigafoos,Jeff %A Alberti,Gloria %A Orlando,Isabella %A Chiariello,Valeria %A Desideri,Lorenzo %+ Lega F D’Oro Research Center, Via Linguetta 3, Osimo, 60027, Italy, 39 3408323465, giulio.lancioni@uniba.it %K technology %K tablet %K task %K instructions %K intellectual disability, visual impairment, hearing impairment %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people’s request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). Methods: The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the “where” and “how” the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks. %M 38865701 %R 10.2196/59315 %U https://rehab.jmir.org/2024/1/e59315 %U https://doi.org/10.2196/59315 %U http://www.ncbi.nlm.nih.gov/pubmed/38865701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53159 %T Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study %A Stang,Garrett S %A Tanner,Nichole T %A Hatch,Ashley %A Godbolt,Jakarri %A Toll,Benjamin A %A Rojewski,Alana M %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Box G-S121-3, Providence, RI, 02912, United States, 1 4018633375, garrett_stang@brown.edu %K lung cancer screening %K LCS %K electronic health records %K EHR %K Health Belief Model %K HBM %K self-refer %K tobacco treatment %K cancer screening %K development %K self-referral tool %K electronic health record %K decision-making %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. %M 38865702 %R 10.2196/53159 %U https://formative.jmir.org/2024/1/e53159 %U https://doi.org/10.2196/53159 %U http://www.ncbi.nlm.nih.gov/pubmed/38865702 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55557 %T Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation %A Fisher,Emily %A Venkatesan,Shreenila %A Benevides,Pedro %A Bertrand,Elodie %A Brum,Paula Schimidt %A El Baou,Céline %A Ferri,Cleusa P %A Fossey,Jane %A Jelen,Maria %A Laks,Jerson %A Liu,Lisa %A Mograbi,Daniel C %A Natarajan,Nirupama %A Naylor,Renata %A Pantouli,Despina %A Ramanujam,Vaishnavi %A Rangaswamy,Thara %A Santos de Carvalho,Raquel L %A Stoner,Charlotte %A Vaitheswaran,Sridhar %A Spector,Aimee %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 5770, emily.fisher@ucl.ac.uk %K psychosocial %K intervention %K technology %K COVID-19 %K LMIC %K low and middle income countries %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. %M 38861708 %R 10.2196/55557 %U https://aging.jmir.org/2024/1/e55557 %U https://doi.org/10.2196/55557 %U http://www.ncbi.nlm.nih.gov/pubmed/38861708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49669 %T Just-in-Time Adaptive Intervention for Stabilizing Sleep Hours of Japanese Workers: Microrandomized Trial %A Takeuchi,Hiroki %A Ishizawa,Tetsuro %A Kishi,Akifumi %A Nakamura,Toru %A Yoshiuchi,Kazuhiro %A Yamamoto,Yoshiharu %+ Graduate School of Education, The University of Tokyo, Bunkyo-ku Hongo 7-3-1, Tokyo, 113-8654, Japan, 81 03 5841 3981, takeuchi@p.u-tokyo.ac.jp %K objective push-type sleep feedback %K stability of habitual sleep behaviors %K just-in-time adaptive intervention %K microrandomized trial %K mobile phone %D 2024 %7 11.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbance is a major contributor to future health and occupational issues. Mobile health can provide interventions that address adverse health behaviors for individuals in a vulnerable health state in real-world settings (just-in-time adaptive intervention). Objective: This study aims to identify a subpopulation with vulnerable sleep state in daily life (study 1) and, immediately afterward, to test whether providing mobile health intervention improved habitual sleep behaviors and psychological wellness in real-world settings by conducting a microrandomized trial (study 2). Methods: Japanese workers (n=182) were instructed to collect data on their habitual sleep behaviors and momentary symptoms (including depressive mood, anxiety, and subjective sleep quality) using digital devices in a real-world setting. In study 1, we calculated intraindividual mean and variability of sleep hours, midpoint of sleep, and sleep efficiency to characterize their habitual sleep behaviors. In study 2, we designed and conducted a sleep just-in-time adaptive intervention, which delivered objective push-type sleep feedback messages to improve their sleep hours for a subset of participants in study 1 (n=81). The feedback messages were generated based on their sleep data measured on previous nights and were randomly sent to participants with a 50% chance for each day (microrandomization). Results: In study 1, we applied hierarchical clustering to dichotomize the population into 2 clusters (group A and group B) and found that group B was characterized by unstable habitual sleep behaviors (large intraindividual variabilities). In addition, linear mixed-effect models showed that the interindividual variability of sleep hours was significantly associated with depressive mood (β=3.83; P=.004), anxiety (β=5.70; P=.03), and subjective sleep quality (β=−3.37; P=.03). In study 2, we found that providing sleep feedback prolonged subsequent sleep hours (increasing up to 40 min; P=.01), and this effect lasted for up to 7 days. Overall, the stability of sleep hours in study 2 was significantly improved among participants in group B compared with the participants in study 1 (P=.001). Conclusions: This is the first study to demonstrate that providing sleep feedback can benefit the modification of habitual sleep behaviors in a microrandomized trial. The findings of this study encourage the use of digitalized health intervention that uses real-time health monitoring and personalized feedback. %M 38861313 %R 10.2196/49669 %U https://www.jmir.org/2024/1/e49669 %U https://doi.org/10.2196/49669 %U http://www.ncbi.nlm.nih.gov/pubmed/38861313 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54207 %T Leveraging Ecological Momentary Assessment Data to Characterize Individual Mobility: Exploratory Pilot Study in Rural Uganda %A Khalifa,Aleya %A Beres,Laura K %A Anok,Aggrey %A Mbabali,Ismail %A Katabalwa,Charles %A Mulamba,Jeremiah %A Thomas,Alvin G %A Bugos,Eva %A Nakigozi,Gertrude %A Chang,Larry W %A Grabowski,M Kate %+ Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, United States, 1 212 305 2862, ak4598@cumc.columbia.edu %K ecological momentary assessment %K spatial analysis %K geographic mobility %K global positioning system %K health behaviors %K Uganda %K mobility %K pilot study %K smartphone %K alcohol %K cigarette %K smoking %K promoting %K promotion %K alcohol use %K cigarette smoking %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective: Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods: Pilot trial participants were recruited from the Rakai Community Cohort Study—an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non–long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information, mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results: Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303 (IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points—76% (IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions: Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobility and health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similar settings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging such individual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change. %M 38857493 %R 10.2196/54207 %U https://formative.jmir.org/2024/1/e54207 %U https://doi.org/10.2196/54207 %U http://www.ncbi.nlm.nih.gov/pubmed/38857493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53806 %T Defining Activity Thresholds Triggering a “Stand Hour” for Apple Watch Users: Cross-Sectional Study %A Lyons,Katy %A Hei Man,Alison Hau %A Booth,David %A Rena,Graham %+ Division of Cellular and Systems Medicine, Ninewells Hospital and Medical School, University of Dundee, Jacqui Wood Centre, James Arrott Drive, Dundee, DD1 9SY, United Kingdom, 44 660111, k.m.lyons@dundee.ac.uk %K stand hour %K Apple Watch %K sedentary behavior %K light physical activity %K cardiovascular disease %K type 2 diabetes %K data collection %K wearable %K wearables %K watch %K smartwatch %K stand %K standing %K sedentary %K physical activity %K exercise %K movement %K algorithm %K algorithms %K predict %K predictive %K predictor %K predictors %K prediction %K machine learning %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sedentary behavior (SB) is one of the largest contributing factors increasing the risk of developing noncommunicable diseases, including cardiovascular disease and type 2 diabetes. Guidelines from the World Health Organization for physical activity suggest the substitution of SB with light physical activity. The Apple Watch contains a health metric known as the stand hour (SH). The SH is intended to record standing with movement for at least 1 minute per hour; however, the activity measured during the determination of the SH is unclear. Objective: In this cross-sectional study, we analyzed the algorithm used to determine time spent standing per hour. To do this, we investigated activity measurements also recorded on Apple Watches that influence the recording of an SH. We also aimed to estimate the values of any significant SH predictors in the recording of a SH. Methods: The cross-sectional study used anonymized data obtained in August 2022 from 20 healthy individuals gathered via convenience sampling. Apple Watch data were extracted from the Apple Health app through the use of a third-party app. Appropriate statistical models were fitted to analyze SH predictors. Results: Our findings show that active energy (AE) and step count (SC) measurements influence the recording of an SH. Comparing when an SH is recorded with when an SH is not recorded, we found a significant difference in the mean and median AE and SC. Above a threshold of 97.5 steps or 100 kJ of energy, it became much more likely that an SH would be recorded when each predictor was analyzed as a separate entity. Conclusions: The findings of this study reveal the pivotal role of AE and SC measurements in the algorithm underlying the SH recording; however, our findings also suggest that a recording of an SH is influenced by more than one factor. Irrespective of the internal validity of the SH metric, it is representative of light physical activity and might, therefore, have use in encouraging individuals through various means, for example, notifications, to reduce their levels of SB. %M 38857078 %R 10.2196/53806 %U https://formative.jmir.org/2024/1/e53806 %U https://doi.org/10.2196/53806 %U http://www.ncbi.nlm.nih.gov/pubmed/38857078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56493 %T Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment %A Philpot,Lindsey M %A Ramar,Priya %A Roellinger,Daniel L %A Njeru,Jane W %A Ebbert,Jon O %+ Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 538 1882, Philpot.Lindsey@mayo.edu %K electronic health records %K digital determinants of health %K patient portals %K eHealth %K digital health %K technology acceptance model %K digital health literacy %K digital inclusion %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. %M 38695754 %R 10.2196/56493 %U https://formative.jmir.org/2024/1/e56493 %U https://doi.org/10.2196/56493 %U http://www.ncbi.nlm.nih.gov/pubmed/38695754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48520 %T mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study %A Tran,Dieu-My %A Dingley,Catherine %A Bonilla,Roger %+ School of Nursing, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453018, Las Vegas, NV, 89154, United States, 1 7028951220, dieu-my.tran@unlv.edu %K blood pressure %K mHealth %K self-management %K students %K intervention %K elevated blood pressure %K college %K hypertension %K young adult %K mobile app %K smartphone %K monitoring %K text messaging %K text mining %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant’s BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants’ (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. %M 38848120 %R 10.2196/48520 %U https://formative.jmir.org/2024/1/e48520 %U https://doi.org/10.2196/48520 %U http://www.ncbi.nlm.nih.gov/pubmed/38848120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46300 %T Clinicians’ Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health %A Thomas,Donna Claire %A Litherland,Eva Frances %A Masso,Sarah %A Raymundo,Gianina %A Keep,Melanie %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Avenue, Camperdown, 2006, Australia, 61 2 93519539, donna.thomas@sydney.edu.au %K telehealth %K pediatric %K allied health %K focus group %K decision-making %K community-based %K counseling %K speech pathology %K occupational therapy %K clinical services %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. Objective: The aim of this study is to explore clinicians’ decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians’ perceptions of telehealth utility beyond COVID-19 lockdowns. Methods: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community–based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. Results: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: “flexible telehealth use,” “telehealth can be superior to in-person therapy,” and “fear that in-person services may be replaced.” Conclusions: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience. %M 38848121 %R 10.2196/46300 %U https://formative.jmir.org/2024/1/e46300 %U https://doi.org/10.2196/46300 %U http://www.ncbi.nlm.nih.gov/pubmed/38848121 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50087 %T YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study %A van Dijk,Merle R %A van der Marel,Anne-Fleur %A van Rheenen-Flach,Leonie E %A Ganzevoort,Wessel %A Moll,Etelka %A Scheele,Fedde %A Velzel,Joost %+ Department of Obstetrics and Gynecology, Onze Lieve Vrouwen Gasthuis, Oosterpark 9, Amsterdam, 1061AC, Netherlands, 31 0205999111, m.r.vandijk@olvg.nl %K YouTube %K ECV %K external cephalic version %K breech %K education %K video %K cesarean %K health education %K childbirth %K patient information %K cross-sectional study %K cesarean delivery %K implementation %K usefulness %K medical information %K pregnancy %K pregnant women %K engagement %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. %M 38843520 %R 10.2196/50087 %U https://formative.jmir.org/2024/1/e50087 %U https://doi.org/10.2196/50087 %U http://www.ncbi.nlm.nih.gov/pubmed/38843520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52251 %T Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study %A Narang,Gaurav %A Chen,Yaozhu J %A Wedel,Nicole %A Wu,Melody %A Luo,Michelle %A Atreja,Ashish %+ Rx.Health, 21 Penn Plaza, 368 9th Avenue, New York, NY, 10001, United States, 1 6469699939, gnarang@commure.com %K cyclic vomiting syndrome %K vomiting %K vomit %K emetic %K emesis %K gut %K GI %K gastrointestinal %K internal medicine %K prototype %K prototypes %K iterative %K self-management %K disease management %K gut-brain interaction %K gut-brain %K artificial intelligence %K digital patient assistant %K assistant %K assistants %K design thinking %K design %K patient-centric %K patient centred %K patient centered %K patient-centric approach %K System Usability Scale %K symptom tracking %K digital health solution %K user experience %K usability %K symptom %K symptoms %K tracking %K monitoring %K participatory %K co-design digital health technology %K patient assistance %K patient experience %K mobile phone %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients’ quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA’s effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA’s potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA’s role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. %M 38842924 %R 10.2196/52251 %U https://formative.jmir.org/2024/1/e52251 %U https://doi.org/10.2196/52251 %U http://www.ncbi.nlm.nih.gov/pubmed/38842924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54256 %T Performance of a Wearable Ring in Controlled Hypoxia: A Prospective Observational Study %A Mastrototaro,John J %A Leabman,Michael %A Shumate,Joe %A Tompkins,Kim L %+ Movano Inc dba Movano Health, 6800 Koll Center Pkwy, Suite 160, Pleasanton, CA, 94566, United States, 1 408 981 4889, ktompkins@movano.com %K pulse oximetry %K SpO2 %K pulse oximeter %K hypoxia %K hypoxemia %K clinical trial %K accuracy %K digital health %K wearable %K smart ring %K ISO 80601-2-61 %K racial bias %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over recent years, technological advances in wearables have allowed for continuous home monitoring of heart rate and oxygen saturation. These devices have primarily been used for sports and general wellness and may not be suitable for medical decision-making, especially in saturations below 90% and in patients with dark skin color. Wearable clinical-grade saturation of peripheral oxygen (SpO2) monitoring can be of great value to patients with chronic diseases, enabling them and their clinicians to better manage their condition with reliable real-time and trend data. Objective: This study aimed to determine the SpO2 accuracy of a wearable ring pulse oximeter compared with arterial oxygen saturation (SaO2) in a controlled hypoxia study based on the International Organization for Standardization (ISO) 80601-2-61:2019 standard over the range of 70%-100% SaO2 in volunteers with a broad range of skin color (Fitzpatrick I to VI) during nonmotion conditions. In parallel, accuracy was compared with a calibrated clinical-grade reference pulse oximeter (Masimo Radical-7). Acceptable medical device accuracy was defined as a maximum of 4% root mean square error (RMSE) per the ISO 80601-2-61 standard and a maximum of 3.5% RMSE per the US Food and Drug Administration guidance. Methods: We performed a single-center, blinded hypoxia study of the test device in 11 healthy volunteers at the Hypoxia Research Laboratory, University of California at San Francisco, under the direction of Philip Bickler, MD, PhD, and John Feiner, MD. Each volunteer was connected to a breathing apparatus for the administration of a hypoxic gas mixture. To facilitate frequent blood gas sampling, a radial arterial cannula was placed on either wrist of each participant. One test device was placed on the index finger and another test device was placed on the fingertip. SaO2 analysis was performed using an ABL-90 multi-wavelength oximeter. Results: For the 11 participants included in the analysis, there were 236, 258, and 313 SaO2-SpO2 data pairs for the test device placed on the finger, the test device placed on the fingertip, and the reference device, respectively. The RMSE of the test device for all participants was 2.1% for either finger or fingertip placement, while the Masimo Radical-7 reference pulse oximeter RMSE was 2.8%, exceeding the standard (4% or less) and the Food and Drug Administration guidance (3.5% or less). Accuracy of SaO2-SpO2 paired data from the 4 participants with dark skin in the study was separately analyzed for both test device placements and the reference device. The test and reference devices exceeded the minimum accuracy requirements for a medical device with RMSE at 1.8% (finger) and 1.6% (fingertip) and for the reference device at 2.9%. Conclusions: The wearable ring meets an acceptable standard of accuracy for clinical-grade SpO2 under nonmotion conditions without regard to skin color. Trial Registration: ClinicalTrials.gov NCT05920278; https://clinicaltrials.gov/study/NCT05920278 %M 38838332 %R 10.2196/54256 %U https://formative.jmir.org/2024/1/e54256 %U https://doi.org/10.2196/54256 %U http://www.ncbi.nlm.nih.gov/pubmed/38838332 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e45331 %T Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study %A Zheng,Di %A Shang,Yanhong %A Ni,Jian %A Peng,Ling %A Tan,Xiaoming %A Dai,Zhaoxia %A Zhao,Yizhuo %A Gu,Aiqin %A Wang,Jiying %A Song,Yanyan %A Li,Xiaofeng %A Zhang,Junping %A Heng,Wei %A Zhang,Cuiying %A Liu,Chunling %A Li,Hui %A Du,Yingying %A Xu,Jianfang %A Wu,Dan %A Cai,Xuwei %A Meng,Rui %A Dong,Xiaorong %A Ruan,Yaoping %A Jiang,Liyan %+ Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No 241 West Huaihai Rd, Shanghai, 200030, China, 86 13916146759, jiang_liyan2000@126.com %K telehealth %K real-world data %K patient engagement %K lung carcinoma %K patient-reported outcomes %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. Objective: The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician’s perspective. Methods: A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform’s registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Results: Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. Conclusions: This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions. %M 38838304 %R 10.2196/45331 %U https://cancer.jmir.org/2024/1/e45331 %U https://doi.org/10.2196/45331 %U http://www.ncbi.nlm.nih.gov/pubmed/38838304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53918 %T Chinese Oncologists’ Perspectives on Integrating AI into Clinical Practice: Cross-Sectional Survey Study %A Li,Ming %A Xiong,XiaoMin %A Xu,Bo %A Dickson,Conan %+ Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, cdickso1@jh.edu %K artificial intelligence %K AI %K machine learning %K oncologist %K concern %K clinical practice %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid development of artificial intelligence (AI) has brought significant interest to its potential applications in oncology. Although AI-powered tools are already being implemented in some Chinese hospitals, their integration into clinical practice raises several concerns for Chinese oncologists. Objective: This study aims to explore the concerns of Chinese oncologists regarding the integration of AI into clinical practice and to identify the factors influencing these concerns. Methods: A total of 228 Chinese oncologists participated in a cross-sectional web-based survey from April to June in 2023 in mainland China. The survey gauged their worries about AI with multiple-choice questions. The survey evaluated their views on the statements of “The impact of AI on the doctor-patient relationship” and “AI will replace doctors.” The data were analyzed using descriptive statistics, and variate analyses were used to find correlations between the oncologists’ backgrounds and their concerns. Results: The study revealed that the most prominent concerns were the potential for AI to mislead diagnosis and treatment (163/228, 71.5%); an overreliance on AI (162/228, 71%); data and algorithm bias (123/228, 54%); issues with data security and patient privacy (123/228, 54%); and a lag in the adaptation of laws, regulations, and policies in keeping up with AI’s development (115/228, 50.4%). Oncologists with a bachelor’s degree expressed heightened concerns related to data and algorithm bias (34/49, 69%; P=.03) and the lagging nature of legal, regulatory, and policy issues (32/49, 65%; P=.046). Regarding AI’s impact on doctor-patient relationships, 53.1% (121/228) saw a positive impact, whereas 35.5% (81/228) found it difficult to judge, 9.2% (21/228) feared increased disputes, and 2.2% (5/228) believed that there is no impact. Although sex differences were not significant (P=.08), perceptions varied—male oncologists tended to be more positive than female oncologists (74/135, 54.8% vs 47/93, 50%). Oncologists with a bachelor’s degree (26/49, 53%; P=.03) and experienced clinicians (≥21 years; 28/56, 50%; P=.054). found it the hardest to judge. Those with IT experience were significantly more positive (25/35, 71%) than those without (96/193, 49.7%; P=.02). Opinions regarding the possibility of AI replacing doctors were diverse, with 23.2% (53/228) strongly disagreeing, 14% (32/228) disagreeing, 29.8% (68/228) being neutral, 16.2% (37/228) agreeing, and 16.7% (38/228) strongly agreeing. There were no significant correlations with demographic and professional factors (all P>.05). Conclusions: Addressing oncologists’ concerns about AI requires collaborative efforts from policy makers, developers, health care professionals, and legal experts. Emphasizing transparency, human-centered design, bias mitigation, and education about AI’s potential and limitations is crucial. Through close collaboration and a multidisciplinary strategy, AI can be effectively integrated into oncology, balancing benefits with ethical considerations and enhancing patient care. %M 38838307 %R 10.2196/53918 %U https://formative.jmir.org/2024/1/e53918 %U https://doi.org/10.2196/53918 %U http://www.ncbi.nlm.nih.gov/pubmed/38838307 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53406 %T Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals %A Sawyer,Chelsea %A Carney,Rebekah %A Hassan,Lamiece %A Bucci,Sandra %A Sainsbury,John %A Lovell,Karina %A Torous,John %A Firth,Joseph %+ Division of Psychology and Mental Health, University of Manchester, 3.005 Jean Mcfarlane Building, Manchester, M13 9PL, United Kingdom, 44 161 306 7811, Joseph.firth@manchester.ac.uk %K digital health %K behavior change %K mental health care professionals %K physical health %K lifestyle intervention %K qualitative %K thematic analysis %K service optimization %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients’ readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. %M 38837191 %R 10.2196/53406 %U https://humanfactors.jmir.org/2024/1/e53406 %U https://doi.org/10.2196/53406 %U http://www.ncbi.nlm.nih.gov/pubmed/38837191 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53261 %T The Effectiveness of Virtual Reality–Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial %A Szczepocka,Ewa %A Mokros,Łukasz %A Kazmierski,Jakub %A Nowakowska,Karina %A Łucka,Anna %A Antoszczyk,Anna %A Oltra-Cucarella,Javier %A Werzowa,Walter %A Hellevik,Martin Moum %A Skouras,Stavros %A Bagger,Karsten %+ Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland, 48 426757372, ewa.szczepocka@umed.lodz.pl %K cognitive functions %K head-mounted-display %K healthy seniors %K virtual reality %K well-being %K mobile phone %D 2024 %7 5.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being. Objective: The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase. Methods: A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360° nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization–5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants’ individual slopes. Results: In total, 122 (39%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024. Conclusions: VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most. Trial Registration: ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897 International Registered Report Identifier (IRRID): DERR1-10.2196/53261 %M 38837194 %R 10.2196/53261 %U https://www.researchprotocols.org/2024/1/e53261 %U https://doi.org/10.2196/53261 %U http://www.ncbi.nlm.nih.gov/pubmed/38837194 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55798 %T Using the Natural Language Processing System Medical Named Entity Recognition-Japanese to Analyze Pharmaceutical Care Records: Natural Language Processing Analysis %A Ohno,Yukiko %A Kato,Riri %A Ishikawa,Haruki %A Nishiyama,Tomohiro %A Isawa,Minae %A Mochizuki,Mayumi %A Aramaki,Eiji %A Aomori,Tohru %+ Faculty of Pharmacy, Takasaki University of Health and Welfare, 37-1 Nakaorui-machi, Takasaki-shi, Gunma, 370-0033, Japan, 81 273521290, aomori-t@takasaki-u.ac.jp %K natural language processing %K NLP %K named entity recognition %K pharmaceutical care records %K machine learning %K cefazolin sodium %K electronic medical record %K EMR %K extraction %K Japanese %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Large language models have propelled recent advances in artificial intelligence technology, facilitating the extraction of medical information from unstructured data such as medical records. Although named entity recognition (NER) is used to extract data from physicians’ records, it has yet to be widely applied to pharmaceutical care records. Objective: In this study, we aimed to investigate the feasibility of automatic extraction of the information regarding patients’ diseases and symptoms from pharmaceutical care records. The verification was performed using Medical Named Entity Recognition-Japanese (MedNER-J), a Japanese disease-extraction system designed for physicians’ records. Methods: MedNER-J was applied to subjective, objective, assessment, and plan data from the care records of 49 patients who received cefazolin sodium injection at Keio University Hospital between April 2018 and March 2019. The performance of MedNER-J was evaluated in terms of precision, recall, and F1-score. Results: The F1-scores of NER for subjective, objective, assessment, and plan data were 0.46, 0.70, 0.76, and 0.35, respectively. In NER and positive-negative classification, the F1-scores were 0.28, 0.39, 0.64, and 0.077, respectively. The F1-scores of NER for objective (0.70) and assessment data (0.76) were higher than those for subjective and plan data, which supported the superiority of NER performance for objective and assessment data. This might be because objective and assessment data contained many technical terms, similar to the training data for MedNER-J. Meanwhile, the F1-score of NER and positive-negative classification was high for assessment data alone (F1-score=0.64), which was attributed to the similarity of its description format and contents to those of the training data. Conclusions: MedNER-J successfully read pharmaceutical care records and showed the best performance for assessment data. However, challenges remain in analyzing records other than assessment data. Therefore, it will be necessary to reinforce the training data for subjective data in order to apply the system to pharmaceutical care records. %M 38833694 %R 10.2196/55798 %U https://formative.jmir.org/2024/1/e55798 %U https://doi.org/10.2196/55798 %U http://www.ncbi.nlm.nih.gov/pubmed/38833694 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50024 %T A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program %A Burn,Anne-Marie %A Hall,Poppy %A Anderson,Joanna %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 1223336961, amb278@cam.ac.uk %K self-harm %K schools %K young people %K youth %K school staff %K training %K coproduction %K qualitative %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person’s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program’s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. %M 38833286 %R 10.2196/50024 %U https://formative.jmir.org/2024/1/e50024 %U https://doi.org/10.2196/50024 %U http://www.ncbi.nlm.nih.gov/pubmed/38833286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53642 %T Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study %A Umibe,Akiko %A Fushiki,Hiroaki %A Tsunoda,Reiko %A Kuroda,Tatsuaki %A Kuroda,Kazuhiro %A Tanaka,Yasuhiro %+ Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan, 81 489651111, aumibe@dokkyomed.ac.jp %K vestibular function tests %K telemedicine %K smartphone %K virtual reality %K otolith dysfunction screening tool %K vestibular evoked myogenic potential %K iPhone %K mobile phone %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. Objective: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. Methods: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. Results: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from –2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). Conclusions: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool. %M 38833295 %R 10.2196/53642 %U https://formative.jmir.org/2024/1/e53642 %U https://doi.org/10.2196/53642 %U http://www.ncbi.nlm.nih.gov/pubmed/38833295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53411 %T Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Cluster Randomized Controlled Trial %A Kumwichar,Ponlagrit %A Prappre,Tagoon %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Kho Hong, Hat Yai, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K video-enhanced therapy %K tuberculosis %K health care system %K observed therapy %K treatment compliance %K lung disease %K randomized trial %K digital health %K telehealth %K telemedicine %K mobile phone %D 2024 %7 3.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are no recent studies comparing the compliance rates of both patients and observers in tuberculosis treatment between the video-observed therapy (VOT) and directly observed therapy (DOT) programs. Objective: This study aims to compare the average number of days that patients with pulmonary tuberculosis and their observers were compliant under VOT and DOT. In addition, this study aims to compare the sputum conversion rate of patients under VOT with that of patients under DOT. Methods: Patient and observer compliance with tuberculosis treatment between the VOT and DOT programs were compared based on the average number of VOT and DOT compliance days and sputum conversion rates in a 60-day cluster randomized controlled trial with patients with pulmonary tuberculosis (VOT: n=63 and DOT: n=65) with positive sputum acid-fast bacilli smears and 38 observers equally randomized into the VOT and DOT groups (19 observers per group and n=1-5 patients per observer). The VOT group submitted videos to observers via smartphones; the DOT group followed standard procedures. An intention-to-treat analysis assessed the compliance of both the patients and the observers. Results: The VOT group had higher average compliance than the DOT group (patients: mean difference 15.2 days, 95% CI 4.8-25.6; P=.005 and observers: mean difference 21.2 days, 95% CI 13.5-28.9; P<.001). The sputum conversion rates in the VOT and DOT groups were 73% and 61.5%, respectively (P=.17). Conclusions: Smartphone-based VOT significantly outperformed community-based DOT in ensuring compliance with tuberculosis treatment among observers. However, the study was underpowered to confirm improved compliance among patients with pulmonary tuberculosis and to detect differences in sputum conversion rates. Trial Registration: Thai Clinical Trials Registry (TCTR) TCTR20210624002; https://tinyurl.com/3bc2ycrh International Registered Report Identifier (IRRID): RR2-10.2196/38796 %M 38830205 %R 10.2196/53411 %U https://mhealth.jmir.org/2024/1/e53411 %U https://doi.org/10.2196/53411 %U http://www.ncbi.nlm.nih.gov/pubmed/38830205 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e40275 %T The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis %A Walters,Clarice %A Gratzer,David %A Dang,Kevin %A Laposa,Judith %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Gonzalez-Torres,Christina %A Moore,Lindsay P %A Chen,Sheng %A Ma,Clement %A Daskalakis,Zafiris %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4165808021, paul.ritvo@gmail.com %K online intervention %K randomized controlled trial %K major depressive disorder %K text message %K online %K cognitive %K behavior therapy %K treatment %K depression %K disorder %K symptoms %K young adults %K wellness %K procedure %K anxiety %K model %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. Objective: This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Methods: Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Results: Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=–0.029, 95% CI –0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=–0.096, 95% CI –0.80 to 0.61), alliance building disclosures (β=–0.098, 95% CI –0.28 to 0.084), and agreement confirmation (β=–0.076, 95% CI –0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. Conclusions: The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 %M 38820586 %R 10.2196/40275 %U https://formative.jmir.org/2024/1/e40275 %U https://doi.org/10.2196/40275 %U http://www.ncbi.nlm.nih.gov/pubmed/38820586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52726 %T Barriers to Postdischarge Smartphone App Use Among Patients With Traumatic Rib Fractures %A Berrigan,Margaret T %A Beaulieu-Jones,Brendin R %A Baines,Rachel %A Berkowitz,Seth %A Evans,Heather %A Brat,Gabriel A %+ Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 2G, Boston, MA, 02215, United States, 1 617 632 9922, gbrat@bidmc.harvard.edu %K mobile health %K smartphone app %K electronic health record %K postdischarge monitoring %K implementation science %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K mobile phone %D 2024 %7 31.5.2024 %9 Research Letter %J JMIR Form Res %G English %X Rib fractures commonly result from traumatic injury and often require hospitalization for pain control and supportive pulmonary care. Although the use of mobile health technology to share patient-generated health data has increased, it remains limited in patients with traumatic injuries. We sought to assess the feasibility of mobile health tracking in patients with rib fractures by using a smartphone app to monitor postdischarge recovery. We encountered patient, institutional, and process-related obstacles that limited app use. The success of future work requires the acknowledgment of these limitations and the use of an implementation science framework to effectively integrate technological tools for personalized trauma care. %M 38820574 %R 10.2196/52726 %U https://formative.jmir.org/2024/1/e52726 %U https://doi.org/10.2196/52726 %U http://www.ncbi.nlm.nih.gov/pubmed/38820574 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47996 %T Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study %A Musiimenta,Angella %A Tumuhimbise,Wilson %A Atukunda,Esther %A Mugaba,Aaron %A Linnemayr,Sebastian %A Haberer,Jessica %+ Faculty of Computing and Informatics, Mbarara University of Science and Technology, Plot 8-19 Mbarara Kabale Road, Mbarara, P.O. Box 653, Uganda, 256 776820598, amusiimenta@must.ac.ug %K digital adherence technologies %K real-time monitoring %K SMS text message reminders %K mobile money %K financial incentives %K tuberculosis %K medication adherence %K user-centered approach %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. Objective: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. Methods: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients’ experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. Results: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox–based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as “being watched” while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. Conclusions: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care. %M 38819905 %R 10.2196/47996 %U https://humanfactors.jmir.org/2024/1/e47996 %U https://doi.org/10.2196/47996 %U http://www.ncbi.nlm.nih.gov/pubmed/38819905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52170 %T Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study %A Xu,Zidu %A Gu,Yaowen %A Xu,Xiaowei %A Topaz,Maxim %A Guo,Zhen %A Kang,Hongyu %A Sun,Lianglong %A Li,Jiao %+ Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, No 3. Yabao Road, Beijing, 10020, China, 86 1052328740, li.jiao@imicams.ac.cn %K knowledge graph %K personalized food recommendation %K geriatric nutrition %K community %K ubiquitous computing %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: China’s older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph–based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph–based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo’s effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo’s meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults’ own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo’s ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual’s health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo’s performance in real-world settings, emphasizing the robust management of complex health data. The system’s scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. %M 38814702 %R 10.2196/52170 %U https://formative.jmir.org/2024/1/e52170 %U https://doi.org/10.2196/52170 %U http://www.ncbi.nlm.nih.gov/pubmed/38814702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50025 %T Effectiveness of a Mental Health Chatbot for People With Chronic Diseases: Randomized Controlled Trial %A MacNeill,A Luke %A Doucet,Shelley %A Luke,Alison %+ Centre for Research in Integrated Care, University of New Brunswick, 355 Campus Ring Road, Saint John, NB, E2L 4L5, Canada, 1 506 648 5777, luke.macneill@unb.ca %K chatbot %K chronic disease %K arthritis %K diabetes %K mental health %K depression %K anxiety %K stress %K effectiveness %K application %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People with chronic diseases tend to experience more mental health issues than their peers without these health conditions. Mental health chatbots offer a potential source of mental health support for people with chronic diseases. Objective: The aim of this study was to determine whether a mental health chatbot can improve mental health in people with chronic diseases. We focused on 2 chronic diseases in particular: arthritis and diabetes. Methods: Individuals with arthritis or diabetes were recruited using various web-based methods. Participants were randomly assigned to 1 of 2 groups. Those in the treatment group used a mental health chatbot app (Wysa [Wysa Inc]) over a period of 4 weeks. Those in the control group received no intervention. Participants completed measures of depression (Patient Health Questionnaire–9), anxiety (Generalized Anxiety Disorder Scale–7), and stress (Perceived Stress Scale–10) at baseline, with follow-up testing 2 and 4 weeks later. Participants in the treatment group completed feedback questions on their experiences with the app at the final assessment point. Results: A total of 68 participants (n=47, 69% women; mean age 42.87, SD 11.27 years) were included in the analysis. Participants were divided evenly between the treatment and control groups. Those in the treatment group reported decreases in depression (P<.001) and anxiety (P<.001) severity over the study period. No such changes were found among participants in the control group. No changes in stress were reported by participants in either group. Participants with arthritis reported higher levels of depression (P=.004) and anxiety (P=.004) severity than participants with diabetes over the course of the study, as well as higher levels of stress (P=.01); otherwise, patterns of results were similar across these health conditions. In response to the feedback questions, participants in the treatment group said that they liked many of the functions and features of the app, the general design of the app, and the user experience. They also disliked some aspects of the app, with most of these reports focusing on the chatbot’s conversational abilities. Conclusions: The results of this study suggest that mental health chatbots can be an effective source of mental health support for people with chronic diseases such as arthritis and diabetes. Although cost-effective and accessible, these programs have limitations and may not be well suited for all individuals. Trial Registration: ClinicalTrials.gov NCT04620668; https://www.clinicaltrials.gov/study/NCT04620668 %M 38814681 %R 10.2196/50025 %U https://formative.jmir.org/2024/1/e50025 %U https://doi.org/10.2196/50025 %U http://www.ncbi.nlm.nih.gov/pubmed/38814681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56916 %T Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study %A Albright,Liam %A Ko,Woojin %A Buvanesh,Meyhaa %A Haraldsson,Harald %A Polubriaginof,Fernanda %A Kuperman,Gilad J %A Levy,Michelle %A Sterling,Madeline R %A Dell,Nicola %A Estrin,Deborah %+ Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, 2 W Loop Rd, New York, NY, 10044, United States, 1 646 971 3777, nixdell@cornell.edu %K augmented reality %K extended reality %K family caregiver %K home care %K virtual care %K telemedicine %K telehealth %K oncology %K artificial intelligence %K mobile phone %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers’ unmet needs is via the design of digital technologies that support caregivers’ complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. Objective: This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. Methods: We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. Results: We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians’ and caregivers’ perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers’ already significant burdens. Conclusions: These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery. %M 38814705 %R 10.2196/56916 %U https://formative.jmir.org/2024/1/e56916 %U https://doi.org/10.2196/56916 %U http://www.ncbi.nlm.nih.gov/pubmed/38814705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51546 %T Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study %A Mizuno,Emi %A Ogasawara,Takayuki %A Mukaino,Masahiko %A Yamaguchi,Masumi %A Tsukada,Shingo %A Sonoda,Shigeru %A Otaka,Yohei %+ Department of Rehabilitation Medicine, Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo, 0608648, Japan, 81 117066066, masahikovn@gmail.com %K activity monitoring %K smart clothing system %K stroke %K unseen %K monitoring %K recovery %K physical condition %K deconditioning %K muscle wasting %K wearable technology %K wearable %K activity level %K rehabilitation %K physical therapy %K heart rate %K ADL %K activities of daily living %K training %K older people %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. Objective: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. Methods: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients’ daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. Results: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=–0.41, P=.21) or 4 weeks post admission (ρ=–0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=–0.82, P=.002) and 4 weeks post admission (ρ=–0.73, P=.01). Conclusions: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings. %M 38809596 %R 10.2196/51546 %U https://formative.jmir.org/2024/1/e51546 %U https://doi.org/10.2196/51546 %U http://www.ncbi.nlm.nih.gov/pubmed/38809596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45561 %T The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study %A Sapre,Manali %A Elaiho,Cordelia R %A Brar Prayaga,Rena %A Prayaga,Ram %A Constable,Jeremy %A Vangeepuram,Nita %+ Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1198, New York, NY, 10029, United States, 1 917 478 2106, nita.vangeepuram@mssm.edu %K community-based participatory research %K youth %K diabetes prevention %K peer education %K mobile health technology %K SMS text messaging %K mobile phone %K artificial intelligence %K AI %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: “interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective.” Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities. %M 38809599 %R 10.2196/45561 %U https://formative.jmir.org/2024/1/e45561 %U https://doi.org/10.2196/45561 %U http://www.ncbi.nlm.nih.gov/pubmed/38809599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51408 %T Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study %A Willemsen,Romy Fleur %A Chavannes,Niels Henrik %A Aardoom,Jiska Joëlle %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 615174812, r.f.willemsen@lumc.nl %K acceptability %K accessible %K adoption %K application %K design %K ehealth %K engagement %K evaluation study %K feasibility %K health app platform %K health apps %K health empowerment %K prevention %K public health %K uptake %K user-friendly %K users %K wellbeing %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform “FitKnip” was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. Objective: The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. Methods: This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire–8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one’s perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). Results: A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. Conclusions: A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users’ needs and preferences. This can help to increase uptake, engagement, and ultimately the platform’s adoption and effectiveness. %M 38809585 %R 10.2196/51408 %U https://formative.jmir.org/2024/1/e51408 %U https://doi.org/10.2196/51408 %U http://www.ncbi.nlm.nih.gov/pubmed/38809585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50857 %T Where Do I Go When My Doctor’s Office Is Closed? The Availability of Out-of-Hours Care Information on Primary Care Practitioners’ Websites %A Legg,David %A Napierala,Hendrik %A Holzinger,Felix %A Slagman,Anna %+ Health Services Research in Emergency and Acute Medicine, Charité - Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 553 037, david.legg@charite.de %K out of hours %K primary care %K telephone triage %K websites %K care information %D 2024 %7 29.5.2024 %9 Research Letter %J JMIR Form Res %G English %X %M 38809600 %R 10.2196/50857 %U https://formative.jmir.org/2024/1/e50857 %U https://doi.org/10.2196/50857 %U http://www.ncbi.nlm.nih.gov/pubmed/38809600 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54334 %T Exploring Consumers’ Negative Electronic Word-of-Mouth of 5 Military Hospitals in Taiwan Through SERVQUAL and Flower of Services: Web Scraping Analysis %A Huang,Ching-Yuan %A Lee,Po-Chun %A Chen,Long-Hui %+ Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung, 80284, Taiwan, 886 953332550, chyun0124@gmail.com %K electronic word-of-mouth %K eWOM %K service quality %K SERVQUAL scale %K Flower of Services %K health care service quality %K military hospitals %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality. Objective: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality. Methods: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality. Results: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the “Assurance” dimension yielded the least favorable results, registering a negative review rate as high as 58.3%. Closely trailing, the “Responsiveness” dimension recorded a negative review rate of 34.2%. When evaluating the service process, the subitem “In Service: Diagnosis/Examination/Medical/Hospitalization” exhibited the least satisfactory performance, with a negative review rate of 46.2%. This was followed by the subitem “In Service: Pre-diagnosis Waiting,” which had a negative review rate of 20.2%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01). Conclusions: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area. %M 38809602 %R 10.2196/54334 %U https://formative.jmir.org/2024/1/e54334 %U https://doi.org/10.2196/54334 %U http://www.ncbi.nlm.nih.gov/pubmed/38809602 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53071 %T Electronic Immunization Registry in Rwanda: Qualitative Study of Health Worker Experiences %A Uwera,Thaoussi %A Venkateswaran,Mahima %A Bhutada,Kiran %A Papadopoulou,Eleni %A Rukundo,Enock %A K Tumusiime,David %A Frøen,J Frederik %+ Centre of Excellence in Biomedical Engineering and eHealth, University of Rwanda, KG 11 Ave Gasabo, Kigali, Rwanda, 250 788229321, uwera04@gmail.com %K childhood immunization %K electronic immunization registry %K digital health interventions %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Monitoring childhood immunization programs is essential for health systems. Despite the introduction of an electronic immunization registry called e-Tracker in Rwanda, challenges such as lacking population denominators persist, leading to implausible reports of coverage rates of more than 100%. Objective: This study aimed to assess the extent to which the immunization e-Tracker responds to stakeholders’ needs and identify key areas for improvement. Methods: In-depth interviews were conducted with all levels of e-Tracker users including immunization nurses, data managers, and supervisors from health facilities in 5 districts of Rwanda. We used an interview guide based on the constructs of the Human, Organization, and Technology–Fit (HOT-Fit) framework, and we analyzed and summarized our findings using the framework. Results: Immunization nurses reported using the e-Tracker as a secondary data entry tool in addition to paper-based forms, which resulted in considerable dissatisfaction among nurses. While users acknowledged the potential of a digital tool compared to paper-based systems, they also reported the need for improvement of functionalities to support their work, such as digital client appointment lists, lists of defaulters, search and register functions, automated monthly reports, and linkages to birth notifications and the national identity system. Conclusions: Reducing dual documentation for users can improve e-Tracker use and user satisfaction. Our findings can help identify additional digital health interventions to support and strengthen the health information system for the immunization program. %M 38805254 %R 10.2196/53071 %U https://humanfactors.jmir.org/2024/1/e53071 %U https://doi.org/10.2196/53071 %U http://www.ncbi.nlm.nih.gov/pubmed/38805254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54010 %T Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial %A Dinh,Mackenzie %A Lin,Chun Chieh %A Whitfield,Candace %A Farhan,Zahera %A Meurer,William J %A Bailey,Sarah %A Skolarus,Lesli E %+ Davee Department of Neurology, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu %K hypertension %K cognition %K mobile health %K Bluetooth %K remote %K monitoring %K monitor %K low income %K mHealth %K hypertensive %K cardiology %K cardiovascular %K feasibility %K acceptability %K satisfaction %K RCT %K randomized controlled trial %K assessment %K blood pressure %K neurological %K mobile health %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease–related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health–based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message–linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 %M 38805251 %R 10.2196/54010 %U https://formative.jmir.org/2024/1/e54010 %U https://doi.org/10.2196/54010 %U http://www.ncbi.nlm.nih.gov/pubmed/38805251 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55399 %T The Impact of Performance Expectancy, Workload, Risk, and Satisfaction on Trust in ChatGPT: Cross-Sectional Survey Analysis %A Choudhury,Avishek %A Shamszare,Hamid %+ Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, 321 Engineering Sciences Building, 1306 Evansdale Drive, Morgantown, WV, 26506, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu %K ChatGPT %K chatbots %K health care %K health care decision-making %K health-related decision-making %K health care management %K decision-making %K user perception %K usability %K usable %K usableness %K usefulness %K artificial intelligence %K algorithms %K predictive models %K predictive analytics %K predictive system %K practical models %K deep learning %K cross-sectional survey %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: ChatGPT (OpenAI) is a powerful tool for a wide range of tasks, from entertainment and creativity to health care queries. There are potential risks and benefits associated with this technology. In the discourse concerning the deployment of ChatGPT and similar large language models, it is sensible to recommend their use primarily for tasks a human user can execute accurately. As we transition into the subsequent phase of ChatGPT deployment, establishing realistic performance expectations and understanding users’ perceptions of risk associated with its use are crucial in determining the successful integration of this artificial intelligence (AI) technology. Objective: The aim of the study is to explore how perceived workload, satisfaction, performance expectancy, and risk-benefit perception influence users’ trust in ChatGPT. Methods: A semistructured, web-based survey was conducted with 607 adults in the United States who actively use ChatGPT. The survey questions were adapted from constructs used in various models and theories such as the technology acceptance model, the theory of planned behavior, the unified theory of acceptance and use of technology, and research on trust and security in digital environments. To test our hypotheses and structural model, we used the partial least squares structural equation modeling method, a widely used approach for multivariate analysis. Results: A total of 607 people responded to our survey. A significant portion of the participants held at least a high school diploma (n=204, 33.6%), and the majority had a bachelor’s degree (n=262, 43.1%). The primary motivations for participants to use ChatGPT were for acquiring information (n=219, 36.1%), amusement (n=203, 33.4%), and addressing problems (n=135, 22.2%). Some participants used it for health-related inquiries (n=44, 7.2%), while a few others (n=6, 1%) used it for miscellaneous activities such as brainstorming, grammar verification, and blog content creation. Our model explained 64.6% of the variance in trust. Our analysis indicated a significant relationship between (1) workload and satisfaction, (2) trust and satisfaction, (3) performance expectations and trust, and (4) risk-benefit perception and trust. Conclusions: The findings underscore the importance of ensuring user-friendly design and functionality in AI-based applications to reduce workload and enhance user satisfaction, thereby increasing user trust. Future research should further explore the relationship between risk-benefit perception and trust in the context of AI chatbots. %M 38801658 %R 10.2196/55399 %U https://humanfactors.jmir.org/2024/1/e55399 %U https://doi.org/10.2196/55399 %U http://www.ncbi.nlm.nih.gov/pubmed/38801658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50446 %T Evaluating a New Digital App–Based Program for Heart Health: Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Paruthi,Jason %A Buch,Lauren S %A Chaffard,Mathieu %A Schitter,Eva C %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 809 Cuesta Dr, Suite B #1033, Mountain View, CA, 94040, United States, 1 5033801340, kimberly.lockwood@lark.com %K digital health %K cardiovascular disease %K artificial intelligence %K AI %K acceptability and feasibility %K pilot study %K lifestyle coaching %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)–powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. Objective: This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. Methods: This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. Results: On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). Conclusions: The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample. %M 38787598 %R 10.2196/50446 %U https://formative.jmir.org/2024/1/e50446 %U https://doi.org/10.2196/50446 %U http://www.ncbi.nlm.nih.gov/pubmed/38787598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52185 %T Developing a Cost-Effective Surgical Scheduling System Applying Lean Thinking and Toyota’s Methods for Surgery-Related Big Data for Improved Data Use in Hospitals: User-Centered Design Approach %A Lin,Chien-Chung %A Shen,Jian-Hong %A Chen,Shu-Fang %A Chen,Hung-Ming %A Huang,Hung-Meng %+ Department of Orthopedic Surgery, Taipei City Hospital, Number 33, Section 2, Chung-Hwa Road, Taipei, 100, Taiwan, 886 223889595 ext 2102, ericdoctor@gmail.com %K algorithm %K process %K computational thinking %K continuous improvement %K customer needs %K lean principles %K problem solving %K Toyota Production System %K value stream map %K need %K needs %K operating room %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Surgical scheduling is pivotal in managing daily surgical sequences, impacting patient experience and hospital resources significantly. With operating rooms costing approximately US $36 per minute, efficient scheduling is vital. However, global practices in surgical scheduling vary, largely due to challenges in predicting individual surgeon times for diverse patient conditions. Inspired by the Toyota Production System’s efficiency in addressing similar logistical challenges, we applied its principles as detailed in the book “Lean Thinking” by Womack and Jones, which identifies processes that do not meet customer needs as wasteful. This insight is critical in health care, where waste can compromise patient safety and medical quality. Objective: This study aims to use lean thinking and Toyota methods to develop a more efficient surgical scheduling system that better aligns with user needs without additional financial burdens. Methods: We implemented the 5 principles of the Toyota system: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection. Value was defined in terms of meeting the customer’s needs, which in this context involved developing a responsive and efficient scheduling system. Our approach included 2 subsystems: one handling presurgery patient data and another for intraoperative and postoperative data. We identified inefficiencies in the presurgery data subsystem and responded by creating a comprehensive value stream map of the surgical process. We developed 2 Excel (Microsoft Corporation) macros using Visual Basic for Applications. The first calculated average surgery times from intra- or postoperative historic data, while the second estimated surgery durations and generated concise, visually engaging scheduling reports from presurgery data. We assessed the effectiveness of the new system by comparing task completion times and user satisfaction between the old and new systems. Results: The implementation of the revised scheduling system significantly reduced the overall scheduling time from 301 seconds to 261 seconds (P=.02), with significant time reductions in the revised process from 99 seconds to 62 seconds (P<.001). Despite these improvements, approximately 21% of nurses preferred the older system for its familiarity. The new system protects patient data privacy and streamlines schedule dissemination through a secure LINE group (LY Corp), ensuring seamless flow. The design of the system allows for real-time updates and has been effectively monitoring surgical durations daily for over 3 years. The “pull” principle was demonstrated when an unplanned software issue prompted immediate, user-led troubleshooting, enhancing system reliability. Continuous improvement efforts are ongoing, except for the preoperative patient confirmation step, which requires further enhancement to ensure optimal patient safety. Conclusions: Lean principles and Toyota’s methods, combined with computer programming, can revitalize surgical scheduling processes. They offer effective solutions for surgical scheduling challenges and enable the creation of a novel surgical scheduling system without incurring additional costs. %M 38787610 %R 10.2196/52185 %U https://formative.jmir.org/2024/1/e52185 %U https://doi.org/10.2196/52185 %U http://www.ncbi.nlm.nih.gov/pubmed/38787610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54996 %T Barriers to Implementing Registered Nurse–Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study %A Stevens,Elizabeth R %A Xu,Lynn %A Kwon,JaeEun %A Tasneem,Sumaiya %A Henning,Natalie %A Feldthouse,Dawn %A Kim,Eun Ji %A Hess,Rachel %A Dauber-Decker,Katherine L %A Smith,Paul D %A Halm,Wendy %A Gautam-Goyal,Pranisha %A Feldstein,David A %A Mann,Devin M %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, Room 17-13, New York, NY, 10016, United States, 1 6465012558, elizabeth.stevens@nyulangone.org %K integrated clinical prediction rules %K EHR %K electronic health record %K implementation %K barriers %K acute respiratory infections %K antibiotics %K CDS %K clinical decision support %K decision support %K antibiotic %K prescribe %K prescription %K acute respiratory infection %K barrier %K effectiveness %K registered nurse %K RN %K RN-driven intervention %K personnel availability %K workflow variability %K infrastructure %K infrastructures %K law %K laws %K policy %K policies %K clinical-care setting %K clinical setting %K electronic health records %K RN-driven %K antibiotic stewardship %K retrospective analysis %K Consolidated Framework for Implementation Research %K CFIR %K CDS-based intervention %K urgent care %K New York %K chart review %K interview %K interviews %K staff change %K staff changes %K RN shortage %K RN shortages %K turnover %K health system %K nurse %K nurses %K researcher %K researchers %D 2024 %7 23.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. Objective: As a delegation protocol, we adapted a validated electronic health record–integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. Methods: We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. Results: Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. Conclusions: Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. Trial Registration: ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303 %M 38781006 %R 10.2196/54996 %U https://formative.jmir.org/2024/1/e54996 %U https://doi.org/10.2196/54996 %U http://www.ncbi.nlm.nih.gov/pubmed/38781006 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56607 %T Impact of an Automated Population-Level Cirrhosis Screening Program Using Common Pathology Tests on Rates of Cirrhosis Diagnosis and Linkage to Specialist Care (CAPRISE): Protocol for a Pilot Prospective Single-Arm Intervention Study %A Flores,Joan Ericka %A Trambas,Christina %A Jovanovic,Natasha %A Thompson,Alexander J %A Howell,Jessica %+ Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy VIC 3065, Fitzroy, 3065, Australia, 61 0392312211, ericka.flores@svha.org.au %K noninvasive tests %K cirrhosis %K population health %K screening %K liver cirrhosis %K liver %K compensated %K risk factor %K pathology %K population based %K liver screening %K prevalence %K hepatocellular carcinoma %K transient elastography %K FibroScan %D 2024 %7 22.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase–to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care. Objective: This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care. Methods: We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention. Results: As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3%) tests were excluded, with the remaining 42,025 (34.7%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024. Conclusions: We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp International Registered Report Identifier (IRRID): DERR1-10.2196/56607 %M 38776541 %R 10.2196/56607 %U https://www.researchprotocols.org/2024/1/e56607 %U https://doi.org/10.2196/56607 %U http://www.ncbi.nlm.nih.gov/pubmed/38776541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54586 %T A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself %A Brown,Katherine %A Lucassen,Mathijs F G %A Núñez-García,Alicia %A Rimes,Katharine A %A Wallace,Louise M %A Samra,Rajvinder %+ Centre for Research in Psychology and Sports Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL109AB, United Kingdom, 44 1707 284 615, k.brown25@herts.ac.uk %K sexual minority %K gender minority %K lesbian, gay, bisexual, transgender, queer %K LGBTQ+ %K mental well-being %K support %K intervention %K resilience %K digital %K co-design %K sexual and gender minority youth %K SGMY %K mobile phone %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users’ well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself’s content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 %M 38772025 %R 10.2196/54586 %U https://formative.jmir.org/2024/1/e54586 %U https://doi.org/10.2196/54586 %U http://www.ncbi.nlm.nih.gov/pubmed/38772025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54101 %T Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study %A Teh,Pei-Lee %A Kwok,Andrei O J %A Cheong,Wing Loong %A Lee,Shaun %+ School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Malaysia, 60 355145890, shaun.lee@monash.edu %K digital health %K older adults %K digital divide %K aging %K pilot %K Malaysia %K coach %K digital access %K social barrier %K virtual %K virtual coach %K digital tool %K tool %K engagement %K gamification %K user experience %K app %K technology tool %K digital literacy %K user experience design %K decision support %K support %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual’s health condition, and improvement in the user-experience design to accommodate older users’ specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults’ digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. %M 38772022 %R 10.2196/54101 %U https://formative.jmir.org/2024/1/e54101 %U https://doi.org/10.2196/54101 %U http://www.ncbi.nlm.nih.gov/pubmed/38772022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50812 %T A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics %A Karuchit,Samart %A Thiengtham,Panupit %A Tanpradech,Suvimon %A Srinor,Watcharapol %A Yingyong,Thitipong %A Naiwatanakul,Thananda %A Northbrook,Sanny %A Hladik,Wolfgang %+ Informatics Section, Business Services Office, US Centers for Disease Control and Prevention, DDC7 Bldg, 3rd Fl. Ministry of Public Health, Tivanon Road, Nonthaburi, 11000, Thailand, 66 2 580 0669 ext 364, hqd5@cdc.gov %K online respondent-driven sampling %K web-based respondent-driven sampling %K virtual architecture %K men who have sex with men %K Thailand %K MSM %K Asia %K Asian %K gay %K homosexual %K homosexuality %K sexual minority %K sexual minorities %K biobehavioral %K surveillance %K respondent driven sampling %K survey %K surveys %K web app %K web application %K coding %K PHP %K web based %K automation %K automated %K design %K architecture %K information system %K information systems %K online sampling %K HIV %K sexually transmitted infection %K STI %K sexually transmitted disease %K STD %K sexual transmission %K sexually transmitted %K RDS %K webRDS %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Thailand’s HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants’ phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using “borrowed” phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection. %M 38767946 %R 10.2196/50812 %U https://formative.jmir.org/2024/1/e50812 %U https://doi.org/10.2196/50812 %U http://www.ncbi.nlm.nih.gov/pubmed/38767946 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53204 %T Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study %A Amiot,Odile %A Sauvaget,Anne %A Alamome,Isabelle %A Bulteau,Samuel %A Charpeaud,Thomas %A Clair,Anne-Hélène %A Courtet,Philippe %A Drapier,Dominique %A Haffen,Emmanuel %A Fakra,Eric %A Gaudeau-Bosma,Christian %A Gaillard,Adeline %A Mouchabac,Stéphane %A Pineau,Fanny %A Narboni,Véronique %A Duburcq,Anne %A Lecardeur,Laurent %+ DueL, 8 Quai des Docks, Nice, 06300, France, 33 635568024, laurentlecardeur@gmail.com %K prospective acceptability %K digital health %K depression %K e-mental health %K deprexis %K psychotherapy %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective: This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods: Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results: A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions: DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression. %M 38568139 %R 10.2196/53204 %U https://formative.jmir.org/2024/1/e53204 %U https://doi.org/10.2196/53204 %U http://www.ncbi.nlm.nih.gov/pubmed/38568139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53206 %T Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study %A Bozorgmehr,Arezoo %A Thiem,Simon-Konstantin %A Wild,Dorothea %A Reinsdorff,Melanie %A Vollmar,Horst Christian %A Kappernagel,Annika %A Schloessler,Kathrin %A Weissbach,Sabine %A Pentzek,Michael %A Dehnen,Dorothea %A Drexler,Julia %A Mueller,Beate Sigrid %A Pilic,Larisa %A Lehmann,Lion %A Loescher,Susanne %A Hohmann,Elena Darinka %A Frank,Friederike %A Ates,Gülay %A Kersten,Susanne %A Mortsiefer,Achim %A Aretz,Benjamin %A Weltermann,Birgitta %+ Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus1, Bonn, 53127, Germany, 49 228 287 10173, arezoo.bozorgmehr@ukbonn.de %K primary care %K general practice research network %K physicians %K feasibility study %K IT infrastructure %K usability %K FallAkte %K FallAkte Plus system %K mixed methods usability study %K North Rhine-Westphalian general practice research network %K NRW-GPRN %K Germany %K German %K universities %K survey %K questionnaire %K participants %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany’s largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system’s emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. %M 38767942 %R 10.2196/53206 %U https://formative.jmir.org/2024/1/e53206 %U https://doi.org/10.2196/53206 %U http://www.ncbi.nlm.nih.gov/pubmed/38767942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53985 %T Longitudinal Changes in Diagnostic Accuracy of a Differential Diagnosis List Developed by an AI-Based Symptom Checker: Retrospective Observational Study %A Harada,Yukinori %A Sakamoto,Tetsu %A Sugimoto,Shu %A Shimizu,Taro %+ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, 321-0293, Japan, 81 282 86 1111, yharada@dokkyomed.ac.jp %K atypical presentations %K diagnostic accuracy %K diagnosis %K diagnostics %K symptom checker %K uncommon diseases %K symptom checkers %K uncommon %K rare %K artificial intelligence %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) symptom checker models should be trained using real-world patient data to improve their diagnostic accuracy. Given that AI-based symptom checkers are currently used in clinical practice, their performance should improve over time. However, longitudinal evaluations of the diagnostic accuracy of these symptom checkers are limited. Objective: This study aimed to assess the longitudinal changes in the accuracy of differential diagnosis lists created by an AI-based symptom checker used in the real world. Methods: This was a single-center, retrospective, observational study. Patients who visited an outpatient clinic without an appointment between May 1, 2019, and April 30, 2022, and who were admitted to a community hospital in Japan within 30 days of their index visit were considered eligible. We only included patients who underwent an AI-based symptom checkup at the index visit, and the diagnosis was finally confirmed during follow-up. Final diagnoses were categorized as common or uncommon, and all cases were categorized as typical or atypical. The primary outcome measure was the accuracy of the differential diagnosis list created by the AI-based symptom checker, defined as the final diagnosis in a list of 10 differential diagnoses created by the symptom checker. To assess the change in the symptom checker’s diagnostic accuracy over 3 years, we used a chi-square test to compare the primary outcome over 3 periods: from May 1, 2019, to April 30, 2020 (first year); from May 1, 2020, to April 30, 2021 (second year); and from May 1, 2021, to April 30, 2022 (third year). Results: A total of 381 patients were included. Common diseases comprised 257 (67.5%) cases, and typical presentations were observed in 298 (78.2%) cases. Overall, the accuracy of the differential diagnosis list created by the AI-based symptom checker was 172 (45.1%), which did not differ across the 3 years (first year: 97/219, 44.3%; second year: 32/72, 44.4%; and third year: 43/90, 47.7%; P=.85). The accuracy of the differential diagnosis list created by the symptom checker was low in those with uncommon diseases (30/124, 24.2%) and atypical presentations (12/83, 14.5%). In the multivariate logistic regression model, common disease (P<.001; odds ratio 4.13, 95% CI 2.50-6.98) and typical presentation (P<.001; odds ratio 6.92, 95% CI 3.62-14.2) were significantly associated with the accuracy of the differential diagnosis list created by the symptom checker. Conclusions: A 3-year longitudinal survey of the diagnostic accuracy of differential diagnosis lists developed by an AI-based symptom checker, which has been implemented in real-world clinical practice settings, showed no improvement over time. Uncommon diseases and atypical presentations were independently associated with a lower diagnostic accuracy. In the future, symptom checkers should be trained to recognize uncommon conditions. %M 38758588 %R 10.2196/53985 %U https://formative.jmir.org/2024/1/e53985 %U https://doi.org/10.2196/53985 %U http://www.ncbi.nlm.nih.gov/pubmed/38758588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54595 %T Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study %A Soltero,Erica G %A Musaad,Salma M %A O’Connor,Teresia M %A Thompson,Debbe %A Norris,Keith %A Beech,Bettina M %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX, 77030, United States, 1 602 496 0909, soltero@bcm.edu %K health disparities %K diabetes prevention %K Mexican youth %K physical activity %K sleep %K digital health %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. Objective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. Methods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Results: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Conclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth’s desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations. %M 38758584 %R 10.2196/54595 %U https://formative.jmir.org/2024/1/e54595 %U https://doi.org/10.2196/54595 %U http://www.ncbi.nlm.nih.gov/pubmed/38758584 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46151 %T Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study %A Lemos,Marta %A Henriques,Ana Rita %A Lopes,David Gil %A Mendonça,Nuno %A Victorino,André %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute %A Canhão,Helena %A Rodrigues,Ana M %+ CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5 Edifício Amarelo, Lisboa, 1150-190, Portugal, 351 214956435 ext 27016, anarita.henriques@nms.unl.pt %K DigiAdherence %K mHealth %K mobile app %K technology %K utility %K usability %K ICT %K application %K patient-centered %K tool %K prevention %K falls %K treatment %K nutrition %K physical activity %K pilot study %K older adults %K adherence %K engagement %K compliance %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 %M 38758585 %R 10.2196/46151 %U https://formative.jmir.org/2024/1/e46151 %U https://doi.org/10.2196/46151 %U http://www.ncbi.nlm.nih.gov/pubmed/38758585 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50098 %T A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study %A Mancinelli,Elisa %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K digital intervention %K behavioral activation %K feasibility %K pregnancy %K subclinical depression symptoms %D 2024 %7 16.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. Objective: This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women’s needs. Usability and user engagement were evaluated. Methods: A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. Results: Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention’s goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. Conclusions: Overall, the findings have emphasized both the intervention’s merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention’s content to pregnant women’s needs. %M 38753421 %R 10.2196/50098 %U https://humanfactors.jmir.org/2024/1/e50098 %U https://doi.org/10.2196/50098 %U http://www.ncbi.nlm.nih.gov/pubmed/38753421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50398 %T Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study %A Szkodny,Dominika %A Wróblewska-Czajka,Ewa %A Stryja,Mikołaj %A Gara,Filip %A Wylęgała,Edward %+ Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, Panewnicka 65, Katowice, 40-570, Poland, 48 32 605 35 55, dominikacholewa1@gmail.com %K eye donor %K corneal transplant %K donor shortage %K mHealth %K mobile health %K app %K apps %K applications %K application %K tissue procurement %K organ %K procurement %K donor %K donors %K donation %K transplant %K transplantation %K transplants %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K survey %K surveys %K questionnaire %K questionnaires %K reporting %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals’ attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals’ perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application’s usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. %M 38748474 %R 10.2196/50398 %U https://formative.jmir.org/2024/1/e50398 %U https://doi.org/10.2196/50398 %U http://www.ncbi.nlm.nih.gov/pubmed/38748474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58326 %T Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial %A Kim,Sun-Hee %A De Gagne,Jennie C %+ College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 536504831, sunhee421@cu.ac.kr %K cartoon %K cartoons %K webtoon %K webtoons %K story %K stories %K storytelling %K preterm %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K perception %K perceptions %K web-based %K satisfaction %K client satisfaction %K clinical trial protocol %K education %K health belief model %K web-based intervention %K premature birth %K prevention and control %K prevention %K premature %K maternal %K pregnant %K pregnancy %K randomized controlled feasibility trials %K self-efficacy %K women %K randomized %K controlled trial %K controlled trials %K birth %K mobile phone %D 2024 %7 15.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. Objective: This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention—Pregnancy Story I Didn’t Know in Interactive Webtoon Series (PSIDK-iWebtoons)—designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Methods: Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn’t Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. Results: The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. Conclusions: This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857 International Registered Report Identifier (IRRID): DERR1-10.2196/58326 %M 38748471 %R 10.2196/58326 %U https://www.researchprotocols.org/2024/1/e58326 %U https://doi.org/10.2196/58326 %U http://www.ncbi.nlm.nih.gov/pubmed/38748471 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e47382 %T Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them %A Bould,Helen %A Kennedy,Mari-Rose %A Penton-Voak,Ian %A Thomas,Lisa May %A Bird,Jon %A Biddle,Lucy %+ Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 (0)117 9289000, helen.bould@bristol.ac.uk %K eating disorders %K virtual reality %K anorexia nervosa %K bulimia nervosa %K EDNOS %K treatment %K immersive %K clinicians %K qualitative data %K psychoeducation %K therapeutic %K limitations %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Immersive virtual reality (VR) interventions are being developed and trialed for use in the treatment of eating disorders. However, little work has explored the opinions of people with eating disorders, or the clinicians who treat them, on the possible use of VR in this context. Objective: This study aims to use qualitative methodology to explore the views of people with eating disorders, and clinicians who treat them, on the possible use of VR in the treatment of eating disorders. Methods: We conducted a series of focus groups and interviews with people with lived experience of eating disorders and clinicians on their views about VR and how it could potentially be used in the treatment of eating disorders. People with lived experience of eating disorders were recruited between October and December 2020, with focus groups held online between November 2020 and February 2021; clinicians were recruited in September 2021 and interviewed between September and October 2021. We took a thematic approach to analyzing the resulting qualitative data. Results: We conducted 3 focus groups with 10 individuals with a current or previous eating disorder, 2 focus groups with 4 participants, and 1 with 2 participants. We held individual interviews with 4 clinicians experienced in treating people with eating disorders. Clinicians were all interviewed one-to-one because of difficulties in scheduling mutually convenient groups. We describe themes around representing the body in VR, potential therapeutic uses for VR, the strengths and limitations of VR in this context, and the practicalities of delivering VR therapy. Suggested therapeutic uses were to practice challenging situations around food-related and weight/appearance-related scenarios and interactions, to retrain attention, the representation of the body, to represent the eating disorder, for psychoeducation, and to enable therapeutic conversations with oneself. There was a substantial agreement between the groups on these themes. Conclusions: People with lived experience of eating disorders and clinicians with experience in treating eating disorders generated many ideas as to how VR could be used as a part of eating disorders treatment. They were also aware of potential limitations and expressed the need for caution around how bodies are represented in a VR setting. %R 10.2196/47382 %U https://xr.jmir.org/2024/1/e47382 %U https://doi.org/10.2196/47382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49168 %T Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers’ Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study %A Morales-Cahuancama,Bladimir %A Verdezoto,Nervo %A Gonzales-Achuy,Elena %A Quispe-Gala,Cinthia %A Bautista-Olortegui,William %A Hinojosa-Mamani,Paul %A Aparco,Juan Pablo %+ Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Av Ricardo Tizón y Bueno 276, Jesús María, Lima, 15072, Peru, 51 7480000 ext 6626, bmorales@ins.gob.pe %K child %K children %K schoolchildren %K youth %K student %K students %K adolescent %K schoolchildren %K formative research %K digital media %K digital games %K serious game %K serious games %K nutrition %K obesity %K obese %K overweight %K mHealth %K caregivers’ perspectives %K perspective %K perspectives %K diet %K healthy eating %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren’s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren’s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren’s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children’s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers’ perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren’s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. %M 38743472 %R 10.2196/49168 %U https://formative.jmir.org/2024/1/e49168 %U https://doi.org/10.2196/49168 %U http://www.ncbi.nlm.nih.gov/pubmed/38743472 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50430 %T A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study %A Papadopoulos,Petros %A Soflano,Mario %A Connolly,Thomas %+ University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 7920756076, petros.papadopoulos@gmail.com %K mobile health %K mHealth %K digital health intervention %K total knee replacement %K TKR %K total hip replacement %K THR %K dynamic hip screw %K DHS %K rehabilitation %K usability %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range −3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. %M 38743479 %R 10.2196/50430 %U https://humanfactors.jmir.org/2024/1/e50430 %U https://doi.org/10.2196/50430 %U http://www.ncbi.nlm.nih.gov/pubmed/38743479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50679 %T Classifying Self-Reported Rheumatoid Arthritis Flares Using Daily Patient-Generated Data From a Smartphone App: Exploratory Analysis Applying Machine Learning Approaches %A Gandrup,Julie %A Selby,David A %A Dixon,William G %+ Centre for Epidemiology Versus Arthritis, University of Manchester, Oxford Rd, Stopford Building, Manchester, M13 9PT, United Kingdom, 44 1613066000, will.dixon@manchester.ac.uk %K rheumatoid arthritis %K flare %K patient-generated health data %K smartphone %K mobile health %K machine learning %K arthritis %K rheumatic %K rheumatism %K joint %K joints %K arthritic %K musculoskeletal %K flares %K classify %K classification %K symptom %K symptoms %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to predict rheumatoid arthritis (RA) flares between clinic visits based on real-time, longitudinal patient-generated data could potentially allow for timely interventions to avoid disease worsening. Objective: This exploratory study aims to investigate the feasibility of using machine learning methods to classify self-reported RA flares based on a small data set of daily symptom data collected on a smartphone app. Methods: Daily symptoms and weekly flares reported on the Remote Monitoring of Rheumatoid Arthritis (REMORA) smartphone app from 20 patients with RA over 3 months were used. Predictors were several summary features of the daily symptom scores (eg, pain and fatigue) collected in the week leading up to the flare question. We fitted 3 binary classifiers: logistic regression with and without elastic net regularization, a random forest, and naive Bayes. Performance was evaluated according to the area under the curve (AUC) of the receiver operating characteristic curve. For the best-performing model, we considered sensitivity and specificity for different thresholds in order to illustrate different ways in which the predictive model could behave in a clinical setting. Results: The data comprised an average of 60.6 daily reports and 10.5 weekly reports per participant. Participants reported a median of 2 (IQR 0.75-4.25) flares each over a median follow-up time of 81 (IQR 79-82) days. AUCs were broadly similar between models, but logistic regression with elastic net regularization had the highest AUC of 0.82. At a cutoff requiring specificity to be 0.80, the corresponding sensitivity to detect flares was 0.60 for this model. The positive predictive value (PPV) in this population was 53%, and the negative predictive value (NPV) was 85%. Given the prevalence of flares, the best PPV achieved meant only around 2 of every 3 positive predictions were correct (PPV 0.65). By prioritizing a higher NPV, the model correctly predicted over 9 in every 10 non-flare weeks, but the accuracy of predicted flares fell to only 1 in 2 being correct (NPV and PPV of 0.92 and 0.51, respectively). Conclusions: Predicting self-reported flares based on daily symptom scorings in the preceding week using machine learning methods was feasible. The observed predictive accuracy might improve as we obtain more data, and these exploratory results need to be validated in an external cohort. In the future, analysis of frequently collected patient-generated data may allow us to predict flares before they unfold, opening opportunities for just-in-time adaptative interventions. Depending on the nature and implication of an intervention, different cutoff values for an intervention decision need to be considered, as well as the level of predictive certainty required. %M 38743480 %R 10.2196/50679 %U https://formative.jmir.org/2024/1/e50679 %U https://doi.org/10.2196/50679 %U http://www.ncbi.nlm.nih.gov/pubmed/38743480 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e42547 %T Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial %A Müller-Bardorff,Miriam %A Schulz,Ava %A Paersch,Christina %A Recher,Dominique %A Schlup,Barbara %A Seifritz,Erich %A Kolassa,Iris Tatjana %A Kowatsch,Tobias %A Fisher,Aaron %A Galatzer-Levy,Isaac %A Kleim,Birgit %+ Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 0443842351, birgit.kleim@uzh.ch %K cognitive behavioral therapy %K CBT %K transdiagnostic %K anxiety %K digital %K ecological momentary assessment %K EMA %K passive sensing %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective: This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods: This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results: The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions: The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. Trial Registration: ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617 International Registered Report Identifier (IRRID): DERR1-10.2196/42547 %M 38743473 %R 10.2196/42547 %U https://www.researchprotocols.org/2024/1/e42547 %U https://doi.org/10.2196/42547 %U http://www.ncbi.nlm.nih.gov/pubmed/38743473 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53623 %T The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study %A Attarha,Mouna %A Mahncke,Henry %A Merzenich,Michael %+ Posit Science, 160 Pine St Suite 200, San Francisco, CA, 94111, United States, 1 415 394 3100, Mouna.attarha@positscience.com %K web-based cognitive assessment %K remote data collection %K neurocognition %K cognitive profiles %K normative assessment data %K brain health %K cognitive status %K assessment accessibility %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan. Objective: We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision. Methods: Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings. Results: Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors. Conclusions: The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization. %M 38739916 %R 10.2196/53623 %U https://formative.jmir.org/2024/1/e53623 %U https://doi.org/10.2196/53623 %U http://www.ncbi.nlm.nih.gov/pubmed/38739916 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44973 %T Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial %A Wu,Yongda Socrates %A Cheung,Yee Tak Derek %A Lee,Jay Jung Jae %A Wong,Carlos King Ho %A Ho,Sai Yin %A Li,William Ho Cheung %A Yao,Ying %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176636, mpwang@hku.hk %K instant messaging %K text messaging %K chatting %K smoking cessation %K COVID-19 %K community smoker %D 2024 %7 13.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. Objective: This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. Methods: From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. Results: Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). Conclusions: An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. Trial Registration: ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719 %M 38739429 %R 10.2196/44973 %U https://www.jmir.org/2024/1/e44973 %U https://doi.org/10.2196/44973 %U http://www.ncbi.nlm.nih.gov/pubmed/38739429 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50230 %T Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post–COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study) %A Müllenmeister,Christina %A Stoelting,Andrea %A Schröder,Dominik %A Schmachtenberg,Tim %A Ritter,Simon %A El-Sayed,Iman %A Steffens,Sandra %A Klawonn,Frank %A Klawitter,Sandra %A Homann,Stefanie %A Mikuteit,Marie %A Berg,Christoph %A Behrens,Georg %A Hummers,Eva %A Cook,Aisha %A Müller,Frank %A Dopfer-Jablonka,Alexandra %A Happle,Christine %+ Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, Goettingen, 37073, Germany, 49 551396807, christina.muellenmeister@med.uni-goettingen.de %K SARS-CoV-2 %K COVID-19 %K post COVID-19 condition %K pandemic %K occupational therapy %K cognitive deficits %K online treatment %K long Covid %K RCT %K randomized controlled trial %K controlled trials %K internet based %K digital health %K digital intervention %K video %K prerecorded %K feasibility %K acceptability %K effectiveness %K online therapy %D 2024 %7 13.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 syndrome (PCS; also known as “long COVID”) is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID. Objective: The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation. Methods: This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints. Results: The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024. Conclusions: Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS. Trial Registration: German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990 International Registered Report Identifier (IRRID): PRR1-10.2196/50230 %M 38739435 %R 10.2196/50230 %U https://www.researchprotocols.org/2024/1/e50230 %U https://doi.org/10.2196/50230 %U http://www.ncbi.nlm.nih.gov/pubmed/38739435 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54007 %T Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation %A Higashi,Robin T %A Etingen,Bella %A Richardson,Eric %A Palmer,Jennifer %A Zocchi,Mark S %A Bixler,Felicia R %A Smith,Bridget %A McMahon,Nicholas %A Frisbee,Kathleen L %A Fortney,John C %A Turvey,Carolyn %A Evans,Jennifer %A Hogan,Timothy P %+ Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, United States, 1 (214) 648 3645, Robin.Higashi@UTSouthwestern.edu %K measurement-based care %K mobile health app %K mental health %K veteran %K mHealth %K support %K mixed-methods evaluation %K digital health %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA’s Collect-Share-Act model of MBC. %M 38728684 %R 10.2196/54007 %U https://mental.jmir.org/2024/1/e54007 %U https://doi.org/10.2196/54007 %U http://www.ncbi.nlm.nih.gov/pubmed/38728684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44805 %T Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application %A Granviken,Fredrik %A Vasseljen,Ottar %A Bach,Kerstin %A Jaiswal,Amar %A Meisingset,Ingebrigt %+ Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, 7491, Norway, 47 93059497, fredrik.granviken@ntnu.no %K case-based reasoning %K musculoskeletal pain %K physiotherapy %K decision support %K primary care %K artificial intelligence %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. Objective: This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. Methods: Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT’s ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. Results: The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. Conclusions: This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain. %M 38728686 %R 10.2196/44805 %U https://formative.jmir.org/2024/1/e44805 %U https://doi.org/10.2196/44805 %U http://www.ncbi.nlm.nih.gov/pubmed/38728686 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52369 %T Feasibility and Acceptability of a Mobile App–Based TEAM-CBT (Testing Empathy Assessment Methods–Cognitive Behavioral Therapy) Intervention (Feeling Good) for Depression: Secondary Data Analysis %A Bisconti,Nicholas %A Odier,Mackenzie %A Becker,Matthew %A Bullock,Kim %+ PGSP-Stanford PsyD. Consortium, 401 Quarry Rd, Palo Alto, CA, 94304, United States, 1 6506449946, nbisco@stanford.edu %K depression %K mobile health %K mHealth %K cognitive behavioral therapy %K mobile phone %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. Objective: The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. Methods: The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. Results: In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps’ 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). Conclusions: This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app’s efficacy. %M 38728080 %R 10.2196/52369 %U https://mental.jmir.org/2024/1/e52369 %U https://doi.org/10.2196/52369 %U http://www.ncbi.nlm.nih.gov/pubmed/38728080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49276 %T Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model %A He,Yanyun %A Yang,Qian %A Alish,Yousef %A Ma,Shaoying %A Qiu,Zefeng %A Chen,Jian %A Wagener,Theodore %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Rd, Columbus, OH, 43214, United States, 1 9739607969, yanyun.he@osumc.edu %K e-cigarette devices %K price %K web-based vape shop %K battery capacity %K output wattage %K e-cigarette %K vape %K vaping %K consumers %K costs %K prices %K pricing %K feature %K features %K device %K devices %K consumer %K cost %K smoking products %K product safety %K consumer safety %K smoking %K smoker %K smokers %K tax %K taxes %K taxation %K economic %K economics %K regression %K regression model %K health economics %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. Objective: This study will examine how product features are associated with the prices of devices sold in web-based vape shops. Methods: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container–only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. Results: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device–only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. Conclusions: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products. %M 38723251 %R 10.2196/49276 %U https://formative.jmir.org/2024/1/e49276 %U https://doi.org/10.2196/49276 %U http://www.ncbi.nlm.nih.gov/pubmed/38723251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52397 %T Patient and Provider Perspectives About the Use of Patient-Generated Health Data During Pregnancy: Qualitative Exploratory Study %A MacEwan,Sarah R %A Olvera,Ramona G %A Jonnalagadda,Pallavi %A Fareed,Naleef %A McAlearney,Ann Scheck %+ Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, 43202, United States, 1 614 293 0164, Sarah.MacEwan@osumc.edu %K patient-generated health data %K patient-centered care %K obstetrics %K postpartum period %K qualitative methods %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is increasing interest in using patient-generated health data (PGHD) to improve patient-centered care during pregnancy. However, little research has examined the perspectives of patients and providers as they report, collect, and use PGHD to inform obstetric care. Objective: This study aims to explore the perspectives of patients and providers about the use of PGHD during pregnancy, including the benefits and challenges of reporting, collecting, and using these data, as well as considerations for expanding the use of PGHD to improve obstetric care. Methods: We conducted one-on-one interviews with 30 pregnant or postpartum patients and 14 health care providers from 2 obstetrics clinics associated with an academic medical center. Semistructured interview guides included questions for patients about their experience and preferences for sharing PGHD and questions for providers about current processes for collecting PGHD, opportunities to improve or expand the collection of PGHD, and challenges faced when collecting and using this information. Interviews were conducted by phone or videoconference and were audio recorded, transcribed verbatim, and deidentified. Interview transcripts were analyzed deductively and inductively to characterize and explore themes in the data. Results: Patients and providers described how PGHD, including physiologic measurements and experience of symptoms, were currently collected during and between in-person clinic visits for obstetric care. Both patients and providers reported positive perceptions about the collection and use of PGHD during pregnancy. Reported benefits of collecting PGHD included the potential to use data to directly inform patient care (eg, identify issues and adjust medication) and to encourage ongoing patient involvement in their care (eg, increase patient attention to their health). Patients and providers had suggestions for expanding the collection and use of PGHD during pregnancy, and providers also shared considerations about strategies that could be used to expand PGHD collection and use. These strategies included considering the roles of both patients and providers in reporting and interpreting PGHD. Providers also noted the need to consider the unintended consequences of using PGHD that should be anticipated and addressed. Conclusions: Acknowledging the challenges, suggestions, and considerations voiced by patients and providers can inform the development and implementation of strategies to effectively collect and use PGHD to support patient-centered care during pregnancy. %M 38718395 %R 10.2196/52397 %U https://formative.jmir.org/2024/1/e52397 %U https://doi.org/10.2196/52397 %U http://www.ncbi.nlm.nih.gov/pubmed/38718395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53192 %T Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study %A Au-Yeung,Wan-Tai M %A Liu,Yan %A Hanna,Remonda %A Gothard,Sarah %A Rodrigues,Nathaniel %A Leon Guerrero,Cierra %A Beattie,Zachary %A Kaye,Jeffrey %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 503 494 6695, auyeungm@ohsu.edu %K neuropsychiatric symptoms %K mild cognitive impairment %K dementia %K unobtrusive monitoring %K digital biomarkers %K environmental precipitants %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants’ digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants’ severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults’ behavioral symptoms and holistic in situ monitoring of older adults’ behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. %M 38717798 %R 10.2196/53192 %U https://formative.jmir.org/2024/1/e53192 %U https://doi.org/10.2196/53192 %U http://www.ncbi.nlm.nih.gov/pubmed/38717798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55374 %T Efficacy of the iJobs Web-Based Psychoeducational Intervention to Improve Job Search Behavior and Promote Mental Health Among Unemployed People: Protocol for a Waitlist Randomized Controlled Trial %A Bodnaru,Alexandra %A Rusu,Andrei %A Vîrgă,Delia %A Van den Broeck,Anja %A Blonk,Roland W B %A Trancă,Loredana Marcela %A Iliescu,Dragoș %+ Department of Psychology, West University of Timișoara, 4, Vasile Pârvan Boulevard, Timișoara, 300223, Romania, 40 727977093, alexandra.bodnaru@e-uvt.ro %K iJobs %K JOBS II program %K employability %K internet intervention %K randomized-controlled trial %D 2024 %7 8.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Unemployment affects millions of people worldwide and, beyond its economic impact, has severe implications for people’s well-being and mental health. Different programs have been developed in response to this phenomenon, but to date, job-search interventions have proved to be most effective, especially the JOBS II program. The JOBS II program proved not only to be effective for re-employment but also has a positive impact on beneficiaries’ mental health (ie, reduces anxiety or depression). However, by now, this evidence-based program has been delivered only on site in the various countries where it was implemented. In the digital era, web-based alternatives to such programs are highly needed because they have the advantages of scalability and cost-effectiveness. Objective: In this context, we aim to investigate the efficacy of iJobs, the web-based adaptation of the JOBS II program, on job-search intensity and effort, the quality of job-search behaviors, and job-search self-efficacy. Further, 1 month after the intervention, we will also assess the employment status and the satisfaction with the job (if applicable). This study will also investigate the effect of iJobs on well-being and mental health (ie, anxiety and depression). Methods: This study is a 2-arm randomized controlled trial. The 2 independent groups (intervention vs waiting list control group) will be crossed with 3 measurement times (ie, baseline, the postintervention time point, and 1-month follow-up). The design will be a 2 (intervention vs control) × 3 (baseline, the postintervention time point, and 1-month follow-up) factorial design. iJobs is a 2-week intervention consisting of 6 modules: an introductive module and 5 modules adapted from the original JOBS II program to the web-based setting and Romanian population. The web-based intervention also has a human component, as beneficiaries receive personalized written feedback after each module on the platform from a team of psychologists involved in the project. Results: The enrollment of study participants started in June 2023 and is expected to end in May 2024. The data collection is expected to be completed by July 2024. The results are expected to be submitted for publication in the summer of 2024. Conclusions: This study is the first large-scale randomized controlled trial aiming to test the efficacy of a web-based adaptation of the JOBS II program. If our results support the efficacy of iJobs, they will offer the premise for it to become an evidence-based, accessible alternative for unemployed people in Romania and might be implemented in other countries. Trial Registration: ClinicalTrials.gov NCT05962554; https://clinicaltrials.gov/study/NCT05962554 International Registered Report Identifier (IRRID): PRR1-10.2196/55374 %M 38717812 %R 10.2196/55374 %U https://www.researchprotocols.org/2024/1/e55374 %U https://doi.org/10.2196/55374 %U http://www.ncbi.nlm.nih.gov/pubmed/38717812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50507 %T Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study %A Boudreau,Jacqueline Hannah %A Moo,Lauren R %A Kennedy,Meaghan A %A Conti,Jennifer %A Anwar,Chitra %A Pimentel,Camilla B %A Nearing,Kathryn A %A Hung,William W %A Dryden,Eileen M %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, 200 Springs Rd., Bedford, MA, 01730, United States, 1 6033059605, jacqueline.boudreau@va.gov %K caregivers %K geriatrics %K older adults %K rural veterans %K rural %K specialty care %K telehealth %K telemedicine %K veterans %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA’s videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. Conclusions: To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit. %M 38713503 %R 10.2196/50507 %U https://formative.jmir.org/2024/1/e50507 %U https://doi.org/10.2196/50507 %U http://www.ncbi.nlm.nih.gov/pubmed/38713503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52312 %T Accuracy of the Apple Watch Series 4 and Fitbit Versa for Assessing Energy Expenditure and Heart Rate of Wheelchair Users During Treadmill Wheelchair Propulsion: Cross-sectional Study %A Danielsson,Marius Lyng %A Vergeer,Melanie %A Plasqui,Guy %A Baumgart,Julia Kathrin %+ Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Smistadvegen 11, Trondheim, 7026, Norway, +47 47863154, mlyngd@gmail.com %K agreement %K validity %K accuracy %K cross sectional %K physiology %K disability %K disabled %K upper-body exercise %K upper body %K exercise %K physical activity %K ergospirometer %K fitness %K vital %K vitals %K energy %K expenditure %K mHealth %K wearable %K wearables %K mobile health %K smartwatch %K smartwatches %K apple watch %K fitbit %K digital health %K energy expenditure %K heart rate %K wheelchair %K wheelchairs %K fitness trackers %K tracker %K trackers %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Apple Watch (AW) Series 1 provides energy expenditure (EE) for wheelchair users but was found to be inaccurate with an error of approximately 30%, and the corresponding error for heart rate (HR) provided by the Fitbit Charge 2 was approximately 10% to 20%. Improved accuracy of estimated EE and HR is expected with newer editions of these smart watches (SWs). Objective: This study aims to assess the accuracy of the AW Series 4 (wheelchair-specific setting) and the Fitbit Versa (treadmill running mode) for estimating EE and HR during wheelchair propulsion at different intensities. Methods: Data from 20 manual wheelchair users (male: n=11, female: n=9; body mass: mean 75, SD 19 kg) and 20 people without a disability (male: n=11, female: n=9; body mass: mean 75, SD 11 kg) were included. Three 4-minute wheelchair propulsion stages at increasing speed were performed on 3 separate test days (0.5%, 2.5%, or 5% incline), while EE and HR were collected by criterion devices and the AW or Fitbit. The mean absolute percentage error (MAPE) was used to indicate the absolute agreement between the criterion device and SWs for EE and HR. Additionally, linear mixed model analyses assessed the effect of exercise intensity, sex, and group on the SW error. Interclass correlation coefficients were used to assess relative agreement between criterion devices and SWs. Results: The AW underestimated EE with MAPEs of 29.2% (SD 22%) in wheelchair users and 30% (SD 12%) in people without a disability. The Fitbit overestimated EE with MAPEs of 73.9% (SD 7%) in wheelchair users and 44.7% (SD 38%) in people without a disability. Both SWs underestimated HR. The device error for EE and HR increased with intensity for both SWs (all comparisons: P<.001), and the only significant difference between groups was found for HR in the AW (–5.27 beats/min for wheelchair users; P=.02). There was a significant effect of sex on the estimation error in EE, with worse accuracy for the AW (–0.69 kcal/min; P<.001) and better accuracy for the Fitbit (–2.08 kcal/min; P<.001) in female participants. For HR, sex differences were found only for the AW, with a smaller error in female participants (5.23 beats/min; P=.02). Interclass correlation coefficients showed poor to moderate relative agreement for both SWs apart from 2 stage-incline combinations (AW: 0.12-0.57 for EE and 0.11-0.86 for HR; Fitbit: 0.06-0.85 for EE and 0.03-0.29 for HR). Conclusions: Neither the AW nor Fitbit were sufficiently accurate for estimating EE or HR during wheelchair propulsion. The AW underestimated EE and the Fitbit overestimated EE, and both SWs underestimated HR. Caution is hence required when using SWs as a tool for training intensity regulation and energy balance or imbalance in wheelchair users. %M 38713497 %R 10.2196/52312 %U https://formative.jmir.org/2024/1/e52312 %U https://doi.org/10.2196/52312 %U http://www.ncbi.nlm.nih.gov/pubmed/38713497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52853 %T An mHealth Intervention for Gay and Bisexual Men’s Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial %A Leluțiu-Weinberger,Corina %A Filimon,Mircea L %A Hoover,Donald %A Lixandru,Mihai %A Hanu,Lucian %A Dogaru,Bogdan %A Kovacs,Tudor %A Fierbințeanu,Cristina %A Ionescu,Florentina %A Manu,Monica %A Mariș,Alexandra %A Pană,Elena %A Dorobănțescu,Cristian %A Streinu-Cercel,Adrian %A Pachankis,John E %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 646 217 9205, cl4265@cumc.columbia.edu %K gay and bisexual men %K HIV prevention %K heavy alcohol use %K stigma %K mental health %K behavioral intervention %K mobile phone %D 2024 %7 6.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men’s co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. Objective: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. Methods: To test Comunică’s efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men’s identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. Results: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. Conclusions: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. Trial Registration: ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753 International Registered Report Identifier (IRRID): DERR1-10.2196/52853 %M 38709550 %R 10.2196/52853 %U https://www.researchprotocols.org/2024/1/e52853 %U https://doi.org/10.2196/52853 %U http://www.ncbi.nlm.nih.gov/pubmed/38709550 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50747 %T Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study %A Marier-Deschenes,Pascale %A Pinard,Anne Marie %A Jalbert,Laura %A LeBlanc,Annie %+ CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 525, boul. Wilfrid-Hamel Québec, Québec, QC, G1M 2S8, Canada, 1 418 649 3735, pascale.marier-deschenes.1@ulaval.ca %K persistent pain %K eHealth %K self-paced intervention %K web-based program %K evidence based %K web based %K self-management %K pain %K chronic pain %K mixed methods study %K pain treatment %K pain education %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program’s feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview’s first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 %M 38701440 %R 10.2196/50747 %U https://humanfactors.jmir.org/2024/1/e50747 %U https://doi.org/10.2196/50747 %U http://www.ncbi.nlm.nih.gov/pubmed/38701440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51694 %T Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators %A Branitsky,Alison %A Longden,Eleanor %A Bucci,Sandra %A Morrison,Anthony P %A Varese,Filippo %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 07936813441, alison.branitsky@postgrad.manchester.ac.uk %K peer support %K group cohesion %K web-based delivery %K hearing voices %K Hearing Voices Movement %K self-help groups %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. Objective: This study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. Methods: Semistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. Results: The findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. Conclusions: This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants’ environments to gain deeper insight into their subjective worlds. %M 38701439 %R 10.2196/51694 %U https://formative.jmir.org/2024/1/e51694 %U https://doi.org/10.2196/51694 %U http://www.ncbi.nlm.nih.gov/pubmed/38701439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49396 %T Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study %A Kinoshita,Shotaro %A Hanashiro,Sayaka %A Tsutsumi,Shiori %A Shiga,Kiko %A Kitazawa,Momoko %A Wada,Yasuyo %A Inaishi,Jun %A Kashiwagi,Kazuhiro %A Fukami,Toshikazu %A Mashimo,Yasumasa %A Minato,Kazumichi %A Kishimoto,Taishiro %+ Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, #7F Azabudai Hills Mori JP Tower, 1-3-1 Azabudai, Minato-Ku, Tokyo, 106-0041, Japan, 81 3 5363 3829, tkishimoto@keio.jp %K wearable device %K sleep feedback %K well-being %K stress %K ecological momentary assessment %K feasibility study %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. Objective: This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. Methods: A total of 40 office workers (female, 20/40, 50%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants’ stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. Results: The EMA achieved a total response rate of 87.3%, while the Fitbit Inspire 2 wear rate reached 88.0%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day (β=–.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations (β=–.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels (β=–.26, P=.04). Conclusions: Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. Trial Registration: UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053392 %M 38696237 %R 10.2196/49396 %U https://formative.jmir.org/2024/1/e49396 %U https://doi.org/10.2196/49396 %U http://www.ncbi.nlm.nih.gov/pubmed/38696237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50385 %T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups %A Donkin,Liesje %A Bidois-Putt,Marie-Claire %A Wilson,Holly %A Hayward,Penelope %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K Indigenous people %K Māori %K eHealth %K mental health %K web-based intervention %K digital intervention %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. %M 38696236 %R 10.2196/50385 %U https://formative.jmir.org/2024/1/e50385 %U https://doi.org/10.2196/50385 %U http://www.ncbi.nlm.nih.gov/pubmed/38696236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50035 %T Real-World Gait Detection Using a Wrist-Worn Inertial Sensor: Validation Study %A Kluge,Felix %A Brand,Yonatan E %A Micó-Amigo,M Encarna %A Bertuletti,Stefano %A D'Ascanio,Ilaria %A Gazit,Eran %A Bonci,Tecla %A Kirk,Cameron %A Küderle,Arne %A Palmerini,Luca %A Paraschiv-Ionescu,Anisoara %A Salis,Francesca %A Soltani,Abolfazl %A Ullrich,Martin %A Alcock,Lisa %A Aminian,Kamiar %A Becker,Clemens %A Brown,Philip %A Buekers,Joren %A Carsin,Anne-Elie %A Caruso,Marco %A Caulfield,Brian %A Cereatti,Andrea %A Chiari,Lorenzo %A Echevarria,Carlos %A Eskofier,Bjoern %A Evers,Jordi %A Garcia-Aymerich,Judith %A Hache,Tilo %A Hansen,Clint %A Hausdorff,Jeffrey M %A Hiden,Hugo %A Hume,Emily %A Keogh,Alison %A Koch,Sarah %A Maetzler,Walter %A Megaritis,Dimitrios %A Niessen,Martijn %A Perlman,Or %A Schwickert,Lars %A Scott,Kirsty %A Sharrack,Basil %A Singleton,David %A Vereijken,Beatrix %A Vogiatzis,Ioannis %A Yarnall,Alison %A Rochester,Lynn %A Mazzà,Claudia %A Del Din,Silvia %A Mueller,Arne %+ Novartis Biomedical Research, Novartis Pharma AG, Fabrikstrasse 2, Basel, 4056, Switzerland, 41 795544701, felix.kluge@novartis.com %K digital mobility outcomes %K validation %K wearable sensor %K walking %K digital health %K inertial measurement unit %K accelerometer %K Mobilise-D %D 2024 %7 1.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Wrist-worn inertial sensors are used in digital health for evaluating mobility in real-world environments. Preceding the estimation of spatiotemporal gait parameters within long-term recordings, gait detection is an important step to identify regions of interest where gait occurs, which requires robust algorithms due to the complexity of arm movements. While algorithms exist for other sensor positions, a comparative validation of algorithms applied to the wrist position on real-world data sets across different disease populations is missing. Furthermore, gait detection performance differences between the wrist and lower back position have not yet been explored but could yield valuable information regarding sensor position choice in clinical studies. Objective: The aim of this study was to validate gait sequence (GS) detection algorithms developed for the wrist position against reference data acquired in a real-world context. In addition, this study aimed to compare the performance of algorithms applied to the wrist position to those applied to lower back–worn inertial sensors. Methods: Participants with Parkinson disease, multiple sclerosis, proximal femoral fracture (hip fracture recovery), chronic obstructive pulmonary disease, and congestive heart failure and healthy older adults (N=83) were monitored for 2.5 hours in the real-world using inertial sensors on the wrist, lower back, and feet including pressure insoles and infrared distance sensors as reference. In total, 10 algorithms for wrist-based gait detection were validated against a multisensor reference system and compared to gait detection performance using lower back–worn inertial sensors. Results: The best-performing GS detection algorithm for the wrist showed a mean (per disease group) sensitivity ranging between 0.55 (SD 0.29) and 0.81 (SD 0.09) and a mean (per disease group) specificity ranging between 0.95 (SD 0.06) and 0.98 (SD 0.02). The mean relative absolute error of estimated walking time ranged between 8.9% (SD 7.1%) and 32.7% (SD 19.2%) per disease group for this algorithm as compared to the reference system. Gait detection performance from the best algorithm applied to the wrist inertial sensors was lower than for the best algorithms applied to the lower back, which yielded mean sensitivity between 0.71 (SD 0.12) and 0.91 (SD 0.04), mean specificity between 0.96 (SD 0.03) and 0.99 (SD 0.01), and a mean relative absolute error of estimated walking time between 6.3% (SD 5.4%) and 23.5% (SD 13%). Performance was lower in disease groups with major gait impairments (eg, patients recovering from hip fracture) and for patients using bilateral walking aids. Conclusions: Algorithms applied to the wrist position can detect GSs with high performance in real-world environments. Those periods of interest in real-world recordings can facilitate gait parameter extraction and allow the quantification of gait duration distribution in everyday life. Our findings allow taking informed decisions on alternative positions for gait recording in clinical studies and public health. Trial Registration: ISRCTN Registry 12246987; https://www.isrctn.com/ISRCTN12246987 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-050785 %M 38691395 %R 10.2196/50035 %U https://formative.jmir.org/2024/1/e50035 %U https://doi.org/10.2196/50035 %U http://www.ncbi.nlm.nih.gov/pubmed/38691395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54120 %T Community-Dwelling Older Adults’ Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study %A Ausserhofer,Dietmar %A Piccoliori,Giuliano %A Engl,Adolf %A Mahlknecht,Angelika %A Plagg,Barbara %A Barbieri,Verena %A Colletti,Nicoletta %A Lombardo,Stefano %A Gärtner,Timon %A Tappeiner,Waltraud %A Wieser,Heike %A Wiedermann,Christian Josef %+ Institute of General Medicine and Public Health, Lorenz-Böhler-Str. 13, Bolzano, 39100, Italy, 39 0471 067290, dietmar.ausserhofer@claudiana.bz.it %K frail older adults %K Italy %K Italian %K Europe %K European %K digital health %K health technologies %K health technology %K telemedicine %K telehealth %K eHealth %K e-health %K adoption %K readiness %K usage %K survey %K surveys %K questionnaire %K questionnaires %K robotics %K readiness %K adoption %K cross-sectional study %K population-based survey %K stratified probabilistic sampling %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults’ readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults’ readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. %M 38687989 %R 10.2196/54120 %U https://formative.jmir.org/2024/1/e54120 %U https://doi.org/10.2196/54120 %U http://www.ncbi.nlm.nih.gov/pubmed/38687989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50922 %T Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial %A French,Chloe %A Burden,Sorrel %A Stanmore,Emma %+ School of Health Sciences, University of Manchester, 176 Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613067856, emma.stanmore@manchester.ac.uk %K feasibility %K usability %K digital health %K diet %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K dietary %K nutrition %K hydration %K community dwelling %K RCT %K randomized %K controlled trial %K controlled trials %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. Objective: This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). Methods: This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). Results: Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants’ self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. Conclusions: The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. Trial Registration: ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366 International Registered Report Identifier (IRRID): PRR1-10.2196/50922 %M 38687981 %R 10.2196/50922 %U https://www.researchprotocols.org/2024/1/e50922 %U https://doi.org/10.2196/50922 %U http://www.ncbi.nlm.nih.gov/pubmed/38687981 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48185 %T Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study %A Olsen,Christine %A Lungu,Daniel Adrian %+ Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, daniel.a.lungu@uis.no %K app %K BMI %K diet %K exercise %K health %K Heia Meg %K lifestyle change %K longitudinal %K mHealth %K mobile health %K motivation %K nutrition %K obese %K obesity %K overweight %K physical activity %K smartphone apps %K weight %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. %M 38687565 %R 10.2196/48185 %U https://formative.jmir.org/2024/1/e48185 %U https://doi.org/10.2196/48185 %U http://www.ncbi.nlm.nih.gov/pubmed/38687565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53441 %T Precision Assessment of Real-World Associations Between Stress and Sleep Duration Using Actigraphy Data Collected Continuously for an Academic Year: Individual-Level Modeling Study %A Vidal Bustamante,Constanza M %A Coombs III,Garth %A Rahimi-Eichi,Habiballah %A Mair,Patrick %A Onnela,Jukka-Pekka %A Baker,Justin T %A Buckner,Randy L %+ Department of Psychology, Harvard University, 52 Oxford Street, Northwest Building, East Wing, Room 295.06, Cambridge, MA, 02138, United States, 1 617 384 8230, constanzavidalbustamante@gmail.com %K deep phenotyping %K individualized models %K intensive longitudinal data %K sleep %K stress %K actigraphy %K accelerometer %K wearable %K mobile phone %K digital health %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heightened stress and insufficient sleep are common in the transition to college, often co-occur, and have both been linked to negative health outcomes. A challenge concerns disentangling whether perceived stress precedes or succeeds changes in sleep. These day-to-day associations may vary across individuals, but short study periods and group-level analyses in prior research may have obscured person-specific phenotypes. Objective: This study aims to obtain stable estimates of lead-lag associations between perceived stress and objective sleep duration in the individual, unbiased by the group, by developing an individual-level linear model that can leverage intensive longitudinal data while remaining parsimonious. Methods: In total, 55 college students (n=6, 11% second-year students and n=49, 89% first-year students) volunteered to provide daily self-reports of perceived stress via a smartphone app and wore an actigraphy wristband for the estimation of daily sleep duration continuously throughout the academic year (median usable daily observations per participant: 178, IQR 65.5). The individual-level linear model, developed in a Bayesian framework, included the predictor and outcome of interest and a covariate for the day of the week to account for weekly patterns. We validated the model on the cohort of second-year students (n=6, used as a pilot sample) by applying it to variables expected to correlate positively within individuals: objective sleep duration and self-reported sleep quality. The model was then applied to the fully independent target sample of first-year students (n=49) for the examination of bidirectional associations between daily stress levels and sleep duration. Results: Proof-of-concept analyses captured expected associations between objective sleep duration and subjective sleep quality in every pilot participant. Target analyses revealed negative associations between sleep duration and perceived stress in most of the participants (45/49, 92%), but their temporal association varied. Of the 49 participants, 19 (39%) showed a significant association (probability of direction>0.975): 8 (16%) showed elevated stress in the day associated with shorter sleep later that night, 5 (10%) showed shorter sleep associated with elevated stress the next day, and 6 (12%) showed both directions of association. Of note, when analyzed using a group-based multilevel model, individual estimates were systematically attenuated, and some even reversed sign. Conclusions: The dynamic interplay of stress and sleep in daily life is likely person specific. Paired with intensive longitudinal data, our individual-level linear model provides a precision framework for the estimation of stable real-world behavioral and psychological dynamics and may support the personalized prioritization of intervention targets for health and well-being. %M 38687600 %R 10.2196/53441 %U https://formative.jmir.org/2024/1/e53441 %U https://doi.org/10.2196/53441 %U http://www.ncbi.nlm.nih.gov/pubmed/38687600 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53154 %T Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain %A Harnik,Michael Alexander %A Scheidegger,Alina %A Blättler,Larissa %A Nemecek,Zdenek %A Sauter,Thomas C %A Limacher,Andreas %A Reisig,Florian %A grosse Holtforth,Martin %A Streitberger,Konrad %+ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland, 41 31 632 39 65, michael.harnik@insel.ch %K acceptance %K satisfaction %K patient preferences %K COVID-19 pandemic %K health care providers %K phone consultations %K pain therapy %K eHealth services %K patient care %K health care delivery %K telemedicine %K chronic pain %K preference %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients’ preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients’ preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients’ preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. %M 38684086 %R 10.2196/53154 %U https://formative.jmir.org/2024/1/e53154 %U https://doi.org/10.2196/53154 %U http://www.ncbi.nlm.nih.gov/pubmed/38684086 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54581 %T Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial %A Thunström,Almira Osmanovic %A Carlsen,Hanne Krage %A Ali,Lilas %A Larson,Tomas %A Hellström,Andreas %A Steingrimsson,Steinn %+ Region Västra Götaland, Psychiatric Department, Sahlgrenska University Hospital, Journalvägen 5, Gothenburg, 41650, Sweden, 46 313421000, steinn.steingrimsson@gu.se %K chatbot %K chatbots %K chat-bot %K chat-bots %K text-only chatbot, voice-only chatbot %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K mental health service %K mental health services %K interface %K system usability %K usability %K digital health %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K NLP %K natural language processing %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. %M 38683664 %R 10.2196/54581 %U https://humanfactors.jmir.org/2024/1/e54581 %U https://doi.org/10.2196/54581 %U http://www.ncbi.nlm.nih.gov/pubmed/38683664 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55491 %T A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial %A Cooper,Hal %A Nadzri,Farah Zeehan Mohd %A Vyas,Seema %A Juhari,Rumaya %A Ismail,Nellie %A Arshat,Zarinah %A Rajandiran,Durgesh %A Markle,Laurie %A Calderon,Francisco %A Vallance,Inge %A Melendez-Torres,G J %A Facciolà,Chiara %A Senesathith,Vanisa %A Gardner,Frances %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 270325, hallam.cooper@spi.ox.ac.uk %K parenting intervention %K chatbot-led public health intervention %K engagement %K implementation science %K feasibility %K evidence-based program %D 2024 %7 26.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United Nations’ Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. Objective: This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. Methods: This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers’ use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Results: Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. Conclusions: This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. Trial Registration: OSF Registries; https://osf.io/f32ky International Registered Report Identifier (IRRID): DERR1-10.2196/55491 %M 38669679 %R 10.2196/55491 %U https://www.researchprotocols.org/2024/1/e55491 %U https://doi.org/10.2196/55491 %U http://www.ncbi.nlm.nih.gov/pubmed/38669679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55402 %T Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study %A Arring,Noel %A Barton,Debra L %A Lafferty,Carolyn %A Cox,Bryana %A Conroy,Deirdre A %A An,Lawrence %+ College of Nursing, University of Tennessee, 1412 Circle Drive, Room 411, Knoxville, TN, 37966, United States, 1 8659741988, narring@utk.edu %K cognitive behavioral therapy %K insomnia %K mobile health %K breast cancer %K prostate cancer %K colon cancer %K cancer survivor %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. Objective: This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. Methods: A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. Results: In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. Conclusions: The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. Trial Registration: ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459 %M 38669678 %R 10.2196/55402 %U https://formative.jmir.org/2024/1/e55402 %U https://doi.org/10.2196/55402 %U http://www.ncbi.nlm.nih.gov/pubmed/38669678 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52687 %T Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study %A Hu,Lu %A Wyatt,Laura C %A Mohsin,Farhan %A Lim,Sahnah %A Zanowiak,Jennifer %A Mammen,Shinu %A Hussain,Sarah %A Ali,Shahmir H %A Onakomaiya,Deborah %A Belli,Hayley M %A Aifah,Angela %A Islam,Nadia S %+ Department of Population Health, Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 3438, lu.hu@nyulangone.org %K South Asian immigrants %K type 2 diabetes %K technology access %K technology use %K prediabetes %K health disparities %K mHealth %K health equity %K immigrant health %K mobile health %K smartphone %K diabetes %K diabetic %K DM %K diabetes mellitus %K immigrants %K prevention %K regression %K regression model %K logistic regression %K mobile health interventions %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). Objective: This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. Methods: We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. Results: The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). Conclusions: Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. Trial Registration: ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y %M 38669062 %R 10.2196/52687 %U https://formative.jmir.org/2024/1/e52687 %U https://doi.org/10.2196/52687 %U http://www.ncbi.nlm.nih.gov/pubmed/38669062 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57714 %T Therapeutic Uses of Gaming in Mental Health: An Untapped Potential %A Eckardt,Jens Peter %+ Bedre Psykiatri Research Unit (Videnscenter), Gammeltorv 14. 2 sal, Copenhagen, 1457, Denmark, 45 28943288, jp-mail@hotmail.com %K digital mental health interventions %K mental health %K psychiatry %K gaming %K serious games %K casual video games %K commercial games %K exergames %K adolescent %K anxiety %K teenage %K video game %K youth %D 2024 %7 25.4.2024 %9 Letter to the Editor %J JMIR Serious Games %G English %X %M 38662422 %R 10.2196/57714 %U https://games.jmir.org/2024/1/e57714 %U https://doi.org/10.2196/57714 %U http://www.ncbi.nlm.nih.gov/pubmed/38662422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50234 %T Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study %A Kwok,Ian %A Lattie,Emily Gardiner %A Yang,Dershung %A Summers,Amanda %A Cotten,Paul %A Leong,Caroline Alina %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K Alzheimer disease %K dementia %K caregiving %K eHealth %K web-based interventions %K positive emotion %K stress %K coping %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers. %M 38662432 %R 10.2196/50234 %U https://formative.jmir.org/2024/1/e50234 %U https://doi.org/10.2196/50234 %U http://www.ncbi.nlm.nih.gov/pubmed/38662432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51874 %T Objective Assessment of Physical Activity at Home Using a Novel Floor-Vibration Monitoring System: Validation and Comparison With Wearable Activity Trackers and Indirect Calorimetry Measurements %A Nakajima,Yuki %A Kitayama,Asami %A Ohta,Yuji %A Motooka,Nobuhisa %A Kuno-Mizumura,Mayumi %A Miyachi,Motohiko %A Tanaka,Shigeho %A Ishikawa-Takata,Kazuko %A Tripette,Julien %+ Center for Interdisciplinary AI and Data Science, Ochanomizu University, 2-1-1 Otsuka, Bunkyo, 112-8610, Japan, 81 03 5978 2032 ext 2032, tripette.julien@ocha.ac.jp %K smart home system %K physical behavior %K physical activity %K activity tracker %K floor vibration %K housework-related activity %K home-based activity %K mobile phone %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The self-monitoring of physical activity is an effective strategy for promoting active lifestyles. However, accurately assessing physical activity remains challenging in certain situations. This study evaluates a novel floor-vibration monitoring system to quantify housework-related physical activity. Objective: This study aims to assess the validity of step-count and physical behavior intensity predictions of a novel floor-vibration monitoring system in comparison with the actual number of steps and indirect calorimetry measurements. The accuracy of the predictions is also compared with that of research-grade devices (ActiGraph GT9X). Methods: The Ocha-House, located in Tokyo, serves as an independent experimental facility equipped with high-sensitivity accelerometers installed on the floor to monitor vibrations. Dedicated data processing software was developed to analyze floor-vibration signals and calculate 3 quantitative indices: floor-vibration quantity, step count, and moving distance. In total, 10 participants performed 4 different housework-related activities, wearing ActiGraph GT9X monitors on both the waist and wrist for 6 minutes each. Concurrently, floor-vibration data were collected, and the energy expenditure was measured using the Douglas bag method to determine the actual intensity of activities. Results: Significant correlations (P<.001) were found between the quantity of floor vibrations, the estimated step count, the estimated moving distance, and the actual activity intensities. The step-count parameter extracted from the floor-vibration signal emerged as the most robust predictor (r2=0.82; P<.001). Multiple regression models incorporating several floor-vibration–extracted parameters showed a strong association with actual activity intensities (r2=0.88; P<.001). Both the step-count and intensity predictions made by the floor-vibration monitoring system exhibited greater accuracy than those of the ActiGraph monitor. Conclusions: Floor-vibration monitoring systems seem able to produce valid quantitative assessments of physical activity for selected housework-related activities. In the future, connected smart home systems that integrate this type of technology could be used to perform continuous and accurate evaluations of physical behaviors throughout the day. %M 38662415 %R 10.2196/51874 %U https://formative.jmir.org/2024/1/e51874 %U https://doi.org/10.2196/51874 %U http://www.ncbi.nlm.nih.gov/pubmed/38662415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53668 %T Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Gusnowski,April %A Surood,Shireen %A Agyapong,Vincent %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K Text4Hope Cancer Care %K COVID-19 %K cancer %K caregivers %K mental health %K anxiety %K depression %K cancer care %K Canada %K Canadian %K treatment %K stress %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 %M 38657234 %R 10.2196/53668 %U https://formative.jmir.org/2024/1/e53668 %U https://doi.org/10.2196/53668 %U http://www.ncbi.nlm.nih.gov/pubmed/38657234 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51540 %T Investigating Rhythmicity in App Usage to Predict Depressive Symptoms: Protocol for Personalized Framework Development and Validation Through a Countrywide Study %A Ahmed,Md Sabbir %A Hasan,Tanvir %A Islam,Salekul %A Ahmed,Nova %+ Design Inclusion and Access Lab, North South University, Plot # 15, Block B, Bashundhara R/A, Dhaka, 1229, Bangladesh, 880 1781920068, msg2sabbir@gmail.com %K depressive symptoms %K app usage rhythm %K behavioral markers %K personalization %K multitask learning framework %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Understanding a student’s depressive symptoms could facilitate significantly more precise diagnosis and treatment. However, few studies have focused on depressive symptom prediction through unobtrusive systems, and these studies are limited by small sample sizes, low performance, and the requirement for higher resources. In addition, research has not explored whether statistically significant rhythms based on different app usage behavioral markers (eg, app usage sessions) exist that could be useful in finding subtle differences to predict with higher accuracy like the models based on rhythms of physiological data. Objective: The main objective of this study is to explore whether there exist statistically significant rhythms in resource-insensitive app usage behavioral markers and predict depressive symptoms through these marker-based rhythmic features. Another objective of this study is to understand whether there is a potential link between rhythmic features and depressive symptoms. Methods: Through a countrywide study, we collected 2952 students’ raw app usage behavioral data and responses to the 9 depressive symptoms in the 9-item Patient Health Questionnaire (PHQ-9). The behavioral data were retrieved through our developed app, which was previously used in our pilot studies in Bangladesh on different research problems. To explore whether there is a rhythm based on app usage data, we will conduct a zero-amplitude test. In addition, we will develop a cosinor model for each participant to extract rhythmic parameters (eg, acrophase). In addition, to obtain a comprehensive picture of the rhythms, we will explore nonparametric rhythmic features (eg, interdaily stability). Furthermore, we will conduct regression analysis to understand the association of rhythmic features with depressive symptoms. Finally, we will develop a personalized multitask learning (MTL) framework to predict symptoms through rhythmic features. Results: After applying inclusion criteria (eg, having app usage data of at least 2 days to explore rhythmicity), we kept the data of 2902 (98.31%) students for analysis, with 24.48 million app usage events, and 7 days’ app usage of 2849 (98.17%) students. The students are from all 8 divisions of Bangladesh, both public and private universities (19 different universities and 52 different departments). We are analyzing the data and will publish the findings in a peer-reviewed publication. Conclusions: Having an in-depth understanding of app usage rhythms and their connection with depressive symptoms through a countrywide study can significantly help health care professionals and researchers better understand depressed students and may create possibilities for using app usage–based rhythms for intervention. In addition, the MTL framework based on app usage rhythmic features may more accurately predict depressive symptoms due to the rhythms’ capability to find subtle differences. International Registered Report Identifier (IRRID): DERR1-10.2196/51540 %M 38657238 %R 10.2196/51540 %U https://www.researchprotocols.org/2024/1/e51540 %U https://doi.org/10.2196/51540 %U http://www.ncbi.nlm.nih.gov/pubmed/38657238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54478 %T The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial %A Lemmer,Diana %A Moessner,Markus %A Arnaud,Nicolas %A Baumeister,Harald %A Mutter,Agnes %A Klemm,Sarah-Lena %A König,Elisa %A Plener,Paul %A Rummel-Kluge,Christine %A Thomasius,Rainer %A Kaess,Michael %A Bauer,Stephanie %+ Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany, 49 6221 56 7345, stephanie.bauer@med.uni-heidelberg.de %K help seeking %K mental health %K stigma %K mental health literacy %K psychoeducation %K web-based experiment %K web-based randomized controlled trial %K microinterventions %K video-based interventions %D 2024 %7 24.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 %M 38656779 %R 10.2196/54478 %U https://www.jmir.org/2024/1/e54478 %U https://doi.org/10.2196/54478 %U http://www.ncbi.nlm.nih.gov/pubmed/38656779 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e47600 %T Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study %A Lee,Edmund W J %A Tan,Warrick W %A Pham,Ben Tan Phat %A Kawaja,Ariffin %A Theng,Yin-Leng %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, 31 Nanyang Link, WKWSCI Building, #02-06, Singapore 639798, Singapore, 639798, Singapore, 65 6908 3429, elwj88@gmail.com %K wearables %K exergames %K older adults %K active aging %K rehabilitation %K stroke %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults’ views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. %M 38656778 %R 10.2196/47600 %U https://games.jmir.org/2024/1/e47600 %U https://doi.org/10.2196/47600 %U http://www.ncbi.nlm.nih.gov/pubmed/38656778 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48371 %T Exploring the Use of Customized Links to Improve Electronic Engagement With Sexual and Reproductive Health Care Among Young African American Male Individuals: Web-Based Survey Study %A Arena,Sandy %A Adams,Mackenzie %A Burns,Jade %+ School of Nursing, University of Michigan, 400 N Ingalls, Room 3175, Ann Arbor, MI, 48109, United States, 1 734 936 5311, saarena@umich.edu %K African American %K engagement %K men’s health %K recruit %K recruitment %K reproductive health %K sexual behavior %K sexual health behavior %K sexual health %K sexual transmission %K sexually transmitted %K social media %K STIs %K young adult %K young adults %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research has shown that heterosexual African American male individuals aged 18-24 years have a higher prevalence of sexually transmitted infections (STIs) and are more likely to engage in risky sexual behavior. There is a critical need to promote sexual reproductive health (SRH) services among this population, especially in urban settings. Young African American male individuals use social media platforms to access health information, showcasing the potential of social media and web-based links as tools to leverage electronic engagement with this population to promote SRH care. Objective: This study aims to explore electronic engagement with young African American male individuals in discussions about SRH care. This paper focuses on the recruitment and social media marketing methods used to recruit young, heterosexual African American male individuals aged 18-24 years for the Stay Safe Project, a larger study that aims to promote SRH services among this population in Detroit, Michigan. We investigate the use of TinyURL, a URL shortener and customized tool, and culturally informed social media marketing strategies to promote electronic engagement within this population. Methods: Participants were recruited between December 2021 and February 2022 through various modes, including email listserves, Mailchimp, the UMHealthResearch website, X (formerly Twitter), Facebook, and Instagram. Images and vector graphics of African American male individuals were used to create social media advertisements that directed participants to click on a TinyURL that led to a recruitment survey for the study. Results: TinyURL metrics were used to monitor demographic and user data, analyzing the top countries, browsers, operating systems, and devices of individuals who engaged with the customized TinyURL links and the total human and unique clicks from various social media platforms. Mailchimp was the most successful platform for electronic engagement with human and unique clicks on the custom TinyURL link, followed by Instagram and Facebook. In contrast, X, traditional email, and research recruiting websites had the least engagement among our population. Success was determined based on the type of user and follower for each platform, whether gained in the community through sign-ups or promoted at peak user time and embedded and spotlighted on nontraditional media (eg, social media sites, blogs, and podcasts) for the user. Low engagement (eg, traditional email) from the target population, limited visibility, and fewer followers contributed to decreased engagement. Conclusions: This study provides insight into leveraging customized, shortened URLs, TinyURL metrics, and social media platforms to improve electronic engagement with young African American male individuals seeking information and resources about SRH care. The results of this study have been used to develop a pilot intervention for this population that will contribute to strategies for encouraging sexual well-being, clinic use, and appropriate linkage to SRH care services among young, heterosexual African American male individuals. %M 38656772 %R 10.2196/48371 %U https://formative.jmir.org/2024/1/e48371 %U https://doi.org/10.2196/48371 %U http://www.ncbi.nlm.nih.gov/pubmed/38656772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48173 %T Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial %A Grove,Birgith Engelst %A de Thurah,Annette %A Ivarsen,Per %A Kvisgaard,Ann Katrine %A Hjollund,Niels Henrik %A Grytnes,Regine %A Schougaard,Liv Marit Valen %+ AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark, 45 28904835, bigcri@rm.dk %K chronic kidney disease %K pragmatic randomized controlled trial %K process evaluation %K patient-reported outcome measures %K remote monitoring %K monitoring %K patient-reported outcome %K chronic kidney %K intervention %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. Objective: This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. Methods: A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Results: Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient’s health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. Conclusions: This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their “clinical glance,” posing a potential risk of overlooking crucial patients‘ symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. Trial Registration: ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766 %M 38656781 %R 10.2196/48173 %U https://formative.jmir.org/2024/1/e48173 %U https://doi.org/10.2196/48173 %U http://www.ncbi.nlm.nih.gov/pubmed/38656781 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53614 %T Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study %A Smith,Sharissa M %A Bais,Babette %A Ismaili M'hamdi,Hafez %A Schermer,Maartje HN %A Steegers-Theunissen,Régine PM %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 CD, Netherlands, 31 10704 ext 0704, r.steegers@erasmusmc.nl %K preconception care %K mHealth %K mobile health %K pregnancy preparation %K nudge %K health inequality %K socioeconomic status %K lifestyle %K women %K pregnancy %K pregnant women %K pregnant %K socioeconomic %K pilot feasibility study %K mHealth app %K mHealth application %K app %K application %K risk factor %K nutrition %K stress %K chronic stress %K health literacy %K usability %K user satisfaction %K user %K users %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion “living in a deprived neighborhood” was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 %M 38648092 %R 10.2196/53614 %U https://humanfactors.jmir.org/2024/1/e53614 %U https://doi.org/10.2196/53614 %U http://www.ncbi.nlm.nih.gov/pubmed/38648092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53022 %T Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology–Supported Intervention %A Foster,Marva %A Fix,Gemmae M %A Hyde,Justeen %A Dunlap,Shawn %A Byrne,Thomas H %A Sugie,Naomi F %A Kuhn,Randall %A Gabrielian,Sonya %A Roncarati,Jill S %A Zhao,Shibei %A McInnes,D Keith %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, United States, 1 857 203 6671, marva.foster@va.gov %K ethnography %K homelessness %K housing transitions %K longitudinal data %K military %K mobile technology %K smartphone %K social support %K veterans %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population’s health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. Objective: The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. Methods: This study’s design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. Results: The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. Conclusions: This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. International Registered Report Identifier (IRRID): DERR1-10.2196/53022 %M 38648101 %R 10.2196/53022 %U https://www.researchprotocols.org/2024/1/e53022 %U https://doi.org/10.2196/53022 %U http://www.ncbi.nlm.nih.gov/pubmed/38648101 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51858 %T AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation %A Chang,Christel Lynne %A Sinha,Chaitali %A Roy,Madhavi %A Wong,John Chee Meng %+ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 6772 3481, pcmwcmj@nus.edu.sg %K AI %K app %K application %K artificial intelligence %K COVID-19 %K digital %K health care workers %K mental health %K pandemic %K Wysa %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact that the COVID-19 pandemic has had on health care workers’ mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. Objective: This study explores the feasibility of using Wysa, an artificial intelligence–led mental health app, among health care workers. Methods: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. Results: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). Conclusions: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities. %M 38640476 %R 10.2196/51858 %U https://formative.jmir.org/2024/1/e51858 %U https://doi.org/10.2196/51858 %U http://www.ncbi.nlm.nih.gov/pubmed/38640476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51859 %T Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis %A Allcock,Jake Alan %A Zhuang,Mengdie %A Li,Shuyang %A Zhao,Xin %+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 114 222 6339, m.zhuang@sheffield.ac.uk %K digital health %K healthcare service %K regional difference %K National Health Service %K NHS %K digital technology %K health equity %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes—inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients’ requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people’s fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. %M 38639996 %R 10.2196/51859 %U https://formative.jmir.org/2024/1/e51859 %U https://doi.org/10.2196/51859 %U http://www.ncbi.nlm.nih.gov/pubmed/38639996 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e47992 %T Health Care Workers’ Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study %A Slob,Joeri %A van Houwelingen,Thijs %A Kort,Helianthe S M %+ Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 641097762, thijs.vanhouwelingen@hu.nl %K digital technology %K pressure injury %K health care professionals %K mobile phone %K health care workers %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. Objective: This study aims to gain insight into health care workers’ expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. Methods: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. Results: A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Conclusions: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process. %M 38635323 %R 10.2196/47992 %U https://nursing.jmir.org/2024/1/e47992 %U https://doi.org/10.2196/47992 %U http://www.ncbi.nlm.nih.gov/pubmed/38635323 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55132 %T The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study %A Fan,Qiping %A Hoang,Minh-Nguyet %A DuBose,Logan %A Ory,Marcia G %A Vennatt,Jeswin %A Salha,Diana %A Lee,Shinduk %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K evaluation %K usability %K family caregiver %K Alzheimer disease %K dementia %K digital health %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The increasing prevalence of Alzheimer disease and Alzheimer disease–related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. %M 38630527 %R 10.2196/55132 %U https://aging.jmir.org/2024/1/e55132 %U https://doi.org/10.2196/55132 %U http://www.ncbi.nlm.nih.gov/pubmed/38630527 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e53212 %T Virtual Reality for Basic Life Support Training in High School Students: Thematic Analysis of Focus Group Interviews %A Min,Hyojin Jennifer %A Andler,Caroline %A Barber,Rebecca Ortiz La Banca %A Chang,Todd P %A Abelairas-Gomez,Cristian %A Knowlin,Laquanda T %A Liu,Deborah R %A Fijačko,Nino %+ Children’s Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, United States, 1 3233614606, hmin@chla.usc.edu %K virtual reality %K mixed reality %K technology %K basic life support %K cardiovascular pulmonary resuscitation %K near-peer mentoring %K education %K high school students %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: High-quality and engaging cardiopulmonary resuscitation (CPR) training of both health care professionals and members of the public is necessary to provide timely and effective CPR to maximize survival and minimize injuries. Virtual reality (VR) is a novel method to enhance CPR engagement and training. However, a near-peer mentoring framework has not been applied in such training to date. Objective: The purpose of this pilot qualitative study was to understand the acceptability and feasibility of using VR technology to introduce basic life support (BLS) to high school students reinforced by near-peer coaching. Methods: Dyads of high school students underwent BLS training in CPR using a VR experience reinforced by the near-peer mentoring model. Focus group interviews were performed following the intervention. The interview sessions were recorded, transcribed verbatim, and subjected to thematic analysis. VR software data were analyzed after five cycles of chest compressions between the two participants. Results: The overwhelming responses from the three dyads of high school students indicated positive acceptance of learning CPR using VR. Analysis of emerging themes revealed three main categories of barriers and facilitators: (1) motivation to learn CPR, (2) CPR learning modality, and (3) coaching CPR content. These themes supported the theoretical framework of an “intention-focused” paradigm leading to acquiring the skills needed to perform CPR and ultimately increasing the chances of a bystander performing CPR. Conclusions: This study highlights the potential for training a unique population to increase bystander effects using novel VR technology coupled with a near-peer mentoring method. Further research is warranted to measure the outcome of the knowledge attained and the intention to perform CPR by high school students who participate in CPR education using VR and a near-peer mentoring method. %R 10.2196/53212 %U https://xr.jmir.org/2024/1/e53212 %U https://doi.org/10.2196/53212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50897 %T Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Makhura,Onalenna %A Hu,Robin %A Motlogelwa,Nkwebi Peace %A Masizana,Audrey %A Lo,Emily %A Mphoyakgosi,Thongbotho %A Moyo,Sikhulile %+ Department of Computer Science, University of Botswana, Private Bag UB 0022, Gaborone, 00267, Botswana, 267 71786953, ndlovuk@ub.ac.bw %K REDCap %K DHIS2 %K COVID-19 %K National Health Laboratory %K eHealth %K interoperability %K data management %K Botswana %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). Objective: This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. Methods: A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants’ requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. Results: Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap’s capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. Conclusions: Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries. %M 38625736 %R 10.2196/50897 %U https://formative.jmir.org/2024/1/e50897 %U https://doi.org/10.2196/50897 %U http://www.ncbi.nlm.nih.gov/pubmed/38625736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55762 %T Assessing the Accuracy of Generative Conversational Artificial Intelligence in Debunking Sleep Health Myths: Mixed Methods Comparative Study With Expert Analysis %A Bragazzi,Nicola Luigi %A Garbarino,Sergio %+ Human Nutrition Unit, Department of Food and Drugs, University of Parma, Via Volturno 39, Parma, 43125, Italy, 39 0521 903121, nicolaluigi.bragazzi@unipr.it %K sleep %K sleep health %K sleep-related disbeliefs %K generative conversational artificial intelligence %K chatbot %K ChatGPT %K misinformation %K artificial intelligence %K comparative study %K expert analysis %K adequate sleep %K well-being %K sleep trackers %K sleep health education %K sleep-related %K chronic disease %K healthcare cost %K sleep timing %K sleep duration %K presleep behaviors %K sleep experts %K healthy behavior %K public health %K conversational agents %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adequate sleep is essential for maintaining individual and public health, positively affecting cognition and well-being, and reducing chronic disease risks. It plays a significant role in driving the economy, public safety, and managing health care costs. Digital tools, including websites, sleep trackers, and apps, are key in promoting sleep health education. Conversational artificial intelligence (AI) such as ChatGPT (OpenAI, Microsoft Corp) offers accessible, personalized advice on sleep health but raises concerns about potential misinformation. This underscores the importance of ensuring that AI-driven sleep health information is accurate, given its significant impact on individual and public health, and the spread of sleep-related myths. Objective: This study aims to examine ChatGPT’s capability to debunk sleep-related disbeliefs. Methods: A mixed methods design was leveraged. ChatGPT categorized 20 sleep-related myths identified by 10 sleep experts and rated them in terms of falseness and public health significance, on a 5-point Likert scale. Sensitivity, positive predictive value, and interrater agreement were also calculated. A qualitative comparative analysis was also conducted. Results: ChatGPT labeled a significant portion (n=17, 85%) of the statements as “false” (n=9, 45%) or “generally false” (n=8, 40%), with varying accuracy across different domains. For instance, it correctly identified most myths about “sleep timing,” “sleep duration,” and “behaviors during sleep,” while it had varying degrees of success with other categories such as “pre-sleep behaviors” and “brain function and sleep.” ChatGPT’s assessment of the degree of falseness and public health significance, on the 5-point Likert scale, revealed an average score of 3.45 (SD 0.87) and 3.15 (SD 0.99), respectively, indicating a good level of accuracy in identifying the falseness of statements and a good understanding of their impact on public health. The AI-based tool showed a sensitivity of 85% and a positive predictive value of 100%. Overall, this indicates that when ChatGPT labels a statement as false, it is highly reliable, but it may miss identifying some false statements. When comparing with expert ratings, high intraclass correlation coefficients (ICCs) between ChatGPT’s appraisals and expert opinions could be found, suggesting that the AI’s ratings were generally aligned with expert views on falseness (ICC=.83, P<.001) and public health significance (ICC=.79, P=.001) of sleep-related myths. Qualitatively, both ChatGPT and sleep experts refuted sleep-related misconceptions. However, ChatGPT adopted a more accessible style and provided a more generalized view, focusing on broad concepts, while experts sometimes used technical jargon, providing evidence-based explanations. Conclusions: ChatGPT-4 can accurately address sleep-related queries and debunk sleep-related myths, with a performance comparable to sleep experts, even if, given its limitations, the AI cannot completely replace expert opinions, especially in nuanced and complex fields such as sleep health, but can be a valuable complement in the dissemination of updated information and promotion of healthy behaviors. %M 38501898 %R 10.2196/55762 %U https://formative.jmir.org/2024/1/e55762 %U https://doi.org/10.2196/55762 %U http://www.ncbi.nlm.nih.gov/pubmed/38501898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53000 %T Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study %A Karki,Saugat %A Shaw,Sarah %A Lieberman,Michael %A Pérez,Alejandro %A Pincus,Jonathan %A Jakhmola,Priya %A Tailor,Amrita %A Ogunrinde,Oyinkansola Bukky %A Sill,Danielle %A Morgan,Shane %A Alvarez,Miguel %A Todd,Jonathan %A Smith,Dawn %A Mishra,Ninad %+ Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30333, United States, 1 4047187483, skarki@cdc.gov %K clinical decision support systems %K CDS %K gonorrhea %K pre-exposure prophylaxis %K PrEP %K HIV %K sexually transmitted infections %K electronic health records %K guideline adherence %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. Objective: The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record–based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. Methods: We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name “X-Clinic.” We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. Results: Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%). Conclusions: We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use. %M 38621237 %R 10.2196/53000 %U https://formative.jmir.org/2024/1/e53000 %U https://doi.org/10.2196/53000 %U http://www.ncbi.nlm.nih.gov/pubmed/38621237 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52326 %T Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial %A Paul,Margot %A Bullock,Kim %A Bailenson,Jeremy %A Burns,David %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, United States, 1 781 572 4136, mdpaul@stanford.edu %K virtual reality %K extended reality %K major depressive disorder %K behavioral activation %K depression %K Meta Quest 2 %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder (MDD) is a global concern with increasing prevalence. While many evidence-based psychotherapies (EBPs) have been identified to treat MDD, there are numerous barriers to patients accessing them. Virtual reality (VR) has been used as a treatment enhancement for a variety of mental health disorders, but few studies have examined its clinical use in treating MDD. Behavioral activation (BA) is a simple yet effective and established first-line EBP for MDD that has the potential to be easily enhanced and adapted with VR technology. A previous report by our group explored the feasibility and acceptability of VR-enhanced BA in a small clinical proof-of-concept pilot. This study examines the clinical efficacy of a more immersive extended reality (XR)–enhanced BA (XR-BA) prototype. This is the first clinical efficacy test of an XR-BA protocol. Objective: This study examined whether XR-BA was feasible and efficacious in treating MDD in an ambulatory telemedicine clinic. Methods: A nonblinded between-subject randomized controlled trial compared XR-BA to traditional BA delivered via telehealth. The study used a previously established, brief 3-week, 4-session BA EBP intervention. The experimental XR-BA participants were directed to use a Meta Quest 2 (Reality Labs) VR headset to engage in simulated pleasant or mastery activities and were compared to a control arm, which used only real-life mastery or pleasant activities as between-session homework. The Patient Health Questionnaire (PHQ)–9 was the primary outcome measure. Independent-sample and paired-sample t tests (2-tailed) were used to determine statistical significance and confirmed using structural equation modeling. Results: Overall, 26 participants with MDD were randomized to receive either XR-BA (n=13, 50%) or traditional BA (n=13, 50%). The mean age of the 26 participants (n=6, 23% male; n=19, 73% female; n=1, 4% nonbinary or third gender) was 50.3 (SD 17.3) years. No adverse events were reported in either group, and no substantial differences in dropout rates or homework completion were observed. XR-BA was found to be statistically noninferior to traditional BA (t18.6=−0.28; P=.78). Both the XR-BA (t9=2.5; P=.04) and traditional BA (t10=2.3; P=.04) arms showed a statistically significant decrease in PHQ-9 and clinical severity from the beginning of session 1 to the beginning of session 4. There was a significant decrease in PHQ-8 to PHQ-9 scores between the phone intake and the beginning of session 1 for the XR-BA group (t11=2.6; P=.03) but not the traditional BA group (t11=1.4; P=.20). Conclusions: This study confirmed previous findings that XR-BA may be a feasible, non-inferior, and acceptable enhancement to traditional BA. Additionally, there was evidence that supports the potential of XR to enhance expectation or placebo effects. Further research is needed to examine the potential of XR to improve access, outcomes, and barriers to MDD care. Trial Registration: ClinicalTrials.gov NCT05525390; https://clinicaltrials.gov/study/NCT05525390 %M 38437873 %R 10.2196/52326 %U https://mental.jmir.org/2024/1/e52326 %U https://doi.org/10.2196/52326 %U http://www.ncbi.nlm.nih.gov/pubmed/38437873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49993 %T Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study %A Tuot,Delphine S %A Mukherjee,Aarya %A Churape,Amanda %A DeFries,Triveni %A Su,George %A Khoong,Elaine C %A Lyles,Courtney %+ Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 6282068242, Delphine.tuot@ucsf.edu %K digital barriers %K digital support %K digital technologies %K equity %K health care delivery %K safety-net %K telehealth %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. Objective: This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. Methods: We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Results: Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. Conclusions: This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program’s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program’s efficacy. %M 38619874 %R 10.2196/49993 %U https://formative.jmir.org/2024/1/e49993 %U https://doi.org/10.2196/49993 %U http://www.ncbi.nlm.nih.gov/pubmed/38619874 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52412 %T Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study %A Kawamoto,Shota %A Morikawa,Yoshihiko %A Yahagi,Naohisa %+ Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, 252-0882, Japan, 81 466 49 3404, yahagin@sfc.keio.ac.jp %K respiratory syncytial virus %K machine learning %K self-reported information %K clinical decision support system %K decision support %K decision-making %K artificial intelligence %K model development %K evaluation study %K detection %K respiratory %K respiratory virus %K virus %K machine learning model %K pediatric %K Japan %K detection model %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. Objective: This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. Methods: The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting–based machine learning model was developed using the data of 4174 patients aged ≤24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. Results: Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95% CI 0.784-0.833) with good calibration and 0.746 (95% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9% (95% CI 5.4%-8.5%) of patients in the entire cohort would be positive and 68.7% (95% CI 65.4%-71.9%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. Conclusions: Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection. %M 38608268 %R 10.2196/52412 %U https://formative.jmir.org/2024/1/e52412 %U https://doi.org/10.2196/52412 %U http://www.ncbi.nlm.nih.gov/pubmed/38608268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51428 %T The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial %A Kim,KunJung %A Hwang,Hyunchan %A Bae,Sujin %A Kim,Sun Mi %A Han,Doug Hyun %+ Chung Ang University Hospital, 102 Heucsock ro, Seoul, 06973, Republic of Korea, 82 2 6299 3132, hduk70@gmail.com %K digital app %K mHealth %K mobile health %K app %K apps %K application %K applications %K functional near-infrared spectroscopy %K hemodynamic %K hemodynamics %K panic disorder %K anxiety %K panic %K mental %K fear %K spectroscopy %K digital therapy %K fNIRS %K brain %K imaging %K neurology %K neuroscience %K cortex %K cortices %D 2024 %7 12.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80%) was greater than that in the control group (6/21, 29%; χ21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 %M 38608270 %R 10.2196/51428 %U https://www.jmir.org/2024/1/e51428 %U https://doi.org/10.2196/51428 %U http://www.ncbi.nlm.nih.gov/pubmed/38608270 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55080 %T Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model %A Walkner,Tammy %A Karr,Daniel W %A Murray,Sarah %A Heeren,Amanda %A Berry-Stoelzle,Maresi %+ Veterans Rural Health Resource Center, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, United States, 1 319 338 0581, maresi.berry-stoelzle@va.gov %K advance care planning %K chronic disease %K end-of-life care %K health care decision %K medical decision-making %K recruiting %K shared medical decision-making %D 2024 %7 12.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient’s disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient’s place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. Objective: The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans’ current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans’ participation in serious illness care conversations and subsequent EHR documentation. Methods: The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. Results: As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. Conclusions: The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. International Registered Report Identifier (IRRID): RR1-10.2196/55080 %M 38608267 %R 10.2196/55080 %U https://www.researchprotocols.org/2024/1/e55080 %U https://doi.org/10.2196/55080 %U http://www.ncbi.nlm.nih.gov/pubmed/38608267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48525 %T The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study %A Austin,Tara %A Smith,Jennifer %A Rabin,Borsika %A Lindamer,Laurie %A Pittman,James %A Justice,Staley %A Twamley,Elizabeth W %A Lantrip,Crystal %+ Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, 92161, United States, 1 8585528585, tara.austin@va.gov %K army %K cognition %K cognitive %K emotion regulation %K memory symptoms %K memory %K military %K rumination %K subjective cognitive decline %K telehealth %K telemedicine %K veteran %K worry %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. Objective: This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called “Worry Less, Remember More.” The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). Methods: We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83%) and White (10/15, 67%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. Results: Veterans reported that this intervention was acceptable, with 92% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. Conclusions: This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment. %M 38608264 %R 10.2196/48525 %U https://formative.jmir.org/2024/1/e48525 %U https://doi.org/10.2196/48525 %U http://www.ncbi.nlm.nih.gov/pubmed/38608264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53726 %T Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool %A Louch,Gemma %A Berzins,Kathryn %A Walker,Lauren %A Wormald,Gemma %A Blackwell,Kirstin %A Stephens,Michael %A Brown,Mark %A Baker,John %+ School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, United Kingdom, 44 0113343 ext 7173, g.e.louch@leeds.ac.uk %K patient safety %K mental health %K patient involvement %K qualitative %K digital innovation %K real time %K monitoring %K safety %K develop %K development %K design %K perception %K perceptions %K prototype %K evidence scan %K interview %K interviews %K logic model %K programme theory %K dashboard %K dashboards %K interface %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, “getting worse” or “getting better”; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. %M 38607663 %R 10.2196/53726 %U https://formative.jmir.org/2024/1/e53726 %U https://doi.org/10.2196/53726 %U http://www.ncbi.nlm.nih.gov/pubmed/38607663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45959 %T Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey %A Kosyluk,Kristin %A Baeder,Tanner %A Greene,Karah Yeona %A Tran,Jennifer T %A Bolton,Cassidy %A Loecher,Nele %A DiEva,Daniel %A Galea,Jerome T %+ Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 2735, Tampa, FL, 33612, United States, 1 8139746019, kkosyluk@usf.edu %K chatbots %K conversational agents %K mental health %K resources %K screening %K resource referral %K stigma %K label avoidance %K survey %K training %K behavioral %K COVID-19 %K pilot test %K design %K users %K psychological distress %K symptoms %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. %M 38607665 %R 10.2196/45959 %U https://formative.jmir.org/2024/1/e45959 %U https://doi.org/10.2196/45959 %U http://www.ncbi.nlm.nih.gov/pubmed/38607665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53665 %T Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study %A Hebard,Stephen %A Weaver,GracieLee %A Hansen,William B %A Ruppert,Scarlett %+ Department of Public Health Education, University of North Carolina Greensboro, PO BOX 26170, Greensboro, NC, 27402-6170, United States, 1 336 334 5000, gmweaver@uncg.edu %K health care workers %K opioid misuse %K pain management %K prescription opioids %K prevention %K substance abuse %K substance use %K workers %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual’s intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. Objective: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. Methods: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. Results: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (–1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. Conclusions: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees. %M 38607664 %R 10.2196/53665 %U https://formative.jmir.org/2024/1/e53665 %U https://doi.org/10.2196/53665 %U http://www.ncbi.nlm.nih.gov/pubmed/38607664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50968 %T Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study %A O'Brien,Niki %A Fernandez Crespo,Roberto %A O'Driscoll,Fiona %A Prendergast,Mabel %A Chana,Deeph %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Campus, London, W21NY, United Kingdom, 44 (0)20 3312 1310, n.obrien@imperial.ac.uk %K acceptability %K cross sectional %K cybersecurity %K digital health %K digital transformation %K education %K feasibility %K framework %K frameworks %K global health %K health systems %K implementation %K organization %K organizational %K organizations %K patient safety %K SWOT %K TAM %K usability %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care–specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams’ networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone’s responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. %M 38603777 %R 10.2196/50968 %U https://formative.jmir.org/2024/1/e50968 %U https://doi.org/10.2196/50968 %U http://www.ncbi.nlm.nih.gov/pubmed/38603777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49780 %T Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study %A Lorenzo-Luaces,Lorenzo %A Wasil,Akash %A Kacmarek,Corinne N %A DeRubeis,Robert %+ Indiana University-Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K digital mental health %K ethnicity %K health disparities %K internet-based CBT %K cognitive behavioral therapy %K intervention %K mental health %K mental health care %K race %K therapy %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one’s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. %M 38602769 %R 10.2196/49780 %U https://formative.jmir.org/2024/1/e49780 %U https://doi.org/10.2196/49780 %U http://www.ncbi.nlm.nih.gov/pubmed/38602769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57226 %T Smartphone App–Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial %A Ledoux,Andrée-Anne %A Zemek,Roger %A Cairncross,Molly %A Silverberg,Noah %A Sicard,Veronik %A Barrowman,Nicholas %A Goldfield,Gary %A Gray,Clare %A Harris,Ashley D %A Jaworska,Natalia %A Reed,Nick %A Saab,Bechara J %A Smith,Andra %A Walker,Lisa %+ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 1 6137377600 ext 4104, aledoux@cheo.on.ca %K pediatric %K concussion %K persisting symptoms after concussion %K mindfulness %K randomized controlled trial %K feasibility RCT %K psychological intervention %K youth %K digital therapeutics %K eHealth %K mobile health %K mHealth %K mobile phone %D 2024 %7 11.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child’s quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. Objective: The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. Methods: This study is a double-blind Health Canada–regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. Results: The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. Conclusions: This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. Trial Registration: ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802 International Registered Report Identifier (IRRID): DERR1-10.2196/57226 %M 38602770 %R 10.2196/57226 %U https://www.researchprotocols.org/2024/1/e57226 %U https://doi.org/10.2196/57226 %U http://www.ncbi.nlm.nih.gov/pubmed/38602770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52118 %T Effectiveness of a Web-Based Individual Coping and Alcohol Intervention Program for Children of Parents With Alcohol Use Problems: Randomized Controlled Trial %A Wall,Håkan %A Hansson,Helena %A Zetterlind,Ulla %A Kvillemo,Pia %A Elgán,Tobias H %+ Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 700011003, tobias.elgan@ki.se %K adolescent %K adolescents %K alcoholic %K alcoholics %K CBT %K children of impaired parents %K cognitive behavioral therapy %K coping %K digital intervention %K mental health %K randomized controlled trial %K RCT %K self-management %K substance abuse %K substance use %K therapist %K web-based intervention %K youth %D 2024 %7 10.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents. Objective: This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems. Methods: Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL). Results: For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=–0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention. Conclusions: The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence. Trial Registration: ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-12-35 %M 38598286 %R 10.2196/52118 %U https://www.jmir.org/2024/1/e52118 %U https://doi.org/10.2196/52118 %U http://www.ncbi.nlm.nih.gov/pubmed/38598286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56143 %T Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study %A Detsomboonrat,Palinee %A Pisarnturakit,Pagaporn Pantuwadee %+ Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Road, Patumwan, Bangkok, 10330, Thailand, 66 22188545, pagaporn.p@chula.ac.th %K capability %K health survey %K oral health %K mobile apps %K personal health information %K PHI %K satisfaction %K tooth %K teeth %K oral %K dental %K dentist %K dentistry %K data entry %K data collection %K mHealth %K mobile health %K app %K apps %K applications %K periodontal %K survey %K questionnaire %K questionnaires %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. Objective: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. Methods: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients’ information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Results: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). Conclusions: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app. %M 38598287 %R 10.2196/56143 %U https://formative.jmir.org/2024/1/e56143 %U https://doi.org/10.2196/56143 %U http://www.ncbi.nlm.nih.gov/pubmed/38598287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52558 %T Nudges and Prompts Increase Engagement in Self-Guided Digital Health Treatment for Depression and Anxiety: Results From a 3-Arm Randomized Controlled Trial %A van Mierlo,Trevor %A Rondina,Renante %A Fournier,Rachel %+ Evolution Health, 206-90 Eglinton Avenue East, Toronto, ON, M4P 2Y3, Canada, 1 4166448476, tvanmierlo@evolutionhealth.care %K behavioral economics %K digital health %K attrition %K engagement %K nudges %K depression %K anxiety %K mood disorders %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accessible and effective approaches to mental health treatment are important because of common barriers such as cost, stigma, and provider shortage. The effectiveness of self-guided treatment is well established, and its use has intensified because of the COVID-19 pandemic. Engagement remains important as dose-response relationships have been observed. Platforms such as Facebook (Meta Platform, Inc), LinkedIn (Microsoft Corp), and X Corp (formerly known as Twitter, Inc) use principles of behavioral economics to increase engagement. We hypothesized that similar concepts would increase engagement in self-guided digital health. Objective: This 3-arm randomized controlled trial aimed to test whether members of 2 digital self-health courses for anxiety and depression would engage with behavioral nudges and prompts. Our primary hypothesis was that members would click on 2 features: tips and a to-do checklist. Our secondary hypothesis was that members would prefer to engage with directive tips in arm 2 versus social proof and present bias tips in arm 3. Our tertiary hypothesis was that rotating tips and a to-do checklist would increase completion rates. The results of this study will form a baseline for future artificial intelligence–directed research. Methods: Overall, 13,224 new members registered between November 2021 and May 2022 for Evolution Health’s self-guided treatment courses for anxiety and depression. The control arm featured a member home page without nudges or prompts. Arm 2 featured a home page with a tip-of-the-day section. Arm 3 featured a home page with a tip-of-the-day section and a to-do checklist. The research protocol for this study was published in JMIR Research Protocols on August 15, 2022. Results: Arm 3 had significantly younger members (F2,4564=40.97; P<.001) and significantly more female members (χ24=92.2; P<.001) than the other 2 arms. Control arm members (1788/13,224, 13.52%) completed an average of 1.5 course components. Arm 2 members (865/13,224, 6.54%) clicked on 5% of tips and completed an average of 1.8 course components. Arm 3 members (1914/13,224, 14.47%) clicked on 5% of tips, completed 2.7 of 8 to-do checklist items, and completed an average of 2.11 course components. Completion rates in arm 2 were greater than those in arm 1 (z score=3.37; P<.001), and completion rates in arm 3 were greater than those in arm 1 (z score=12.23; P<.001). Engagement in all 8 components in arm 3 was higher than that in arm 2 (z score=1.31; P<.001). Conclusions: Members engaged with behavioral nudges and prompts. The results of this study may be important because efficacy is related to increased engagement. Due to its novel approach, the outcomes of this study should be interpreted with caution and used as a guideline for future research in this nascent field. International Registered Report Identifier (IRRID): RR2-10.2196/37231 %M 38592752 %R 10.2196/52558 %U https://formative.jmir.org/2024/1/e52558 %U https://doi.org/10.2196/52558 %U http://www.ncbi.nlm.nih.gov/pubmed/38592752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52830 %T Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study %A Der-Martirosian,Claudia %A Hou,Cynthia %A Hovsepian,Sona %A Diarra Carter,Maia %A Heyworth,Leonie %A Dobalian,Aram %A Leung,Lucinda %+ Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, 16111 Plummer St, Los Angeles, CA, 91343, United States, 1 818 984 4596, claudia.der-martirosian@va.gov %K interdisciplinary primary care team members %K NASSS framework %K nonadoption, abandonment, scale-up, spread, and sustainability %K primary care %K telehealth %K video-based care %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. Objective: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. Methods: We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. Results: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic—visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology—key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system—changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver’s role (eg, participation of caregivers during video visits); (4) health care organization—leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time—capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). Conclusions: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes. %M 38592760 %R 10.2196/52830 %U https://formative.jmir.org/2024/1/e52830 %U https://doi.org/10.2196/52830 %U http://www.ncbi.nlm.nih.gov/pubmed/38592760 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53998 %T Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App–Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial %A Wilhelm,Sabine %A Bernstein,Emily E %A Bentley,Kate H %A Snorrason,Ivar %A Hoeppner,Susanne S %A Klare,Dalton %A Greenberg,Jennifer L %A Weingarden,Hilary %A McCoy,Thomas H %A Harrison,Oliver %+ Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 617 724 6146, swilhelm@mgh.harvard.edu %K depressive disorder %K depressive %K depression %K open trial %K open trials %K single arm %K smartphone %K cognitive behavioral therapy %K cognitive behavioural therapy %K CBT %K psychotherapy %K psychoeducation %K digital health %K mobile applications %K mHealth %K mobile health %K app %K apps %K application %K applications %K psychiatry %K psychiatric %K feasibility %K acceptability %K usability %K satisfaction %K user experience %K mental %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. Objective: This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. Methods: This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. Results: Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants’ depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. Conclusions: The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. Trial Registration: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329 %M 38592771 %R 10.2196/53998 %U https://mental.jmir.org/2024/1/e53998 %U https://doi.org/10.2196/53998 %U http://www.ncbi.nlm.nih.gov/pubmed/38592771 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53117 %T Evaluation of the e–Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial %A Krakowczyk,Julia Barbara %A Truijens,Femke %A Teufel,Martin %A Lalgi,Tania %A Heinen,Jana %A Schug,Caterina %A Erim,Yesim %A Pantförder,Michael %A Graf,Johanna %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, Essen, Germany, 49 201438755216, julia.krakowczyk@uni-due.de %K psycho-oncology %K eHealth %K digital health %K cancer %K Reduct trial %K oncology %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Make It Training is an e–mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. Conclusions: e–Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support. %M 38592764 %R 10.2196/53117 %U https://cancer.jmir.org/2024/1/e53117 %U https://doi.org/10.2196/53117 %U http://www.ncbi.nlm.nih.gov/pubmed/38592764 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49574 %T Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study %A Sánchez-Quiñones,Beatriz %A Antón-Maldonado,Cristina %A Ibarra Vega,Nataly %A Martorell Mariné,Isabel %A Santamaria,Amparo %+ Hybrid Hematology Department, University Hospital Vinalopó, Calle Tonico Sansano Mora, 14, Alicante, Elche, 03293, Spain, 34 658981769, masantamaria@vinaloposalud.com %K Nootric app %K oncohematology patient %K physical-nutritional well-being %K multidisciplinary team %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients’ physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalopó University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50%) female and 11 (50%) male, ranging between 42 and 84 years of age. Among them, 13 (59%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59%) and multiple myeloma (4/22, 18%). Moreover, 15 (68%) out of 22 patients received immunochemotherapy, while 7 (32%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41%), the adherence rate was 81%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. %M 38588522 %R 10.2196/49574 %U https://formative.jmir.org/2024/1/e49574 %U https://doi.org/10.2196/49574 %U http://www.ncbi.nlm.nih.gov/pubmed/38588522 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48144 %T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study %A Mabetha,Khuthala %A Soepnel,Larske M %A Mabena,Gugulethu %A Motlhatlhedi,Molebogeng %A Nyati,Lukhanyo %A Norris,Shane A %A Draper,Catherine E %+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za %K mobile technologies %K health promotion %K mixed methods %K clinical practice %K mobile phone %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. %M 38588527 %R 10.2196/48144 %U https://formative.jmir.org/2024/1/e48144 %U https://doi.org/10.2196/48144 %U http://www.ncbi.nlm.nih.gov/pubmed/38588527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54109 %T Fast Healthcare Interoperability Resources–Based Support System for Predicting Delivery Type: Model Development and Evaluation Study %A Coutinho-Almeida,João %A Cardoso,Alexandrina %A Cruz-Correia,Ricardo %A Pereira-Rodrigues,Pedro %+ Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, 351 225513600, joaofilipe90@gmail.com %K obstetrics %K machine-learning %K clinical decision support %K interoperability %K interoperable %K obstetric %K cesarean delivery %K cesarean %K cesarean deliveries %K decision support %K pregnant %K pregnancy %K maternal %K algorithm %K algorithms %K simulation %K simulations %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The escalating prevalence of cesarean delivery globally poses significant health impacts on mothers and newborns. Despite this trend, the underlying reasons for increased cesarean delivery rates, which have risen to 36.3% in Portugal as of 2020, remain unclear. This study delves into these issues within the Portuguese health care context, where national efforts are underway to reduce cesarean delivery occurrences. Objective: This paper aims to introduce a machine learning, algorithm-based support system designed to assist clinical teams in identifying potentially unnecessary cesarean deliveries. Key objectives include developing clinical decision support systems for cesarean deliveries using interoperability standards, identifying predictive factors influencing delivery type, assessing the economic impact of implementing this tool, and comparing system outputs with clinicians’ decisions. Methods: This study used retrospective data collected from 9 public Portuguese hospitals, encompassing maternal and fetal data and delivery methods from 2019 to 2020. We used various machine learning algorithms for model development, with light gradient-boosting machine (LightGBM) selected for deployment due to its efficiency. The model’s performance was compared with clinician assessments through questionnaires. Additionally, an economic simulation was conducted to evaluate the financial impact on Portuguese public hospitals. Results: The deployed model, based on LightGBM, achieved an area under the receiver operating characteristic curve of 88%. In the trial deployment phase at a single hospital, 3.8% (123/3231) of cases triggered alarms for potentially unnecessary cesarean deliveries. Financial simulation results indicated potential benefits for 30% (15/48) of Portuguese public hospitals with the implementation of our tool. However, this study acknowledges biases in the model, such as combining different vaginal delivery types and focusing on potentially unwarranted cesarean deliveries. Conclusions: This study presents a promising system capable of identifying potentially incorrect cesarean delivery decisions, with potentially positive implications for medical practice and health care economics. However, it also highlights the challenges and considerations necessary for real-world application, including further evaluation of clinical decision-making impacts and understanding the diverse reasons behind delivery type choices. This study underscores the need for careful implementation and further robust analysis to realize the full potential and real-world applicability of such clinical support systems. %M 38587885 %R 10.2196/54109 %U https://formative.jmir.org/2024/1/e54109 %U https://doi.org/10.2196/54109 %U http://www.ncbi.nlm.nih.gov/pubmed/38587885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53841 %T Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings %A Reading,Jean Miki %A Crane,Melissa M %A Guan,Justin %A Jackman,Ronston %A Thomson,Maria D %A LaRose,Jessica Gokee %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 3125034870, jean.reading@northwestern.edu %K digital health %K gender %K weight loss %K health behaviors %K low touch %K obesity %K obese %K mixed methods analysis %K lifestyle intervention %K young men %K men %K effectiveness %K digital tools %K food intake %K diet %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. Objective: This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). Methods: Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men’s experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. Results: Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. Conclusions: Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. Trial Registration: ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263 %M 38578686 %R 10.2196/53841 %U https://formative.jmir.org/2024/1/e53841 %U https://doi.org/10.2196/53841 %U http://www.ncbi.nlm.nih.gov/pubmed/38578686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50241 %T A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity %A Barnett,Nancy P %A Sokolovsky,Alexander W %A Meisel,Matthew K %A Forkus,Shannon R %A Jackson,Kristina M %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121, Providence, RI, 02912, United States, 1 40189636649, Nancy_Barnett@brown.edu %K Bluetooth technology %K passive sensing %K proximity detection %K ecological momentary assessment %K social influence %K alcohol use %K mobile phone %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. Objective: This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ≥2 individuals are physically proximal. Methods: We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant’s phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant’s EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/50241 %M 38578672 %R 10.2196/50241 %U https://www.researchprotocols.org/2024/1/e50241 %U https://doi.org/10.2196/50241 %U http://www.ncbi.nlm.nih.gov/pubmed/38578672 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53489 %T A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study %A Atefi,Golnaz. L %A van Knippenberg,Rosalia J M %A Bartels,Sara Laureen %A Losada-Baltar,Andrés %A Márquez-González,María %A Verhey,Frans R J %A de Vugt,Marjolein E %+ Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, Maastricht, 6229 ET, Netherlands, 31 (0) 43 388 1022, g.atefi@maastrichtuniversity.nl %K acceptance and commitment therapy %K ACT %K psychological flexibility %K behavior change %K theory-guided eHealth %K web-based intervention %K supported self-help %K family caregivers %K dementia %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. Objective: The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. Methods: A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). Results: A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. Conclusions: Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-070499 %M 38574360 %R 10.2196/53489 %U https://aging.jmir.org/2024/1/e53489 %U https://doi.org/10.2196/53489 %U http://www.ncbi.nlm.nih.gov/pubmed/38574360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54656 %T Evaluation of an e-Learning Program for Community Pharmacists for Dispensing Emicizumab (Hemlibra) in France: Nationwide Cross-Sectional Study %A Chamouard,Valérie %A Freyssenge,Julie %A Clairaz-Mahiou,Béatrice %A Ferrera Bibas,Felicia %A Fraticelli,Laurie %+ Laboratory P2S (Health Systemic Process), UR 4129, University Claude Bernard Lyon 1, 7-11 rue Guillaume Paradin, Lyon, 69372, France, 33 04 78 78 57 45, laurie.fraticelli@univ-lyon1.fr %K hemophilia %K care pathway %K emicizumab %K Kirkpatrick model %K pharmacy %K survey %K Hemlibra %K France %K e-learning program %K pharmacists %K pharmacist %K hemophilia A %K hospital %K HEMOPHAR %K methodology %K community %K engagement %K pharmaceutical %K rare disease %K digital health %K intervention %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab.  Objective: This study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program.  Methods: The methodology is based on Kirkpatrick’s model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3).  Results: The HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists.  Conclusions: This study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease.  Trial Registration: ClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197 International Registered Report Identifier (IRRID): RR2-10.2196/43091 %M 38574351 %R 10.2196/54656 %U https://formative.jmir.org/2024/1/e54656 %U https://doi.org/10.2196/54656 %U http://www.ncbi.nlm.nih.gov/pubmed/38574351 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46593 %T Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review %A Fernández-Álvarez,Javier %A Colombo,Desirée %A Gómez Penedo,Juan Martín %A Pierantonelli,Maitena %A Baños,Rosa María %A Botella,Cristina %+ Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, Castellon de la Plana, 12071, Spain, 34 964 72 80 0, javferalvarez@gmail.com %K social anxiety disorder %K ambulatory assessment %K ecological momentary assessment %K intensive longitudinal methods %K systematic review %K social anxiety %K use %K qualitative synthesis %K emotional %K cognitive %K behavioral %K development %K mental disorder %K anxiety %K mental health %K mobile health %K mHealth %K monitoring %K review %K assessment %K mobile phone %D 2024 %7 4.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder. %M 38574359 %R 10.2196/46593 %U https://mental.jmir.org/2024/1/e46593 %U https://doi.org/10.2196/46593 %U http://www.ncbi.nlm.nih.gov/pubmed/38574359 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e52125 %T A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System %A Esper,Stephen Andrew %A Holder-Murray,Jennifer %A Meister,Katie Ann %A Lin,Hsing-Hua Sylvia %A Hamilton,David Kojo %A Groff,Yram Jan %A Zuckerbraun,Brian Scott %A Mahajan,Aman %+ Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, PA/15213, United States, 1 412 647 2994, espersa@upmc.edu %K digital health solution %K feasibility %K length of stay reduction %K patient engagement %K patient satisfaction %K perioperative medicine %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Pip is a novel digital health platform (DHP) that combines human health coaches (HCs) and technology with patient-facing content. This combination has not been studied in perioperative surgical optimization. Objective: This study’s aim was to test the feasibility of the Pip platform for deploying perioperative, digital, patient-facing optimization guidelines to elective surgical patients, assisted by an HC, at predefined intervals in the perioperative journey. Methods: We conducted an institutional review board–approved, descriptive, prospective feasibility study of patients scheduled for elective surgery and invited to enroll in Pip from 2.5 to 4 weeks preoperatively through 4 weeks postoperatively at an academic medical center between November 22, 2022, and March 27, 2023. Descriptive primary end points were patient-reported outcomes, including patient satisfaction and engagement, and Pip HC evaluations. Secondary end points included mean or median length of stay (LOS), readmission at 7 and 30 days, and emergency department use within 30 days. Secondary end points were compared between patients who received Pip versus patients who did not receive Pip using stabilized inverse probability of treatment weighting. Results: A total of 283 patients were invited, of whom 172 (60.8%) enrolled in Pip. Of these, 80.2% (138/172) patients had ≥1 HC session and proceeded to surgery, and 70.3% (97/138) of the enrolled patients engaged with Pip postoperatively. The mean engagement began 27 days before surgery. Pip demonstrated an 82% weekly engagement rate with HCs. Patients attended an average of 6.7 HC sessions. Of those patients that completed surveys (95/138, 68.8%), high satisfaction scores were recorded (mean 4.8/5; n=95). Patients strongly agreed that HCs helped them throughout the perioperative process (mean 4.97/5; n=33). The average net promoter score was 9.7 out of 10. A total of 268 patients in the non-Pip group and 128 patients in the Pip group had appropriate overlapping distributions of stabilized inverse probability of treatment weighting for the analytic sample. The Pip cohort was associated with LOS reduction when compared to the non-Pip cohort (mean 2.4 vs 3.1 days; median 1.9, IQR 1.0-3.1 vs median 3.0, IQR 1.1-3.9 days; mean ratio 0.76; 95% CI 0.62-0.93; P=.009). The Pip cohort experienced a 49% lower risk of 7-day readmission (relative risk [RR] 0.51, 95% CI 0.11-2.31; P=.38) and a 17% lower risk of 30-day readmission (RR 0.83, 95% CI 0.30-2.31; P=.73), though these did not reach statistical significance. Both cohorts had similar 30-day emergency department returns (RR 1.06, 95% CI 0.56-2.01, P=.85). Conclusions: Pip is a novel mobile DHP combining human HCs and perioperative optimization content that is feasible to engage patients in their perioperative journey and is associated with reduced hospital LOS. Further studies assessing the impact on clinical and patient-reported outcomes from the use of Pip or similar DHPs HC combinations during the perioperative journey are required. %M 38573737 %R 10.2196/52125 %U https://periop.jmir.org/2024/1/e52125 %U https://doi.org/10.2196/52125 %U http://www.ncbi.nlm.nih.gov/pubmed/38573737 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54168 %T Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach %A McLaren,Jaye E %A Hoang-Gia,Dat %A Dorisca,Eugenia %A Hartz,Stephanie %A Dang,Stuti %A Moo,Lauren %+ New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2000, Jaye.McLaren@va.gov %K Alzheimer disease %K caregiver education %K dementia %K interdisciplinary %K older adults %K virtual resources %K website development %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were “general dementia information,” “activities of daily living,” and “self-care and support.” Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. %M 38573761 %R 10.2196/54168 %U https://formative.jmir.org/2024/1/e54168 %U https://doi.org/10.2196/54168 %U http://www.ncbi.nlm.nih.gov/pubmed/38573761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54912 %T Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial %A Borrelli,Belinda %A Bartlett,Y Kiera %A Fulford,Daniel %A Frasco,Greg %A Armitage,Christopher J %A Wearden,Alison %+ Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Floor 3, 560 Harrison Ave, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K smoking cessation %K mobile app %K motivation %K depressed mood %K depression %K behavioral activation %K negative affect %K positive affect %K quit smoking %K health behavior change %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. Objective: This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. Methods: Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. Results: There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI –0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=–0.19, SE 0.10; 95% CI –0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=–0.26, SE 0.15; 95% CI –0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. Conclusions: The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial. %M 38573739 %R 10.2196/54912 %U https://formative.jmir.org/2024/1/e54912 %U https://doi.org/10.2196/54912 %U http://www.ncbi.nlm.nih.gov/pubmed/38573739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50018 %T The Role of Mental Health Stigma in University Students’ Satisfaction With Web-Based Stress Management Resources: Intervention Study %A Cho,Sohyun %A Bastien,Laurianne %A Petrovic,Julia %A Böke,Bilun Naz %A Heath,Nancy L %+ Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC, H3A 1Y2, Canada, 1 514 398 4242, sohyun.cho@mail.mcgill.ca %K help-seeking behavior %K help-seeking %K mental health services %K mental health stigma %K mental health %K university students %K web-based workshop %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students’ mental health and well-being. However, there is a lack of research on students’ satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students’ help-seeking behaviors and their satisfaction with and uptake of these resources. Objective: This study explored potential differences in students’ satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students’ strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches. Methods: University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2. Results: Interestingly, a 2-way mixed ANOVA revealed no significant group × time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students’ strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use. Conclusions: While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students’ satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students’ coping capacity. %M 38573758 %R 10.2196/50018 %U https://formative.jmir.org/2024/1/e50018 %U https://doi.org/10.2196/50018 %U http://www.ncbi.nlm.nih.gov/pubmed/38573758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55270 %T Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study %A Wang,Zheng %A Kempen,John %A Luo,Gang %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 6179122529, gang_luo@meei.harvard.edu %K vision screening %K refractive error %K strabismus %K smartphone %K visual acuity %K vision %K visual %K eye %K eyes %K screening %K mHealth %K mobile health %K app %K apps %K application %K applications %K feasibility %K optometry %K ophthalmology %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. %M 38573757 %R 10.2196/55270 %U https://formative.jmir.org/2024/1/e55270 %U https://doi.org/10.2196/55270 %U http://www.ncbi.nlm.nih.gov/pubmed/38573757 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56206 %T Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study %A Correia de Barros,Ana %A Bergmans,Mariëtte %A Hasanaj,Kreshnik %A Krasniqi,Drianë %A Nóbrega,Catarina %A Carvalho Carneiro,Bruna %A Vasconcelos,Priscila A %A Quinta-Gomes,Ana Luísa %A Nobre,Pedro J %A Couto da Silva,Joana %A Mendes-Santos,Cristina %+ Fraunhofer Portugal AICOS, Rua Alfredo Allen, 455, Porto, 4200-135, Portugal, 351 220430306, ana.barros@fraunhofer.pt %K internet interventions %K mobile health %K mHealth %K older adults %K sexual health %K smartphone %K user experience %K pilot study %K mobile phone %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app’s usefulness and ease of use. Usability was assessed as “Ok/Fair.” The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants’ perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. %M 38568726 %R 10.2196/56206 %U https://humanfactors.jmir.org/2024/1/e56206 %U https://doi.org/10.2196/56206 %U http://www.ncbi.nlm.nih.gov/pubmed/38568726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50850 %T Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial %A Jobim Fischer,Vinicius %A Rossato Holz,Maila %A Billieux,Joël %A Andersson,Gerhard %A Vögele,Claus %+ Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9740, viniciusjfischer@gmail.com %K emotion regulation %K internet %K sexual health %K FSFI %K randomized controlled trial %K intervention %K psychosexual intervention %K sexual disorder %K sexual dysfunction %K internet-based %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet. Objective: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women. Methods: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up. Results: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings. Conclusions: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects. Trial Registration: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177 %M 38568720 %R 10.2196/50850 %U https://formative.jmir.org/2024/1/e50850 %U https://doi.org/10.2196/50850 %U http://www.ncbi.nlm.nih.gov/pubmed/38568720 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57238 %T Designing, Developing, and Testing a Chatbot for Parents and Caregivers of Children and Young People With Rheumatological Conditions (the IMPACT Study): Protocol for a Co-Designed Proof-of-Concept Study %A Livermore,Polly %A Kupiec,Klaudia %A Wedderburn,Lucy R %A Knight,Andrea %A Solebo,Ameenat L %A Shafran,Roz %A Robert,Glenn %A Sebire,N J %A Gibson,Faith %A , %+ Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom, 44 2074059200, polly.livermore@ucl.ac.uk %K caregivers %K chatbot %K paediatric rheumatology %K parents and caregivers %K parents/carers %K pediatric %K proof-of-concept %K quality of life %K rheumatology %D 2024 %7 3.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric rheumatology is a term that encompasses over 80 conditions affecting different organs and systems. Children and young people with rheumatological chronic conditions are known to have high levels of mental health problems and therefore are at risk of poor health outcomes. Clinical psychologists can help children and young people manage the daily difficulties of living with one of these conditions; however, there are insufficient pediatric psychologists in the United Kingdom. We urgently need to consider other ways of providing early, essential support to improve their current well-being. One way of doing this is to empower parents and caregivers to have more of the answers that their children and young people need to support them further between their hospital appointments. Objective: The objective of this co-designed proof-of-concept study is to design, develop, and test a chatbot intervention to support parents and caregivers of children and young people with rheumatological conditions. Methods: This study will explore the needs and views of children and young people with rheumatological conditions, their siblings, parents, and caregivers, as well as health care professionals working in pediatric rheumatology. We will ask approximately 100 participants in focus groups where they think the gaps are in current clinical care and what ideas they have for improving upon them. Creative experience-based co-design workshops will then decide upon top priorities to develop further while informing the appearance, functionality, and practical delivery of a chatbot intervention. Upon completion of a minimum viable product, approximately 100 parents and caregivers will user-test the chatbot intervention in an iterative sprint methodology to determine its worth as a mechanism for support for parents. Results: A total of 73 children, young people, parents, caregivers, and health care professionals have so far been enrolled in the study, which began in November 2023. The anticipated completion date of the study is April 2026. The data analysis is expected to be completed in January 2026, with the results being published in April 2026. Conclusions: This study will provide evidence on the accessibility, acceptability, and usability of a chatbot intervention for parents and caregivers of children and young people with rheumatological conditions. If proven useful, it could lead to a future efficacy trial of one of the first chatbot interventions to provide targeted and user-suggested support for parents and caregivers of children with chronic health conditions in health care services. This study is unique in that it will detail the needs and wants of children, young people, siblings, parents, and caregivers to improve the current support given to families living with pediatric rheumatological conditions. It will be conducted across the whole of the United Kingdom for all pediatric rheumatological conditions at all stages of the disease trajectory. International Registered Report Identifier (IRRID): DERR1-10.2196/57238 %M 38568725 %R 10.2196/57238 %U https://www.researchprotocols.org/2024/1/e57238 %U https://doi.org/10.2196/57238 %U http://www.ncbi.nlm.nih.gov/pubmed/38568725 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53684 %T Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial %A Cook,Robert L %A Richards,Veronica L %A Gullett,Joseph M %A Lerner,Brenda D G %A Zhou,Zhi %A Porges,Eric C %A Wang,Yan %A Kahler,Christopher W %A Barnett,Nancy P %A Li,Zhigang %A Pallikkuth,Suresh %A Thomas,Emmanuel %A Rodriguez,Allan %A Bryant,Kendall J %A Ghare,Smita %A Barve,Shirish %A Govind,Varan %A Dévieux,Jessy G %A Cohen,Ronald A %A , %+ Southern HIV and Alcohol Research Consortium, University of Florida, 2004 Mowry Road, Department of Epidemiology, Gainesville, FL, 32610, United States, 1 3522735869, cookrl@ufl.edu %K alcohol %K contingency management %K biosensor %K HIV infection %K cognitive function %D 2024 %7 2.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. Objective: The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. Methods: The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. Results: We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. Conclusions: This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. Trial Registration: ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701 International Registered Report Identifier (IRRID): DERR1-10.2196/53684 %M 38564243 %R 10.2196/53684 %U https://www.researchprotocols.org/2024/1/e53684 %U https://doi.org/10.2196/53684 %U http://www.ncbi.nlm.nih.gov/pubmed/38564243 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49217 %T A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study %A O'Sullivan,Shaunagh %A McEnery,Carla %A Cagliarini,Daniela %A Hinton,Jordan D X %A Valentine,Lee %A Nicholas,Jennifer %A Chen,Nicola A %A Castagnini,Emily %A Lester,Jacqueline %A Kanellopoulos,Esta %A D'Alfonso,Simon %A Gleeson,John F %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Road, Parkville, Australia, 61 428282470, shaunagh.osullivan@orygen.org.au %K digital intervention %K blended care %K youth mental health %K transdiagnostic intervention %K psychotic disorders %K borderline personality disorder %K digital health %K mobile phone %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people’s preferences and calls for integration of these services, current mental health services rarely offer blended models of care. Objective: This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. Methods: A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. Results: eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians’ competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. Conclusions: eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services. %M 38557432 %R 10.2196/49217 %U https://mental.jmir.org/2024/1/e49217 %U https://doi.org/10.2196/49217 %U http://www.ncbi.nlm.nih.gov/pubmed/38557432 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53995 %T Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study %A Bendtsen,Magnus Grønlund %A Schönwandt,Bodil Marie Thuesen %A Rubæk,Mette %A Hitz,Mette Friberg %+ Research Unit, Medical Department, Zealand University Hospital, Lykkebækvej 1, Koege, 4600, Denmark, 45 22893352, mag.bendtsen@gmail.com %K eHealth literacy %K health literacy %K mHealth %K mobile health %K eHealth %K mobile health apps %K self-management %K osteoporosis %K usability %K acceptability %D 2024 %7 1.4.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients’ experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app “My Bones.” Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app’s usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. %M 38557362 %R 10.2196/53995 %U https://www.i-jmr.org/2024/1/e53995 %U https://doi.org/10.2196/53995 %U http://www.ncbi.nlm.nih.gov/pubmed/38557362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52920 %T A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study %A Acharya,Harshdeep %A Sykes,Kevin J %A Neira,Ton Mirás %A Scott,Angela %A Pacheco,Christina M %A Sanner,Matthew %A Ablah,Elizabeth %A Oyowe,Kevin %A Ellerbeck,Edward F %A Greiner,K Allen %A Corriveau,Erin A %A Finocchario-Kessler,Sarah %+ Health and Wellness Center, Baylor Scott and White Health, 4500 Spring Avenue, Dallas, TX, 75210, United States, 1 820 0111 ext 214, Kevin.Sykes@bswhealth.org %K public health %K database %K community health worker %K social determinants of health %K health worker %K health workers %K CHW %K CHWs %K community-based %K data collection %K functionality %K develop %K development %K EHR %K EHRs %K EMR %K EMRs %K dashboard %K dashboards %K health record %K health records %K documentation %K medical record %K medical records %K equity %K inequity %K inequities %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act–compliant record system, improved client engagement, enrollment processes, and identification of resources. Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings. %M 38557671 %R 10.2196/52920 %U https://formative.jmir.org/2024/1/e52920 %U https://doi.org/10.2196/52920 %U http://www.ncbi.nlm.nih.gov/pubmed/38557671 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e45754 %T The Implementation of Recommender Systems for Mental Health Recovery Narratives: Evaluation of Use and Performance %A Slade,Emily %A Rennick-Egglestone,Stefan %A Ng,Fiona %A Kotera,Yasuhiro %A Llewellyn-Beardsley,Joy %A Newby,Chris %A Glover,Tony %A Keppens,Jeroen %A Slade,Mike %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 823 0812, emily_slade@outlook.com %K recommender system %K mean absolute error %K precision %K intralist diversity %K item space coverage %K fairness across users %K psychosis %K Narrative Experiences Online trial %K NEON trial %K lived experience narrative %K recovery story %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recommender systems help narrow down a large range of items to a smaller, personalized set. NarraGive is a first-in-field hybrid recommender system for mental health recovery narratives, recommending narratives based on their content and narrator characteristics (using content-based filtering) and on narratives beneficially impacting other similar users (using collaborative filtering). NarraGive is integrated into the Narrative Experiences Online (NEON) intervention, a web application providing access to the NEON Collection of recovery narratives. Objective: This study aims to analyze the 3 recommender system algorithms used in NarraGive to inform future interventions using recommender systems for lived experience narratives. Methods: Using a recently published framework for evaluating recommender systems to structure the analysis, we compared the content-based filtering algorithm and collaborative filtering algorithms by evaluating the accuracy (how close the predicted ratings are to the true ratings), precision (the proportion of the recommended narratives that are relevant), diversity (how diverse the recommended narratives are), coverage (the proportion of all available narratives that can be recommended), and unfairness (whether the algorithms produce less accurate predictions for disadvantaged participants) across gender and ethnicity. We used data from all participants in 2 parallel-group, waitlist control clinical trials of the NEON intervention (NEON trial: N=739; NEON for other [eg, nonpsychosis] mental health problems [NEON-O] trial: N=1023). Both trials included people with self-reported mental health problems who had and had not used statutory mental health services. In addition, NEON trial participants had experienced self-reported psychosis in the previous 5 years. Our evaluation used a database of Likert-scale narrative ratings provided by trial participants in response to validated narrative feedback questions. Results: Participants from the NEON and NEON-O trials provided 2288 and 1896 narrative ratings, respectively. Each rated narrative had a median of 3 ratings and 2 ratings, respectively. For the NEON trial, the content-based filtering algorithm performed better for coverage; the collaborative filtering algorithms performed better for accuracy, diversity, and unfairness across both gender and ethnicity; and neither algorithm performed better for precision. For the NEON-O trial, the content-based filtering algorithm did not perform better on any metric; the collaborative filtering algorithms performed better on accuracy and unfairness across both gender and ethnicity; and neither algorithm performed better for precision, diversity, or coverage. Conclusions: Clinical population may be associated with recommender system performance. Recommender systems are susceptible to a wide range of undesirable biases. Approaches to mitigating these include providing enough initial data for the recommender system (to prevent overfitting), ensuring that items can be accessed outside the recommender system (to prevent a feedback loop between accessed items and recommended items), and encouraging participants to provide feedback on every narrative they interact with (to prevent participants from only providing feedback when they have strong opinions). %M 38551630 %R 10.2196/45754 %U https://mental.jmir.org/2024/1/e45754 %U https://doi.org/10.2196/45754 %U http://www.ncbi.nlm.nih.gov/pubmed/38551630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51058 %T Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study %A Thomas,Amy %A Asnes,Andrea %A Libby,Kyle %A Hsiao,Allen %A Tiyyagura,Gunjan %+ Department of Pediatrics, Yale University School of Medicine, Pediatric Emergency Medicine, PO Box 208064, New Haven, CT, 06520, United States, 1 203 464 6343, gunjan.tiyyagura@yale.edu %K child abuse %K clinical decision support %K CDS %K pediatrics %K child %K children %K natural language processing %K usability %K clinical decision support system %K physical abuse %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the impact of physical abuse on children, it is often underdiagnosed, especially among children evaluated in emergency departments (EDs). Electronic clinical decision support (CDS) can improve the recognition of child physical abuse. Objective: We aimed to develop and test the usability of a natural language processing–based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants’ charts. Methods: Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis. Results: Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype. Conclusions: With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases. %M 38551639 %R 10.2196/51058 %U https://www.jmir.org/2024/1/e51058 %U https://doi.org/10.2196/51058 %U http://www.ncbi.nlm.nih.gov/pubmed/38551639 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50907 %T Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity %A Bilder,Deborah A %A Mthembu,Mariah %A Worsham,Whitney %A Aguayo,Patricia %A Knight,Jacob R %A Deng,Steven W %A Singh,Tejinder P %A Davis,John %+ University of Utah Huntsman Mental Health Institute, 383 Colorow Drive, Room 360, Salt Lake City, UT, 84108, United States, 1 801 410 0852, deborah.bilder@hsc.utah.edu %K developmental disabilities %K disruptive behavior %K psychiatric comorbidity %K web-based %K psychiatric crisis %K disability %K mental health %K behavioral crises %K intervention %K general population %K screening %K accuracy %K mood disorder %K sources of distress %K autism %K intellectual disability %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. Objective: This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey’s clinical implementation and evaluation of validity. Methods: Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers’ psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Results: Focus group members (n=17) expressed positive feedback overall about the survey’s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Conclusions: Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey’s impact on the psychiatric and medical management of distress in individuals with DD. %M 38551644 %R 10.2196/50907 %U https://mental.jmir.org/2024/1/e50907 %U https://doi.org/10.2196/50907 %U http://www.ncbi.nlm.nih.gov/pubmed/38551644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48027 %T The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study %A Chaves,Antonio %A Arnáez,Sandra %A García-Soriano,Gemma %+ Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963983389, gemma.garcia@uv.es %K obsessive-compulsive disorder %K OCD %K mental health literacy %K stigma %K app %K help-seeking intention %K seek help %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the “stigma monster” over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory–Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire–27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. %M 38551629 %R 10.2196/48027 %U https://mhealth.jmir.org/2024/1/e48027 %U https://doi.org/10.2196/48027 %U http://www.ncbi.nlm.nih.gov/pubmed/38551629 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50036 %T Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis %A Zhang,Chunyu %A Hu,Ning %A Li,Rui %A Zhu,Aiping %A Yu,Zhongguang %+ Respiratory Centre, China-Japan Friendship Hospital, Yinghua Road 2#, Beijing, 100013, China, 86 84206468, yzg081892@163.com %K web-based consultation %K Andersen Behavioral Model %K qualitative comparative analysis %K perceived convenience %K complementary role %K user's confidence %K China %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users’ perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user’s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user’s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user’s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations’ application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. %M 38551645 %R 10.2196/50036 %U https://formative.jmir.org/2024/1/e50036 %U https://doi.org/10.2196/50036 %U http://www.ncbi.nlm.nih.gov/pubmed/38551645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55742 %T User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial %A Gerbutavicius,Rokas %A Merle,David A %A Wolf,Armin %A Dimopoulos,Spyridon %A Kortuem,Karsten Ulrich %A Kortuem,Friederike Charlotte %+ Department for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str.7, Tuebingen, 72076, Germany, 49 70712988088, rokas.gerbutavicius@med.uni-tuebingen.de %K mHealth %K mobile health %K workflow optimization %K patient satisfaction %K health education %K educational background %K phacoemulsification %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the “Patient Journey” app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. %M 38551619 %R 10.2196/55742 %U https://formative.jmir.org/2024/1/e55742 %U https://doi.org/10.2196/55742 %U http://www.ncbi.nlm.nih.gov/pubmed/38551619 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e47914 %T A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report %A Dietrich,Damien %A Bornet dit Vorgeat,Helena %A Perrin Franck,Caroline %A Ligier,Quentin %+ Geneva Hub for Global Digital Health, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 227714730, damien.dietrich@gmail.com %K patient empowerment %K mobile apps %K digital health %K mobile health %K implementation science %K health care system %K hospital information system %K health promotion %D 2024 %7 28.3.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Objective: Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. Methods: The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. Implementation (Results): The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. Conclusions: This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a “key success” indicator. %M 38546728 %R 10.2196/47914 %U https://medinform.jmir.org/2024/1/e47914 %U https://doi.org/10.2196/47914 %U http://www.ncbi.nlm.nih.gov/pubmed/38546728 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54073 %T Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial %A Liu,Albert Y %A Alleyne,Cat-Dancing %A Doblecki-Lewis,Susanne %A Koester,Kimberly A %A Gonzalez,Rafael %A Vinson,Janie %A Scott,Hyman %A Buchbinder,Susan %A Torres,Thiago S %+ Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, United States, 1 628 217 7408, albert.liu@sfdph.org %K preexposure prophylaxis %K PrEP %K Spanish-speaking %K Latino %K transgender %K men who have sex with men %K mobile health %K mHealth %K HIV prevention %K HIV %K technology %K formative %K development %K mobile technology, mobile app %K text-messaging %K SMS %K app %K application %K USA %K United States %K health equity %K mHealth tool %K tool %K acceptability %K self-management %K pilot %K support %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. Objective: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. Methods: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. Results: Participants in focus groups liked the “human touch” of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the “good” to “excellent” range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. Conclusions: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial. %M 38536232 %R 10.2196/54073 %U https://formative.jmir.org/2024/1/e54073 %U https://doi.org/10.2196/54073 %U http://www.ncbi.nlm.nih.gov/pubmed/38536232 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54395 %T Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial %A Rein,David B %A Hackney,Madeleine E %A Haddad,Yara K %A Sublett,Farah A %A Moreland,Briana %A Imhof,Laurie %A Peterson,Cora %A Legha,Jaswinder K %A Mark,Janice %A Vaughan,Camille P %A Johnson II,Theodore M %A Bergen,Gwen %A , %+ Department of Public Health, NORC at the University of Chicago, 1447 Peachtree St NE #700, Atlanta, GA, 30309, United States, 1 4048230318, rein-david@norc.org %K aging %K cost-effectiveness %K elderly %K fall risk screening %K fall risk %K falls %K medication management %K older adults %K physical therapy %K prevention %K public health %K telemedicine %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Center for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial. Objective: This study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting. Methods: STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)–led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment. Results: The study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025. Conclusions: The STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention’s effectiveness and cost-effectiveness. Trial Registration: ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736 International Registered Report Identifier (IRRID): RR1-10.2196/54395 %M 38346180 %R 10.2196/54395 %U https://www.researchprotocols.org/2024/1/e54395 %U https://doi.org/10.2196/54395 %U http://www.ncbi.nlm.nih.gov/pubmed/38346180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56324 %T Effects of Electronic Nicotine Delivery Systems Substitution on Body Weight Status: Protocol for a Systematic Review and Meta-Analysis %A La Rosa,Giusy Rita Maria %A Qureshi,Maria Ahmed %A Frittitta,Lucia %A Anastasi,Erika %A Polosa,Riccardo %+ Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 89, Catania, 95123, Italy, 39 095 4781124, g_larosa92@live.it %K Electronic Nicotine Delivery Systems %K body weight %K smoking cessation %K tobacco harm reduction %K systematic review %K meta-analysis %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Weight gain following smoking cessation is a well-documented concern, often attributed to the absence of nicotine’s metabolic influence. The adoption of Electronic Nicotine Delivery Systems (ENDS) has been used to achieve smoking cessation, with claims of aiding weight control. However, existing reviews present conflicting conclusions on ENDS’ impact on weight status, necessitating a rigorous evaluation. Objective: We aim to conduct a systematic review with meta-analysis to assess the actual impact of ENDS on weight status in individuals who have ceased or reduced conventional smoking. The primary goal is to provide clinicians with evidence-based insights into the potential effects of ENDS use as a smoking substitute on weight control. Methods: Adhering to PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, our systematic review will analyze randomized and nonrandomized controlled trials, clinical trials (quasi-experimental), and prospective or retrospective cohort studies on the weight status effects of ENDS among individuals who have either quit or reduced smoking. Searches will include PubMed, Scopus, and Cochrane Library, covering the period from 2010 to January 2024. A gray literature search and supplementary searches will be performed. Data will be extracted independently by 2 reviewers and quality assessments will be conducted concurrently. Quality assessments will use Joanna Briggs Institute tools, 2020 version, along with bias assessments for internal validity and reporting bias based on the Catalogue of Bias. The included studies will be examined for any internal data reporting discrepancies by using Puljak’s checklist. Meta-analysis and subgroup analyses (ie, general ENDS usage, ENDS use coupled with a reduction in smoking exceeding 50%, and exclusive ENDS use for achieving smoking cessation) are planned. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: The protocol has been registered in PROSPERO (CRD42023494974) and the entire systematic review is expected to be completed by April 2024. The main goal of this review is to retrieve all current human research studies investigating the influence of ENDS on weight management among individuals who have quit or reduced smoking. Furthermore, the review will assess the quality of these studies and examine potential biases to identify the most dependable evidence available. Dissemination strategies will include traditional journal publications, social media announcements, and a white paper. The latter, available for download and distributed at conferences, aims to reach a broad audience, including clinicians and ENDS users. Conclusions: The review will address the importance of informing health care professionals and patients about the current and robust evidence regarding the effects of transitioning to ENDS for smoking cessation on weight status. Trial Registration: PROSPERO CRD42023494974; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=494974 International Registered Report Identifier (IRRID): PRR1-10.2196/56324 %M 38530329 %R 10.2196/56324 %U https://www.researchprotocols.org/2024/1/e56324 %U https://doi.org/10.2196/56324 %U http://www.ncbi.nlm.nih.gov/pubmed/38530329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54815 %T eHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study %A Creasy,Stephanie L %A Sweet,Sheridan %A Myers,Janet J %A Shumway,Martha %A Tolou-Shams,Marina %A McCaffrey,Nicole %A Dauria,Emily F %+ Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, 130 De Soto St, 6th Floor, Pittsburgh, PA, 15261, United States, 1 4126243136, STC69@pitt.edu %K substance use %K HIV prevention %K carceral system %K intervention development %K young adult %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, the proportion of criminal legal–involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. Objective: This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. Methods: The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal–involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. Results: The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. Conclusions: This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. International Registered Report Identifier (IRRID): DERR1-10.2196/54815 %M 38530335 %R 10.2196/54815 %U https://www.researchprotocols.org/2024/1/e54815 %U https://doi.org/10.2196/54815 %U http://www.ncbi.nlm.nih.gov/pubmed/38530335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47248 %T Best Practices in Evolving Privacy Frameworks for Patient Age Data: Census Data Study %A Moffatt,Colin %A Leshin,Jonah %+ Datavant, 44 Montgomery St 3rd floor, San Francisco, CA, 94104, United States, 1 415 520 1171, jonah@datavant.com %K census %K date of birth %K deidentification %K HIPAA %K Health Insurance Portability and Accountability Act %K k-anonymity %K patient privacy %K policy %K reidentification risk %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the previous 4 decennial censuses, the population of the United States has grown older, with the proportion of individuals aged at least 90 years old in the 2010 census being more than 2 and a half times what it was in the 1980 census. This suggests that the threshold for constraining age introduced in the Safe Harbor method of the HIPAA (Health Insurance Portability and Accountability Act) in 1996 may be increased without exceeding the original levels of risk. This is desirable to maintain or even increase the utility of affected data sets without compromising privacy. Objective: In light of the upcoming release of 2020 census data, this study presents a straightforward recipe for updating age-constrained thresholds in the context of new census data and derives recommendations for new thresholds from the 2010 census. Methods: Using census data dating back to 1980, we used group size considerations to analyze the risk associated with various maximum age thresholds over time. We inferred the level of risk of the age cutoff of 90 years at the time of HIPAA’s inception in 1996 and used this as a baseline from which to recommend updated cutoffs. Results: The maximum age threshold may be increased by at least 2 years without exceeding the levels of risk conferred in HIPAA’s original recommendations. Moreover, in the presence of additional information that restricts the population in question to a known subgroup with increased longevity (for example, restricting to female patients), the threshold may be increased further. Conclusions: Increasing the maximum age threshold would enable the data user to gain more utility from the data without introducing risk beyond what was originally envisioned with the enactment of HIPAA. Going forward, a recurring update of such thresholds is advised, in line with the considerations detailed in the paper. %M 38526530 %R 10.2196/47248 %U https://formative.jmir.org/2024/1/e47248 %U https://doi.org/10.2196/47248 %U http://www.ncbi.nlm.nih.gov/pubmed/38526530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55615 %T Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study %A Kargarandehkordi,Ali %A Slade,Christopher %A Washington,Peter %+ Department of Information and Computer Sciences, University of Hawaii at Manoa, 1680 East-West Road, Honolulu, HI, 96822, United States, 1 5126800926, pyw@hawaii.edu %K stress %K hypertension %K precision health %K personalized artificial intelligence %K wearables %K ecological momentary assessments %K passive sensing %K mobile phone %D 2024 %7 25.3.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Referred to as the “silent killer,” elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app’s messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project’s clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 %M 38526539 %R 10.2196/55615 %U https://www.researchprotocols.org/2024/1/e55615 %U https://doi.org/10.2196/55615 %U http://www.ncbi.nlm.nih.gov/pubmed/38526539 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e43078 %T Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study %A Lieder,Falk %A Chen,Pin-Zhen %A Prentice,Mike %A Amo,Victoria %A Tošić,Mateo %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, Los Angeles, CA, 90095, United States, 1 424 259 5300, falk.lieder@psych.ucla.edu %K gamification %K points %K feedback %K behavior change %K habit formation %K chatbot %K digital interventions %K mobile phone %K artificial intelligence %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. Objective: In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. Methods: As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot’s optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants’ water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. Results: A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases). Conclusions: Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. Trial Registration: Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8 %M 38517466 %R 10.2196/43078 %U https://games.jmir.org/2024/1/e43078 %U https://doi.org/10.2196/43078 %U http://www.ncbi.nlm.nih.gov/pubmed/38517466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53402 %T Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment %A Sharma,Nikita %A Grotenhuijs,Karen %A Gemert-Pijnen,J E W C van %A Oinas-Kukkonen,Harri %A Braakman-Jansen,L M A %+ Faculty of Behavioural, Management and Social Sciences, University of Twente, Zilverling, Hallenweg 19,, Enschede, 7522 NH, Netherlands, 31 534899111, n.sharma@utwente.nl %K older adult care %K informal caregivers %K cognitive impairment %K sensing solutions %K information communication platform %K low-fidelity %K lo-fi prototype %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. Objective: For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Methods: Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. Results: The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. Conclusions: In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users’ needs and privacy. %M 38517461 %R 10.2196/53402 %U https://formative.jmir.org/2024/1/e53402 %U https://doi.org/10.2196/53402 %U http://www.ncbi.nlm.nih.gov/pubmed/38517461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49133 %T Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study %A O'Kane,Kiarah M K %A Otamendi,Thalia %A Silverberg,Noah D %A Choi,Esther %A Sicard,Veronik %A Zemek,Roger %A Healey,Katherine %A Brown,Olivier %A Butterfield,Lauren %A Smith,Andra %A Goldfield,Gary %A Kardish,Rachel %A Saab,Bechara J %A Ledoux,Andrée-Anne %A Cairncross,Molly %+ Department of Psychology, Simon Fraser University, Robert C. Brown Hall 7321, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 778 782 7458, molly_cairncross@sfu.ca %K adolescent %K concussion %K digital therapeutics %K eHealth %K mHealth %K mindfulness %K mobile health %K social presence %K working alliance %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence—the extent to which digital encounters feel like they are occurring in person—may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents’ development of therapeutic alliance and social presence with the intervention. Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by “developing a genuine connection” with their mindfulness guides and “sensing real people.” Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides’ “personal backgrounds and voices,” such that participants felt more connected to the guides by knowing information about them and through the guides’ calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants’ average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents’ development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment. %M 38517472 %R 10.2196/49133 %U https://formative.jmir.org/2024/1/e49133 %U https://doi.org/10.2196/49133 %U http://www.ncbi.nlm.nih.gov/pubmed/38517472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50931 %T Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis %A Gnant,Michael %A Abdullah,Khatijah Lim %A Boyle,Frances %A Huang,Chiun-Sheng %A Bickford,Katie %A Neunie,Sola %A Noble,Alexander %A Nunn,Anne %A Sproat,Caroline %A Harbeck,Nadia %A Barrios,Carlos %+ Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, BT86/E01, Vienna, 1090, Austria, 43 1 40160 35602, mgnant@icloud.com %K continuing medical education %K early breast cancer %K performance %K risk stratification %K shared decision-making %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. Objective: This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. Methods: We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Results: Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Conclusions: Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities. %M 38512328 %R 10.2196/50931 %U https://formative.jmir.org/2024/1/e50931 %U https://doi.org/10.2196/50931 %U http://www.ncbi.nlm.nih.gov/pubmed/38512328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53593 %T Parents’ User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study %A Cyrkot,Samantha %A Hartling,Lisa %A Scott,Shannon D %A Elliott,Sarah A %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 4-474 Edmonton Clinical Health Academy, 11405-87 Avenue, Edmonton, AB, T6G1C9, Canada, 1 7804921241, se2@ualberta.ca %K awareness %K COVID-19 %K credibility %K credible %K descriptive %K guidelines %K health evidence %K information behavior %K information needs %K information seeking %K information-seeking behaviour %K interface %K internet %K interview %K knowledge mobilization %K parent %K parenting %K public health %K qualitative %K recommendation %K recommender %K SARS-CoV-2 %K think-aloud activity %K think-aloud %K trust %K trustworthy %K usability %K user experience %K web design %K website %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents’ experiences when accessing and using the RecMap website for COVID-19 health decision-making. Objective: To explore (1) where parents look for COVID-19 health information and why, (2) parents’ user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents’ awareness, use, and engagement with the RecMap website. Methods: We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to “think aloud” as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. Results: A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants’ information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. Conclusions: Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public. %M 38506915 %R 10.2196/53593 %U https://formative.jmir.org/2024/1/e53593 %U https://doi.org/10.2196/53593 %U http://www.ncbi.nlm.nih.gov/pubmed/38506915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47960 %T Effectiveness of a Web-based and Mobile Therapy Chatbot on Anxiety and Depressive Symptoms in Subclinical Young Adults: Randomized Controlled Trial %A Karkosz,Stanisław %A Szymański,Robert %A Sanna,Katarzyna %A Michałowski,Jarosław %+ Laboratory of Affective Neuroscience in Poznan, SWPS University, Chodakowska 19/31, Warsaw, 03-815, Poland, 48 22 517 96 00, skarkosz@swps.edu.pl %K chatbots %K conversational agents %K chatbot %K conversational agent %K artificial intelligence %K mental health %K depression %K anxiety %K depressive %K cognitive distortions %K young adults %K randomized control trial %K RCT %K user experience %K CBT %K psychotherapy %K cognitive behavioral therapy %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increased need to provide specialized help for people with depressive and anxiety symptoms, particularly teenagers and young adults. There is evidence from a 2-week intervention that chatbots (eg, Woebot) are effective in reducing depression and anxiety, an effect that was not detected in the control group that was provided self-help materials. Although chatbots are a promising solution, there is limited scientific evidence for the efficacy of agent-guided cognitive behavioral therapy (CBT) outside the English language, especially for highly inflected languages. Objective: This study aimed to measure the efficacy of Fido, a therapy chatbot that uses the Polish language. It targets depressive and anxiety symptoms using CBT techniques. We hypothesized that participants using Fido would show a greater reduction in anxiety and depressive symptoms than the control group. Methods: We conducted a 2-arm, open-label, randomized controlled trial with 81 participants with subclinical depression or anxiety who were recruited via social media. Participants were divided into experimental (interacted with a fully automated Fido chatbot) and control (received a self-help book) groups. Both intervention methods addressed topics such as general psychoeducation and cognitive distortion identification and modification via Socratic questioning. The chatbot also featured suicidal ideation identification and redirection to suicide hotlines. We used self-assessment scales to measure primary outcomes, including the levels of depression, anxiety, worry tendencies, satisfaction with life, and loneliness at baseline, after the 2-week intervention and at the 1-month follow-up. We also controlled for secondary outcomes, including engagement and frequency of use. Results: There were no differences in anxiety and depressive symptoms between the groups at enrollment and baseline. After the intervention, depressive and anxiety symptoms were reduced in both groups (chatbot: n=36; control: n=38), which remained stable at the 1-month follow-up. Loneliness was not significantly different between the groups after the intervention, but an exploratory analysis showed a decline in loneliness among participants who used Fido more frequently. Both groups used their intervention technique with similar frequency; however, the control group spent more time (mean 117.57, SD 72.40 minutes) on the intervention than the Fido group (mean 79.44, SD 42.96 minutes). Conclusions: We did not replicate the findings from previous (eg, Woebot) studies, as both arms yielded therapeutic effects. However, such results are in line with other research of Internet interventions. Nevertheless, Fido provided sufficient help to reduce anxiety and depressive symptoms and decreased perceived loneliness among high-frequency users, which is one of the first pieces of evidence of chatbot efficacy with agents that use a highly inflected language. Further research is needed to determine the long-term, real-world effectiveness of Fido and its efficacy in a clinical sample. Trial Registration: ClinicalTrials.gov NCT05762939; https://clinicaltrials.gov/study/NCT05762939; Open Science Foundation Registry 2cqt3; https://osf.io/2cqt3 %M 38506892 %R 10.2196/47960 %U https://formative.jmir.org/2024/1/e47960 %U https://doi.org/10.2196/47960 %U http://www.ncbi.nlm.nih.gov/pubmed/38506892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49857 %T An Ecological Mobile Momentary Intervention to Support Dynamic Goal Pursuit: Feasibility and Acceptability Study %A O'Driscoll,Ciarán %A Singh,Aneesha %A Chichua,Iya %A Clodic,Joachim %A Desai,Anjali %A Nikolova,Dara %A Yap,Alex Jie %A Zhou,Irene %A Pilling,Stephen %+ CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 207679 1897, c.odriscoll@ucl.ac.uk %K goal pursuit %K ecological momentary intervention %K ecological momentary assessment %K mood %K dynamics %K network analysis %K MCII %K COM-B %K support %K pilot study %K training %K feasibility %K acceptability %K self-monitoring %K implementation %K psychological %K effectiveness %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals can experience difficulties pursuing their goals amid multiple competing priorities in their environment. Effective goal dynamics require flexible and generalizable pursuit skills. Supporting successful goal pursuit requires a perpetually adapting intervention responsive to internal states. Objective: The purpose of this study was to (1) develop a flexible intervention that can adapt to an individual’s changing short to medium-term goals and be applied to their daily life and (2) examine the feasibility and acceptability of the just-in-time adaptive intervention for goal pursuit. Methods: This study involved 3 iterations to test and systematically enhance all aspects of the intervention. During the pilot phase, 73 participants engaged in an ecological momentary assessment (EMA) over 1 month. After week 1, they attended an intervention training session and received just-in-time intervention prompts during the following 3 weeks. The training employed the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for goal setting, along with mental contrasting with implementation intentions (MCII). Subsequent prompts, triggered by variability in goal pursuit, guided the participants to engage in MCII in relation to their current goal. We evaluated feasibility and acceptability, efficacy, and individual change processes by combining intensive (single-case experimental design) and extensive methods. Results: The results suggest that the digital intervention was feasible and acceptable to participants. Compliance with the intervention was high (n=63, 86%). The participants endorsed high acceptability ratings relating to both the study procedures and the intervention. All participants (N=73, 100%) demonstrated significant improvements in goal pursuit with an average difference of 0.495 units in the outcome (P<.001). The results of the dynamic network modeling suggest that self-monitoring behavior (EMA) and implementing the MCII strategy may aid in goal reprioritization, where goal pursuit itself is a driver of further goal pursuit. Conclusions: This pilot study demonstrated the feasibility and acceptability of a just-in-time adaptive intervention among a nonclinical adult sample. This intervention used self-monitoring of behavior, the COM-B framework, and MCII strategies to improve dynamic goal pursuit. It was delivered via an Ecological Momentary Intervention (EMI) procedure. Future research should consider the utility of this approach as an additional intervention element within psychological interventions to improve goal pursuit. Sustaining goal pursuit throughout interventions is central to their effectiveness and warrants further evaluation. %M 38506904 %R 10.2196/49857 %U https://formative.jmir.org/2024/1/e49857 %U https://doi.org/10.2196/49857 %U http://www.ncbi.nlm.nih.gov/pubmed/38506904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50506 %T Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study %A Breuer-Asher,Inbar %A Ritholz,Marilyn D %A Horwitz,David L %A Manejwala,Omar %A Behar,Ephraim %A Fundoiano-Hershcovitz,Yifat %+ DarioHealth, Ofek 8, 5 Tarshish Street, Caesarea, 3079821, Israel, 972 525296979, yifat@dariohealth.com %K mental health %K perceived stress %K stress reduction %K digital health %K video sessions %K behavioral health %K relaxation %K breathing exercises %K CBT %K anxiety %K cognitive behavioral therapy %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective: This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy–based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods: Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results: Analysis revealed a significant decrease in stress symptoms (β=–.25; 95% CI –0.32 to –0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=–.07; 95% CI –0.13 to –0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions: This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy–based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective. %M 38502164 %R 10.2196/50506 %U https://formative.jmir.org/2024/1/e50506 %U https://doi.org/10.2196/50506 %U http://www.ncbi.nlm.nih.gov/pubmed/38502164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55041 %T Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study %A Aycock,Chase A %A Mallawaarachchi,Indika %A Wang,Xin-Qun %A Cassidy,Daniel G %A Ellis,Jordan M %A Klesges,Robert C %A Talcott,G Wayne %A Wiseman,Kara %+ Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, United States, 1 4342348126, kara.wiseman@virginia.edu %K text messaging %K alcohol reduction %K binge drinking %K US %K United States %K US military %K alcohol misuse %K military %K functioning %K readiness %K health %K career %K careers %K text message %K text messages %K short message service %K SMS %K SMS intervention %K drinking %K Air Force %K Airmen %K mixed methods approach %K message %K messages %K development study %K qualitative coding %K drinking alcohol %K alcohol consumption %K survey %K descriptive statistics %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force. %M 38502165 %R 10.2196/55041 %U https://formative.jmir.org/2024/1/e55041 %U https://doi.org/10.2196/55041 %U http://www.ncbi.nlm.nih.gov/pubmed/38502165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50716 %T Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees %A Drover,Caitlin M %A Elder,Adam S %A Guthrie,Brandon L %A Revere,Debra %A Briggs,Nicole L %A West,Laura M %A Higgins,Amanda %A Lober,William B %A Karras,Bryant T %A Baseman,Janet G %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Seattle, WA, 98195-1616, United States, 1 5056159180, eldera3@uw.edu %K COVID-19 %K exposure notification %K digital public health tool %K survey analysis %K conference %K online survey %K digital tool %K public health %K contact tracing %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: WA Notify was Washington State’s smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. Objective: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. Methods: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Results: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Conclusions: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases. %M 38498047 %R 10.2196/50716 %U https://formative.jmir.org/2024/1/e50716 %U https://doi.org/10.2196/50716 %U http://www.ncbi.nlm.nih.gov/pubmed/38498047 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49647 %T Physicians’ and Patients’ Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients %A Färber,Andri %A Schwabe,Christiane %A Stalder,Philipp H %A Dolata,Mateusz %A Schwabe,Gerhard %+ ZHAW School of Management and Law, Zurich University of Applied Sciences, Theaterstr. 17, Winterthur, 8401, Switzerland, 41 79 642 08 85, xfbe@zhaw.ch %K adherence to treatment %K digital agents %K eHealth %K electronic medical records %K health literacy %K mobile health %K mHealth %K mobile phone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. Objective: This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents—a silent digital expert, a communicative digital expert, and a digital companion (DC). Methods: We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. Results: Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. Conclusions: Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings. %M 38498022 %R 10.2196/49647 %U https://humanfactors.jmir.org/2024/1/e49647 %U https://doi.org/10.2196/49647 %U http://www.ncbi.nlm.nih.gov/pubmed/38498022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48050 %T Preliminary Efficacy of a Cognitive Behavioral Therapy–Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial %A Chen,Shanshan %A Tang,Jinsong %A Wu,Congyang %A Zhang,Ge %A Zhang,Jing %A Liao,Yanhui %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 18814898844, liaoyanhui@zju.edu.cn %K China %K cognitive behavioral therapy %K program acceptability %K randomized controlled trial %K smartphone app %K smoking cessation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The overall prevalence of cigarette smokers in China is very high, and China’s total cigarette consumption makes up more than 40% of the world’s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app–based smoking cessation trial in China. Objective: This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)–based smoking cessation smartphone app among smokers seeking treatment in China. Methods: We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a “thank you” message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. Results: A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Conclusions: Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Trial Registration: ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041985 %M 38498030 %R 10.2196/48050 %U https://formative.jmir.org/2024/1/e48050 %U https://doi.org/10.2196/48050 %U http://www.ncbi.nlm.nih.gov/pubmed/38498030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e33868 %T Using Principles of Digital Development for a Smartphone App to Support Data Collection in Patients With Acute Myocardial Infarction and Physical Activity Intolerance: Case Study %A Cáceres Rivera,Diana Isabel %A Rojas,Luz Mileyde Jaimes %A Rojas,Lyda Z %A Gomez,Diana Canon %A Castro Ruiz,David Andrés %A López Romero,Luis Alberto %+ Facultad de Enfermería, Universidad Cooperativa de Colombia, Torre 2 Apto 203, Bucaramanga, 64000, Colombia, 57 3014006658, dianacaceresrivera@gmail.com %K app %K applications of medical informatics %K coronary disease %K data collection %K development %K health care reform %K health data %K medical informatics %K medical informatics apps %K mobile app %K mobile applications %K nursing diagnosis %K nursing research %K research data %K software %K validation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals. Objective: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis “intolerance to physical activity” in patients with acute myocardial infarction. Methods: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index. Results: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%). Conclusions: We developed a mobile app for validating the diagnosis of “activity intolerance.” Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs. %M 38498019 %R 10.2196/33868 %U https://formative.jmir.org/2024/1/e33868 %U https://doi.org/10.2196/33868 %U http://www.ncbi.nlm.nih.gov/pubmed/38498019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46820 %T Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study %A Simmich,Joshua %A Andrews,Nicole Emma %A Claus,Andrew %A Murdoch,Megan %A Russell,Trevor Glen %+ RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, 296 Herston Road, Herston, Brisbane, 4029, Australia, 61 7 3365 5560, j.simmich@uq.edu.au %K GPS %K mobile apps %K exercise test %K pain %K chronic pain %K mobile phone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. Objective: The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. Methods: People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. Results: The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI −2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and −77.6 (95% CI −107.7 to −61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. Conclusions: In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment. %M 38498031 %R 10.2196/46820 %U https://formative.jmir.org/2024/1/e46820 %U https://doi.org/10.2196/46820 %U http://www.ncbi.nlm.nih.gov/pubmed/38498031 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52809 %T A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care %A Henderson,Kyra %A Reihm,Jennifer %A Koshal,Kanishka %A Wijangco,Jaeleene %A Sara,Narender %A Miller,Nicolette %A Doyle,Marianne %A Mallory,Alicia %A Sheridan,Judith %A Guo,Chu-Yueh %A Oommen,Lauren %A Rankin,Katherine P %A Sanders,Stephan %A Feinstein,Anthony %A Mangurian,Christina %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, 1651 4th Street, San Francisco, CA, 94158, United States, 1 4155027209, riley.bove@ucsf.edu %K depression %K quality of life %K bring your own device %K mHealth %K closed-loop %K clinical trial %K multiple sclerosis %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. Objective: This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. Methods: During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. Results: MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. Conclusions: Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense–funded feasibility and efficacy trial, which is now underway. Trial Registration: ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x %M 38488827 %R 10.2196/52809 %U https://formative.jmir.org/2024/1/e52809 %U https://doi.org/10.2196/52809 %U http://www.ncbi.nlm.nih.gov/pubmed/38488827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50056 %T Adapting the Number of Questions Based on Detected Psychological Distress for Cognitive Behavioral Therapy With an Embodied Conversational Agent: Comparative Study %A Shidara,Kazuhiro %A Tanaka,Hiroki %A Adachi,Hiroyoshi %A Kanayama,Daisuke %A Kudo,Takashi %A Nakamura,Satoshi %+ Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, 630-0192, Japan, 81 80 4687 8116, shidara.kazuhiro.sc5@is.naist.jp %K cognitive behavioral therapy %K psychological distress detection %K embodied conversational agents %K automatic thoughts %K long short-term memory %K multitask learning %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The high prevalence of mental illness is a critical social problem. The limited availability of mental health services is a major factor that exacerbates this problem. One solution is to deliver cognitive behavioral therapy (CBT) using an embodied conversational agent (ECA). ECAs make it possible to provide health care without location or time constraints. One of the techniques used in CBT is Socratic questioning, which guides users to correct negative thoughts. The effectiveness of this approach depends on a therapist’s skill to adapt to the user’s mood or distress level. However, current ECAs do not possess this skill. Therefore, it is essential to implement this adaptation ability to the ECAs. Objective: This study aims to develop and evaluate a method that automatically adapts the number of Socratic questions based on the level of detected psychological distress during a CBT session with an ECA. We hypothesize that this adaptive approach to selecting the number of questions will lower psychological distress, reduce negative emotional states, and produce more substantial cognitive changes compared with a random number of questions. Methods: In this study, which envisions health care support in daily life, we recruited participants aged from 18 to 65 years for an experiment that involved 2 different conditions: an ECA that adapts a number of questions based on psychological distress detection or an ECA that only asked a random number of questions. The participants were assigned to 1 of the 2 conditions, experienced a single CBT session with an ECA, and completed questionnaires before and after the session. Results: The participants completed the experiment. There were slight differences in sex, age, and preexperimental psychological distress levels between the 2 conditions. The adapted number of questions condition showed significantly lower psychological distress than the random number of questions condition after the session. We also found a significant difference in the cognitive change when the number of questions was adapted based on the detected distress level, compared with when the number of questions was fewer than what was appropriate for the level of distress detected. Conclusions: The results show that an ECA adapting the number of Socratic questions based on detected distress levels increases the effectiveness of CBT. Participants who received an adaptive number of questions experienced greater reductions in distress than those who received a random number of questions. In addition, the participants showed a greater amount of cognitive change when the number of questions matched the detected distress level. This suggests that adapting the question quantity based on distress level detection can improve the results of CBT delivered by an ECA. These results illustrate the advantages of ECAs, paving the way for mental health care that is more tailored and effective. %M 38483464 %R 10.2196/50056 %U https://formative.jmir.org/2024/1/e50056 %U https://doi.org/10.2196/50056 %U http://www.ncbi.nlm.nih.gov/pubmed/38483464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53555 %T Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study %A Snyder,Morgan %A Elkins,Gary R %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, United States, 1 254 710 2961, gary_elkins@baylor.edu %K hypnotherapy %K hot flashes %K smartphone app %K mHealth %K mobile health %K app %K apps %K applications %K hypnosis %K menopause %K menopausal %K gynecology %K usage %K women's health %K user %K users %K demographics %K demographic %K characteristic %K characteristics %K mental health %K alternative %K complementary %K mind body %K hypnotism %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=–0.09). Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app. %M 38483465 %R 10.2196/53555 %U https://formative.jmir.org/2024/1/e53555 %U https://doi.org/10.2196/53555 %U http://www.ncbi.nlm.nih.gov/pubmed/38483465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50737 %T Implementing a Sodium-Glucose Cotransporter 2 Inhibitor Module With a Software Tool (Future Health Today): Qualitative Study %A Suen,Matthew %A Manski-Nankervis,Jo-Anne %A McBride,Caroline %A Lumsden,Natalie %A Hunter,Barbara %+ Department of General Practice and Primary Care, University of Melbourne, Level 3, North Wing, Building, 181 Grattan Street, Medical Building, Parkville, 3010, Australia, 61 383443369, matthew.suen@unimelb.edu.au %K type 2 diabetes %K CP-FIT %K electronic health %K clinical decision support tool %K primary care %K SGLT2 inhibitor %K complication %K tool %K digital health intervention %K thematic analysis %K decision support %K diabetes management %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care plays a key role in the management of type 2 diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been demonstrated to reduce hospitalization and cardiac and renal complications. Tools that optimize management, including appropriate prescribing, are a priority for treating chronic diseases. Future Health Today (FHT) is software that facilitates clinical decision support and quality improvement. FHT applies algorithms to data stored in electronic medical records in general practice to identify patients who are at risk of a chronic disease or who have a chronic disease that may benefit from intensification of management. The platform continues to evolve because of rigorous evaluation, continuous improvement, and expansion of the conditions hosted on the platform. FHT currently displays recommendations for the identification and management of chronic kidney disease, cardiovascular disease, type 2 diabetes, and cancer risk. A new module will be introduced to FHT focusing on SGLT2 inhibitors in patients with type 2 diabetes who have chronic kidney diseases, cardiovascular diseases, or risk factors for cardiovascular disease. Objective: The study aims to explore the barriers and enablers to the implementation of an SGLT2 inhibitor module within the Future Health Today software. Methods: Clinic staff were recruited to participate in interviews on their experience in their use of a tool to improve prescribing behavior for SGLT2 inhibitors. Thematic analysis was guided by Clinical Performance Feedback Intervention Theory. Results: In total, 16 interviews were completed. Identified enablers of use included workflow alignment, clinical appropriateness, and active delivery of the module. Key barriers to use were competing priorities, staff engagement, and knowledge of the clinical topic. Conclusions: There is a recognized benefit to the use of a clinical decision support tool to support type 2 diabetes management, but barriers were identified that impeded the usability and actionability of the module. Successful and effective implementation of this tool could support the optimization of patient management of type 2 diabetes in primary care. %M 38477973 %R 10.2196/50737 %U https://formative.jmir.org/2024/1/e50737 %U https://doi.org/10.2196/50737 %U http://www.ncbi.nlm.nih.gov/pubmed/38477973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48080 %T Improving Behavioral-Based Safety Training in Using Verbal Commands Through a Theory-Driven and Feedback-Based Nonimmersive Virtual Reality Game: Development and Usability Study %A Atagbuzia,Chukwudiebube %A Ng,Ean H %A Natarajan,Ganapathy %+ Oregon State University, 204 Rogers Hall, Oregon State University, Corvallis, OR, 97331, United States, 1 15417370570, ean.ng@oregonstate.edu %K behavioral safety training %K SERES framework %K Reflection, Engagement, Choice, Information, Play, Exposition framework %K gamification %K gestalt laws of perception %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The construction, chemical, aviation, medical, and health care industries have used serious games for safety training. To our knowledge, serious games have not been developed focusing on behavioral change to improve safety through the use of verbal commands and instilling players with heightened awareness of their spatial proximity to other people in their surroundings. Objective: We aimed to develop a theory-driven serious game for improving safety behavior using verbal commands and validate the implementation of the theoretical frameworks used for game development. The game developed, KitchenSpeak, was a first-person character (FPC) game where users respond to in-game prompts to use loud verbal commands when they are approaching another employee’s blind spot. Methods: In addition to using the SERES framework in guiding the general game design and development, and the Reflection, Engagement, Choice, Information, Play, Exposition (RECIPE) framework to inform the design of the game mechanics, we also applied gestalt laws of perception for graphic design to guide the design of the game’s user interface. We conducted 2 evaluative tests (alpha and beta) to collect end user and stakeholder feedback on the implementation of the theoretical frameworks, as well as to collect relevant information for full-scale implementation and a future validation study. Results: The alpha and beta tests had 8 and 40 participants, respectively. The alpha test results revealed that the theoretical frameworks were adequately applied; however, suggestions were also made to modify and improve the game. The beta test results suggested further improvements for the game design and found no differences in the perception of ease of play between participants with and without previous FPC gaming experience (P=.47; Kruskal-Wallis). Results suggested that the game met its design and theoretical requirements, and it would be easily playable by all players regardless of their previous experience in FPC games. Conclusions: A theory-driven and evidence-based FPC game titled KitchenSpeak was developed to teach the use of kitchen-speak terms in commercial kitchens. Evaluative tests were conducted to validate the implementation of the theoretical frameworks. Our main contributions are creating and validating game-based training to improve behavioral-based safety in the workplace and the incorporation of gestalt laws of perception for graphic design in the game’s user interface. %M 38470470 %R 10.2196/48080 %U https://formative.jmir.org/2024/1/e48080 %U https://doi.org/10.2196/48080 %U http://www.ncbi.nlm.nih.gov/pubmed/38470470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55205 %T Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study %A Poudyal,Anubhuti %A Lewis,Delta-Marie %A Taha,Sarah %A Martinez,Alyssa J %A Magoun,Lauren %A Ho,Y Xian %A Carmio,Natali %A Naslund,John A %A Sanchez,Katherine %A Lesh,Neal %A Patel,Vikram %+ Department of Sociomedical Sciences, Columbia Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, United States, 1 (212) 305 2862, ap4150@cumc.columbia.edu %K digital technology %K mental health %K depression %K task sharing %K nonspecialist providers %K peer supervision %K therapy quality %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. Objective: We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. Methods: We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app’s overall usability. We also calculated the participants’ likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. Results: A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants’ likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs’ workloads. Conclusions: We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app’s use and efficacy in real-world settings to support task-shared mental health programs across the United States. %M 38466971 %R 10.2196/55205 %U https://formative.jmir.org/2024/1/e55205 %U https://doi.org/10.2196/55205 %U http://www.ncbi.nlm.nih.gov/pubmed/38466971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47803 %T Optimization of Using Multiple Machine Learning Approaches in Atrial Fibrillation Detection Based on a Large-Scale Data Set of 12-Lead Electrocardiograms: Cross-Sectional Study %A Chuang,Beau Bo-Sheng %A Yang,Albert C %+ Digital Medicine and Smart Healthcare Research Center, National Yang Ming Chiao Tung University, No 155, Li-Nong St, Sec.2, Beitou District, Taipei, 112304, Taiwan, 886 228267995, accyang@nycu.edu.tw %K machine learning %K atrial fibrillation %K light gradient boosting machine %K power spectral density %K digital health %K electrocardiogram %K machine learning algorithm %K atrial fibrillation detection %K real-time %K detection %K electrocardiography leads %K clinical outcome %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Atrial fibrillation (AF) represents a hazardous cardiac arrhythmia that significantly elevates the risk of stroke and heart failure. Despite its severity, its diagnosis largely relies on the proficiency of health care professionals. At present, the real-time identification of paroxysmal AF is hindered by the lack of automated techniques. Consequently, a highly effective machine learning algorithm specifically designed for AF detection could offer substantial clinical benefits. We hypothesized that machine learning algorithms have the potential to identify and extract features of AF with a high degree of accuracy, given the intricate and distinctive patterns present in electrocardiogram (ECG) recordings of AF. Objective: This study aims to develop a clinically valuable machine learning algorithm that can accurately detect AF and compare different leads’ performances of AF detection. Methods: We used 12-lead ECG recordings sourced from the 2020 PhysioNet Challenge data sets. The Welch method was used to extract power spectral features of the 12-lead ECGs within a frequency range of 0.083 to 24.92 Hz. Subsequently, various machine learning techniques were evaluated and optimized to classify sinus rhythm (SR) and AF based on these power spectral features. Furthermore, we compared the effects of different frequency subbands and different lead selections on machine learning performances. Results: The light gradient boosting machine (LightGBM) was found to be the most effective in classifying AF and SR, achieving an average F1-score of 0.988 across all ECG leads. Among the frequency subbands, the 0.083 to 4.92 Hz range yielded the highest F1-score of 0.985. In interlead comparisons, aVR had the highest performance (F1=0.993), with minimal differences observed between leads. Conclusions: In conclusion, this study successfully used machine learning methodologies, particularly the LightGBM model, to differentiate SR and AF based on power spectral features derived from 12-lead ECGs. The performance marked by an average F1-score of 0.988 and minimal interlead variation underscores the potential of machine learning algorithms to bolster real-time AF detection. This advancement could significantly improve patient care in intensive care units as well as facilitate remote monitoring through wearable devices, ultimately enhancing clinical outcomes. %M 38466973 %R 10.2196/47803 %U https://formative.jmir.org/2024/1/e47803 %U https://doi.org/10.2196/47803 %U http://www.ncbi.nlm.nih.gov/pubmed/38466973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45202 %T A Deep Learning–Based Approach for Prediction of Vancomycin Treatment Monitoring: Retrospective Study Among Patients With Critical Illness %A Kim,Dohyun %A Choi,Hyun-Soo %A Lee,DongHoon %A Kim,Minkyu %A Kim,Yoon %A Han,Seon-Sook %A Heo,Yeonjeong %A Park,Ju-Hee %A Park,Jinkyeong %+ Department of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea, 82 1027747808, pjk3318@gmail.com %K critically ill %K deep learning %K inflammation %K machine learning %K pharmacokinetic %K therapeutic drug monitoring %K vancomycin %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Vancomycin pharmacokinetics are highly variable in patients with critical illnesses, and clinicians commonly use population pharmacokinetic (PPK) models based on a Bayesian approach to dose. However, these models are population-dependent, may only sometimes meet the needs of individual patients, and are only used by experienced clinicians as a reference for making treatment decisions. To assist real-world clinicians, we developed a deep learning–based decision-making system that predicts vancomycin therapeutic drug monitoring (TDM) levels in patients in intensive care unit. Objective: This study aimed to establish joint multilayer perceptron (JointMLP), a new deep-learning model for predicting vancomycin TDM levels, and compare its performance with the PPK models, extreme gradient boosting (XGBoost), and TabNet. Methods: We used a 977-case data set split into training and testing groups in a 9:1 ratio. We performed external validation of the model using 1429 cases from Kangwon National University Hospital and 2394 cases from the Medical Information Mart for Intensive Care–IV (MIMIC-IV). In addition, we performed 10-fold cross-validation on the internal training data set and calculated the 95% CIs using the metric. Finally, we evaluated the generalization ability of the JointMLP model using the MIMIC-IV data set. Results: Our JointMLP model outperformed other models in predicting vancomycin TDM levels in internal and external data sets. Compared to PPK, the JointMLP model improved predictive power by up to 31% (mean absolute error [MAE] 6.68 vs 5.11) on the internal data set and 81% (MAE 11.87 vs 6.56) on the external data set. In addition, the JointMLP model significantly outperforms XGBoost and TabNet, with a 13% (MAE 5.75 vs 5.11) and 14% (MAE 5.85 vs 5.11) improvement in predictive accuracy on the inner data set, respectively. On both the internal and external data sets, our JointMLP model performed well compared to XGBoost and TabNet, achieving prediction accuracy improvements of 34% and 14%, respectively. Additionally, our JointMLP model showed higher robustness to outlier data than the other models, as evidenced by its higher root mean squared error performance across all data sets. The mean errors and variances of the JointMLP model were close to zero and smaller than those of the PPK model in internal and external data sets. Conclusions: Our JointMLP approach can help optimize treatment outcomes in patients with critical illnesses in an intensive care unit setting, reducing side effects associated with suboptimal vancomycin administration. These include increased risk of bacterial resistance, extended hospital stays, and increased health care costs. In addition, the superior performance of our model compared to existing models highlights its potential to help real-world clinicians. %M 38152042 %R 10.2196/45202 %U https://formative.jmir.org/2024/1/e45202 %U https://doi.org/10.2196/45202 %U http://www.ncbi.nlm.nih.gov/pubmed/38152042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52427 %T Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals %A Percy,Carol %A Turner,Andrew %A Orr,Charys %+ Centre for Intelligent Healthcare, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 2477 659 337, c.percy@coventry.ac.uk %K anxiety %K depression %K PCOS %K peer support %K polycystic ovary syndrome %K positive well-being %K psychoeducation %K self-management %K web-based health intervention %K women’s health %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way. Objective: We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them. Methods: We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify “antecedents” (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention. Results: Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place). Conclusions: We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention’s acceptability, scalability, and cost-effectiveness. %M 38451567 %R 10.2196/52427 %U https://formative.jmir.org/2024/1/e52427 %U https://doi.org/10.2196/52427 %U http://www.ncbi.nlm.nih.gov/pubmed/38451567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46817 %T Comparison of the Discrimination Performance of AI Scoring and the Brixia Score in Predicting COVID-19 Severity on Chest X-Ray Imaging: Diagnostic Accuracy Study %A Tenda,Eric Daniel %A Yunus,Reyhan Eddy %A Zulkarnaen,Benny %A Yugo,Muhammad Reynalzi %A Pitoyo,Ceva Wicaksono %A Asaf,Moses Mazmur %A Islamiyati,Tiara Nur %A Pujitresnani,Arierta %A Setiadharma,Andry %A Henrina,Joshua %A Rumende,Cleopas Martin %A Wulani,Vally %A Harimurti,Kuntjoro %A Lydia,Aida %A Shatri,Hamzah %A Soewondo,Pradana %A Yusuf,Prasandhya Astagiri %+ Department of Medical Physiology and Biophysics/ Medical Technology Cluster IMERI, Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No.6, Jakarta, 10430, Indonesia, 62 812 8459 4272, prasandhya.a.yusuf@ui.ac.id %K artificial intelligence %K Brixia %K chest x-ray %K COVID-19 %K CAD4COVID %K pneumonia %K radiograph %K artificial intelligence scoring system %K AI scoring system %K prediction %K disease severity %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The artificial intelligence (AI) analysis of chest x-rays can increase the precision of binary COVID-19 diagnosis. However, it is unknown if AI-based chest x-rays can predict who will develop severe COVID-19, especially in low- and middle-income countries. Objective: The study aims to compare the performance of human radiologist Brixia scores versus 2 AI scoring systems in predicting the severity of COVID-19 pneumonia. Methods: We performed a cross-sectional study of 300 patients suspected with and with confirmed COVID-19 infection in Jakarta, Indonesia. A total of 2 AI scores were generated using CAD4COVID x-ray software. Results: The AI probability score had slightly lower discrimination (area under the curve [AUC] 0.787, 95% CI 0.722-0.852). The AI score for the affected lung area (AUC 0.857, 95% CI 0.809-0.905) was almost as good as the human Brixia score (AUC 0.863, 95% CI 0.818-0.908). Conclusions: The AI score for the affected lung area and the human radiologist Brixia score had similar and good discrimination performance in predicting COVID-19 severity. Our study demonstrated that using AI-based diagnostic tools is possible, even in low-resource settings. However, before it is widely adopted in daily practice, more studies with a larger scale and that are prospective in nature are needed to confirm our findings. %M 38451633 %R 10.2196/46817 %U https://formative.jmir.org/2024/1/e46817 %U https://doi.org/10.2196/46817 %U http://www.ncbi.nlm.nih.gov/pubmed/38451633 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50926 %T Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking %A Anders,Carolin %A Moorthy,Preetha %A Svensson,Laura %A Müller,Julia %A Heinze,Oliver %A Knaup,Petra %A Wallwiener,Markus %A Deutsch,Thomas M %A Le,Thao-Vy %A Weinert,Lina %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34651, Carolin.Anders@med.uni-heidelberg.de %K mobile health %K mHealth %K usability %K breast cancer %K eye tracking %K user interface %K mixed methods %K mobile phone %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app’s content regularly, and self-administration. In contrast to the app’s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients’ feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. %M 38441959 %R 10.2196/50926 %U https://humanfactors.jmir.org/2024/1/e50926 %U https://doi.org/10.2196/50926 %U http://www.ncbi.nlm.nih.gov/pubmed/38441959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51141 %T The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study %A Al-Sbei,Rasha %A Ataya,Jawdat %A Jamous,Issam %A Dashash,Mayssoon %+ Medical Education Program, Syrian Virtual University, Al-Mazzeh Street, Damascus, 35329, Syrian Arab Republic, 963 992287487, dr.jawdat.ataya@gmail.com %K restorative dentistry %K online learning %K dental education %K dental graduates %K Syria %K education %K dental %K dentistry %K dental practice %K effectiveness %K educational program %K survey %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. Objective: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. Methods: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants’ knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. Results: The results showed a significant improvement in the participants’ knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. Conclusions: The findings indicated a notable enhancement in the participants’ understanding of restorative dentistry. The participants’ high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field. %M 38441921 %R 10.2196/51141 %U https://formative.jmir.org/2024/1/e51141 %U https://doi.org/10.2196/51141 %U http://www.ncbi.nlm.nih.gov/pubmed/38441921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49492 %T Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility %A Zheng,Amy %A Bergh,Marissa %A Patel Murali,Komal %A Sadarangani,Tina %+ New York University Rory Meyers College of Nursing, 433 First Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, msb7677@nyu.edu %K adult day services %K primary health care %K health communication %K dementia %K mobile health %K mHealth %K community-based %K health care %K older adults %K older adult %K chronic condition %K health information %K feasibility %K acceptability %K CareMOBI %K mixed methods design %K caregivers %K caregiver %K care workers %K nurses %K social workers %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. %M 38427418 %R 10.2196/49492 %U https://formative.jmir.org/2024/1/e49492 %U https://doi.org/10.2196/49492 %U http://www.ncbi.nlm.nih.gov/pubmed/38427418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50528 %T A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study %A Ni,Chenxu %A Wang,Yi-fu %A Zhang,Yun-ting %A Yuan,Min %A Xu,Qing %A Shen,Fu-ming %A Li,Dong-Jie %A Huang,Fang %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 66302570, hazel_huang@126.com %K WeChat applet %K usability testing %K utility testing %K cancer patients %K patients %K cancer %K qualitative study %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a “Mini Program,” is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, “DolphinCare,” among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ≥50%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. %M 38421700 %R 10.2196/50528 %U https://formative.jmir.org/2024/1/e50528 %U https://doi.org/10.2196/50528 %U http://www.ncbi.nlm.nih.gov/pubmed/38421700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47458 %T Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences %A Patel,Priya %A Brown,Susan %A Guo,Boliang %A Holmes,Emily A %A Iyadurai,Lalitha %A Kingslake,Jonathan %A Highfield,Julie %A Morriss,Richard %+ NIHR ARC East Midlands, University of Nottingham, Innovation Park Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 7790988203, Priya.Patel1@nottingham.ac.uk %K intensive care %K posttraumatic stress disorder %K PTSD %K qualitative research %K intervention study %K health care professionals %K digital intervention %K staff well-being %K pandemic %K intrusive memories %K work-related trauma %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial. %M 38421698 %R 10.2196/47458 %U https://formative.jmir.org/2024/1/e47458 %U https://doi.org/10.2196/47458 %U http://www.ncbi.nlm.nih.gov/pubmed/38421698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47570 %T How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study %A Ma,Shaoying %A Kaareen,Aadeeba %A Park,Hojin %A He,Yanyun %A Jiang,Shuning %A Qiu,Zefeng %A Xie,Zidian %A Li,Dongmei %A Chen,Jian %A O’Connor,Richard J %A Fong,Geoffrey T %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus, OH, 43214, United States, 1 6148976063, shaoying.ma@osumc.edu %K tobacco %K electronic cigarette %K e-cigarette %K electronic nicotine delivery systems %K electronic nicotine delivery system %K vaping %K market surveillance %K tobacco marketing %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. Objective: To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. Methods: In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. Results: As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. Conclusions: As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers’ marketing behaviors, and identify regulatory impacts. %M 38416562 %R 10.2196/47570 %U https://formative.jmir.org/2024/1/e47570 %U https://doi.org/10.2196/47570 %U http://www.ncbi.nlm.nih.gov/pubmed/38416562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49494 %T Help-Seeking, Support, and Engagement in Gestational Diabetes Mellitus Online Communities on Facebook: Content Analysis %A Pham,Sheila %A Churruca,Kate %A Ellis,Louise A %A Braithwaite,Jeffrey %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, 2113, Australia, 61 423078104, sheila.pham@mq.edu.au %K clinical management %K communication %K content analysis %K engagement %K Facebook %K gestational diabetes %K health communication %K help-seeking behavior %K mental distress %K online communities %K peer-support %K self-disclosure %K self-management %K support %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing information about pregnancy on Facebook and the documented benefits of diabetes online communities, the same may be true of GDM online communities. Objective: This study aimed to categorize and quantify what is being discussed in GDM Facebook groups, including informational and emotional help-seeking behavior, and how this support and engagement may be demonstrated by peers through comments and reactions. Methods: We sourced the data from the 2 largest Facebook groups focused on GDM in Australia. A summative content analysis was conducted on original posts across the 2 groups and coded for topics as well as help-seeking types. The coding scheme was based on the previous work of Liang and Scammon. Visible indicators of engagement, including the number of comments and “reactions,” were tabled and manually evaluated. Results: There were 388 original posts, and the analysis produced 6 topics: GDM self-management (199/388, 51.3%), GDM clinical management (120/388, 30.9%), preparing for birth (40/388, 10.3%), mental distress (35/388, 9%), birth announcement (29/388, 7.5%), and GDM journey reflections (21/388, 5.4%). Secondary coding of help-seeking type revealed more than half of the posts were informational help-seeking (224/388, 57.7%), while a small proportion were both informational and emotional help-seeking (44/388, 11.3%), and some (12/388, 3.1%) were emotional help-seeking only. Self-disclosure was identified as a fourth category, comprising almost a quarter of all posts (90/388, 23.2%). A total of 6022 comments were posted in response to the original posts, and there were 4452 reactions across all posts. Emotional help-seeking attracted the most comments per thread (mean 21.5, SD 19.8), followed by informational and emotional help-seeking (mean 20.2, SD 14.7), informational help-seeking (mean 15.6, SD 14.6), and self-disclosure (mean 14.3, SD 21.8). Across all help-seeking categories, few reactions occurred compared to comments; in contrast, self-disclosure attracted a large number of reactions (mean 9.4, SD 45.3). Conclusions: This is one of the first studies to examine peer support in a GDM online community on Facebook. Our findings suggest that active participants’ needs around information and support in relation to GDM are being somewhat met by peer-led online communities. Given the practical limitations of formal health care, including the provision of ongoing social support, it is important to recognize how GDM online communities can complement formal health care and help address unmet needs. %M 38407949 %R 10.2196/49494 %U https://formative.jmir.org/2024/1/e49494 %U https://doi.org/10.2196/49494 %U http://www.ncbi.nlm.nih.gov/pubmed/38407949 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49110 %T Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study %A Milton,Alyssa %A Ozols A M,Ingrid %A Cassidy,Tayla %A Jordan,Dana %A Brown,Ellie %A Arnautovska,Urska %A Cook,Jim %A Phung,Darren %A Lloyd-Evans,Brynmor %A Johnson,Sonia %A Hickie,Ian %A Glozier,Nick %+ Faculty of Medicine and Health, The University of Sydney, Level 5 Professor Marie Bashir Centre, 67-73 Missenden Rd, Camperdown, 2050, Australia, 61 02 9515 1461, alyssa.milton@sydney.edu.au %K self-management %K serious mental illness %K self-care %K digital health tools %K blended interventions %K peer support %K mobile phone %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. Objective: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. Methods: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ≥18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. Results: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals’ unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. Conclusions: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step. %M 38393768 %R 10.2196/49110 %U https://formative.jmir.org/2024/1/e49110 %U https://doi.org/10.2196/49110 %U http://www.ncbi.nlm.nih.gov/pubmed/38393768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48881 %T Perception of Apps for Mental Health Assessment With Recommendations for Future Design: United Kingdom Semistructured Interview Study %A Funnell,Erin L %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Benacek,Jiri %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K app design %K digital health %K eHealth %K interviews %K mental health %K mHealth %K mobile phone %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care provision in the United Kingdom is overwhelmed by a high demand for services. There are high rates of under-, over-, and misdiagnosis of common mental health disorders in primary care and delays in accessing secondary care. This negatively affects patient functioning and outcomes. Digital tools may offer a time-efficient avenue for the remote assessment and triage of mental health disorders that can be integrated directly into existing care pathways to support clinicians. However, despite the potential of digital tools in the field of mental health, there remain gaps in our understanding of how the intended user base, people with lived experiences of mental health concerns, perceive these technologies. Objective: This study explores the perspectives and attitudes of individuals with lived experiences of mental health concerns on mental health apps that are designed to support self-assessment and triage. Methods: A semistructured interview approach was used to explore the perspectives of the interviewees using 5 open-ended questions. Interviews were transcribed verbatim from audio data recordings. The average interview lasted 46 minutes (rounded to the nearest min; SD 12.93 min). A thematic analysis was conducted. Results: Overall, 16 individuals were interviewed in this study. The average age was 42.25 (SD 15.18) years, half of the interviewees identified as women (8/16, 50%), and all were White (16/16, 100%). The thematic analysis revealed six major themes: (1) availability and accessibility, (2) quality, (3) attitudes, (4) safety, (5) impact, and (6) functionality. Conclusions: Engaging in clear communication regarding data security and privacy policies, adopting a consent-driven approach to data sharing, and identifying gaps in the app marketplace to foster the inclusion of a range of mental health conditions and avoid oversaturation of apps for common mental health disorders (eg, depression and anxiety) were identified as priorities from interviewees’ comments. Furthermore, reputation was identified as a driver of uptake and engagement, with endorsement from a respected source (ie, health care provider, academic institution) or direct recommendation from a trusted health care professional associated with increased interest and trust. Furthermore, there was an interest in the role that co-designed digital self-assessments could play in existing care pathways, particularly in terms of facilitating informed discussions with health care professionals during appointments and by signposting individuals to the most appropriate services. In addition, interviewees discussed the potential of mental health apps to provide waiting list support to individuals awaiting treatment by providing personalized psychoeducation, self-help tips, and sources of help. However, concerns regarding the quality of care being affected because of digital delivery have been reported; therefore, frequent monitoring of patient acceptability and care outcomes is warranted. In addition, communicating the rationale and benefits of digitizing services will likely be important for securing interest and uptake from health care service users. %M 38393760 %R 10.2196/48881 %U https://formative.jmir.org/2024/1/e48881 %U https://doi.org/10.2196/48881 %U http://www.ncbi.nlm.nih.gov/pubmed/38393760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51996 %T Comprehensive Assessment and Early Prediction of Gross Motor Performance in Toddlers With Graph Convolutional Networks–Based Deep Learning: Development and Validation Study %A Chun,Sulim %A Jang,Sooyoung %A Kim,Jin Yong %A Ko,Chanyoung %A Lee,JooHyun %A Hong,JaeSeong %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 6th floor, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K child development %K digital health %K artificial intelligence %K gross %K motor %K movement %K development %K developmental %K machine learning %K pediatric %K pediatrics %K paediatric %K paediatrics %K toddler %K toddlers %K child %K children %K limb %K limbs %K algorithm %K algorithms %K kinesiology %K GCN %K graph convolutional networks %K convolutional network %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate and timely assessment of children’s developmental status is crucial for early diagnosis and intervention. More accurate and automated developmental assessments are essential due to the lack of trained health care providers and imprecise parental reporting. In various areas of development, gross motor development in toddlers is known to be predictive of subsequent childhood developments. Objective: The purpose of this study was to develop a model to assess gross motor behavior and integrate the results to determine the overall gross motor status of toddlers. This study also aimed to identify behaviors that are important in the assessment of overall gross motor skills and detect critical moments and important body parts for the assessment of each behavior. Methods: We used behavioral videos of toddlers aged 18-35 months. To assess gross motor development, we selected 4 behaviors (climb up the stairs, go down the stairs, throw the ball, and stand on 1 foot) that have been validated with the Korean Developmental Screening Test for Infants and Children. In the child behavior videos, we estimated each child’s position as a bounding box and extracted human keypoints within the box. In the first stage, the videos with the extracted human keypoints of each behavior were evaluated separately using a graph convolutional networks (GCN)–based algorithm. The probability values obtained for each label in the first-stage model were used as input for the second-stage model, the extreme gradient boosting (XGBoost) algorithm, to predict the overall gross motor status. For interpretability, we used gradient-weighted class activation mapping (Grad-CAM) to identify important moments and relevant body parts during the movements. The Shapley additive explanations method was used for the assessment of variable importance, to determine the movements that contributed the most to the overall developmental assessment. Results: Behavioral videos of 4 gross motor skills were collected from 147 children, resulting in a total of 2395 videos. The stage-1 GCN model to evaluate each behavior had an area under the receiver operating characteristic curve (AUROC) of 0.79 to 0.90. Keypoint-mapping Grad-CAM visualization identified important moments in each behavior and differences in important body parts. The stage-2 XGBoost model to assess the overall gross motor status had an AUROC of 0.90. Among the 4 behaviors, “go down the stairs” contributed the most to the overall developmental assessment. Conclusions: Using movement videos of toddlers aged 18-35 months, we developed objective and automated models to evaluate each behavior and assess each child’s overall gross motor performance. We identified the important behaviors for assessing gross motor performance and developed methods to recognize important moments and body parts while evaluating gross motor performance. %M 38381519 %R 10.2196/51996 %U https://formative.jmir.org/2024/1/e51996 %U https://doi.org/10.2196/51996 %U http://www.ncbi.nlm.nih.gov/pubmed/38381519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52338 %T Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial %A Badaghi,Nasim %A van Kruijsbergen,Mette %A Speckens,Anne %A Vilé,Joëlle %A Prins,Judith %A Kelders,Saskia %A Kwakkenbos,Linda %+ Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 0624835397, nasim.badaghimoreno@radboudumc.nl %K cancer %K eHeath %K online interventions %K mindfulness %K psycho-oncology %K qualitative research %K oncology %K CBT %K blended %K eMBCT %K iCBT %K cognitive therapy %K unguided %K psychotherapy %K MBCT %K co-creation %K therapist %K self-guided %K peer-support %K co-design %K participatory %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. Objective: The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Methods: Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. Results: We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Conclusions: Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. Trial Registration: ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916 %M 38381493 %R 10.2196/52338 %U https://formative.jmir.org/2024/1/e52338 %U https://doi.org/10.2196/52338 %U http://www.ncbi.nlm.nih.gov/pubmed/38381493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51727 %T Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study %A Hashtarkhani,Soheil %A Schwartz,David L %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center, 50 N Dunlap Street, R492, Memphis, TN, 38103, United States, 1 9012875863, ashabann@uthsc.edu %K geographical information system %K geoprocessing tool %K health disparities %K health equity %K health services management %K hemodialysis services %K spatial accessibility %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. Objective: In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Methods: Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users’ choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. Results: The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. Conclusions: These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively. %M 38381503 %R 10.2196/51727 %U https://formative.jmir.org/2024/1/e51727 %U https://doi.org/10.2196/51727 %U http://www.ncbi.nlm.nih.gov/pubmed/38381503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49526 %T Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study %A Muehlensiepen,Felix %A Hoffmann,Marie Josephine %A Nübel,Jonathan %A Ignatyev,Yury %A Heinze,Martin %A Butter,Christian %A Haase-Fielitz,Anja %+ Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Fehrbelliner Str 38, Neuruppin, 16816, Germany, 49 49333869 ext 4649, anja.haase-fielitz@mhb-fontane.de %K acceptance %K adoption %K cardiac %K cardiology %K cross sectional %K health services research %K heart %K preference %K survey %K telecardiology %K telehealth %K telemedicine %D 2024 %7 20.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology. %M 38376898 %R 10.2196/49526 %U https://formative.jmir.org/2024/1/e49526 %U https://doi.org/10.2196/49526 %U http://www.ncbi.nlm.nih.gov/pubmed/38376898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52195 %T Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study %A Cook,Stephanie H %A Wood,Erica P %A Rodrigues,Mariana %A Jachero Caldas,Janice %A Delorme,Maxline %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, Room 757, New York, NY, 10003, United States, 1 212 992 5635, sc5810@nyu.edu %K study protocol %K young sexual minority men %K YSSM %K cardiovascular disease risk %K health behaviors %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). Objective: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. Methods: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. Results: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one’s finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=−0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. Conclusions: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples. %M 38373036 %R 10.2196/52195 %U https://formative.jmir.org/2024/1/e52195 %U https://doi.org/10.2196/52195 %U http://www.ncbi.nlm.nih.gov/pubmed/38373036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50113 %T Patient and Therapist Perceptions of a Publicly Funded Internet-Based Cognitive Behavioral Therapy (iCBT) Program for Ontario Adults During the COVID-19 Pandemic: Qualitative Study %A Thapar,Serena %A Nguyen,Megan %A Khan,Bilal Noreen %A Fanaieyan,Roz %A Kishimoto,Vanessa %A Liu,Rebecca %A Bolea-Alamañac,Blanca %A Leon-Carlyle,Marisa %A O’Riordan,Anne %A Keresteci,Maggie %A Bhattacharyya,Onil %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 6474580101, serena.thapar@mail.mcgill.ca %K depression %K anxiety %K cognitive behavioral therapy %K digital health %K internet-delivered cognitive behavioral therapy %K iCBT %K CBT %K implementation %K facilitators %K barriers %K interviews %K qualitative %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the anticipated rise in mental health symptoms experienced at the population level during the COVID-19 pandemic, the Ontario government provided 2 therapist-assisted internet-delivered cognitive behavioral therapy (iCBT) programs to adults free of charge at the point of service. Objective: The study aims to explore the facilitators of and barriers to implementing iCBT at the population level in Ontario, Canada, from the perspective of patients and therapists to better understand how therapist-assisted iCBT programs can be effectively implemented at the population level and inform strategies for enhancing service delivery and integration into the health care system. Methods: Using a convenience sampling methodology, semistructured interviews were conducted with 10 therapists who delivered iCBT and 20 patients who received iCBT through either of the publicly funded programs to explore their perspectives of the program. Interview data were analyzed using inductive thematic analysis to generate themes. Results: Six salient themes were identified. Facilitators included the therapist-assisted nature of the program; the ease of registration and the lack of cost; and the feasibility of completing the psychoeducational modules given the online and self-paced nature of the program. Barriers included challenges with the online remote modality for developing the therapeutic alliance; the program’s generalized nature, which limited customization to individual needs; and a lack of formal integration between the iCBT program and the health care system. Conclusions: Although the program was generally well-received by patients and therapists due to its accessibility and feasibility, the digital format of the program presented both benefits and unique challenges. Strategies for improving the quality of service delivery include opportunities for synchronous communication between therapists and patients, options for increased customization, and the formal integration of iCBT into a broader stepped-care model that centralizes patient referrals between care providers and promotes continuity of care. %M 38373027 %R 10.2196/50113 %U https://formative.jmir.org/2024/1/e50113 %U https://doi.org/10.2196/50113 %U http://www.ncbi.nlm.nih.gov/pubmed/38373027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53654 %T Development of Cost-Effective Fatty Liver Disease Prediction Models in a Chinese Population: Statistical and Machine Learning Approaches %A Zhang,Liang %A Huang,Yueqing %A Huang,Min %A Zhao,Chun-Hua %A Zhang,Yan-Jun %A Wang,Yi %+ Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baitaxi Road, Gusu District, Suzhou, 215000, China, 86 13812757566, huangyq_sz@163.com %K NAFLD %K artificial intelligence %K public health %K transient elastography %K diagnosis %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) in China presents a significant public health concern. Traditional ultrasound, commonly used for fatty liver screening, often lacks the ability to accurately quantify steatosis, leading to insufficient follow-up for patients with moderate-to-severe steatosis. Transient elastography (TE) provides a more quantitative diagnosis of steatosis and fibrosis, closely aligning with biopsy results. Moreover, machine learning (ML) technology holds promise for developing more precise diagnostic models for NAFLD using a variety of laboratory indicators. Objective: This study aims to develop a novel ML-based diagnostic model leveraging TE results for staging hepatic steatosis. The objective was to streamline the model’s input features, creating a cost-effective and user-friendly tool to distinguish patients with NAFLD requiring follow-up. This innovative approach merges TE and ML to enhance diagnostic accuracy and efficiency in NAFLD assessment. Methods: The study involved a comprehensive analysis of health examination records from Suzhou Municipal Hospital, spanning from March to May 2023. Patient data and questionnaire responses were meticulously inputted into Microsoft Excel 2019, followed by thorough data cleaning and model development using Python 3.7, with libraries scikit-learn and numpy to ensure data accuracy. A cohort comprising 978 residents with complete medical records and TE results was included for analysis. Various classification models, including logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost), were constructed and evaluated based on the area under the receiver operating characteristic curve (AUROC). Results: Among the 916 patients included in the study, 273 were diagnosed with moderate-to-severe NAFLD. The concordance rate between traditional ultrasound and TE for detecting moderate-to-severe NAFLD was 84.6% (231/273). The AUROC values for the RF, LightGBM, XGBoost, SVM, KNN, and LR models were 0.91, 0.86, 0.83, 0.88, 0.77, and 0.81, respectively. These models achieved accuracy rates of 84%, 81%, 78%, 81%, 76%, and 77%, respectively. Notably, the RF model exhibited the best performance. A simplified RF model was developed with an AUROC of 0.88, featuring 62% sensitivity and 90% specificity. This simplified model used 6 key features: waist circumference, BMI, fasting plasma glucose, uric acid, total bilirubin, and high-sensitivity C-reactive protein. This approach offers a cost-effective and user-friendly tool while streamlining feature acquisition for training purposes. Conclusions: The study introduces a groundbreaking, cost-effective ML algorithm that leverages health examination data for identifying moderate-to-severe NAFLD. This model has the potential to significantly impact public health by enabling targeted investigations and interventions for NAFLD. By integrating TE and ML technologies, the study showcases innovative approaches to advancing NAFLD diagnostics. %M 38363597 %R 10.2196/53654 %U https://formative.jmir.org/2024/1/e53654 %U https://doi.org/10.2196/53654 %U http://www.ncbi.nlm.nih.gov/pubmed/38363597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52337 %T An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation %A Kwa,Zhi Yin %A Li,Jinqiu %A Loh,Dale Lincoln %A Lee,Yang Yang %A Liu,Guangyu %A Zhu,Lixia %A Pikkarainen,Minna %A He,Honggu %A Mali,Vidyadhar Padmakar %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, MD 11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K circumcision %K self-efficacy %K perioperative anxiety %K postoperative pain %K mobile phone %K postoperative %K pain %K anxiety %K distractions %K distraction %K perioperative %K interview %K interviews %K child %K children %K surgery %K surgical %K recovery %K health outcome %K health outcomes %K pediatric %K pediatrics %K content analysis %K emotional %K mobile health %K app %K apps %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. Objective: This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. Methods: Based on the review of the literature and previous studies, Bandura’s self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. Results: The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. Conclusions: ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404 %M 38363589 %R 10.2196/52337 %U https://formative.jmir.org/2024/1/e52337 %U https://doi.org/10.2196/52337 %U http://www.ncbi.nlm.nih.gov/pubmed/38363589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44717 %T Contactless Monitoring System Versus Gold Standard for Respiratory Rate Monitoring in Emergency Department Patients: Pilot Comparison Study %A Goldfine,Charlotte E %A Oshim,Md Farhan Tasnim %A Chapman,Brittany P %A Ganesan,Deepak %A Rahman,Tauhidur %A Carreiro,Stephanie P %+ Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 617 732 5640, cgoldfine@bwh.harvard.edu %K cardiopulmonary monitoring %K contactless monitor %K radar %K respiratory rate %K vital signs %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory rate is a crucial indicator of disease severity yet is the most neglected vital sign. Subtle changes in respiratory rate may be the first sign of clinical deterioration in a variety of disease states. Current methods of respiratory rate monitoring are labor-intensive and sensitive to motion artifacts, which often leads to inaccurate readings or underreporting; therefore, new methods of respiratory monitoring are needed. The PulsON 440 (P440; TSDR Ultra Wideband Radios and Radars) radar module is a contactless sensor that uses an ultrawideband impulse radar to detect respiratory rate. It has previously demonstrated accuracy in a laboratory setting and may be a useful alternative for contactless respiratory monitoring in clinical settings; however, it has not yet been validated in a clinical setting. Objective: The goal of this study was to (1) compare the P440 radar module to gold standard manual respiratory rate monitoring and standard of care telemetry respiratory monitoring through transthoracic impedance plethysmography and (2) compare the P440 radar to gold standard measurements of respiratory rate in subgroups based on sex and disease state. Methods: This was a pilot study of adults aged 18 years or older being monitored in the emergency department. Participants were monitored with the P440 radar module for 2 hours and had gold standard (manual respiratory counting) and standard of care (telemetry) respiratory rates recorded at 15-minute intervals during that time. Respiratory rates between the P440, gold standard, and standard telemetry were compared using Bland-Altman plots and intraclass correlation coefficients. Results: A total of 14 participants were enrolled in the study. The P440 and gold standard Bland-Altman analysis showed a bias of –0.76 (–11.16 to 9.65) and an intraclass correlation coefficient of 0.38 (95% CI 0.06-0.60). The P440 and gold standard had the best agreement at normal physiologic respiratory rates. There was no change in agreement between the P440 and the gold standard when grouped by admitting diagnosis or sex. Conclusions: Although the P440 did not have statistically significant agreement with gold standard respiratory rate monitoring, it did show a trend of increased agreement in the normal physiologic range, overestimating at low respiratory rates, and underestimating at high respiratory rates. This trend is important for adjusting future models to be able to accurately detect respiratory rates. Once validated, the contactless respiratory monitor provides a unique solution for monitoring patients in a variety of settings. %M 38363588 %R 10.2196/44717 %U https://formative.jmir.org/2024/1/e44717 %U https://doi.org/10.2196/44717 %U http://www.ncbi.nlm.nih.gov/pubmed/38363588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e34162 %T Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study %A Saby,Adam %A Alvarez,Anthony %A Smolins,David %A Petros,James %A Nguyen,Lincoln %A Trujillo,Michael %A Aygün,Oytun %+ Karuna Labs, 185 Wythe Avenue Brooklyn, New York, NY, 11249, United States, 1 641824514, oytunsultanaygun@gmail.com %K centralized pain %K dicentralized pain %K digital therapeutics %K visual analog scale %K Fear-Avoidance Beliefs Questionnaire %K Oswestry %K Oswestry Low Back Pain Disability Questionnaire %K Pain Catastrophizing Scale %K Patient Health Questionnaire %K sensorimotor %K virtual reality %K chronic pain %K pain %K rehabilitation %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. Objective: The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. Methods: An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. Results: A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). Conclusions: This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. Trial Registration: ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875 %M 38363591 %R 10.2196/34162 %U https://formative.jmir.org/2024/1/e34162 %U https://doi.org/10.2196/34162 %U http://www.ncbi.nlm.nih.gov/pubmed/38363591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38803 %T Use Intention and User Expectations of Human-Supported and Self-Help eHealth Interventions: Internet-Based Randomized Controlled Trial %A Cohen Rodrigues,Talia R %A Reijnders,Thomas %A Breeman,Linda D %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Atsma,Douwe E %A Evers,Andrea WM %+ Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 71 527 3627, t.r.cohen.rodrigues@fsw.leidenuniv.nl %K eHealth %K human support %K Unified Theory of Acceptance and Use of Technology %K use intention %K UTAUT %K working alliance %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. Objective: This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. Methods: A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app–based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. Results: Use intention did not differ significantly between the 2 conditions (t142=–1.133; P=.26). Performance expectancy (F1,140=69.269; P<.001), effort expectancy (F1,140=3.961; P=.049), social influence (F1,140=90.025; P<.001), and expected working alliance (F1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F1,140=4.363; P=.04) and effort expectancy (F1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. Conclusions: As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention’s helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. Trial Registration: OSF Registries osf.io/n47cz; https://osf.io/n47cz %M 38358784 %R 10.2196/38803 %U https://formative.jmir.org/2024/1/e38803 %U https://doi.org/10.2196/38803 %U http://www.ncbi.nlm.nih.gov/pubmed/38358784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54194 %T Measurement of Head Circumference Using a Smartphone: Feasibility Cohort Study %A Yordanov,Stefan %A Akhter,Kalsoom %A Quan Teh,Jye %A Naushahi,Jawad %A Jalloh,Ibrahim %+ Academic Division of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 01223 805000 ext 348134, yordanov.stefan@yahoo.com %K head circumference %K HC %K hydrocephalus %K neurosurgery %K pediatric neurosurgery %K paediatric neurosurgery %K neurology %K neuro %K neurosurgeon %K neurologist %K mobile health %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate head circumference (HC) measurement is essential when assessing neonates and infants. Tape measure HC measurements are prone to errors, particularly when performed by parents/guardians, due to individual differences in head shape, hair style and texture, subject cooperation, and examiner techniques, including tape measure placement and tautness. There is, therefore, the need for a more reliable method. Objective: The primary objective of this study was to evaluate the validity, reliability, and consistency of HC app measurement compared to the current standard of practice, serving as a proof-of-concept for use by health care professionals. Methods: We recruited infants attending the neurosurgery clinic, and parents/guardians were approached and consented to participate in the study. Along with the standard head circumference measurement, measurements were taken with the head circumference app (HC app) developed in-house, and we also collected baseline medical history and characteristics. For the statistical analysis, we used RStudio (version 4.1.1). In summary, we analyzed covariance and intraclass correlation coefficient (ICC) to compare the measurement's within-rater and interrater reliability. The F test was used to analyze the variance between measurements and the Bland-Altman agreement, t test, and correlation coefficients were used to compare the tape measurement to the measures taken by the HC app. We also used nonvalidated questionnaires to explore parental or guardians’ experiences, assess their views on app utility, and collect feedback. Results: The total number of recruited patients was 37. Comparison between the app measurements and the measurements with a tape measure showed poor reliability (ICC=0.177) and wide within-app variations (ICC=0.341). The agreement between the measurements done by parents/guardians and the tape measurements done by the researcher was good (ICC=0.901). Parental/guardian feedback was overall very positive, with most of the parents/guardians reporting that the app was easy to use (n=31, 84%) and that they are happy to use the app in an unsupervised setting, provided that they are assured of the measurement quality. Conclusions: We developed this project as a proof-of-concept study, and as such, the app has shown great potential to be used both in a clinical setting and by parents/guardians in their own homes. %M 38354022 %R 10.2196/54194 %U https://formative.jmir.org/2024/1/e54194 %U https://doi.org/10.2196/54194 %U http://www.ncbi.nlm.nih.gov/pubmed/38354022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47181 %T Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study %A Locke,Sean %A Osborne,Jenna %+ Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON, L2S 3A1, Canada, 1 905 668 5550 ext 4958, slocke@brocku.ca %K mobile health %K mHealth %K behavior change %K stress management %K intervention %K pilot study %K heart rate variability %K health coaching %K coach %K coaching %K coaches %K work-related stress %K stress %K wellness %K burnout %K behavioral intervention %K work %K worker %K workers %K employee %K employees %K occupational health %K job %K satisfaction %K web-based %K remote %K corporate %K web analytics %K biofeedback %K survey %K surveys %K interview %K interviews %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. Objective: This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. Methods: The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Results: Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. Conclusions: The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner. %M 38354036 %R 10.2196/47181 %U https://formative.jmir.org/2024/1/e47181 %U https://doi.org/10.2196/47181 %U http://www.ncbi.nlm.nih.gov/pubmed/38354036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52660 %T Using #ActuallyAutistic on Twitter for Precision Diagnosis of Autism Spectrum Disorder: Machine Learning Study %A Jaiswal,Aditi %A Washington,Peter %+ Department of Information and Computer Sciences, University of Hawaii at Manoa, Room 312C, Pacific Ocean Science and Technology, 1680 East-West Road, Honolulu, HI, 96822, United States, 1 8088296359, ajaiswal@hawaii.edu %K autism %K autism spectrum disorder %K machine learning %K natural language processing %K public health %K sentiment analysis %K social media analysis %K Twitter %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing use of social media platforms has given rise to an unprecedented surge in user-generated content, with millions of individuals publicly sharing their thoughts, experiences, and health-related information. Social media can serve as a useful means to study and understand public health. Twitter (subsequently rebranded as “X”) is one such social media platform that has proven to be a valuable source of rich information for both the general public and health officials. We conducted the first study applying Twitter data mining to autism screening. Objective: We aimed to study the feasibility of autism screening from Twitter data and discuss the ethical implications of such models. Methods: We developed a machine learning model to attempt to distinguish individuals with autism from their neurotypical peers based on the textual patterns from their public communications on Twitter. We collected 6,515,470 tweets from users’ self-identification with autism using “#ActuallyAutistic” and a separate control group. To construct the data set, we targeted English-language tweets using the search query “#ActuallyAutistic” posted from January 1, 2014 to December 31, 2022. We encrypted all user IDs and stripped the tweets of identifiable information such as the associated email address prior to analysis. From these tweets, we identified unique users who used keywords such as “autism” OR “autistic” OR “neurodiverse” in their profile description and collected all the tweets from their timelines. To build the control group data set, we formulated a search query excluding the hashtag “#ActuallyAutistic” and collected 1000 tweets per day during the same time period. We trained a word2vec model and an attention-based, bidirectional long short-term memory model to validate the performance of per-tweet and per-profile classification models. We deleted the data set and the models after our analysis. Results: Our tweet classifier reached a 73% accuracy, a 0.728 area under the receiver operating characteristic curve score, and an 0.71 F1-score using word2vec representations fed into a logistic regression model, while the user profile classifier achieved an 0.78 area under the receiver operating characteristic curve score and an F1-score of 0.805 using an attention-based, bidirectional long short-term memory model. Conclusions: We have shown that it is feasible to train machine learning models using social media data to predict use of the #ActuallyAutistic hashtag, an imperfect proxy for self-reported autism. While analyzing textual differences in naturalistic text has the potential to help clinicians screen for autism, there remain ethical questions that must be addressed for such research to move forward and to translate into the real world. While machine learning has the potential to improve behavioral research, there are still a plethora of ethical issues in digital phenotyping studies using social media with respect to user consent of marginalized populations. Achieving this requires a more inclusive approach during the model development process that involves the autistic community directly in the ideation and consent processes. %M 38354045 %R 10.2196/52660 %U https://formative.jmir.org/2024/1/e52660 %U https://doi.org/10.2196/52660 %U http://www.ncbi.nlm.nih.gov/pubmed/38354045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49322 %T The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial %A Salas-Groves,Emily %A Alcorn,Michelle %A Childress,Allison %A Galyean,Shannon %+ Nutritional Sciences, Texas Tech University, 1301 Akron Avenue, Lubbock, TX, 79409, United States, 1 806 834 2286, shannon.galyean@ttu.edu %K older adults %K culinary medicine %K protein %K muscle mass %K muscle strength %K physical activity %K nutrition intervention %K online %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults’ muscle strength and mass. Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group’s muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit. Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978 %M 38349721 %R 10.2196/49322 %U https://formative.jmir.org/2024/1/e49322 %U https://doi.org/10.2196/49322 %U http://www.ncbi.nlm.nih.gov/pubmed/38349721 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45471 %T Nonuse of Blended Web-Based and Face-To-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study %A Tarp,Kristine %A Christiansen,Regina %A Bilberg,Randi %A Borkner,Simone %A Dalsgaard,Caroline %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 21292332, ket@nfa.dk %K alcohol use disorder %K blended internet-based and face-to-face cognitive behavioral therapy %K nonuse %K patient perceptions %K qualitative %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies for health care has been the focus of social studies, which have concentrated on the digital divide between individuals who use technology and those who do not—with the latter often being considered as individuals with shortcomings. In Denmark, 91% of the population have computers and 97 out of 100 families have internet access, indicating that lack of access to technology is not the primary reason for nonuse. Although previous studies have primarily focused on participants' perspectives of using internet-based treatment for alcohol use disorder (AUD), no study has investigated individuals’ reasons to prefer face-to-face treatment over blended face-to-face and internet-based cognitive behavioral therapy (bCBT) for AUD among treatment-seeking populations. Objective: The aim of this qualitative study was to investigate the nonuse of bCBT among patients with AUD. Specifically, this study aims to explore patients' reasons for choosing not to receive treatment via this format. Methods: This study was conducted among Danish patients with AUD who were enrolled in the study “Blending internet treatment into conventional face-to-face treatment for alcohol use disorder (Blend-A)” but had not used bCBT. The participant group consisted of 11 patients with AUD: 3 women and 8 men. The age range of the participants was 29-78 years (mean 59 years). Individual semistructured interviews were conducted using cell phones to gather participants’ reasons for not choosing bCBT. The interviews were recorded, transcribed, and analyzed using thematic analysis. Five authors performed the analysis in 3 steps: (1) two authors read the transcripts and coded themes from their immediate impression of the material, (2) one author provided feedback, which was used to group overlapping themes together or create new themes that better reflected the content, and (3) the remaining two authors provided feedback on the analysis to improve its structure, readability, and relevance to the research aim. Results: We found that the participants had various reasons for choosing face-to-face treatment over bCBT; these reasons were more related to personal matters and lesser to digital health literacy. We identified 4 themes related to personal matters for choosing face-to-face treatment over bCBT: (1) patients’ need for attending sessions in person, (2) preference for verbal communication, (3) desire for immediate feedback, and (4) feeling more empowered and motivated with face-to-face sessions. Conclusions: This study provides valuable insight into participants’ perspectives on blended therapy for AUD and highlights the importance of considering personal factors when designing digital health interventions. Our study indicates that most of the participants choose not to use bCBT for AUD because they perceive such treatment formats as impersonal. Instead, they prefer direct communication with the therapist, including the ability to express and comprehend facial expressions and body language. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03122-4 %M 38349711 %R 10.2196/45471 %U https://formative.jmir.org/2024/1/e45471 %U https://doi.org/10.2196/45471 %U http://www.ncbi.nlm.nih.gov/pubmed/38349711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44111 %T Evaluating the Intensity of Exposure to MTV Shuga, an Edutainment Program for HIV Prevention: Cross-Sectional Study in Eastern Cape, South Africa %A Mulwa,Sarah %A Baker,Venetia %A Cawood,Cherie %A Khanyile,David %A O'Donnell,Dominique %A Sarrassat,Sophie %A Cousens,Simon %A Birdthistle,Isolde %+ Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 863, sarah.mulwa@lshtm.ac.uk %K young people %K media %K evaluation %K dose-response %K edutainment %K HIV prevention %K mobile phone %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: MTV Shuga is an edutainment campaign designed to equip young people with knowledge, motivation, and informed choices to protect themselves from HIV infection. From 2019 to 2020, a total of 10 episodes of a new dramatic series, MTV Shuga “Down South 2” (DS2), were broadcast via television and the internet, alongside complementary media activities. Objective: This study aims to investigate whether the intensity of DS2 exposure was linked with positive HIV prevention outcomes in a setting with high HIV prevalence and relatively low levels of HIV testing. Methods: We analyzed data from a web-based survey of participants aged 15 to 24 years in South Africa in 2020. The survey was promoted via social media platforms of schools, universities, and communities in Eastern Cape, South Africa. The primary exposure of interest was the intensity of exposure to DS2, measured by the number of episodes of DS2 watched on the television or the internet or listened to on the radio (out of 10 episodes). Individuals who had not watched or listened to any DS2 episode were classified according to other MTV Shuga content that they had accessed. We estimated associations between the intensity of DS2 exposure and HIV-related outcomes, including knowledge of HIV status, awareness of HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP), uptake of HIVST, and demand for HIVST and PrEP, adjusting for potential confounders using multivariable logistic regression. Results: Among the 3431 survey participants, 827 (24.1%) were exposed to DS2. Specifically, 18.1% (622/3431) watched or listened to only 1 DS2 episode, and 2.4% (82/3431), 1.7% (58/3431), and 1.8% (62/3431) watched or listened to 2 to 4, 5 to 7, and 8 to 10 DS2 episodes, respectively. Increasing the exposure to DS2 was associated with improvements in most outcomes. Exposure to multiple episodes (eg, 2-4, 5-7, and 8-10) was associated with successively higher odds of knowing one’s HIV status, awareness of PrEP and HIVST, and uptake of HIVST compared with no MTV Shuga exposure, albeit with statistical uncertainty around some estimates. The interest in using HIVST or PrEP was high overall (>80%), with no measurable differences by DS2 intensity. Conclusions: We found evidence consistent with a dose-response relationship between MTV Shuga DS2 exposure and outcomes, including knowledge of HIV status, awareness and uptake of HIVST, and awareness of PrEP among young people in Eastern Cape. This indicates that greater engagement with a youth-focused edutainment campaign can improve HIV testing and prevention options in a setting and population with high need. However, only a few participants accessed multiple DS2 episodes despite its availability on multiple media platforms. We conclude that there is potential to benefit more young people by increasing access to and interest in the show. %M 38349729 %R 10.2196/44111 %U https://formative.jmir.org/2024/1/e44111 %U https://doi.org/10.2196/44111 %U http://www.ncbi.nlm.nih.gov/pubmed/38349729 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e46697 %T A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study %A Pine,Russell %A Mbinta,James %A Te Morenga,Lisa %A Fleming,Theresa %+ School of Health, Victoria University of Wellington, Kelburn Parade, Kelburn, Wellington, 6012, New Zealand, 64 4 472 1000, russell.pine@vuw.ac.nz %K adolescent %K anxiety %K casual video games %K digital mental health interventions %K gaming %K mental health %K micro interventions %K serious game %K teenage %K video game %K youth %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored. Objective: This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents. Methods: We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children’s Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4. Results: Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI –0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI –2.71 to 4.31; P=.64) for GHSQ; –1.09 (95% CI –2.83 to 0.66; P=.21) for FS; and –3.42 (95% CI –6.84 to –0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful. Conclusions: The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation. International Registered Report Identifier (IRRID): RR2-10.2196/31588 %M 38345848 %R 10.2196/46697 %U https://games.jmir.org/2024/1/e46697 %U https://doi.org/10.2196/46697 %U http://www.ncbi.nlm.nih.gov/pubmed/38345848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38372 %T Privacy, Security, and Legal Issues in the Health Cloud: Structured Review for Taxonomy Development %A Zandesh,Zahra %+ Information Technology and Statistics Department, Tehran University of Medical Sciences, Keshavarz Blvd, next to the intersection of Qods St., Tehran, 1417653761, Iran, 98 2181633102, Zandesh.z@gmail.com %K taxonomy %K privacy %K security %K legal %K cloud computing %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Privacy in our digital world is a very complicated topic, especially when meeting cloud computing technological achievements with its multidimensional context. Here, privacy is an extended concept that is sometimes referred to as legal, philosophical, or even technical. Consequently, there is a need to harmonize it with other aspects in health care in order to provide a new ecosystem. This new ecosystem can lead to a paradigm shift involving the reconstruction and redesign of some of the most important and essential requirements like privacy concepts, legal issues, and security services. Cloud computing in the health domain has markedly contributed to other technologies, such as mobile health, health Internet of Things, and wireless body area networks, with their increasing numbers of embedded applications. Other dependent applications, which are usually used in health businesses like social networks, or some newly introduced applications have issues regarding privacy transparency boundaries and privacy-preserving principles, which have made policy making difficult in the field. Objective: One way to overcome this challenge is to develop a taxonomy to identify all relevant factors. A taxonomy serves to bring conceptual clarity to the set of alternatives in in-person health care delivery. This study aimed to construct a comprehensive taxonomy for privacy in the health cloud, which also provides a prospective landscape for privacy in related technologies. Methods: A search was performed for relevant published English papers in databases, including Web of Science, IEEE Digital Library, Google Scholar, Scopus, and PubMed. A total of 2042 papers were related to the health cloud privacy concept according to predefined keywords and search strings. Taxonomy designing was performed using the deductive methodology. Results: This taxonomy has 3 layers. The first layer has 4 main dimensions, including cloud, data, device, and legal. The second layer has 15 components, and the final layer has related subcategories (n=57). This taxonomy covers some related concepts, such as privacy, security, confidentiality, and legal issues, which are categorized here and defined by their expansion and distinctive boundaries. The main merits of this taxonomy are its ability to clarify privacy terms for different scenarios and signalize the privacy multidisciplinary objectification in eHealth. Conclusions: This taxonomy can cover health industry requirements with its specifications like health data and scenarios, which are considered as the most complicated among businesses and industries. Therefore, the use of this taxonomy could be generalized and customized to other domains and businesses that have less complications. Moreover, this taxonomy has different stockholders, including people, organizations, and systems. If the antecedent effort in the taxonomy is proven, subject matter experts could enhance the extent of privacy in the health cloud by verifying, evaluating, and revising this taxonomy. %M 38345858 %R 10.2196/38372 %U https://formative.jmir.org/2024/1/e38372 %U https://doi.org/10.2196/38372 %U http://www.ncbi.nlm.nih.gov/pubmed/38345858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51225 %T The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study %A Lee,Hyerim %A Choi,Eung Ho %A Shin,Jung U %A Kim,Tae-Gyun %A Oh,Jooyoung %A Shin,Bokyoung %A Sim,Jung Yeon %A Shin,Jaeyong %A Kim,Meelim %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, Atkinson Hall, 9500 Gilman Dr, La Jolla, San Diego, CA, 92121, United States, 1 323 776 5171, mek007@health.ucsd.edu %K atopic %K dermatitis %K experimental design %K mobile health %K patient engagement %K research methodology %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. Objective: We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. Methods: We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification (“basic” or “advanced”) and human coach (“on” or “off”) experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. Results: The primary outcome indicated that group 4, provided with “advanced-level push notifications” and a “human coach,” showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. Conclusions: These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. Trial Registration: Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv %M 38335015 %R 10.2196/51225 %U https://formative.jmir.org/2024/1/e51225 %U https://doi.org/10.2196/51225 %U http://www.ncbi.nlm.nih.gov/pubmed/38335015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47555 %T Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study %A Pierz,Kerri A %A Locantore,Nicholas %A McCreary,Gretchen %A Calvey,Robert J %A Hackney,Nickole %A Doshi,Pooja %A Linnell,John %A Sundaramoorthy,Abirammy %A Reed,Carol R %A Yates,Julie %+ Wellinks (Convexity Scientific, Inc), 85 Willow Street, New Haven, CT, 06511, United States, 1 203 240 5619, kerri.pierz@wellinks.com %K chronic obstructive pulmonary disease %K COPD %K health coaching %K pulmonary rehabilitation %K remote care %K disease management %K patient engagement %K Wellinks %K digital health %K adult %K mobile app %K remote model of care %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery. Objective: This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD. Methods: A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score. Results: In total, 141 adults consented and completed Wellinks onboarding; 84.4% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7% (n=78) were female. Most participants (n=119, 84.4%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3% and 89.4%, respectively, at week 1 but waned over the study period to 8.5% and 9.2%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5% (n=85) and 91% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24. Conclusions: This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools. Trial Registration: ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280 %M 38335023 %R 10.2196/47555 %U https://formative.jmir.org/2024/1/e47555 %U https://doi.org/10.2196/47555 %U http://www.ncbi.nlm.nih.gov/pubmed/38335023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47360 %T Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study %A Bhattacharjee,Ananya %A Chen,Pan %A Mandal,Abhijoy %A Hsu,Anne %A O'Leary,Katie %A Mariakakis,Alex %A Williams,Joseph Jay %+ Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON, M5S 2E4, Canada, 1 647 619 6982, ananya@cs.toronto.edu %K reflection %K mental health %K stress %K reflective questioning activity %K RQA %K brief intervention %K computer-mediated communication %K email %K SMS text messaging %K mobile phone %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA’s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants’ subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. %M 38329800 %R 10.2196/47360 %U https://formative.jmir.org/2024/1/e47360 %U https://doi.org/10.2196/47360 %U http://www.ncbi.nlm.nih.gov/pubmed/38329800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43770 %T Predictors of Mental Health Literacy in a Sample of Health Care Major Students: Pilot Evaluation Study %A Tohme,Pia %A Abi Fadel,Nour %A Yaktine,Nour %A Abi-Habib,Rudy %+ Department of Social and Education Sciences, Lebanese American University, Beirut Campus, Chouran, Beirut, 5056, Lebanon, 961 01786456 ext 2733, rudy.abihabib@lau.edu.lb %K awareness %K COVID-19 %K digital health literacy %K digital health %K disorder %K empathy %K health literacy %K literacy %K mental health literacy %K mental health %K mentalizing %K questionnaire %K students %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The numerous mental health awareness campaigns during the COVID-19 pandemic have shifted our understanding and perception of mental health. Objective: The purpose of this study is to evaluate predictors of mental health literacy (MHL), that is, one’s knowledge and beliefs about mental disorders. We evaluate whether digital health literacy, empathy, and mentalizing contribute to MHL. Methods: Our sample consisted of 89 health care major students, aged between 17 and 32 years, studying at a university in Lebanon. The Mental Health Literacy Scale for Healthcare Students (MHLS-HS), the eHealth Literacy Questionnaire (eHLQ), the Basic Empathy Scale (BES), and the Reflective Functioning Questionnaire-8 (RFQ-8) were used. Results: Multiple regression analyses revealed that the Engagement in Own Health subscale of digital health literacy constituted a predictor of MHL. While empathy and mentalizing did not directly predict MHL, they were found to predict components of MHL. Conclusions: This is the first study to evaluate digital health literacy, empathy, and mentalizing as predictors of MHL in Lebanon, a country where mental health is still considered taboo. Moreover, this pilot study is the first to provide some support for the predictive role of some digital health literacy subscales on MHL in light of the rise of the digital era following the COVID-19 pandemic. %M 38329801 %R 10.2196/43770 %U https://formative.jmir.org/2024/1/e43770 %U https://doi.org/10.2196/43770 %U http://www.ncbi.nlm.nih.gov/pubmed/38329801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38891 %T A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort %A Gannamani,Rahul %A Castela Forte,José %A Folkertsma,Pytrik %A Hermans,Sven %A Kumaraswamy,Sridhar %A van Dam,Sipko %A Chavannes,Niels %A van Os,Hendrikus %A Pijl,Hanno %A Wolffenbuttel,Bruce H R %+ Ancora Health BV, Hereplein 34, Groningen, 9711LM, Netherlands, 31 628218360, jose@ancora.health %K lifestyle intervention %K prevention %K obesity %K overweight %K weight loss %K digital health %K intervention %K weight %K pilot %K digital %K data %K Fogg Behavior Model %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. Objective: The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. Methods: Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. Results: Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. Conclusions: Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL. %M 38329792 %R 10.2196/38891 %U https://formative.jmir.org/2024/1/e38891 %U https://doi.org/10.2196/38891 %U http://www.ncbi.nlm.nih.gov/pubmed/38329792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e32690 %T Vision-Language Model for Generating Textual Descriptions From Clinical Images: Model Development and Validation Study %A Ji,Jia %A Hou,Yongshuai %A Chen,Xinyu %A Pan,Youcheng %A Xiang,Yang %+ Peng Cheng Laboratory, No. 2 Xingke 1st Street, Shenzhen, 518000, China, 86 18566668732, panyoucheng4@gmail.com %K clinical image %K radiology report generation %K vision-language model %K multistage fine-tuning %K prior knowledge %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The automatic generation of radiology reports, which seeks to create a free-text description from a clinical radiograph, is emerging as a pivotal intersection between clinical medicine and artificial intelligence. Leveraging natural language processing technologies can accelerate report creation, enhancing health care quality and standardization. However, most existing studies have not yet fully tapped into the combined potential of advanced language and vision models. Objective: The purpose of this study was to explore the integration of pretrained vision-language models into radiology report generation. This would enable the vision-language model to automatically convert clinical images into high-quality textual reports. Methods: In our research, we introduced a radiology report generation model named ClinicalBLIP, building upon the foundational InstructBLIP model and refining it using clinical image-to-text data sets. A multistage fine-tuning approach via low-rank adaptation was proposed to deepen the semantic comprehension of the visual encoder and the large language model for clinical imagery. Furthermore, prior knowledge was integrated through prompt learning to enhance the precision of the reports generated. Experiments were conducted on both the IU X-RAY and MIMIC-CXR data sets, with ClinicalBLIP compared to several leading methods. Results: Experimental results revealed that ClinicalBLIP obtained superior scores of 0.570/0.365 and 0.534/0.313 on the IU X-RAY/MIMIC-CXR test sets for the Metric for Evaluation of Translation with Explicit Ordering (METEOR) and the Recall-Oriented Understudy for Gisting Evaluation (ROUGE) evaluations, respectively. This performance notably surpasses that of existing state-of-the-art methods. Further evaluations confirmed the effectiveness of the multistage fine-tuning and the integration of prior information, leading to substantial improvements. Conclusions: The proposed ClinicalBLIP model demonstrated robustness and effectiveness in enhancing clinical radiology report generation, suggesting significant promise for real-world clinical applications. %M 38329788 %R 10.2196/32690 %U https://formative.jmir.org/2024/1/e32690 %U https://doi.org/10.2196/32690 %U http://www.ncbi.nlm.nih.gov/pubmed/38329788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54299 %T Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App %A Young,Stephanie Ruth %A Dworak,Elizabeth McManus %A Byrne,Greg Joseph %A Jones,Callie Madison %A Yao,Lihua %A Yoshino Benavente,Julia Noelani %A Diaz,Maria Varela %A Curtis,Laura %A Gershon,Richard %A Wolf,Michael %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue 21st Floor, Chicago, IL, 60611-3008, United States, 1 3125033303, stephanieruth.young@northwestern.edu %K cognitive screening %K cognitive %K cognition %K psychometric %K usability %K feasibility %K early detection %K dementia %K Alzheimer’s disease, Alzheimer's %K Alzheimer’s disease and age-related dementia %K mHealth, mobile health apps %K detection %K screening %K mobile health %K mobile phone %K app %K apps %K applications %K applications %K user experience %K smartphone %K smartphones %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians’ ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics’ time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants’ rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants’ abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. %M 38324368 %R 10.2196/54299 %U https://formative.jmir.org/2024/1/e54299 %U https://doi.org/10.2196/54299 %U http://www.ncbi.nlm.nih.gov/pubmed/38324368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50561 %T Tumor Immunotherapy–Related Information on Internet-Based Videos Commonly Used by the Chinese Population: Content Quality Analysis %A Ni,Chen-xu %A Fei,Yi-bo %A Wu,Ran %A Cao,Wen-xiang %A Liu,Wenhao %A Huang,Fang %A Shen,Fu-ming %A Li,Dong-jie %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 021 66302570, djli@tongji.edu.cn %K immunotherapy %K internet videos %K quality %K misinformation %K health informatics %K Chinese %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tumor immunotherapy is an innovative treatment today, but there are limited data on the quality of immunotherapy information on social networks. Dissemination of misinformation through the internet is a major social issue. Objective: Our objective was to characterize the quality of information and presence of misinformation about tumor immunotherapy on internet-based videos commonly used by the Chinese population. Methods: Using the keyword “tumor immunotherapy” in Chinese, we searched TikTok, Tencent, iQIYI, and BiliBili on March 5, 2022. We reviewed the 118 screened videos using the Patient Education Materials Assessment Tool—a validated instrument to collect consumer health information. DISCERN quality criteria and the JAMA (Journal of the American Medical Association) Benchmark Criteria were used for assessing the quality and reliability of the health information. The videos’ content was also evaluated. Results: The 118 videos about tumor immunotherapy were mostly uploaded by channels dedicated to lectures, health-related animations, and interviews; their median length was 5 minutes, and 79% of them were published in and after 2018. The median understandability and actionability of the videos were 71% and 71%, respectively. However, the quality of information was moderate to poor on the validated DISCERN and JAMA assessments. Only 12 videos contained misinformation (score of >1 out of 5). Videos with a doctor (lectures and interviews) not only were significantly less likely to contain misinformation but also had better quality and a greater forwarding number. Moreover, the results showed that more than half of the videos contain little or no content on the risk factors and management of tumor immunotherapy. Overall, over half of the videos had some or more information on the definition, symptoms, evaluation, and outcomes of tumor immunotherapy. Conclusions: Although the quality of immunotherapy information on internet-based videos commonly used by Chinese people is moderate, these videos have less misinformation and better content. Caution must be exercised when using these videos as a source of tumor immunotherapy–related information. %M 38324352 %R 10.2196/50561 %U https://formative.jmir.org/2024/1/e50561 %U https://doi.org/10.2196/50561 %U http://www.ncbi.nlm.nih.gov/pubmed/38324352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47372 %T Explainable Machine Learning Classification to Identify Vulnerable Groups Among Parenting Mothers: Web-Based Cross-Sectional Questionnaire Study %A Hanai,Akiko %A Ishikawa,Tetsuo %A Sugao,Shoko %A Fujii,Makoto %A Hirai,Kei %A Watanabe,Hiroko %A Matsuzaki,Masayo %A Nakamoto,Goji %A Takeda,Toshihiro %A Kitabatake,Yasuji %A Itoh,Yuichi %A Endo,Masayuki %A Kimura,Tadashi %A Kawakami,Eiryo %+ Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, W507/509 West Research Building,, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, 230-0045, Japan, 81 455039455, tetsuo.ishikawa@riken.jp %K explainable machine-learning %K unsupervised clustering %K perceived support %K resilience %K adaptation %K mother’s health %K mobile phone %K machine learning %K web-based %K parenting %K postpartum %K antenatal %K survey %K mother %K women %K newborn %K psychosocial %K infant %K parents %K children %K depression %K digital health %K maternal %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. Objective: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. Methods: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. Results: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. Conclusions: The classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality. %M 38324356 %R 10.2196/47372 %U https://formative.jmir.org/2024/1/e47372 %U https://doi.org/10.2196/47372 %U http://www.ncbi.nlm.nih.gov/pubmed/38324356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46824 %T Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study %A Yu,Chou Chuen %A Tou,Nien Xiang %A Low,James Alvin %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore, 65 68078024, yu.chou.chuen@geri.com.sg %K COVID-19 %K digital divide %K well-being %K older adults %K information and communication technology %K internet of things %K online %K mental health %K lockdown %K depression %K stress %K anxiety %K digital technology %K pandemic %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. %M 38319700 %R 10.2196/46824 %U https://formative.jmir.org/2024/1/e46824 %U https://doi.org/10.2196/46824 %U http://www.ncbi.nlm.nih.gov/pubmed/38319700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46746 %T Attitudes Toward School-Based Surveillance of Adolescents’ Social Media Activity: Convergent Parallel Mixed Methods Survey %A Burke,Colin %A Triplett,Cynthia %A Rubanovich,Caryn Kseniya %A Karnaze,Melissa M %A Bloss,Cinnamon S %+ Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive MC0811, La Jolla, CA, 92093-0811, United States, 1 (858) 534 2230, cbloss@eng.ucsd.edu %K social media %K surveillance %K privacy %K public health %K students %K schools %K social media monitoring %K SMM %K school safety %K mental health %K adolescents %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults’ overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. %M 38319696 %R 10.2196/46746 %U https://formative.jmir.org/2024/1/e46746 %U https://doi.org/10.2196/46746 %U http://www.ncbi.nlm.nih.gov/pubmed/38319696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51021 %T Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App %A Masiero,Marianna %A Filipponi,Chiara %A Fragale,Elisa %A Pizzoli,Silvia Francesca Maria %A Munzone,Elisabetta %A Milani,Alessandra %A Guido,Luca %A Guardamagna,Vittorio %A Marceglia,Sara %A Prandin,Roberto %A Prenassi,Marco %A Caruso,Annamaria %A Manzelli,Vania %A Savino,Chiara %A Conti,Costanza %A Rizzi,Federica %A Casalino,Alice %A Candiani,Giulia %A Memini,Francesca %A Chiveri,Luca %A Vitali,Andrea Luigi %A Corbo,Massimo %A Grasso,Roberto %A Didier,Florence %A Ferrucci,Roberta %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372009, marianna.masiero@unimi.it %K chronic pain %K eHealth %K cancer %K decision-making %K survivorship %K self-efficacy %K pain %K oncology %K health ecosystem %K health ecosystems %K breast %K survivor %K survivors %K mHealth %K mobile health %K app %K apps %K applications %K MARS %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. Objective: This pilot study aims to evaluate patients’ experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. Methods: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. Results: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). Conclusions: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. International Registered Report Identifier (IRRID): RR2-10.2196/41216 %M 38306176 %R 10.2196/51021 %U https://formative.jmir.org/2024/1/e51021 %U https://doi.org/10.2196/51021 %U http://www.ncbi.nlm.nih.gov/pubmed/38306176 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e50705 %T Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study %A Gray,Megan %A Baird,Austin %A Sawyer,Taylor %A James,Jasmine %A DeBroux,Thea %A Bartlett,Michelle %A Krick,Jeanne %A Umoren,Rachel %+ Division of Neonatology, University of Washington, M/S FA.2.113, 4800 Sand Point Way, Seattle, WA, 98105, United States, 1 206 919 5476, graym1@uw.edu %K prenatal counseling %K virtual health %K virtual patient %K simulation %K neonatology %K ChatGPT %K AI %K artificial intelligence %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Using virtual patients, facilitated by natural language processing, provides a valuable educational experience for learners. Generating a large, varied sample of realistic and appropriate responses for virtual patients is challenging. Artificial intelligence (AI) programs can be a viable source for these responses, but their utility for this purpose has not been explored. Objective: In this study, we explored the effectiveness of generative AI (ChatGPT) in developing realistic virtual standardized patient dialogues to teach prenatal counseling skills. Methods: ChatGPT was prompted to generate a list of common areas of concern and questions that families expecting preterm delivery at 24 weeks gestation might ask during prenatal counseling. ChatGPT was then prompted to generate 2 role-plays with dialogues between a parent expecting a potential preterm delivery at 24 weeks and their counseling physician using each of the example questions. The prompt was repeated for 2 unique role-plays: one parent was characterized as anxious and the other as having low trust in the medical system. Role-play scripts were exported verbatim and independently reviewed by 2 neonatologists with experience in prenatal counseling, using a scale of 1-5 on realism, appropriateness, and utility for virtual standardized patient responses. Results: ChatGPT generated 7 areas of concern, with 35 example questions used to generate role-plays. The 35 role-play transcripts generated 176 unique parent responses (median 5, IQR 4-6, per role-play) with 268 unique sentences. Expert review identified 117 (65%) of the 176 responses as indicating an emotion, either directly or indirectly. Approximately half (98/176, 56%) of the responses had 2 or more sentences, and half (88/176, 50%) included at least 1 question. More than half (104/176, 58%) of the responses from role-played parent characters described a feeling, such as being scared, worried, or concerned. The role-plays of parents with low trust in the medical system generated many unique sentences (n=50). Most of the sentences in the responses were found to be reasonably realistic (214/268, 80%), appropriate for variable prenatal counseling conversation paths (233/268, 87%), and usable without more than a minimal modification in a virtual patient program (169/268, 63%). Conclusions: Generative AI programs, such as ChatGPT, may provide a viable source of training materials to expand virtual patient programs, with careful attention to the concerns and questions of patients and families. Given the potential for unrealistic or inappropriate statements and questions, an expert should review AI chat outputs before deploying them in an educational program. %M 38300696 %R 10.2196/50705 %U https://mededu.jmir.org/2024/1/e50705 %U https://doi.org/10.2196/50705 %U http://www.ncbi.nlm.nih.gov/pubmed/38300696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49616 %T Comparison of Blended Learning With Traditional Dermatology Learning for Medical Students: Prospective Evaluation Study %A Silva,Cristiana Silveira %A Vasconcellos,Cidia %A Souza,Murilo Barreto %A Fernandes,Juliana Dumet %A Rego,Vitoria Regina Pedreira de Almeida %+ Department of Dermatology, Federal University of Bahia, Av. Milton Santos, s/nº - Ondina, Salvador, BA, 40170-110, Brazil, 55 7133362850, silveira.cristiana@gmail.com %K dermatology %K distance education %K distance learning %K e-learning %K medical education %K undergraduate medical education %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel internet-based applications and associated technologies have influenced all aspects of society, ranging from commerce and business to entertainment and health care, and education is no exception. In this context, this study was designed to evaluate the impact of a dermatology e-learning program on the academic performance of medical students in dermatology. Objective: The aim of this study is to develop a dermatology blended-learning course for undergraduate medical students, evaluate the knowledge gained by students exposed to this course, and compare the results to those of traditional teaching methods. Methods: In this prospective study, we evaluated the performance of fourth-semester medical students at the Federal University of Bahia, Brazil. Students who had been in their second year of the medical course in 2019 were considered the control group, while students in their second year in 2020 were considered the blended or hybrid group. The first group attended traditional classes, using printed material (books and handouts), while the second group used our web-based course and e-book as a supplement in a hybrid web-plus-traditional fashion. Neither participants nor evaluators were blinded. The students in both groups were subjected to the same pre- and postcourse face-to-face, multiple-choice, paper-based evaluations, and we compared their performances. The content of the classes was the same for both groups. All didactic activities were developed by a team of certified dermatologists and professors from the university. Results: A total of 129 students were selected and divided into 2 groups: the control group (n=57) and the hybrid group (n=72). The precourse tests did not indicate any difference between the control group (mean score 2.74, SD 1.25) and the hybrid group (mean score 3.2, SD 1.22 SD; P>.05). The hybrid group had better final-term grades (mean 8.18, SD 1.26) than the traditional group (mean 7.11, SD 1.04). This difference was statistically significant (P<.05). Conclusions: This study explores pedagogical possibilities in the field of dermatology teaching for medical school students. The results suggest that the performance of undergraduate students who attended the course with additional e-learning material was superior when compared to the performance of those who participated in the traditional course alone. %M 38300698 %R 10.2196/49616 %U https://formative.jmir.org/2024/1/e49616 %U https://doi.org/10.2196/49616 %U http://www.ncbi.nlm.nih.gov/pubmed/38300698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49497 %T Data Representation Structure to Support Clinical Decision-Making in the Pediatric Intensive Care Unit: Interview Study and Preliminary Decision Support Interface Design %A Yakob,Najia %A Laliberté,Sandrine %A Doyon-Poulin,Philippe %A Jouvet,Philippe %A Noumeir,Rita %+ Pediatric Intensive Care Unit, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada, 1 514 345 4927, philippe.jouvet@umontreal.ca %K data representation %K decision support %K critical care %K clinical workflow %K clinical decision-making %K prototype %K design %K intensive care unit %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves the use of knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. In addition, the increasing use of clinical decision support systems (CDSSs) provides assistance to clinicians in their practice, allowing them to improve patient outcomes. In the pediatric intensive care unit (PICU), clinicians must process high volumes of data and deal with ever-growing workloads. As they use multiple systems daily to assess patients’ status and to adjust the health care plan, including electronic health records (EHR), clinical systems (eg, laboratory, imaging and pharmacy), and connected devices (eg, bedside monitors, mechanical ventilators, intravenous pumps, and syringes), clinicians rely mostly on their judgment and ability to trace relevant data for decision-making. In these circumstances, the lack of optimal data structure and adapted visual representation hinder clinician’s cognitive processes and clinical decision-making skills. Objective: In this study, we designed a prototype to optimize the representation of clinical data collected from existing sources (eg, EHR, clinical systems, and devices) via a structure that supports the integration of a home-developed CDSS in the PICU. This study was based on analyzing end user needs and their clinical workflow. Methods: First, we observed clinical activities in a PICU to secure a better understanding of the workflow in terms of staff tasks and their use of EHR on a typical work shift. Second, we conducted interviews with 11 clinicians from different staff categories (eg, intensivists, fellows, nurses, and nurse practitioners) to compile their needs for decision support. Third, we structured the data to design a prototype that illustrates the proposed representation. We used a brain injury care scenario to validate the relevance of integrated data and the utility of main functionalities in a clinical context. Fourth, we held design meetings with 5 clinicians to present, revise, and adapt the prototype to meet their needs. Results: We created a structure with 3 levels of abstraction—unit level, patient level, and system level—to optimize clinical data representation and display for efficient patient assessment and to provide a flexible platform to host the internally developed CDSS. Subsequently, we designed a preliminary prototype based on this structure. Conclusions: The data representation structure allows prioritizing patients via criticality indicators, assessing their conditions using a personalized dashboard, and monitoring their courses based on the evolution of clinical values. Further research is required to define and model the concepts of criticality, problem recognition, and evolution. Furthermore, feasibility tests will be conducted to ensure user satisfaction. %M 38300695 %R 10.2196/49497 %U https://formative.jmir.org/2024/1/e49497 %U https://doi.org/10.2196/49497 %U http://www.ncbi.nlm.nih.gov/pubmed/38300695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54253 %T Improvements in Adolescents’ Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study %A Huffman,Landry Goodgame %A Lawrence-Sidebottom,Darian %A Beam,Aislinn Brenna %A Parikh,Amit %A Guerra,Rachael %A Roots,Monika %A Huberty,Jennifer %+ Bend Health Inc, 2810 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K behavioral care %K mental health %K web-based coaching %K web-based therapy %K eating disorders %K eating %K anorexia %K coach %K coaching %K pediatric %K pediatrics %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K digital mental health intervention %K DMHI %K collaborative %K digital health %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. Objective: This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents’ disordered eating behaviors. Methods: Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. Results: Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). Conclusions: Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms. %M 38294855 %R 10.2196/54253 %U https://formative.jmir.org/2024/1/e54253 %U https://doi.org/10.2196/54253 %U http://www.ncbi.nlm.nih.gov/pubmed/38294855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51571 %T Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study %A Moore,Richard %A Al-Tamimi,Abdel-Karim %A Freeman,Elizabeth %+ Sheffield Hallam University, Sport and Physical Activity Research Centre / Advanced Wellbeing Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Advanced Wellbeing Research Centre, Sheffield, S9 3TU, United Kingdom, 44 7751234185, r.moore@shu.ac.uk %K physical activity %K inactivity %K conversational agent %K CA %K adolescent %K public health %K digital health interventions %K mobile phone %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called “Phyllis” to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model. Objective: The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA. Methods: The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey. Results: The co-design participants were students aged 11 to 13 years, with a sex distribution of 56% (5/9) female and 44% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a “lack of confidence,” “fear of failure,” and a “lack of motivation.” The CA’s persona, named “Phyllis,” was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA’s persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students’ agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA. Conclusions: The results showed high acceptability and a positive user experience, indicating the CA’s potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA’s potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents. %M 38294857 %R 10.2196/51571 %U https://formative.jmir.org/2024/1/e51571 %U https://doi.org/10.2196/51571 %U http://www.ncbi.nlm.nih.gov/pubmed/38294857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43286 %T Formative Evaluation of a Comprehensive Self-Management Intervention for Irritable Bowel Syndrome, Comorbid Anxiety, and Depression: Mixed Methods Study %A Kamp,Kendra %A Yang,Pei-Lin %A Friedman,Emily %A Lopez,Alejandra %A Iribarren,Sarah %A Barney,Pamela %A Munson,Sean %A Heitkemper,Margaret %A Levy,Rona %+ Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, United States, 1 206 221 4617, kamp@uw.edu %K acceptability %K anxiety %K depression %K design %K effectiveness %K feasibility %K implementation %K intervention %K irritable bowel syndrome %K management %K mixed methods %K patient %K self-management %K support %K usability %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Irritable bowel syndrome (IBS) is a disorder of the gut-brain interaction that is associated with abdominal pain, altered bowel patterns, and reduced quality of life. Up to 50% of patients with IBS also report anxiety or depressive symptoms. Although effective self-management interventions exist for individuals with IBS, few have been effectively implemented, and most do not consider the unique needs of patients with comorbid IBS and anxiety or depression. Objective: This study aimed to determine the anticipated acceptability, appropriateness, feasibility, and usability of a comprehensive self-management intervention using an implementation science and human-centered design approach among individuals with comorbid IBS and anxiety or depression and health care providers. Methods: A convergent mixed methods design was used to elicit feedback on the comprehensive self-management intervention outline and content to identify refinement needs before testing. Patients with IBS and moderate to severe anxiety or depression and health care providers were purposefully sampled from primary care and gastroenterology settings. Participants completed semistructured interviews and surveys on anticipated acceptability, appropriateness, feasibility, and usability. Results: Patient participants (n=12) were on average 36.8 (SD 12.2) years of age, and 42% (5/12) were currently receiving psychological therapy. Health care providers (n=14) were from primary care (n=7) and gastroenterology (n=7) settings. The mean usability scores (out of 100) were 52.5 (SD 14.5) for patients and 45.6 (SD 11.6) for providers. For patients and providers, qualitative data expanded the quantitative findings for acceptability and appropriateness. Acceptability findings were the comprehensive nature of the intervention and discussion of the gut-brain interaction. For appropriateness, participants reported that the intervention provided structure, accountability, and support. Feasibility was confirmed for patients, but there was a divergence of findings between quantitative and qualitative measures for providers. Patients focused on intervention feasibility, while providers focused on implementation feasibility in the clinic. Identified usability issues to address before implementation included the intervention delivery format, length, and lack of integration into health care settings that, if not addressed, may limit the reach of the intervention. Conclusions: Patients and health care providers found the intervention acceptable and appropriate. Several feasibility and usability issues were identified, including intervention delivery methods, length of intervention, and the best methods to implement in the clinic setting. The next steps are to refine the intervention to address the identified issues and test in a pilot study whether addressing usability issues leads to the anticipated improvements in implementation and uptake. %M 38294871 %R 10.2196/43286 %U https://formative.jmir.org/2024/1/e43286 %U https://doi.org/10.2196/43286 %U http://www.ncbi.nlm.nih.gov/pubmed/38294871 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54132 %T Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study %A Landry,Caeleigh A %A McCall,Hugh C %A Beahm,Janine D %A Titov,Nickolai %A Dear,Blake %A Carleton,R Nicholas %A Hadjistavropoulos,Heather D %+ Department of Psychology, University of Regina, Administration-Humanities, AH 345, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, heather.hadjistavropoulos@uregina.ca %K public safety personnel %K PSP %K internet therapy %K mindfulness %K meditation %K internet-delivered cognitive behavioral therapy %K iCBT %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. Objective: This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. Methods: A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. Results: Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time. Conclusions: This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations. %M 38289655 %R 10.2196/54132 %U https://formative.jmir.org/2024/1/e54132 %U https://doi.org/10.2196/54132 %U http://www.ncbi.nlm.nih.gov/pubmed/38289655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53439 %T Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study %A Breitenstein,Susan M %A Berteletti,Julia %A Smoske,Shea %A Barger,Charles %A Tipps,Kyrie %A Helsabeck,Nathan P %+ College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K usability %K development %K dashboard %K portal %K implementation %K design %K System Usability Scale %K internet-based intervention %K parents %K parent %K child %K children %K web-based %K web-based parent training %K PT %K descriptive survey %K single group %K survey %K system usability %K ezParent %K videoconference %K information %K reviews on usage %K improvement %K qualitative %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. Objective: The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. Methods: This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. Results: Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. Conclusions: Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants’ progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion. %M 38289675 %R 10.2196/53439 %U https://formative.jmir.org/2024/1/e53439 %U https://doi.org/10.2196/53439 %U http://www.ncbi.nlm.nih.gov/pubmed/38289675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49561 %T “I Just Wanted a Dentist in My Phone”—Designing Evidence-Based mHealth Prototype to Improve Preschool Children’s Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children’s Teeth %A Al-yaseen,Waraf %A Raggio,Daniela Procida %A Araujo,Mariana %A Innes,Nicola %+ School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom, 44 07413162068, Al-yaseenw1@cardiff.ac.uk %K oral health promotion %K mobile health %K mHealth %K children %K oral health %K behavior change %K coproduction %K mobile phone %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals’ health maintenance. However, little is known about caring for their child’s teeth and what their preferences would be regarding the content or design of an oral health app. Objective: This study aims to co-design the prototype of an app named App for Children’s Teeth with parents, providing a source of information for them about caring for their children’s teeth and promoting positive dental habits. Methods: This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ≤6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children’s oral health, and (3) collect feedback about the app’s acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis. Results: The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children’s Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child’s age, and “In a Nutshell” bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas. Conclusions: The coproduction design approach highlighted parents’ need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child’s age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives. Trial Registration: Open Science Framework; https://osf.io/uj9az %M 38289667 %R 10.2196/49561 %U https://formative.jmir.org/2024/1/e49561 %U https://doi.org/10.2196/49561 %U http://www.ncbi.nlm.nih.gov/pubmed/38289667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45659 %T Acceptability of a Self-Led Mindfulness-Based Intervention for Teens with Type 1 Diabetes: Pilot Randomized Controlled Trial %A Humiston,Tori %A Cummings,Caroline %A Suss,Stephen %A Cohen,Laura B %A Hazlett-Stevens,Holly %A Hughes Lansing,Amy %+ Department of Psychological Sciences, University of Vermont, 2 Colchester Ave, Burlington, VT, 05401, United States, 1 8026562670, tori.humiston@uvm.edu %K adolescents %K diabetes distress %K diabetes %K health group intervention %K intervention %K mindfulness %K psychosocial intervention %K self-led mindfulness %K type 1 diabetes %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes distress among adolescents with type 1 diabetes has been associated with suboptimal diabetes outcomes, including lower quality of life, increased diabetes self-management challenges, and suboptimal glycemic outcomes. Objective: This study examined the feasibility and acceptability of a scalable self-led mindfulness-based intervention to reduce diabetes distress in adolescents with type 1 diabetes. Methods: Adolescents (N=25) aged between 14 and 18 years diagnosed with type 1 diabetes completed a baseline assessment. Participants were randomized to receive a 10-week self-guided mindfulness-based stress reduction workbook program (e-book or paper option) immediately (n=15) or after a 10-week wait (n=10). During the intervention period, participants completed weekly assignments and feedback surveys. At 10 weeks and 20 weeks, follow-up assessments were completed. Results: Findings indicated that participants did not find the original intervention feasible or acceptable. Adolescents reported barriers to completing the weekly material, such as that they forgot or that the material was not sufficiently related to their diabetes management. Adolescents also reported that a digital format rather than a workbook or e-book may be more acceptable. Results from weekly surveys provided the foundation for recommendations for future iterations of the mindfulness-based intervention for adolescents with type 1 diabetes. Conclusions: Participant feedback informed recommendations for self-led mindfulness programs for youth with type 1 diabetes. Adolescents indicated that a shorter, digital mindfulness-based intervention focused on diabetes-specific behaviors may be more helpful. Trial Registration: ClinicalTrials.gov NCT05115175; https://clinicaltrials.gov/study/NCT05115175 %M 38289663 %R 10.2196/45659 %U https://formative.jmir.org/2024/1/e45659 %U https://doi.org/10.2196/45659 %U http://www.ncbi.nlm.nih.gov/pubmed/38289663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49592 %T Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study %A Tran,Karen C %A Mak,Meagan %A Kuyper,Laura M %A Bittman,Jesse %A Mangat,Birinder %A Lindsay,Heather %A Kim Sing,Chad %A Xu,Liang %A Wong,Hubert %A Dawes,Martin %A Khan,Nadia %A Ho,Kendall %+ Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 5181, karen.tran4@vch.ca %K hypertension %K remote-home monitoring %K feasibility study %K health monitor %K telehealth %K pilot study %K mobile phone %K monitoring %K telemonitoring %K blood pressure %K emergency department %K hypertension %K morbidity %K mortality %K primary care %K physician care %K management %K hypertension medication %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient’s condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by –13/–5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. %M 38111177 %R 10.2196/49592 %U https://formative.jmir.org/2024/1/e49592 %U https://doi.org/10.2196/49592 %U http://www.ncbi.nlm.nih.gov/pubmed/38111177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46418 %T Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study %A Hiemstra,Madison S %A Reichert,Sonja M %A Mitchell,Marc S %+ School of Kinesiology, Western University, 1151 Richmond Street, Thames Hall, Room TH 3199, London, ON, N6A 3K7, Canada, 1 (519) 661 2111 ext 87936, marc.mitchell@uwo.ca %K activity monitor %K diabetes self-management education %K flash glucose monitor %K glycated hemoglobin %K group education %K HbA1c %K T2D %K type 2 diabetes %K virtual care %K wearables %D 2024 %7 29.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program. Objective: We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes. Methods: We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA1c) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively. Results: A total of 10 adults living with T2D were recruited (female 60%; age 49.9, SD 14.3 years; estimated HbA1c 6.2%, SD 0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3.2 (SD 2.6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were “satisfied” with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA1c are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA1c was 6.2% (SD 0.5%) and 6.2% (SD 0.6%) at baseline and week 6, respectively. Conclusions: This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA1c >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted. Trial Registration: ClinicalTrials.gov NCT04498819; https://clinicaltrials.gov/study/NCT04498819 %M 38285502 %R 10.2196/46418 %U https://formative.jmir.org/2024/1/e46418 %U https://doi.org/10.2196/46418 %U http://www.ncbi.nlm.nih.gov/pubmed/38285502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52200 %T Patient Phenotyping for Atopic Dermatitis With Transformers and Machine Learning: Algorithm Development and Validation Study %A Wang,Andrew %A Fulton,Rachel %A Hwang,Sy %A Margolis,David J %A Mowery,Danielle %+ University of Pennsylvania, A206 Richards Building, 3700 Hamilton Walk, Philadelphia, PA, 19104, United States, 1 2157466677, dlmowery@pennmedicine.upenn.edu %K atopic dermatitis %K classification %K classifier %K dermatitis %K dermatology %K EHR %K electronic health record %K health records %K health %K informatics %K machine learning %K natural language processing %K NLP %K patient phenotyping %K phenotype %K skin %K transformer %K transformers %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Atopic dermatitis (AD) is a chronic skin condition that millions of people around the world live with each day. Performing research into identifying the causes and treatment for this disease has great potential to provide benefits for these individuals. However, AD clinical trial recruitment is not a trivial task due to the variance in diagnostic precision and phenotypic definitions leveraged by different clinicians, as well as the time spent finding, recruiting, and enrolling patients by clinicians to become study participants. Thus, there is a need for automatic and effective patient phenotyping for cohort recruitment. Objective: This study aims to present an approach for identifying patients whose electronic health records suggest that they may have AD. Methods: We created a vectorized representation of each patient and trained various supervised machine learning methods to classify when a patient has AD. Each patient is represented by a vector of either probabilities or binary values, where each value indicates whether they meet a different criteria for AD diagnosis. Results: The most accurate AD classifier performed with a class-balanced accuracy of 0.8036, a precision of 0.8400, and a recall of 0.7500 when using XGBoost (Extreme Gradient Boosting). Conclusions: Creating an automated approach for identifying patient cohorts has the potential to accelerate, standardize, and automate the process of patient recruitment for AD studies; therefore, reducing clinician burden and informing the discovery of better treatment options for AD. %M 38277207 %R 10.2196/52200 %U https://formative.jmir.org/2024/1/e52200 %U https://doi.org/10.2196/52200 %U http://www.ncbi.nlm.nih.gov/pubmed/38277207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54274 %T Development and Implementation of Digital Diagnostic Algorithms for Neonatal Units in Zimbabwe and Malawi: Development and Usability Study %A Gannon,Hannah %A Larsson,Leyla %A Chimhuya,Simbarashe %A Mangiza,Marcia %A Wilson,Emma %A Kesler,Erin %A Chimhini,Gwendoline %A Fitzgerald,Felicity %A Zailani,Gloria %A Crehan,Caroline %A Khan,Nushrat %A Hull-Bailey,Tim %A Sassoon,Yali %A Baradza,Morris %A Heys,Michelle %A Chiume,Msandeni %+ Population, Policy and Practice, Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, United Kingdom, 44 (0) 20 7905 ext 2600, h.gannon@ucl.ac.uk %K mobile health %K mHealth %K neonatology %K digital health %K mobile apps %K newborn %K Malawi, Zimbabwe %K usability %K clinical decision support %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. Objective: This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. Methods: Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital’s health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). Results: Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. Conclusions: This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings. %M 38277198 %R 10.2196/54274 %U https://formative.jmir.org/2024/1/e54274 %U https://doi.org/10.2196/54274 %U http://www.ncbi.nlm.nih.gov/pubmed/38277198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48880 %T Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study %A Schröder,Sonja %A Buntrock,Claudia %A Neumann,Louisa %A Müller,Jürgen L %A Fromberger,Peter %+ Clinic for Psychiatry and Psychotherapy – Forensic Psychiatry, University Medical Center Göttingen, Rosdorfer Weg 70, Göttingen, 37081, Germany, 49 5514022114, sonja.schroeder@med.uni-goettingen.de %K mHealth %K web-based intervention %K acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K sexual offenses against children %K child abuse %K child pornography %K children %K sexual offense %K cross-sectional study %K community %K anxiety %K psychiatry %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. Objective: For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. Methods: This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. Results: Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants’ belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. Conclusions: For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants’ attitudes toward web-based interventions were important in predicting acceptance. Trial Registration: German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256 %M 38277200 %R 10.2196/48880 %U https://formative.jmir.org/2024/1/e48880 %U https://doi.org/10.2196/48880 %U http://www.ncbi.nlm.nih.gov/pubmed/38277200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45506 %T Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation %A Walker,Tim %A Buckingham,Sarah Ann %A Poole,Ria %A Elliott,Lewis Roland %A Menneer,Tamaryn %A Tu,Gengyang %A Morrissey,Karyn %+ European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Truro, TR1 3HD, United Kingdom, 44 (0) 1872 258131, t.w.walker@exeter.ac.uk %K digital training %K telephone-based %K social housing %K feasibility %K acceptability %K communication technologies %K sociodigital inequalities %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. Objective: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). Methods: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority’s Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. Results: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). Conclusions: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies. %M 38277209 %R 10.2196/45506 %U https://formative.jmir.org/2024/1/e45506 %U https://doi.org/10.2196/45506 %U http://www.ncbi.nlm.nih.gov/pubmed/38277209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44029 %T Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study %A Vanderkruik,Rachel C %A Ferguson,Craig %A Kobylski,Lauren A %A Locascio,Joseph J %A Hamlett,Gabriella E %A Killenberg,Parker C %A Lewis,Robert %A Jones,Noah %A Rossa,Ella T %A Dineen,Hannah %A Picard,Rosalind %A Cohen,Lee S %+ Center for Women's Mental Health, Massachusetts General Hospital, 185 Cambridge St, Ste 2200, Boston, MA, 02114, United States, 1 781 691 9071, rvanderkruik@mgh.harvard.edu %K perinatal depression %K pregnancy %K behavioral activation %K mobile app %K digital intervention %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=−.35; t61=−3.05; P=.003), number of activities completed (β=−.12; t61=−2.05; P=.04), days played (β=−.12; t58=−2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=−3.05; t45=−2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. %M 38277191 %R 10.2196/44029 %U https://formative.jmir.org/2024/1/e44029 %U https://doi.org/10.2196/44029 %U http://www.ncbi.nlm.nih.gov/pubmed/38277191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54747 %T Machine Learning and Symptom Patterns in Degenerative Cervical Myelopathy: Web-Based Survey Study %A Touzet,Alvaro Yanez %A Rujeedawa,Tanzil %A Munro,Colin %A Margetis,Konstantinos %A Davies,Benjamin M %+ University of Cambridge, The Old Schools, Trinity Ln, Cambridge, Cambridge, CB2 1TN, United Kingdom, 44 01223 337733, bd375@cam.ac.uk %K cervical %K myelopathy %K machine learning %K cluster %K clusters %K clustering %K spine %K spinal %K compression %K neck %K degenerative %K k-means %K patient reported %K degenerative cervical myelopathy %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined. Objective: This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features. Methods: A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics. Results: After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM. Conclusions: Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches. %M 38271070 %R 10.2196/54747 %U https://formative.jmir.org/2024/1/e54747 %U https://doi.org/10.2196/54747 %U http://www.ncbi.nlm.nih.gov/pubmed/38271070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51770 %T An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study %A Sienko,Anna %A Thirunavukarasu,Arun James %A Kuzmich,Tanya %A Allen,Louise %+ School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, United Kingdom, 44 1223 336700, as2866@cam.ac.uk %K audiology %K audiometry %K hearing test %K eHealth %K mobile application %K automated audiometry %K hearing loss %K hearing impairment %K web-app %K web-apps %K web-application %K digital health %K hearing %K adult %K adults %K mobile health %K mhealth %K community-based %K home-based %K assistive technology %K screening %K usability %K ears %K ear %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. Objective: This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. Methods: Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. Results: DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. Conclusions: This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment. %M 38271088 %R 10.2196/51770 %U https://formative.jmir.org/2024/1/e51770 %U https://doi.org/10.2196/51770 %U http://www.ncbi.nlm.nih.gov/pubmed/38271088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47572 %T Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study %A El Barbari,Jan Siad %A Fikuart,Maxim %A Beisemann,Nils %A Müller,Michael %A Syrek,Hannah %A Grützner,Paul Alfred %A Franke,Jochen %A Vetter,Sven Yves %+ Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str 13, Ludwigshafen am Rhein, 67071, Germany, 49 621 6810 2480, sven.vetter@bgu-ludwigshafen.de %K app %K device usability %K digital camera %K medical photo %K medical photography %K mRay app %K PACS %K patient care %K patient education %K picture archiving and communication system %K questionnaire %K smartphone %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. Objective: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. Methods: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. Results: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer’s intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. Conclusions: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size. %M 38271087 %R 10.2196/47572 %U https://formative.jmir.org/2024/1/e47572 %U https://doi.org/10.2196/47572 %U http://www.ncbi.nlm.nih.gov/pubmed/38271087 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52414 %T Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study %A Soller,Brian %A Myers,Orrin %A Sood,Akshay %+ Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico MSC 10 5550, Albuquerque, NM, 871310001, United States, 1 5052724751, asood@salud.unm.edu %K community of practice %K knowledge transfer %K pneumoconiosis %K telementoring %K rural health care %K transfer %K information %K rural %K virtual community %K lung diseases %K lung disease %K rural professionals %K rural professional %K multidisciplinary management %K multidisciplinary %K miners %K miner %K health equity %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the re-emergence of coal workers’ pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners’ Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown. Objective: We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach. Methods: This is a cross-sectional study of 70 professionals participating in the Miners’ Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants’ patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent’s self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources. Results: Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons). Conclusions: Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners. %M 38265861 %R 10.2196/52414 %U https://formative.jmir.org/2024/1/e52414 %U https://doi.org/10.2196/52414 %U http://www.ncbi.nlm.nih.gov/pubmed/38265861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50572 %T Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study %A Sharma,Pravesh %A Kamath,Celia %A Brockman,Tabetha A %A Roche,Anne %A Sinicrope,Pamela %A Jiang,Ruoxiang %A Decker,Paul A %A Pazdernik,Vanessa %A Patten,Christi %+ Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI, 54703, United States, 1 7158385369, sharma.pravesh@mayo.edu %K digital health %K telemedicine %K telehealth %K video visits %K appointments %K SDoH, social determinants of health %K social determinants %K appointment %K users %K sociodemographic %K prevention %K discomfort %K video communication %K communication %K willingness %K mobile phone %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, “Have you ever had a video appointment with a healthcare provider?” “Yes” respondents were defined as “users” (adapted to video appointments), and “no” respondents were defined as “persistent nonusers” of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients’ decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients’ negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a “digital health coordinator” could be assigned to assist with various digital health solutions. %M 38265855 %R 10.2196/50572 %U https://formative.jmir.org/2024/1/e50572 %U https://doi.org/10.2196/50572 %U http://www.ncbi.nlm.nih.gov/pubmed/38265855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47157 %T A Bluetooth-Enabled Device for Real-Time Detection of Sitting, Standing, and Walking: Cross-Sectional Validation Study %A Daryabeygi-Khotbehsara,Reza %A Rawstorn,Jonathan C %A Dunstan,David W %A Shariful Islam,Sheikh Mohammed %A Abdelrazek,Mohamed %A Kouzani,Abbas Z %A Thummala,Poojith %A McVicar,Jenna %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hw, Melbourne Burwood, 3125, Australia, 61 3 924 45936, reza.d@deakin.edu.au %K activity tracker %K algorithms %K deep neural network %K machine learning %K real-time data %K Sedentary behaviOR Detector %K sedentary behavior %K SORD %K standing %K validation %K walking %K wearables %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study assesses the accuracy of a Bluetooth-enabled prototype activity tracker called the Sedentary behaviOR Detector (SORD) device in identifying sedentary, standing, and walking behaviors in a group of adult participants. Objective: The primary objective of this study was to determine the criterion and convergent validity of SORD against direct observation and activPAL. Methods: A total of 15 healthy adults wore SORD and activPAL devices on their thighs while engaging in activities (lying, reclining, sitting, standing, and walking). Direct observation was facilitated with cameras. Algorithms were developed using the Python programming language. The Bland-Altman method was used to assess the level of agreement. Results: Overall, 1 model generated a low level of bias and high precision for SORD. In this model, accuracy, sensitivity, and specificity were all above 0.95 for detecting sitting, reclining, standing, and walking. Bland-Altman results showed that mean biases between SORD and direct observation were 0.3% for sitting and reclining (limits of agreement [LoA]=–0.3% to 0.9%), 1.19% for standing (LoA=–1.5% to 3.42%), and –4.71% for walking (LoA=–9.26% to –0.16%). The mean biases between SORD and activPAL were –3.45% for sitting and reclining (LoA=–11.59% to 4.68%), 7.45% for standing (LoA=–5.04% to 19.95%), and –5.40% for walking (LoA=–11.44% to 0.64%). Conclusions: Results suggest that SORD is a valid device for detecting sitting, standing, and walking, which was demonstrated by excellent accuracy compared to direct observation. SORD offers promise for future inclusion in theory-based, real-time, and adaptive interventions to encourage physical activity and reduce sedentary behavior. %M 38265864 %R 10.2196/47157 %U https://formative.jmir.org/2024/1/e47157 %U https://doi.org/10.2196/47157 %U http://www.ncbi.nlm.nih.gov/pubmed/38265864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46941 %T Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach %A Messina,Anna %A Amati,Rebecca %A Annoni,Anna Maria %A Bano,Beatrice %A Albanese,Emiliano %A Fiordelli,Maddalena %+ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 0782104055, anna.messina@usi.ch %K informal caregivers %K iSupport %K dementia %K digital interventions %K mHealth %K community-based participatory research %K community %K caregiver %K mental distress %K physical distress %K support %K development %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from “lesson” to “chapter” and from “suffering from” dementia to “affected by” dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. %M 38265857 %R 10.2196/46941 %U https://formative.jmir.org/2024/1/e46941 %U https://doi.org/10.2196/46941 %U http://www.ncbi.nlm.nih.gov/pubmed/38265857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38064 %T Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research %A Morsa,Maxime %A Perrin,Amélie %A David,Valérie %A Rault,Gilles %A Le Roux,Enora %A Alberti,Corinne %A Gagnayre,Rémi %A Pougheon Bertrand,Dominique %+ Adaptation, Resilience and Change Research Unit, University of Liège, 1 Place des Orateurs, Liège, 4000, Belgium, 32 4 3662272, maxime.morsa@uliege.be %K cystic fibrosis %K mobile health %K mHealth %K patient education %K chronic disease %K empowerment %K devices %K patients %K detection %K treatment %K respiratory %K education %K monitoring %K care %D 2024 %7 23.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. Objective: This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users’ point of view to detect PEx early and treat it. This study focused on the patients’ experiences as the first and main users of home monitoring. Methods: A qualitative study was conducted to explore patients’ and professionals’ experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. Results: A total of 20 patients completed the study. Three main categories emerged from the patients’ verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients’ learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. Conclusions: We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 %M 38261372 %R 10.2196/38064 %U https://formative.jmir.org/2024/1/e38064 %U https://doi.org/10.2196/38064 %U http://www.ncbi.nlm.nih.gov/pubmed/38261372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48527 %T Predictive Value of Machine Learning for Platinum Chemotherapy Responses in Ovarian Cancer: Systematic Review and Meta-Analysis %A Wang,Qingyi %A Chang,Zhuo %A Liu,Xiaofang %A Wang,Yunrui %A Feng,Chuwen %A Ping,Yunlu %A Feng,Xiaoling %+ Department of Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150000, China, 86 13604800585, doctorfxl@163.com %K ovarian cancer %K platinum chemotherapy response %K machine learning %K platinum-based therapy %K predictive potential %D 2024 %7 22.1.2024 %9 Review %J J Med Internet Res %G English %X Background: Machine learning is a potentially effective method for predicting the response to platinum-based treatment for ovarian cancer. However, the predictive performance of various machine learning methods and variables is still a matter of controversy and debate. Objective: This study aims to systematically review relevant literature on the predictive value of machine learning for platinum-based chemotherapy responses in patients with ovarian cancer. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically searched the PubMed, Embase, Web of Science, and Cochrane databases for relevant studies on predictive models for platinum-based therapies for the treatment of ovarian cancer published before April 26, 2023. The Prediction Model Risk of Bias Assessment tool was used to evaluate the risk of bias in the included articles. Concordance index (C-index), sensitivity, and specificity were used to evaluate the performance of the prediction models to investigate the predictive value of machine learning for platinum chemotherapy responses in patients with ovarian cancer. Results: A total of 1749 articles were examined, and 19 of them involving 39 models were eligible for this study. The most commonly used modeling methods were logistic regression (16/39, 41%), Extreme Gradient Boosting (4/39, 10%), and support vector machine (4/39, 10%). The training cohort reported C-index in 39 predictive models, with a pooled value of 0.806; the validation cohort reported C-index in 12 predictive models, with a pooled value of 0.831. Support vector machine performed well in both the training and validation cohorts, with a C-index of 0.942 and 0.879, respectively. The pooled sensitivity was 0.890, and the pooled specificity was 0.790 in the training cohort. Conclusions: Machine learning can effectively predict how patients with ovarian cancer respond to platinum-based chemotherapy and may provide a reference for the development or updating of subsequent scoring systems. %M 38252469 %R 10.2196/48527 %U https://www.jmir.org/2024/1/e48527 %U https://doi.org/10.2196/48527 %U http://www.ncbi.nlm.nih.gov/pubmed/38252469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45637 %T Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population %A Le Roy,Barbara %A Martin-Krumm,Charles %A Poupon,Charlotte %A Richieri,Raphaëlle %A Malbos,Eric %A Barthélémy,Fanny %A Guedj,Eric %A Trousselard,Marion %+ Unité neurophysiologie du stress, Institut de recherche biomédicale des armées, Place Général Valérie André, Brétigny-sur-Orge, 91220, France, 33 123456789, barbara.m.le.roy@gmail.com %K countermeasures %K mental health %K physical activity %K virtual reality %K user experience %D 2024 %7 22.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). Objective: This study aims to investigate the impact of physical exercise in a VR environment. Methods: A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). Results: First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality–stimulation=1.90; hedonic quality–identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). Conclusions: These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine. %M 38252484 %R 10.2196/45637 %U https://formative.jmir.org/2024/1/e45637 %U https://doi.org/10.2196/45637 %U http://www.ncbi.nlm.nih.gov/pubmed/38252484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52835 %T Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study %A Danielson,Carla Kmett %A Moreland,Angela %A Hahn,Austin %A Banks,Devin %A Ruggiero,Kenneth J %+ Department of Psychiatry & Behavioral Science, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, United States, 1 8437922945, danielso@musc.edu %K traumatic stress %K prevention %K substance use %K HIV %K qualitative methods %K adolescents %K mobile phone %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non–trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. Objective: The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. Methods: Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. Results: In total, 4 overarching themes emerged from the participants’ answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users’ favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: “This app has much that is of interest to me.” Adolescents generally found the app easier to use than did caregivers and clinicians. Conclusions: The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial Registration: ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720 %M 38236634 %R 10.2196/52835 %U https://formative.jmir.org/2024/1/e52835 %U https://doi.org/10.2196/52835 %U http://www.ncbi.nlm.nih.gov/pubmed/38236634 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48945 %T Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study %A Calear,Alison L %A Batterham,Philip J %A McCallum,Sonia M %A Banfield,Michelle %A Moore,Elizabeth %A Johnson,Natalie %A Morse,Alyssa R %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, 2601, Australia, 61 261258406, Alison.Calear@anu.edu.au %K mental health services %K youth %K navigation tool %K mental health %K website %K user experience %K design %K service %K services %K access %K accessibility %K health care system %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. Objective: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. Methods: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants’ views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. Results: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. Conclusions: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support. %M 38236625 %R 10.2196/48945 %U https://formative.jmir.org/2024/1/e48945 %U https://doi.org/10.2196/48945 %U http://www.ncbi.nlm.nih.gov/pubmed/38236625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53931 %T A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study %A Nordby,Emilie S %A Guribye,Frode %A Schønning,Viktor %A Andersen,Sander Lindholm %A Kuntsi,Jonna %A Lundervold,Astri J %+ Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, Bergen, 5036, Norway, 47 45440197, emilie.nordby@uib.no %K ADHD %K adult %K adults %K app %K applications %K apps %K attention deficit %K blended intervention %K blended %K develop %K development %K digital %K emotion regulation %K emotion %K emotional %K emotions %K feasibility %K group session %K group sessions %K hybrid %K hyperactivity %K inattention %K mental health %K neurodevelopmental %K psychotherapy %K satisfaction %K skill %K training %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. Objective: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. Methods: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. Results: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. Conclusions: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028 %M 38231536 %R 10.2196/53931 %U https://formative.jmir.org/2024/1/e53931 %U https://doi.org/10.2196/53931 %U http://www.ncbi.nlm.nih.gov/pubmed/38231536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50211 %T Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study %A Alsaad,Ebtihal %A AlDossary,Sharifah %+ Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Al Haras Al Watani St, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, Riyadh, PO Box 3660/ 11481, Saudi Arabia, 966 114299999, ebtihalalsaad@gmail.com %K misinformation %K education %K WhatsApp %K intervention %K pre-postintervention design %K health literacy %K educational %K video %K videos %K consumer %K consumers %K patient education %K survey %K surveys %K web-based information %K health information %K reliability %K accuracy %K reliable %K social media %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation can adversely affect individuals’ quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. Objective: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. Methods: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants’ ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. Results: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants’ abilities to identify misinformation in WhatsApp messages (z=–6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the “forwarded” label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). Conclusions: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants’ abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions. %M 38231563 %R 10.2196/50211 %U https://formative.jmir.org/2024/1/e50211 %U https://doi.org/10.2196/50211 %U http://www.ncbi.nlm.nih.gov/pubmed/38231563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46367 %T Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study %A Sommer,Jordana L %A Reynolds,Kristin %A Hebbard,Pamela %A Smith,Michael S D %A Mota,Natalie %A Mutch,W Alan C %A Maples-Keller,Jessica %A Roos,Leslie %A El-Gabalawy,Renée %+ Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, AE207 Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada, 1 204 787 4713, sommerj@myumanitoba.ca %K virtual reality %K preoperative anxiety and distress %K breast cancer surgery %K anesthesia %K feasibility %K pilot %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. Objective: This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Methods: Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants’ impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Results: Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, “It was realistic to my past surgical experiences”), impacting their degree of preparedness and expectations for surgery (eg, “The sounds and sights and procedures give you a test run; they prepare you for the actual day”), and having a calming or relaxing effect (eg, “You feel more relaxed for the surgery”). Conclusions: This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. Trial Registration: ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618 %M 38231570 %R 10.2196/46367 %U https://formative.jmir.org/2024/1/e46367 %U https://doi.org/10.2196/46367 %U http://www.ncbi.nlm.nih.gov/pubmed/38231570 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50823 %T Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study %A Shanmugavel,Aarthi %A Shakya,Prabin Raj %A Shrestha,Archana %A Nepal,Jyoti %A Shrestha,Abha %A Daneault,Jean-Francois %A Rawal,Shristi %+ Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Stanley S Bergen, Jr Building, Suite 923, 65 Bergen Street, Newark, NJ, 07107, United States, 1 973 972 2710, shristi.rawal@rutgers.edu %K mHealth %K mobile health %K gestational diabetes %K telehealth %K usability testing %K LMICs %K low- and middle-income countries %K user-centric design %K social cognitive theory %K South Asians %K maternal health %K diabetes %K diabetes mellitus %K daily glucose monitoring %K hospital %K medical institution %K health center %K clinical utility %K Nepal %K low income %K clinical trial %K focus group %K interview %K health care provider %K medical practitioner %K mobile app %K application %K digital health %K app %K apps %K health education %K web based %K self-monitoring %K glucose %K physical activity %K intervention %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps can aid with the management of gestational diabetes mellitus (GDM) by providing patient education, reinforcing regular blood glucose monitoring and diet/lifestyle modification, and facilitating clinical and social support. Objective: This study aimed to describe our process of designing and developing a culturally tailored app, Garbhakalin Diabetes athawa Madhumeha—Dhulikhel Hospital (GDM-DH), to support GDM management among Nepalese patients by applying a user-centered design approach. Methods: A multidisciplinary team of experts, as well as health care providers and patients in Dhulikhel Hospital (Dhulikhel, Nepal), contributed to the development of the GDM-DH app. After finalizing the app’s content and features, we created the app’s wireframe, which illustrated the app’s proposed interface, navigation sequences, and features and function. Feedback was solicited on the wireframe via key informant interviews with health care providers (n=5) and a focus group and in-depth interviews with patients with GDM (n=12). Incorporating their input, we built a minimum viable product, which was then user-tested with 18 patients with GDM and further refined to obtain the final version of the GDM-DH app. Results: Participants in the focus group and interviews unanimously concurred on the utility and relevance of the proposed mobile app for patients with GDM, offering additional insight into essential modifications and additions to the app’s features and content (eg, inclusion of example meal plans and exercise videos).The mean age of patients in the usability testing (n=18) was 28.8 (SD 3.3) years, with a mean gestational age of 27.2 (SD 3.0) weeks. The mean usability score across the 10 tasks was 3.50 (SD 0.55; maximum score=5 for “very easy”); task completion rates ranged from 55.6% (n=10) to 94.4% (n=17). Findings from the usability testing were reviewed to further optimize the GDM-DH app (eg, improving data visualization). Consistent with social cognitive theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose, blood pressure, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden, as well as automatic feedback and data visualization. The app also includes a social network “follow” feature to add friends and family and give them permission to view logged data and a progress summary. Health care providers can use the web-based admin portal of the GDM-DH app to enter/review glucose levels and other clinical measures, track patient progress, and guide treatment and counseling accordingly. Conclusions: To the best of our knowledge, this is the first mobile health platform for GDM developed for a low-income country and the first one containing a social support feature. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app. %M 38231562 %R 10.2196/50823 %U https://formative.jmir.org/2024/1/e50823 %U https://doi.org/10.2196/50823 %U http://www.ncbi.nlm.nih.gov/pubmed/38231562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51732 %T Enabling Personalization for Digital Cognitive Stimulation to Support Communication With People With Dementia: Pilot Intervention Study as a Prelude to AI Development %A Hird,Nick %A Osaki,Tohmi %A Ghosh,Samik %A Palaniappan,Sucheendra K %A Maeda,Kiyoshi %+ Aikomi Ltd Co, Yokohama Blue Avenue 12th Floor, 4-4-2 Minatomirai, Yokohama, Kanagawa, 220-0012, Japan, 81 70 4538 2854, nick.hird@aikomi.co.jp %K dementia %K digital technology %K communication %K engagement %K cognitive stimulation %K artificial intelligence %K AI %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining good communication and engagement between people with dementia and their caregivers is a major challenge in dementia care. Cognitive stimulation is a psychosocial intervention that supports communication and engagement, and several digital applications for cognitive stimulation have been developed. Personalization is an important factor for obtaining sustainable benefits, but the time and effort required to personalize and optimize applications often makes them difficult for routine use by nonspecialist caregivers and families. Although artificial intelligence (AI) has great potential to support automation of the personalization process, its use is largely unexplored because of the lack of suitable data from which to develop and train machine learning models. Objective: This pilot study aims to evaluate a digital application called Aikomi in Japanese care homes for its potential to (1) create and deliver personalized cognitive stimulation programs to promote communication and engagement between people with dementia and usual care staff and (2) capture meaningful personalized data suitable for the development of AI systems. Methods: A modular technology platform was developed and used to create personalized programs for 15 people with dementia living in 4 residential care facilities in Japan with the cooperation of a family member or care staff. A single intervention with the program was conducted with the person with dementia together with a care staff member, and for some participants, smell stimulation was provided using selected smell sticks in conjunction with the digital program. All sessions were recorded using a video camera, and the combined personalized data obtained by the platform were analyzed. Results: Most people with dementia (10/15, 67%) showed high levels of engagement (>40 on Engagement of a Person with Dementia Scale), and there were no incidences of negative reactions toward the programs. Care staff reported that some participants showed extended concentration and spontaneous communication while using Aikomi, which was not their usual behavior. Smell stimulation promoted engagement for some participants even when they were unable to identify the smell. No changes in well-being were observed following the intervention according to the Mental Function Impairment Scale. The level of response to each type of content in the stimulation program varied greatly according to the person with dementia, and personalized data captured by the Aikomi platform enabled understanding of correlations between stimulation content and responses for each participant. Conclusions: This study suggests that the Aikomi digital application is acceptable for use by persons with dementia and care staff and may have the potential to promote communication and engagement. The platform captures personalized data, which can provide suitable input for machine learning. Further investigation of Aikomi will be conducted to develop AI systems and create personalized digital cognitive stimulation applications that can be easily used by nonspecialist caregivers. %M 38227357 %R 10.2196/51732 %U https://formative.jmir.org/2024/1/e51732 %U https://doi.org/10.2196/51732 %U http://www.ncbi.nlm.nih.gov/pubmed/38227357 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44923 %T The Impact of Social Media Use on Mental Health and Family Functioning Within Web-Based Communities in Saudi Arabia: Ethnographic Correlational Study %A Alwuqaysi,Bdour %A Abdul-Rahman,Alfie %A Borgo,Rita %+ King's College London, 155 Wandsworth Road, Apt 3004, Sky Gardns, London, SW8 2FZ, United Kingdom, 44 07470334344, bdour.alwuqaysi@hotmail.com %K social media use %K mental health %K family functioning %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, increasing numbers of parents, activists, and decision-makers have raised concerns about the potential adverse effects of social media use on both mental health and family functioning. Although some studies have indicated associations between social media use and negative mental health outcomes, others have found no evidence of mental health harm. Objective: This correlation study investigated the interplay between social media use, mental health, and family functioning. Analyzing data from 314 users, this study explores diverse mental health outcomes. The study places particular emphasis on the Saudi Arabian sample, providing valuable insights into the cultural context and shedding light on the specific dynamics of social media’s impact on mental well-being and family dynamics in this demographic context. Methods: We collected data through a subsection of an anonymous web-based survey titled “The Effect of COVID-19 on Social Media Usage, Mental Health, and Family Functioning.” The survey was distributed through diverse web-based platforms in Saudi Arabia, emphasizing the Saudi sample. The participants indicated their social media accounts and estimated their daily use. Mental health was assessed using the General Health Questionnaire and family functioning was evaluated using the Family Assessment Device Questionnaire. In addition, 6 mental health conditions (anxiety, self-esteem, depression, body dysmorphia, social media addiction, and eating disorders) were self-reported by participants. Results: The study demonstrates a pattern of frequent social media use, with a significant portion dedicating 3-5 hours daily for web-based activities, and most of the sample accessed platforms multiple times a day. Despite concerns about social media addiction and perceived unhealthiness, participants cited staying connected with friends and family as their primary motivation for social media use. WhatsApp was perceived as the most positively impactful, whereas TikTok was considered the most negative for our Saudi sample. YouTube, Instagram, and Snapchat users reported poorer mental health compared with nonusers of these platforms. Mental health effects encompassed anxiety and addiction, with age and gender emerging as significant factors. Associations between social media use and family functioning were evident, with higher social media quartiles correlating with a greater likelihood of mental health and unhealthy family functioning. Logistic regression identified age and gender as factors linked to affected mental health, particularly noting that female participants aged 25-34 years were found to be more susceptible to affected mental health. In addition, multivariable analysis identified age and social media use quartiles as factors associated with poor family functioning. Conclusions: This study examined how social media affects mental health and family functioning in Saudi Arabia. These findings underscore the need for culturally tailored interventions to address these challenges, considering diverse demographic needs. Recognizing these nuances can guide the development of interventions to promote digital well-being, acknowledging the importance of familial connections in Saudi society. %M 38227352 %R 10.2196/44923 %U https://formative.jmir.org/2024/1/e44923 %U https://doi.org/10.2196/44923 %U http://www.ncbi.nlm.nih.gov/pubmed/38227352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50222 %T Exploring Adolescents’ Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study %A Høgsdal,Helene %A Kyrrestad,Henriette %A Rye,Marte %A Kaiser,Sabine %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT The Arctic University of Norway, Campus Tromsø, Tromsø, 9019, Norway, 47 77646619, helene.hogsdal@uit.no %K mental health applications %K mental health %K adolescents %K adolescent %K youth %K mobile health %K app %K apps %K application %K applications %K opinion %K opinions %K cross sectional %K survey %K surveys %K questionnaire %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents’ attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, “What do you think about mental health apps in general?”). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. %M 38224474 %R 10.2196/50222 %U https://formative.jmir.org/2024/1/e50222 %U https://doi.org/10.2196/50222 %U http://www.ncbi.nlm.nih.gov/pubmed/38224474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45391 %T Clinical Needs Assessment of a Machine Learning–Based Asthma Management Tool: User-Centered Design Approach %A Zheng,Lu %A Ohde,Joshua W %A Overgaard,Shauna M %A Brereton,Tracey A %A Jose,Kristelle %A Wi,Chung-Il %A Peterson,Kevin J %A Juhn,Young J %+ Center for Digital Health, Mayo Clinic, 200 1st Street South West, Rochester, MN, United States, 1 480 758 0664, zheng.lu@mayo.edu %K asthma %K formative research %K user-centered design %K machine learning (ML) %K artificial intelligence (AI) %K qualitative %K user needs. %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Personalized asthma management depends on a clinician’s ability to efficiently review patient’s data and make timely clinical decisions. Unfortunately, efficient and effective review of these data is impeded by the varied format, location, and workflow of data acquisition, storage, and processing in the electronic health record. While machine learning (ML) and clinical decision support tools are well-positioned as potential solutions, the translation of such frameworks requires that barriers to implementation be addressed in the formative research stages. Objective: We aimed to use a structured user-centered design approach (double-diamond design framework) to (1) qualitatively explore clinicians’ experience with the current asthma management system, (2) identify user requirements to improve algorithm explainability and Asthma Guidance and Prediction System prototype, and (3) identify potential barriers to ML-based clinical decision support system use. Methods: At the “discovery” phase, we first shadowed to understand the practice context. Then, semistructured interviews were conducted digitally with 14 clinicians who encountered pediatric asthma patients at 2 outpatient facilities. Participants were asked about their current difficulties in gathering information for patients with pediatric asthma, their expectations of ideal workflows and tools, and suggestions on user-centered interfaces and features. At the “define” phase, a synthesis analysis was conducted to converge key results from interviewees’ insights into themes, eventually forming critical “how might we” research questions to guide model development and implementation. Results: We identified user requirements and potential barriers associated with three overarching themes: (1) usability and workflow aspects of the ML system, (2) user expectations and algorithm explainability, and (3) barriers to implementation in context. Even though the responsibilities and workflows vary among different roles, the core asthma-related information and functions they requested were highly cohesive, which allows for a shared information view of the tool. Clinicians hope to perceive the usability of the model with the ability to note patients’ high risks and take proactive actions to manage asthma efficiently and effectively. For optimal ML algorithm explainability, requirements included documentation to support the validity of algorithm development and output logic, and a request for increased transparency to build trust and validate how the algorithm arrived at the decision. Acceptability, adoption, and sustainability of the asthma management tool are implementation outcomes that are reliant on the proper design and training as suggested by participants. Conclusions: As part of our comprehensive informatics-based process centered on clinical usability, we approach the problem using a theoretical framework grounded in user experience research leveraging semistructured interviews. Our focus on meeting the needs of the practice with ML technology is emphasized by a user-centered approach to clinician engagement through upstream technology design. %M 38224482 %R 10.2196/45391 %U https://formative.jmir.org/2024/1/e45391 %U https://doi.org/10.2196/45391 %U http://www.ncbi.nlm.nih.gov/pubmed/38224482 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51361 %T Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study %A Nguyen,Quynh C %A Aparicio,Elizabeth M %A Jasczynski,Michelle %A Channell Doig,Amara %A Yue,Xiaohe %A Mane,Heran %A Srikanth,Neha %A Gutierrez,Francia Ximena Marin %A Delcid,Nataly %A He,Xin %A Boyd-Graber,Jordan %+ Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4254 Stadium Dr., College Park, MD, 20742, United States, 1 301 405 6425, qtnguyen@umd.edu %K chatbot %K health information %K maternal and child health %K health disparities %K health equity %K health informatics %K preventive health care %K postpartum care %K patient education %K newborn care %K prenatal care %K mobile phone %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. Objective: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. Methods: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children’s book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie’s knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial’s sample size calculations. Results: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie’s answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. Conclusions: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot’s ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515 %M 38214963 %R 10.2196/51361 %U https://formative.jmir.org/2024/1/e51361 %U https://doi.org/10.2196/51361 %U http://www.ncbi.nlm.nih.gov/pubmed/38214963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51795 %T Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study %A Efe,Zeki %A Baldofski,Sabrina %A Kohls,Elisabeth %A Eckert,Melanie %A Saee,Shadi %A Thomas,Julia %A Wundrack,Richard %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstr 10, Haus 13, Leipzig, 04103, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K e-mental health %K chat counseling %K crisis %K helpline %K linguistic %K language %K Linguistic Inquiry and Word Count %K LIWC %K psychiatric symptoms %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person’s mental health state and is known to be a marker for psychopathology. Objective: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. Methods: For this study, the anonymized chat content of a German messenger–based psychosocial chat counseling service for children and adolescents (“krisenchat”) between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. Results: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. Conclusions: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users’ psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services. %M 38214955 %R 10.2196/51795 %U https://formative.jmir.org/2024/1/e51795 %U https://doi.org/10.2196/51795 %U http://www.ncbi.nlm.nih.gov/pubmed/38214955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43683 %T Mapping the Cardiometabolic Patient Experience and Self-Care Behaviors to Inform Design, Implementation, and Persistent Use of Digital Health Care Solutions: Mixed Methods Study %A Liska,Jan %A Mical,Marie %A Maillard,Christophe %A Dessapt,Cécile %A Bendig,Europa %A Mai,Daniel %A Piette,John D %A De Geest,Sabina %A Fontaine,Guillaume %+ Sanofi, 46-48 Avenue de la Grande Armée, Paris, 75017, France, 33 141247000, Jan.Liska@sanofi.com %K self-care %K adherence %K digital health %K design %K implementation %K coronary %K type 2 diabetes %K care %K patient engagement %K behavior %K interview %K treatment %K tool %K digital tool %K support %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiometabolic conditions including acute coronary syndrome (ACS) and type 2 diabetes (T2D) require comprehensive care and patient engagement in self-care behaviors, and the drivers of those behaviors at the individual and health system level are still poorly understood. Objective: We aim to gain insights into self-care behaviors of individuals with cardiometabolic conditions. Methods: A convenience sample of 98 adult patients with ACS and T2D was recruited in the United States, Germany, and Taiwan to participate in a mixed methods study using ethnographic methods. All participants completed 7-day web-based diaries tracking their level of engagement, and 48 completed 90-minute web-based semistructured interviews between February 4, 2021, and March 27, 2021, focusing on themes including moments of engagement. Qualitative analysis identified factors influencing self-care practices and a Patient Mind States Model prototype. Results: Patient reports indicate that many patients feel social pressure to adhere to treatment. Patients’ experience can be understood within 5 categories defined in terms of their degree of engagement and adherence (“ignoring,” “struggling,” “juggling,” “controlling,” and “reframing”). Conclusions: For people living with ACS and T2D, the self-care journey is defined by patterns of patient experiences, which can identify areas that tailored digital health care interventions may play a meaningful role. %M 38214969 %R 10.2196/43683 %U https://formative.jmir.org/2024/1/e43683 %U https://doi.org/10.2196/43683 %U http://www.ncbi.nlm.nih.gov/pubmed/38214969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52157 %T Promoting Self-Efficacy of Individuals With Autism in Practicing Social Skills in the Workplace Using Virtual Reality and Physiological Sensors: Mixed Methods Study %A Kim,Sung-In %A Jang,So-youn %A Kim,Taewan %A Kim,Bogoan %A Jeong,Dayoung %A Noh,Taehyung %A Jeong,Mingon %A Hall,Kaely %A Kim,Meelim %A Yoo,Hee Jeong %A Han,Kyungsik %A Hong,Hwajung %A Kim,Jennifer G %+ Georgia Institute of Technology, 225 North Ave, Atlanta, GA, 30332, United States, 1 404 894 2000, jennifer.kim@cc.gatech.edu %K autism %K virtual reality %K workplace %K self-efficacy %K social skills %K data reflection %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism often experience heightened anxiety in workplace environments because of challenges in communication and sensory overload. As these experiences can result in negative self-image, promoting their self-efficacy in the workplace is crucial. Virtual reality (VR) systems have emerged as promising tools for enhancing the self-efficacy of individuals with autism in navigating social scenarios, aiding in the identification of anxiety-inducing situations, and preparing for real-world interactions. However, there is limited research exploring the potential of VR to enhance self-efficacy by facilitating an understanding of emotional and physiological states during social skills practice. Objective: This study aims to develop and evaluate a VR system that enabled users to experience simulated work-related social scenarios and reflect on their behavioral and physiological data through data visualizations. We intended to investigate how these data, combined with the simulations, can support individuals with autism in building their self-efficacy in social skills. Methods: We developed WorkplaceVR, a comprehensive VR system designed for engagement in simulated work-related social scenarios, supplemented with data-driven reflections of users’ behavioral and physiological responses. A within-subject deployment study was subsequently conducted with 14 young adults with autism to examine WorkplaceVR’s feasibility. A mixed methods approach was used, compassing pre- and postsystem use assessments of participants’ self-efficacy perceptions. Results: The study results revealed WorkplaceVR’s effectiveness in enhancing social skills and self-efficacy among individuals with autism. First, participants exhibited a statistically significant increase in perceived self-efficacy following their engagement with the VR system (P=.02). Second, thematic analysis of the interview data confirmed that the VR system and reflections on the data fostered increased self-awareness among participants about social situations that trigger their anxiety, as well as the behaviors they exhibit during anxious moments. This increased self-awareness prompted the participants to recollect their related experiences in the real world and articulate anxiety management strategies. Furthermore, the insights uncovered motivated participants to engage in self-advocacy, as they wanted to share the insights with others. Conclusions: This study highlights the potential of VR simulations enriched with physiological and behavioral sensing as a valuable tool for augmenting self-efficacy in workplace social interactions for individuals with autism. Data reflection facilitated by physiological sensors helped participants with autism become more self-aware of their emotions and behaviors, advocate for their characteristics, and develop positive self-beliefs. %M 38206652 %R 10.2196/52157 %U https://formative.jmir.org/2024/1/e52157 %U https://doi.org/10.2196/52157 %U http://www.ncbi.nlm.nih.gov/pubmed/38206652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51200 %T Dentists’ Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study %A Li,Shuning %A Felix Gomez,Grace Gomez %A Xu,Huiping %A Rajapuri,Anushri Singh %A Dixon,Brian E %A Thyvalikakath,Thankam %+ Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, 415 Lansing St, Indianapolis, IN, 46201, United States, 1 3172745460, tpt@iu.edu %K dentistry %K medical history %K integrated medical and dental records %K health information exchange %K medical record %K dental record %K dental %K medical information %K dental care %K adverse drug effect %K medication %K allergies %K cost %K data safety %K data accuracy %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists’ information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists’ information needs regarding patients’ medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents’ characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients’ medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient’s information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients’ medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs. %M 38206667 %R 10.2196/51200 %U https://formative.jmir.org/2024/1/e51200 %U https://doi.org/10.2196/51200 %U http://www.ncbi.nlm.nih.gov/pubmed/38206667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48935 %T Population-Level Portal-Based Anxiety and Depression Screening Perspectives in HIV Care Clinicians: Qualitative Study Using the Consolidated Framework for Implementation Research %A Zimmer,Daniela %A Staab,Erin M %A Ridgway,Jessica P %A Schmitt,Jessica %A Franco,Melissa %A Hunter,Scott J %A Motley,Darnell %A Laiteerapong,Neda %+ Section of General Internal Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 312 702 8847, dazimmer@bsd.uchicago.edu %K HIV %K patient portal %K clinic staff perspectives %K depression and anxiety screening %K implementation %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are common among people with HIV and are associated with inadequate viral suppression, disease progression, and increased mortality. However, depression and anxiety are underdiagnosed and undertreated in people with HIV owing to inadequate visit time and personnel availability. Conducting population-level depression and anxiety screening via the patient portal is a promising intervention that has not been studied in HIV care settings. Objective: We aimed to explore facilitators of and barriers to implementing population-level portal-based depression and anxiety screening for people with HIV. Methods: We conducted semistructured hour-long qualitative interviews based on the Consolidated Framework for Implementation Research with clinicians at an HIV clinic. Results: A total of 10 clinicians participated in interviews. In total, 10 facilitators and 7 barriers were identified across 5 Consolidated Framework for Implementation Research domains. Facilitators included advantages of systematic screening outside clinic visits; the expectation that assessment frequency could be tailored to patient needs; evidence from the literature and previous experience in other settings; respect for patient privacy; empowering patients and facilitating communication about mental health; compatibility with clinic culture, workflows, and systems; staff beliefs about the importance of mental health screening and benefits for HIV care; engaging all clinic staff and leveraging their strengths; and clear planning and communication with staff. Barriers included difficulty in ensuring prompt response to suicidal ideation; patient access, experience, and comfort using the portal; limited availability of mental health services; variations in how providers use the electronic health record and communicate with patients; limited capacity to address mental health concerns during HIV visits; staff knowledge and self-efficacy regarding the management of mental health conditions; and the impersonal approach to a sensitive topic. Conclusions: We proposed 13 strategies for implementing population-level portal-based screening for people with HIV. Before implementation, clinics can conduct local assessments of clinicians and clinic staff; engage clinicians and clinic staff with various roles and expertise to support the implementation; highlight advantages, relevance, and evidence for population-level portal-based mental health screening; make screening frequency adaptable based on patient history and symptoms; use user-centered design methods to refine results that are displayed and communicated in the electronic health record; make screening tools available for patients to use on demand in the portal; and create protocols for positive depression and anxiety screeners, including those indicating imminent risk. During implementation, clinics should communicate with clinicians and clinic staff and provide training on protocols; provide technical support and demonstrations for patients on how to use the portal; use multiple screening methods for broad reach; use patient-centered communication in portal messages; provide clinical decision support tools, training, and mentorship to help clinicians manage mental health concerns; and implement integrated behavioral health and increase mental health referral partnerships. %M 38206651 %R 10.2196/48935 %U https://formative.jmir.org/2024/1/e48935 %U https://doi.org/10.2196/48935 %U http://www.ncbi.nlm.nih.gov/pubmed/38206651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47308 %T Office Workers’ Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study %A Rutter,Sophie %A Sanger,Sally %A Madden,Andrew D %A Ehdeed,Sukaina %A Stones,Catherine %+ Information School, University of Sheffield, The Wave 2, Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 0114 222 2659, s.rutter@sheffield.ac.uk %K hand hygiene %K smart sanitizers %K Internet of Things %K IoT %K offices %K workplaces %K smart systems %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers’ own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. %M 38206674 %R 10.2196/47308 %U https://formative.jmir.org/2024/1/e47308 %U https://doi.org/10.2196/47308 %U http://www.ncbi.nlm.nih.gov/pubmed/38206674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46222 %T The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study %A Josefsson,Cecilia %A Liljeroos,Thea %A Hellgren,Margareta %A Pöder,Ulrika %A Hedström,Mariann %A Olsson,Erik M G %+ Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, Uppsala, 751 22, Sweden, 46 18 471 66 72, cecilia.josefsson@pubcare.uu.se %K diabetes mellitus %K type 2 %K health behavior %K mobile health %K mobile application %K pilot study %K mobile app %K mHealth %K diabetes %K diabetic %K RCT %K randomized %K glycemic %K self care %K self management %K blood sugar %K T2D %K diabetes type 2 %K home-testing %K digital health %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). Objective: This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. Methods: Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. Results: Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. Conclusions: Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement. %M 38198200 %R 10.2196/46222 %U https://formative.jmir.org/2024/1/e46222 %U https://doi.org/10.2196/46222 %U http://www.ncbi.nlm.nih.gov/pubmed/38198200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46284 %T Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study %A Gill,Roopan %A Ogilvie,Gina %A Norman,Wendy V %A Fitzsimmons,Brian %A Maher,Ciana %A Renner,Regina %+ Department of Obstetrics and Gynecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada, 1 4169782216, roopan.gill@gmail.com %K mobile health %K mHealth %K digital health %K abortion %K human-centered design %K sexual and reproductive health %K qualitative research %K mixed methods %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women’s and Children’s Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. %M 38194252 %R 10.2196/46284 %U https://formative.jmir.org/2024/1/e46284 %U https://doi.org/10.2196/46284 %U http://www.ncbi.nlm.nih.gov/pubmed/38194252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52969 %T Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial %A Alvarez,Carmen %A Aryal,Subhash %A Vrany,Elizabeth %A Sanchez R,Maria Jose %A Quiles,Rosalphie %A Escobar-Acosta,Lia %A Hill-Briggs,Felicia %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2158980715, alcarmen@nursing.upenn.edu %K Latina immigrant %K mental health %K depression %K anxiety %K problem-solving %K intervention study %K trauma-informed %K depressive %K Latinx %K Latin %K Latino %K Latina %K Hispanic %K Spanish %K immigrant %K immigrants %K survivor %K child %K children %K childhood %K trauma %K traumatic %K adverse %K telehealth %K telemedicine %K eHealth %K digital health %K feasibility %K acceptability %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention—Cuidándome (quee-DAN-doh-meh, “taking care of myself”). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. Objective: The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem–solving styles. Methods: We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem–solving styles at baseline, post intervention, and 3- and 6-month follow-up. Results: Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). Conclusions: A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. Trial Registration: ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518 %M 38190239 %R 10.2196/52969 %U https://formative.jmir.org/2024/1/e52969 %U https://doi.org/10.2196/52969 %U http://www.ncbi.nlm.nih.gov/pubmed/38190239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51839 %T Methodological Insights on Recruitment and Retention From a Remote Randomized Controlled Trial Examining the Effectiveness of an Alcohol Reduction App: Descriptive Analysis Study %A Oldham,Melissa %A Dinu,Larisa %A Loebenberg,Gemma %A Field,Matt %A Hickman,Matthew %A Michie,Susan %A Brown,Jamie %A Garnett,Claire %+ University College London, London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K alcohol %K digital care %K digital intervention %K ethnic minority %K methods %K mHealth %K randomised controlled trial %K recruitment %K retention %K social media %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Randomized controlled trials (RCTs) with no in-person contact (ie, remote) between researchers and participants offer savings in terms of cost and time but present unique challenges. Objective: The goal of this study is to examine the differences between different forms of remote recruitment (eg, National Health Service [NHS] website, social media, and radio advertising) in the proportion of participants recruited, demographic diversity, follow-up rates, and cost. We also examine the cost per participant of sequential methods of follow-up (emails, phone calls, postal surveys, and postcards). Finally, our experience with broader issues around study advertising and participant deception is discussed. Methods: We conducted a descriptive analysis of 5602 increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥8), taking part in a 2-arm, parallel group, remote RCT with a 1:1 allocation, comparing the intervention (Drink Less app) with usual digital care (NHS alcohol advice web page). Participants were recruited between July 2020 and March 2022 and compensated with gift vouchers of up to £36 (a currency exchange rate of £1=US $1.26988 is applicable) for completing follow-up surveys, with 4 stages of follow-up: email reminders, phone calls, postal survey, and postcard. Results: The three main recruitment methods were advertisements on (1) social media (2483/5602, 44.32%), (2) the NHS website (1961/5602, 35.01%), and (3) radio and newspapers (745/5602, 13.3%), with the remaining methods of recruitment accounting 7.37% (413/5602) of the sample. The overall recruitment cost per participant varied from £0 to £11.01. Costs were greater when recruiting participants who were men (£0-£28.85), from an ethnic minority group (£0-£303.81), and more disadvantaged (£0-£49.12). Targeted approaches were useful for recruiting more men but less useful in achieving diversity in ethnicity and socioeconomic status. Follow-up at 6 months was 79.58% (4458/5602). Of those who responded, 92.4% (4119/4458) responded by email. Each additional stage of follow-up resulted in an additional 2-3 percentage points of the overall sample being followed up, although phone calls, postal surveys, and postcards were more resource intensive than email reminders. Conclusions: For remote RCTs, researchers could benefit from using a range of recruitment methods and cost-targeted approaches to achieve demographic diversity. Automated emails with substantial financial incentives for prompt completion can achieve good follow-up rates, and sequential, offline follow-up options, such as phone calls and postal surveys, can further increase follow-up rates but are comparatively expensive. We also make broader recommendations focused on striking the right balance when designing remote RCTs. Careful planning, ongoing maintenance, and dynamic decision-making are required throughout a trial to balance the competing demands of participation among those eligible, deceptive participation among those who are not eligible, and ensuring no postrandomization bias is introduced by data-checking protocols. %M 38180802 %R 10.2196/51839 %U https://formative.jmir.org/2024/1/e51839 %U https://doi.org/10.2196/51839 %U http://www.ncbi.nlm.nih.gov/pubmed/38180802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46515 %T Prevalence of Body Dysmorphic Disorder in the Spanish Population: Cross-Sectional Web-Based Questionnaire Study %A Loewen,Álvaro %A Blasco-Fontecilla,Hilario %A Li,Chao %A Bella-Fernández,Marcos %A Ruiz-Antorán,Belén %+ Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, C/ Manuel de Falla, 1, Majadahonda, 28222, Spain, 34 911911690, hmblasco@yahoo.es %K body dysmorphic disorder %K prevalence %K adults %K Spain %K comorbidities %K mental health %K depression %K anxiety %K OCD %K obsessive-compulsive disorder %D 2024 %7 4.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Body dysmorphic disorder (BDD) is defined as excessive concern with mild or nonexistent defects in personal physical appearance, which are not perceived by others. The worldwide prevalence of BDD ranges between 0.5% and 3.2%, with no differences across genders. The mean age of onset of BDD is 16.9 years. BDD is typically associated with young age, psychiatric disorders, and dermatological procedures. Patients with BDD typically display poorer mental health status than patients diagnosed with other mental disorders. Objective: The aim of this study was to estimate the prevalence of BDD in Spain and to identify the variables associated with BDD. Methods: We performed a cross-sectional descriptive study by collecting data through an anonymous web-based survey targeting the Spanish population aged 18 years or older. The measures in this study were (1) sociodemographic variables, (2) variables associated with dermatological and psychiatric disorders and cosmetic procedures, (3) scales measuring quality of life (12-item Short Form health survey, version 2) and (4) BDD (BDD Questionnaire). Statistical analysis was performed with SPSS software version 21. P values less than .05 were considered significant. Results: Of the 2091 participants who took the survey, 322 (15.2%) met the criteria of having BDD. The mean age of the participants with BDD was 23.5 (SD 9.6) years. In terms of BDD prevalence, women accounted for 19.9% (284/1421), men accounted for 5.2% (34/653), and students accounted for 25.2% (263/1043). Approximately 46.6% (150/322) of the participants with BDD reported a history of psychiatric comorbidities, including anxiety disorders, depressive disorders, and eating disorders. BDD was significantly associated with female gender, younger age (18-24 years), students, monthly income of less than €500 (€1=US $1.11), and the presence of dermatological and some psychiatric disorders such as depression, anxiety, and eating disorders (P<.05). The number of body parts of concern in participants with BDD was significantly higher than that in those without BDD (4.6 vs 2.2, respectively; P<.001). Regarding the body parts of concern, body fat was the most common concern for both groups with BDD and without BDD, followed by thighs, face, hips, and skin in the BDD group and thighs, teeth, and hair in the non-BDD group. Participants with BDD showed a significantly poorer self-perception of their mental health, irrespective of the presence of any mental disorder (P<.001). Conclusions: Our findings showed that the prevalence of BDD in Spain was higher than expected. Further, BDD is frequently associated with other psychiatric disorders, particularly depressive disorder, anxiety disorder, and eating disorder. Participants with BDD had a poorer perception of quality of life associated with mental but not physical health problems. Finally, the perception of quality of mental health life in participants with BDD was independent of diagnosis of any mental disorder. %M 38175692 %R 10.2196/46515 %U https://formative.jmir.org/2024/1/e46515 %U https://doi.org/10.2196/46515 %U http://www.ncbi.nlm.nih.gov/pubmed/38175692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39211 %T Comparing Self-Reported Running Distance and Pace With a Commercial Fitness Watch Data: Reliability Study %A Bullock,Garrett %A Stocks,Joanne %A Feakins,Benjamin %A Alizadeh,Zahra %A Arundale,Amelia %A Kluzek,Stefan %+ Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27411, United States, 1 3367144264, garrettbullock@gmail.com %K GPS %K Garmin %K training load %K running %K exercise %K fitness %K wearables %K running %K running distance %K pace %K pace distance %D 2024 %7 4.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is substantial evidence exploring the reliability of running distance self-reporting and GPS wearable technology, but there are currently no studies investigating the reliability of participant self-reporting in comparison to GPS wearable technology. There is also a critical sports science and medical research gap due to a paucity of reliability studies assessing self-reported running pace. Objective: The purpose of this study was to assess the reliability of weekly self-reported running distance and pace compared to a commercial GPS fitness watch, stratified by sex and age. These data will give clinicians and sports researchers insights into the reliability of runners’ self-reported pace, which may improve training designs and rehabilitation prescriptions. Methods: A prospective study of recreational runners was performed. Weekly running distance and average running pace were captured through self-report and a fitness watch. Baseline characteristics collected included age and sex. Intraclass correlational coefficients were calculated for weekly running distance and running pace for self-report and watch data. Bland-Altman plots assessed any systemic measurement error. Analyses were then stratified by sex and age. Results: Younger runners reported improved weekly distance reliability (median 0.93, IQR 0.92-0.94). All ages demonstrated similar running pace reliability. Results exhibited no discernable systematic bias. Conclusions: Weekly self-report demonstrated good reliability for running distance and moderate reliability for running pace in comparison to the watch data. Similar reliability was observed for male and female participants. Younger runners demonstrated improved running distance reliability, but all age groups exhibited similar pace reliability. Running pace potentially should be monitored through technological means to increase precision. %M 38175696 %R 10.2196/39211 %U https://formative.jmir.org/2024/1/e39211 %U https://doi.org/10.2196/39211 %U http://www.ncbi.nlm.nih.gov/pubmed/38175696 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49353 %T User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study %A Young,Karen %A Xiong,Ting %A Lee,Rachel %A Banerjee,Ananya Tina %A Leslie,Myles %A Ko,Wellam Yu %A Pham,Quynh %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, q.pham@uhn.ca %K digital health %K virtual care %K digital therapeutics %K prostate cancer %K cancer survivorship %K user-centred design %K usability %K supportive care %K cultural adaptation %K Chinese Canadians %D 2024 %7 1.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants’ desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. %M 38163295 %R 10.2196/49353 %U https://humanfactors.jmir.org/2024/1/e49353 %U https://doi.org/10.2196/49353 %U http://www.ncbi.nlm.nih.gov/pubmed/38163295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51658 %T Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial %A Pandya,Apurvakumar %A K S,Mythri %A Mishra,Shweta %A Bajaj,Kriti %+ Parul Institute of Public Health, Parul University, At & Post - Limda, Waghodia, Vadodara, 391760, India, 91 9825558237, drapurvakumar@gmail.com %K smoking %K nicotine dependence %K smoking cessation %K QuitSure app %K smartphone application %K mHealth %K mobile health %K app %K apps %K application %K applications %K nicotine %K smoke %K smoker %K quit %K quitting %K cessation %K abstinence %K mobile phone %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. Objective: This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. Methods: In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. Results: The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs’ studies. Conclusions: The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence. %M 38157243 %R 10.2196/51658 %U https://formative.jmir.org/2023/1/e51658 %U https://doi.org/10.2196/51658 %U http://www.ncbi.nlm.nih.gov/pubmed/38157243 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45905 %T Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals %A Leo,Hannah P %A Folk,Johanna B %A Rodriguez,Christopher %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, United States, 1 4154767000, Marina.Tolou-Shams@ucsf.edu %K foster youth %K telehealth %K family-based interventions %K mental health %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. Objective: This study aims to understand child welfare system professionals’ perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. Methods: This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. Results: Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. Conclusions: Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin. %M 38157238 %R 10.2196/45905 %U https://formative.jmir.org/2023/1/e45905 %U https://doi.org/10.2196/45905 %U http://www.ncbi.nlm.nih.gov/pubmed/38157238 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e54284 %T Exploring Generation Z and Young Millennials’ Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study %A Park,Susanna Y %A Yourell,Jacqlyn %A McAlister,Kelsey L %A Huberty,Jennifer %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84101, United States, 1 720 675 7228, syjpark@gmail.com %K Gen Z %K Generation Z %K millennial %K GenZennials %K millennials %K young adult %K young adults %K spirituality %K spiritual %K self-care %K mental health %K sleep %K mobile health %K app %K apps %K digital health %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K thematic analysis %K mobile phone %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care. Objective: There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app’s relevance to GenZennials, and (4) gather feedback and suggestions to improve the app. Methods: Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews. Results: Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app’s variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app’s inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app. Conclusions: This is the first study to qualitatively explore GenZennials’ perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials’ spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health. %M 38064199 %R 10.2196/54284 %U https://formative.jmir.org/2023/1/e54284 %U https://doi.org/10.2196/54284 %U http://www.ncbi.nlm.nih.gov/pubmed/38064199 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53619 %T A Remotely Delivered, Semaglutide-Supported Specialist Weight Management Program: Preliminary Findings From a Retrospective Service Evaluation %A Richards,Rebecca %A Wren,Gina M %A Campion,Peta %A Whitman,Michael %+ Second Nature, 483 Green Lanes, London, N13 4BS, United Kingdom, 44 020 3488 076, becky@secondnature.io %K digital health intervention %K smartphone %K obesity management %K medication %K mobile phone %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital weight management interventions have the potential to increase access to novel pharmacotherapy for people living with obesity. At present, there is limited real-world evidence on the effectiveness, feasibility, and acceptability of this type of intervention. Objective: This retrospective service evaluation examines real-world data to evaluate the preliminary impact of Second Nature’s 24-month, remotely delivered, semaglutide-supported weight management intervention for adults living with obesity at 12 weeks. Methods: Retrospective data were extracted in October 2023 for participants who started the intervention between June 8, 2023, and July 22, 2023. The primary outcomes were weight change (kg) and percentage of weight change at 12 weeks. The secondary outcomes were the proportion of participants who achieved ≥5% and ≥10% weight loss and the feasibility and acceptability of this type of intervention. Descriptive statistics were used to evaluate the baseline characteristics, retention, engagement, prevalence of side effects, and weight change. A paired 2-tailed t test was used to determine the significance of weight change. Content analysis was used to analyze the free-text questionnaire responses. Results: A total of 113 participants with a mean baseline BMI of 38.4 kg/m2 (SD 7.3) were included in the analysis (n=102, 90.4% women, mean age 46.6, SD 11.1 years). Over 12 weeks, 23% (n=26) of participants withdrew from the intervention. A total of 70.8% (n=80) of participants provided weight data at 12 weeks. The average weight loss observed over this 12-week period was 6.5 (SD 4.4) kg (P<.001) or 6.4% (SD 4.2%) of their starting weight (P<.001). Of the 80 participants who recorded weight readings, 62.5% (n=50) achieved ≥5% weight loss, and 11.3% (n=9) achieved ≥10% weight loss. Engagement with the app-based program declined from a mean of 131 (SD 142.6) home screen views in week 0 to 35 (SD 57.1) in week 11. Common side effects reported over 12 weeks included feeling more tired than usual, constipation, and feeling sick. However, a significant proportion of participants reported no side effects. Most participants (n=106, 93.8%) did not experience any difficulties in medication administration. Qualitative data showed that most participants had a positive or neutral experience of the intervention, with some reporting perceived benefits as early as 4 weeks. Most participants did not feel that improvements in the intervention were needed; however, some participants faced issues with medication shipping or logistics. Conclusions: This retrospective preliminary service evaluation suggests that a remotely delivered semaglutide-supported weight management intervention has the potential to be effective, feasible, and acceptable for self-paying consumer adults with obesity in the United Kingdom. Areas for further improvement were highlighted, including user engagement in an app-based program. A full-service evaluation at the end of the 24-month intervention with a larger sample size is required to support these early findings. %M 38153780 %R 10.2196/53619 %U https://formative.jmir.org/2023/1/e53619 %U https://doi.org/10.2196/53619 %U http://www.ncbi.nlm.nih.gov/pubmed/38153780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49239 %T Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study %A Tan,Tze Chin %A Roslan,Nur Emillia Binte %A Li,James Weiquan %A Zou,Xinying %A Chen,Xiangmei %A Ratnasari, %A Santosa,Anindita %+ Division of Rheumatology and Immunology, Department of Medicine, Changi General Hospital, 2 Simei Street 3, Level 6, Medical Centre, Singapore, 529889, Singapore, 65 90128379, anindita.santosa@singhealth.com.sg %K conversational agents %K digital technology in medicine %K rheumatology %K early diagnosis %K education %K patient‒physician interactions %K autoimmune rheumatic diseases %K chatbot %K implementation %K patient survey %K digital health intervention %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. Objective: We aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). Methods: We administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. Results: Between June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients’ comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. Conclusions: This study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts. %M 37219234 %R 10.2196/49239 %U https://formative.jmir.org/2023/1/e49239 %U https://doi.org/10.2196/49239 %U http://www.ncbi.nlm.nih.gov/pubmed/37219234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51798 %T Exploring the Potential of ChatGPT-4 in Predicting Refractive Surgery Categorizations: Comparative Study %A Ćirković,Aleksandar %A Katz,Toam %+ Care Vision Germany, Ltd, Zeltnerstraße 1-3, Nuremberg, 90443, Germany, 49 9119564950, aleksandar.cirkovic@mailbox.org %K artificial intelligence %K machine learning %K decision support systems %K clinical %K refractive surgical procedures %K risk assessment %K ophthalmology %K health informatics %K predictive modeling %K data analysis %K medical decision-making %K eHealth %K ChatGPT-4 %K ChatGPT %K refractive surgery %K categorization %K AI-powered algorithm %K large language model %K decision-making %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Refractive surgery research aims to optimally precategorize patients by their suitability for various types of surgery. Recent advances have led to the development of artificial intelligence–powered algorithms, including machine learning approaches, to assess risks and enhance workflow. Large language models (LLMs) like ChatGPT-4 (OpenAI LP) have emerged as potential general artificial intelligence tools that can assist across various disciplines, possibly including refractive surgery decision-making. However, their actual capabilities in precategorizing refractive surgery patients based on real-world parameters remain unexplored. Objective: This exploratory study aimed to validate ChatGPT-4’s capabilities in precategorizing refractive surgery patients based on commonly used clinical parameters. The goal was to assess whether ChatGPT-4’s performance when categorizing batch inputs is comparable to those made by a refractive surgeon. A simple binary set of categories (patient suitable for laser refractive surgery or not) as well as a more detailed set were compared. Methods: Data from 100 consecutive patients from a refractive clinic were anonymized and analyzed. Parameters included age, sex, manifest refraction, visual acuity, and various corneal measurements and indices from Scheimpflug imaging. This study compared ChatGPT-4’s performance with a clinician’s categorizations using Cohen κ coefficient, a chi-square test, a confusion matrix, accuracy, precision, recall, F1-score, and receiver operating characteristic area under the curve. Results: A statistically significant noncoincidental accordance was found between ChatGPT-4 and the clinician’s categorizations with a Cohen κ coefficient of 0.399 for 6 categories (95% CI 0.256-0.537) and 0.610 for binary categorization (95% CI 0.372-0.792). The model showed temporal instability and response variability, however. The chi-square test on 6 categories indicated an association between the 2 raters’ distributions (χ²5=94.7, P<.001). Here, the accuracy was 0.68, precision 0.75, recall 0.68, and F1-score 0.70. For 2 categories, the accuracy was 0.88, precision 0.88, recall 0.88, F1-score 0.88, and area under the curve 0.79. Conclusions: This study revealed that ChatGPT-4 exhibits potential as a precategorization tool in refractive surgery, showing promising agreement with clinician categorizations. However, its main limitations include, among others, dependency on solely one human rater, small sample size, the instability and variability of ChatGPT’s (OpenAI LP) output between iterations and nontransparency of the underlying models. The results encourage further exploration into the application of LLMs like ChatGPT-4 in health care, particularly in decision-making processes that require understanding vast clinical data. Future research should focus on defining the model’s accuracy with prompt and vignette standardization, detecting confounding factors, and comparing to other versions of ChatGPT-4 and other LLMs to pave the way for larger-scale validation and real-world implementation. %M 38153777 %R 10.2196/51798 %U https://formative.jmir.org/2023/1/e51798 %U https://doi.org/10.2196/51798 %U http://www.ncbi.nlm.nih.gov/pubmed/38153777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51065 %T Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study %A Reid,Denzil %A Mehta,Jyotsna %A Anis,Karim %A Mehta,Shail %+ Keva Health, 12 Bedford Street, Lexington, MA, 02420, United States, 1 8007275382, jyotsna@kevahealth.com %K asthma %K remote patient monitoring %K virtual care solution %K respiratory care %K chronic disease management %K spirometry %K telehealth %K management %K chronic disease %K virtual care %K patient monitoring %K respiratory %K respiratory care %K respiratory illness %K patient monitoring tool %K tool %K decision-making %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits. Objective: This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring. Methods: Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ≥18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app’s usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study’s time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient’s symptoms and objective data. Results: Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient’s asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64% (14/22) and 91% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education. Conclusions: In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings. %M 38153783 %R 10.2196/51065 %U https://formative.jmir.org/2023/1/e51065 %U https://doi.org/10.2196/51065 %U http://www.ncbi.nlm.nih.gov/pubmed/38153783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52410 %T mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study %A Choi,Soyoung %A Sajib,Md Refat Uz Zaman %A Manzano,Jenna %A Chlebek,Christian Joseph %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 272 Freer Hall, 906 South Goodwin Avenue, Urbana, IL, 61801-3028, United States, 1 2174024128, soyoung@illinois.edu %K aging %K mobile health %K older adults %K technology %K visual impairment %K wearables %K wearable %K vision %K visual %K qualitative analysis %K health behavior %K mHealth %K mHealth technology %K digital technology %K medical application %K application %K app %K applications %K usage %K well-being %K cross-section interview %K interview %K interviews %K tracking %K health data %K symptom monitoring %K monitor %K monitoring %K symptom %K symptoms %K physical activity %K walking %K routine %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals’ disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. %M 38145472 %R 10.2196/52410 %U https://formative.jmir.org/2023/1/e52410 %U https://doi.org/10.2196/52410 %U http://www.ncbi.nlm.nih.gov/pubmed/38145472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51921 %T Designing Human-Centered AI to Prevent Medication Dispensing Errors: Focus Group Study With Pharmacists %A Zheng,Yifan %A Rowell,Brigid %A Chen,Qiyuan %A Kim,Jin Yong %A Kontar,Raed Al %A Yang,X Jessie %A Lester,Corey A %+ Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, United States, 1 734 647 8849, lesterca@umich.edu %K artificial intelligence %K communication %K design methods %K design %K development %K engineering %K focus groups %K human-computer interaction %K medication errors %K morbidity %K mortality %K patient safety %K safety %K SEIPS %K Systems Engineering Initiative for Patient Safety %K tool %K user-centered design methods %K user-centered %K visualization %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication errors, including dispensing errors, represent a substantial worldwide health risk with significant implications in terms of morbidity, mortality, and financial costs. Although pharmacists use methods like barcode scanning and double-checking for dispensing verification, these measures exhibit limitations. The application of artificial intelligence (AI) in pharmacy verification emerges as a potential solution, offering precision, rapid data analysis, and the ability to recognize medications through computer vision. For AI to be embraced, it must be designed with the end user in mind, fostering trust, clear communication, and seamless collaboration between AI and pharmacists. Objective: This study aimed to gather pharmacists’ feedback in a focus group setting to help inform the initial design of the user interface and iterative designs of the AI prototype. Methods: A multidisciplinary research team engaged pharmacists in a 3-stage process to develop a human-centered AI system for medication dispensing verification. To design the AI model, we used a Bayesian neural network that predicts the dispensed pills’ National Drug Code (NDC). Discussion scripts regarding how to design the system and feedback in focus groups were collected through audio recordings and professionally transcribed, followed by a content analysis guided by the Systems Engineering Initiative for Patient Safety and Human-Machine Teaming theoretical frameworks. Results: A total of 8 pharmacists participated in 3 rounds of focus groups to identify current challenges in medication dispensing verification, brainstorm solutions, and provide feedback on our AI prototype. Participants considered several teaming scenarios, generally favoring a hybrid teaming model where the AI assists in the verification process and a pharmacist intervenes based on medication risk level and the AI’s confidence level. Pharmacists highlighted the need for improving the interpretability of AI systems, such as adding stepwise checkmarks, probability scores, and details about drugs the AI model frequently confuses with the target drug. Pharmacists emphasized the need for simplicity and accessibility. They favored displaying only essential information to prevent overwhelming users with excessive data. Specific design features, such as juxtaposing pill images with their packaging for quick comparisons, were requested. Pharmacists preferred accept, reject, or unsure options. The final prototype interface included (1) checkmarks to compare pill characteristics between the AI-predicted NDC and the prescription’s expected NDC, (2) a histogram showing predicted probabilities for the AI-identified NDC, (3) an image of an AI-provided “confused” pill, and (4) an NDC match status (ie, match, unmatched, or unsure). Conclusions: In partnership with pharmacists, we developed a human-centered AI prototype designed to enhance AI interpretability and foster trust. This initiative emphasized human-machine collaboration and positioned AI as an augmentative tool rather than a replacement. This study highlights the process of designing a human-centered AI for dispensing verification, emphasizing its interpretability, confidence visualization, and collaborative human-machine teaming styles. %M 38145475 %R 10.2196/51921 %U https://formative.jmir.org/2023/1/e51921 %U https://doi.org/10.2196/51921 %U http://www.ncbi.nlm.nih.gov/pubmed/38145475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48850 %T Risk, Trust, and Emotion in Online Pharmacy Medication Purchases: Multimethod Approach Incorporating Customer Self-Reports, Facial Expressions, and Neural Activation %A Ersöz,Semra %A Nissen,Anika %A Schütte,Reinhard %+ Institute for Marketing and Retail, Faculty of Economic Sciences, University of Duisburg-Essen, Universitätsstr 12, Essen, 45141, Germany, 49 2011833385, semra.ersoez@wiwinf.uni-due.de %K online pharmacy %K emotion %K facial expression %K fNIRS %K functional near-infrared spectroscopy %K risk %K trust %K pharmacy %K purchase %K purchasing %K consumer %K consumers %K customer %K customers %K drug %K drugs %K pharmaceutical %K buy %K buyer %K pharmacies %K perception %K perceived %K pharmaceutics %K pharmaceutic %K business %K commerce %K commercial %K e-commerce %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Online pharmacies are used less than other e-commerce sites in Germany. Shopping behavior does not correspond to consumption behavior, as online purchases are predominantly made for over-the-counter (OTC) medications. Objective: The objective of this study was to understand the purchasing experiences of online pharmacy customers in terms of critical factors for online pharmacy adoption. Methods: This study examined the perceived risk, perceived trust, and emotions related to purchasing medications online and, consequently, the purchase intention toward online pharmacies. In a within-subjects design (N=37 participants), 2 German online pharmacies with different perceptions of risk and trust were investigated for their main business, namely OTC and prescription drugs. The results of a preliminary study led to 1 online pharmacy with high and 1 with significantly low self-reported risk by the prestudy sample. Emotions were measured with a multimethod approach during and after the purchase situation as follows: (1) neural evaluation processes using functional near-infrared spectroscopy, (2) the automated direct motor response during the use of the online pharmacy via facial expression analysis (FaceReader), and (3) subjective evaluations through self-reports. Following the shopping experiences at both pharmacies for both product types, risk, trust, and purchase intention toward the pharmacies were assessed using self-assessments. Results: The 2 online pharmacies were rated differently in terms of risk, trust, emotions, and purchase intention. The high-risk pharmacy was also perceived as having lower trust and vice versa. Significantly stronger negative emotional expressions on customers’ faces and different neural activations in the ventromedial prefrontal cortex and dorsomedial prefrontal cortex were measured when purchasing prescription drugs from the high-risk pharmacy than from the low-risk pharmacy, combined with OTC medications. In line with this, customers’ self-ratings indicated higher negative emotions for the high-risk pharmacy and lower negative emotions for the low-risk pharmacy. Moreover, the ratings showed lower purchase intention for the high-risk pharmacy. Conclusions: Using multimethod measurements, we showed that the preceding neural activation and subsequent verbal evaluation of online pharmacies are reflected in the customers’ immediate emotional facial expressions. High-risk online pharmacies and prescription drugs lead to stronger negative emotional facial expressions and trigger neural evaluation processes that imply perceived loss. Low-risk online pharmacies and OTC medications lead to weaker negative emotional facial expressions and trigger neural evaluation processes that signify certainty and perceived reward. The results may provide an explanation for why OTC medications are purchased online more frequently than prescription medications. %M 38145483 %R 10.2196/48850 %U https://formative.jmir.org/2023/1/e48850 %U https://doi.org/10.2196/48850 %U http://www.ncbi.nlm.nih.gov/pubmed/38145483 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46579 %T Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study %A Peart,Natalie %A Hetrick,Sarah %A Gibson,Kerry %A Stasiak,Karolina %+ Department of Psychology, University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand, 64 276758552, nnatalie.peart@auckland.ac.nz %K counseling %K distress %K empathize %K internet %K mental health %K online text %K proactive %K qualitative study %K risk assessment %K self-harm %K social media %K suicide %K validation %K youth %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality. Objective: Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context. Methods: We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke’s reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention. Results: A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person’s post and emojis to further conversations and build rapport. Conclusions: The findings highlight the importance of the counselor’s role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person’s experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively. %M 38145477 %R 10.2196/46579 %U https://formative.jmir.org/2023/1/e46579 %U https://doi.org/10.2196/46579 %U http://www.ncbi.nlm.nih.gov/pubmed/38145477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52995 %T Automated Credibility Assessment of Web-Based Health Information Considering Health on the Net Foundation Code of Conduct (HONcode): Model Development and Validation Study %A Bayani,Azadeh %A Ayotte,Alexandre %A Nikiema,Jean Noel %+ Centre de recherche en santé publique, Université de Montréal et Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, H3C 3J7, Canada, 1 4389980241, azadeh.bayani@umontreal.ca %K HONcode %K infodemic %K natural language processing %K web-based health information %K machine learning %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of users are turning to web-based sources as an important source of health care guidance information. Thus, trustworthy sources of information should be automatically identifiable using objective criteria. Objective: The purpose of this study was to automate the assessment of the Health on the Net Foundation Code of Conduct (HONcode) criteria, enhancing our ability to pinpoint trustworthy health information sources. Methods: A data set of 538 web pages displaying health content was collected from 43 health-related websites. HONcode criteria have been considered as web page and website levels. For the website-level criteria (confidentiality, transparency, financial disclosure, and advertising policy), a bag of keywords has been identified to assess the criteria using a rule-based model. For the web page–level criteria (authority, complementarity, justifiability, and attribution) several machine learning (ML) approaches were used. In total, 200 web pages were manually annotated until achieving a balanced representation in terms of frequency. In total, 3 ML models—random forest, support vector machines (SVM), and Bidirectional Encoder Representations from Transformers (BERT)—were trained on the initial annotated data. A second step of training was implemented for the complementarity criterion using the BERT model for multiclass classification of the complementarity sentences obtained by annotation and data augmentation (positive, negative, and noncommittal sentences). Finally, the remaining web pages were classified using the selected model and 100 sentences were randomly selected for manual review. Results: For web page–level criteria, the random forest model showed a good performance for the attribution criterion while displaying subpar performance in the others. BERT and SVM had a stable performance across all the criteria. BERT had a better area under the curve (AUC) of 0.96, 0.98, and 1.00 for neutral sentences, justifiability, and attribution, respectively. SVM had the overall better performance for the classification of complementarity with the AUC equal to 0.98. Finally, SVM and BERT had an equal AUC of 0.98 for the authority criterion. For the website level criteria, the rule-based model was able to retrieve web pages with an accuracy of 0.97 for confidentiality, 0.82 for transparency, and 0.51 for both financial disclosure and advertising policy. The final evaluation of the sentences determined 0.88 of precision and the agreement level of reviewers was computed at 0.82. Conclusions: Our results showed the potential power of automating the HONcode criteria assessment using ML approaches. This approach could be used with different types of pretrained models to accelerate the text annotation, and classification and to improve the performance in low-resource cases. Further work needs to be conducted to determine how to assign different weights to the criteria, as well as to identify additional characteristics that should be considered for consolidating these criteria into a comprehensive reliability score. %M 38133919 %R 10.2196/52995 %U https://formative.jmir.org/2023/1/e52995 %U https://doi.org/10.2196/52995 %U http://www.ncbi.nlm.nih.gov/pubmed/38133919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50550 %T Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study %A Fridriksdottir,Nanna %A Ingadottir,Brynja %A Skuladottir,Kristin %A Zoëga,Sigridur %A Gunnarsdottir,Sigridur %+ Landspitali- The National University Hospital of Iceland, Hringbraut, Reykjavik, 101, Iceland, 354 543 1000 ext 6065, nannafri@landspitali.is %K web portal for patients with cancer %K supportive digital health service %K symptom monitoring %K self-management support %K feasibility %K usability %K acceptability %K patient education %K health engagement %K patient-reported outcomes %K digital health service %K patient portal %K electronic health records %K mobile phone %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System–Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients’ Knowledge Expectations), and received knowledge (Hospital Patients’ Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=−.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=−.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. %M 38015268 %R 10.2196/50550 %U https://formative.jmir.org/2023/1/e50550 %U https://doi.org/10.2196/50550 %U http://www.ncbi.nlm.nih.gov/pubmed/38015268 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50413 %T College Students’ Employability, Cognition, and Demands for ChatGPT in the AI Era Among Chinese Nursing Students: Web-Based Survey %A Luo,Yuanyuan %A Weng,Huiting %A Yang,Li %A Ding,Ziwei %A Wang,Qin %+ Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renming Middle Road of Furong District, Changsha, 410011, China, 86 187 7480 6226, wangqin3421@csu.edu.cn %K college students’ employability %K artificial intelligence quotient %K ChatGPT %K nursing students %K China %K college student %K AI %K artificial intelligence %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the rapid development of artificial intelligence (AI) and the widespread use of ChatGPT, nursing students’ artificial intelligence quotient (AIQ), employability, cognition, and demand for ChatGPT are worthy of attention. Objective: We aimed to investigate Chinese nursing students’ AIQ and employability status as well as their cognition and demand for the latest AI tool—ChatGPT. This study was conducted to guide future initiatives in nursing intelligence education and to improve the employability of nursing students. Methods: We used a cross-sectional survey to understand nursing college students’ AIQ, employability, cognition, and demand for ChatGPT. Using correlation analysis and multiple hierarchical regression analysis, we explored the relevant factors in the employability of nursing college students. Results: In this study, out of 1788 students, 1453 (81.30%) had not used ChatGPT, and 1170 (65.40%) had never heard of ChatGPT before this survey. College students’ employability scores were positively correlated with AIQ, self-regulation ability, and their home location and negatively correlated with school level. Additionally, men scored higher on college students’ employability compared to women. Furthermore, 76.5% of the variance was explained by the multiple hierarchical regression model for predicting college students’ employability scores. Conclusions: Chinese nursing students have limited familiarity and experience with ChatGPT, while their AIQ remains intermediate. Thus, educators should pay more attention to cultivating nursing students’ AIQ and self-regulation ability to enhance their employability. Employability, especially for female students, those from rural backgrounds, and students in key colleges, deserves more attention in future educational efforts. %M 38133923 %R 10.2196/50413 %U https://formative.jmir.org/2023/1/e50413 %U https://doi.org/10.2196/50413 %U http://www.ncbi.nlm.nih.gov/pubmed/38133923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48958 %T Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial %A Lee,Donghee N %A Sadasivam,Rajani S %A Stevens,Elise M %+ Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 774 455 4871, donghee.lee10@umassmed.edu %K mood %K smoking cessation messages %K computer-tailored health communication %K innovation %K smoking %K cessation %K digital intervention %K effectiveness %K text mining %K adult %K motivation %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants’ current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. Objective: This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. Methods: In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. Results: There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. Conclusions: Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants’ mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes. %M 38133916 %R 10.2196/48958 %U https://formative.jmir.org/2023/1/e48958 %U https://doi.org/10.2196/48958 %U http://www.ncbi.nlm.nih.gov/pubmed/38133916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34346 %T The Effects of Virtual Reality Telemedicine With Pediatric Patients Diagnosed With Posttraumatic Stress Disorder: Exploratory Research Method Case Report %A Bogdanski,Erin %+ TheraVR Inc, 5855 Horton Street, Emeryville, CA, 94608, United States, 1 707 394 6088, erinb@theravr.io %K virtual reality %K psychology %K neuroscience %K behavioral health %K telehealth %K eHealth %K telemedicine %K trauma %K traumatic %K PTSD %K posttraumatic stress disorder %K mental health %K mental condition %K mental illness %K cognitive behavioral therapy %K CBT %K avatar %K case study %K pediatric %K child %K youth %K psychiatric disorder %D 2023 %7 22.12.2023 %9 Case Report %J JMIR Form Res %G English %X Background: Trauma-focused cognitive behavioral therapy (TF-CBT) strategies are common interventions to treat child trauma and a posttraumatic stress disorder (PTSD) diagnosis in children with histories of sexual and physical abuse. With the advent of COVID-19, the disruption of child development combined with intense exposure to technology and screen time indicate a need for delivering other novel approaches to treat pediatric PTSD. Virtual reality (VR) has been used with evidence-based TF-CBT as an intervention in lab-based settings, but never as telehealth. Such technologies, including a VR head-mounted device (HMD) programmed with novel TheraVR software, for psychotherapy and treating trauma-related symptoms could redefine how pediatric populations respond to treatment. Objective: The aim of this exploratory single-case study was to reflect symptom improvement and patient engagement using VR as telehealth. Methods: The patient was a 10-year-old girl of Middle Eastern descent diagnosed with trauma and comorbid medical conditions. The patient was in divorced joint parental custody and a Child Protective Services report was made with referral for therapy. Night terrors, hallucinations, depression, anxiety, isolation, and encopresis symptoms were assessed at the beginning of treatment. Clinical analysis met the criteria for a diagnosis of early onset PTSD, which was treated over the course of 7 months using TF-CBT. A cross-analysis design was used to compare improved effectiveness in treatment and patient outcomes when moving from delivery of care with telehealth using desktop and tablet synchronous technology to 2D VR desktop telehealth with TheraVR software and subsequently HMD VR telehealth with TheraVR software. Sessions were conducted in private practice providing psychotherapy for remote patient care, collateral care with the family, and coordination of clinical care with the patient’s pediatrician. Safety and protocols for reducing triggers were clinically monitored by the provider. Results: Over the course of treatment, and moving from standard telehealth to 2D VR to TheraVR with a standalone HMD, there was a significant reduction in PTSD symptoms. The transfer from using the standard video conferencing with face-to-face video to using customizable avatar technology with an assigned scene environment presented an increase in patient retention and follow-through with the treatment goals. The continuous use of delivery of care using VR with the TheraVR software demonstrated breakthrough clinical observations where the patient devised her own interventions for coping with mood, emotional regulation, and negative cognitive processes using the 10 different VR environments. Conclusions: This study shows the potential efficacy in using VR specifically for younger populations as a better modality of pediatrics care, while improving engagement with the provider through telehealth. These findings suggest the value of further research through larger clinical trials including pediatric patients diagnosed with severe trauma or trauma-related symptoms to assess the effectiveness of TheraVR software. %M 38133920 %R 10.2196/34346 %U https://formative.jmir.org/2023/1/e34346 %U https://doi.org/10.2196/34346 %U http://www.ncbi.nlm.nih.gov/pubmed/38133920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48296 %T Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study %A Dunlop,Emma %A Ferguson,Aimee %A Mueller,Tanja %A Baillie,Kelly %A Laskey,Jennifer %A Clarke,Julie %A Kurdi,Amanj %A Wales,Ann %A Connolly,Thomas %A Bennie,Marion %+ Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral St, Glasgow, G4 0RE, United Kingdom, 44 01415482478, emma.dunlop@strath.ac.uk %K cancer %K clinicians %K mHealth %K mixed methods study %K patient reported outcome measures %K patients %K technology acceptance model %D 2023 %7 21.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients’ lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. Objective: The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. Methods: We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. Results: A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was “quite likely” that the technologies would be easy to use and they would be “quite likely” to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions “with around half” of their patients. Conclusions: This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research. %M 38127422 %R 10.2196/48296 %U https://formative.jmir.org/2023/1/e48296 %U https://doi.org/10.2196/48296 %U http://www.ncbi.nlm.nih.gov/pubmed/38127422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42505 %T A Biobanking System for Diagnostic Images: Architecture Development, COVID-19–Related Use Cases, and Performance Evaluation %A Esposito,Giuseppina %A Allarà,Ciro %A Randon,Marco %A Aiello,Marco %A Salvatore,Marco %A Aceto,Giuseppe %A Pescapè,Antonio %+ Bio Check Up Srl, Via Riviera di Chiaia, 9a, Naples, 80122, Italy, 39 08119322515, gesposito@biocheckup.net %K biobank %K diagnostics %K COVID-19 %K network performance %K eHealth %D 2023 %7 21.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Systems capable of automating and enhancing the management of research and clinical data represent a significant contribution of information and communication technologies to health care. A recent advancement is the development of imaging biobanks, which are now enabling the collection and storage of diagnostic images, clinical reports, and demographic data to allow researchers identify associations between lifestyle and genetic factors and imaging-derived phenotypes. Objective: The aim of this study was to design and evaluate the system performance of a network for an operating biobank of diagnostic images, the Bio Check Up Srl (BCU) Imaging Biobank, based on the Extensible Neuroimaging Archive Toolkit open-source platform. Methods: Three usage cases were designed focusing on evaluation of the memory and computing consumption during imaging collections upload and during interactions between two kinds of users (researchers and radiologists) who inspect chest computed tomography scans of a COVID-19 cohort. The experiments considered three network setups: (1) a local area network, (2) virtual private network, and (3) wide area network. The experimental setup recorded the activity of a human user interacting with the biobank system, which was continuously replayed multiple times. Several metrics were extracted from network traffic traces and server logs captured during the activity replay. Results: Regarding the diagnostic data transfer, two types of containers were considered: the Web and the Database containers. The Web appeared to be the more memory-hungry container with a higher computational load (average 2.7 GB of RAM) compared to that of the database. With respect to user access, both users demonstrated the same network performance level, although higher resource consumption was registered for two different actions: DOWNLOAD & LOGOUT (100%) for the researcher and OPEN VIEWER (20%-50%) for the radiologist. Conclusions: This analysis shows that the current setup of BCU Imaging Biobank is well provisioned for satisfying the planned number of concurrent users. More importantly, this study further highlights and quantifies the resource demands of specific user actions, providing a guideline for planning, setting up, and using an image biobanking system. %M 38064636 %R 10.2196/42505 %U https://formative.jmir.org/2023/1/e42505 %U https://doi.org/10.2196/42505 %U http://www.ncbi.nlm.nih.gov/pubmed/38064636 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51691 %T Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals %A Safiee,Ladan %A Rough,Daniel %A George,Priya %A Mudenha,Roselyn %+ School of Science and Engineering, University of Dundee, Queen Mother Building, Dundee, DD1 4HB, United Kingdom, 44 07585552201, drough001@dundee.ac.uk %K gestational diabetes %K self-management %K mobile health %K mHealth %K qualitative study %K mobile phone %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. Objective: This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women’s perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. Methods: In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Results: Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women’s lifestyle constraints, technology’s design not meeting women’s needs, and optimizing the technology’s design to meet women’s needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology’s design to improve the quality of care, technology to support women’s independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. Conclusions: The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement. %M 38113070 %R 10.2196/51691 %U https://humanfactors.jmir.org/2023/1/e51691 %U https://doi.org/10.2196/51691 %U http://www.ncbi.nlm.nih.gov/pubmed/38113070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47080 %T Patient Portal Use and Risk of Readmissions in Decompensated Cirrhosis: Retrospective Study %A Louissaint,Jeremy %A Gibbs,Jeffrey %A Shenoy,Abhishek %A Cohen-Mekelburg,Shirley %A Lok,Anna %A Tapper,Elliot %+ Division of Digestive and Liver Diseases, University of Texas Southwestern, 5959 Harry Hines Blvd, Dallas, TX, 75390, United States, 1 214 645 6294, jeremy.louissaint@utsouthwestern.edu %K cirrhosis %K patient portal %K readmissions %K telehealth %K telemedicine %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are a common electronic medical record tool that allow for the asynchronous exchange of health information between patients and their health care teams. Patients can leverage patient portals to perform tasks such as viewing test results, reviewing clinical notes, and messaging their health care team. The impact of patient portal use on clinical outcomes in cirrhosis is unknown. Objective: In this study, we evaluated the relationship between patient portal use patterns and readmissions in cirrhosis. Methods: We identified 131 patients with decompensated cirrhosis with an index cirrhosis-related admission between May 1, 2018, and May 1, 2019. We then examined patient portal enrollment and use data during the 6-month period preceding the study period. Portal functions evaluated included sending a message, reading a message, and reading a test result. Use was categorized as active (sending a message) and passive (reading a message or test result) and was further stratified as no, moderate, or frequent use based on the frequency of portal function use compared to the mean. The primary outcomes were 90-day and overall readmissions, adjusted for age, model for end-stage liver disease–sodium, alcohol-related cirrhosis etiology, ascites, and hepatic encephalopathy. Portal functions assessed included sending a message, reading a message, and reading a result; the total number of times a portal function was performed was divided by the number of months the patient was enrolled in the patient portal during the 6-month period. Results: The study population was 50.4% (66/131) female, with a mean age of 58 years. Enrollment in the patient portal was 63.4% (83/131), and there was no significant difference in enrollment based on clinical or demographic characteristics. For the entire cohort, 14.5% (19/131) and 22.1% (29/131) of patients were moderate and frequent active users, respectively. Of those enrolled in the patient portal, 97.6% (81/83) of patients were moderate or frequent passive users for both reading a message and reading a test result. Moderate active users had less 90-day readmissions (odds ratio 0.77, 95% CI 0.60-1.00) and overall readmissions (subdistribution hazard ratio 0.42, 95% CI 0.21-0.84), compared to nonactive users. There was no relationship between readmissions and passive use. Conclusions: Passive use of the patient portal is very high but is not associated with the risk of readmissions in people with decompensated cirrhosis. However, moderately active use of the patient portal is associated with a reduced risk of readmissions. Further work is needed to identify possible confounders and refine key use behaviors that may be protective with regard to the risk of readmission in this population. %M 38113099 %R 10.2196/47080 %U https://formative.jmir.org/2023/1/e47080 %U https://doi.org/10.2196/47080 %U http://www.ncbi.nlm.nih.gov/pubmed/38113099 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44762 %T Narrowing the Patient–Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App %A Yamashiki,Noriyo %A Kawabata,Kyoko %A Murata,Miki %A Ikeda,Shunichiro %A Fujimaki,Takako %A Suwa,Kanehiko %A Seki,Toshihito %A Aramaki,Eiji %A Naganuma,Makoto %+ Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Fumizono 10-15, Moriguchi, Osaka, 570-8507, Japan, 81 6 6992 1001, yamashno@takii.kmu.ac.jp %K alcohol-related liver disease %K alcohol use disorder %K alcoholism %K smartphone %K mobile health %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients’ smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report–based feedback source for patients with ALD. Objective: The aims of this study were assessment of whether journaling (self-report) and self-report–based feedback can help patients maintain abstinence and improve liver function data. Methods: This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (%CDT), and GGT-CDT (GGT-CDT= 0.8 × ln[GGT] + 1.3 × ln[%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. Results: Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44% and 100% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician’s view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean %CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. Conclusions: These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. Trial Registration: UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj %R 10.2196/44762 %U https://formative.jmir.org/2023/1/e44762/ %U https://doi.org/10.2196/44762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52804 %T Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health, Inc, 9450 SW Gemini Drive #58509, Beaverton, OR, 97008, United States, 1 7708619131, landry.huffman@bendhealth.com %K adolescents %K anxiety %K children %K depression %K digital mental health intervention %K reliable change %D 2023 %7 18.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. Objective: This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. Methods: We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. Results: Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. Conclusions: Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people. %M 38109174 %R 10.2196/52804 %U https://formative.jmir.org/2023/1/e52804 %U https://doi.org/10.2196/52804 %U http://www.ncbi.nlm.nih.gov/pubmed/38109174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50573 %T Building on Existing Classifications of Behavior Change Techniques to Classify Planned Coping Strategies: Physical Activity Diary Study %A Braun,Maya %A Schroé,Helene %A De Paepe,Annick L %A Crombez,Geert %+ Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Gent, 9000, Belgium, 32 0456159365, maya.braun@ugent.be %K behavior change %K problem-solving %K classification %K personalization %K physically active %K digital intervention %K solution %K techniques %K plan %K physical activity %D 2023 %7 18.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: When trying to be more physically active, preparing for possible barriers by considering potential coping strategies increases the likelihood of plan enactment. Digital interventions can support this process by providing personalized recommendations for coping strategies, but this requires that possible coping strategies are identified and classified. Existing classification systems of behavior change, such as the compendium of self-enactable techniques, may be reused to classify coping strategies in the context of physical activity (PA) coping planning. Objective: This study investigated whether coping strategies created by a student population to overcome barriers to be physically active can be mapped onto the compendium of self-enactable techniques and which adaptations or additions to the frameworks are needed. Methods: In total, 359 Flemish university students created action and coping plans for PA for 8 consecutive days in 2020, resulting in 5252 coping plans. A codebook was developed iteratively using the compendium of self-enactable techniques as a starting point to code coping strategies. Additional codes were added to the codebook iteratively. Interrater reliability was calculated, and descriptive statistics were provided for the coping strategies. Results: Interrater reliability was moderate (Cohen κ=0.72) for the coded coping strategies. Existing self-enactable techniques covered 64.6% (3393/5252) of the coded coping strategies, and added coping strategies covered 28.52% (n=1498). The remaining coping strategies could not be coded as entries were too vague or contained no coping strategy. The added classes covered multiple ways of adapting the original action plan, managing one’s time, ensuring the availability of required material, and doing the activity with someone else. When exploring the data further, we found that almost half (n=2371, 45.1%) of the coping strategies coded focused on contextual factors. Conclusions: The study’s objective was to categorize PA coping strategies. The compendium of self-enactable techniques addressed almost two-thirds (3393/5252, 64.6%) of these strategies, serving as valuable starting points for classification. In total, 9 additional strategies were integrated into the self-enactable techniques, which are largely absent in other existing classification systems. These new techniques can be seen as further refinements of “problem-solving” or “coping planning.” Due to data constraints stemming from the COVID-19 pandemic and the study’s focus on a healthy Flemish student population, it is anticipated that more coping strategies would apply under normal conditions, in the general population, and among clinical groups. Future research should expand to diverse populations and establish connections between coping strategies and PA barriers, with ontologies recommended for this purpose. This study is a first step in classifying the content of coping strategies for PA. We believe this is an important and necessary step toward digital health interventions that incorporate personalized suggestions for PA coping plans. %M 38109171 %R 10.2196/50573 %U https://formative.jmir.org/2023/1/e50573 %U https://doi.org/10.2196/50573 %U http://www.ncbi.nlm.nih.gov/pubmed/38109171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48055 %T A Device for Prehabilitation of Total Knee Replacement Surgery (Slider): Usability Study %A Islam,Riasat %A Gooch,Daniel %A Karlakki,Sudheer %A Price,Blaine %+ School of Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 3003035303, riasat.islam@open.ac.uk %K physiotherapy %K rehabilitation %K prehabilitation, knee replacement %K community physiotherapy %K outpatient %K gamification %K motivation %K adherence %K knee %K exercise %K preoperative %K postoperative %K usability %K validation %K software %K exergames %K geriatric rehabilitation %K self-regulated exercise %K assistive technology %K telerehabilitation %K digital health %K healthcare delivery %D 2023 %7 18.12.2023 %9 Early Reports %J JMIR Form Res %G English %X Background: Rehabilitation, or “prehabilitation,” is essential in preparing for and recovering from knee replacement surgery. The recent demand for these services has surpassed available resources, a situation further strained by the COVID-19 pandemic, which has led to a pivot toward digital solutions such as web- or app-based videos and wearables. These solutions, however, face challenges with user engagement, calibration requirements, and skin contact issues. This study evaluated the practicality of a low-contact, gamified device designed to assist with prehabilitation exercises. Objective: The study aimed to assess the practicality and user-friendliness of a newly designed physiotherapy device (Slider) that enables exercise monitoring without the need for direct contact with the skin. Methods: A total of 17 patients awaiting knee replacement surgery at a UK National Health Service (NHS) hospital participated in this study. They used the device over a 2-week period and subsequently provided feedback through a usability and acceptability questionnaire. Results: The study was completed by all participants, with a majority (13/17, 76%) finding the device intuitive and easy to use. The majority of patients were satisfied with the device’s ability to meet their presurgery physiotherapy requirements (16/17, 94%) and expressed a willingness to continue using it (17/17, 100%). No safety issues or adverse effects were reported by the participants. Conclusions: The results indicate that the device was found to be a feasible option for patients to conduct presurgery physiotherapy exercises independently, away from a clinical setting. Further research involving a larger and more diverse group of participants is recommended to validate these findings more robustly. %M 38109191 %R 10.2196/48055 %U https://formative.jmir.org/2023/1/e48055 %U https://doi.org/10.2196/48055 %U http://www.ncbi.nlm.nih.gov/pubmed/38109191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49685 %T Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study %A Mohanraj,Sangeetha %A Malone,Laurie A %A Mendonca,Christen J %A Thirumalai,Mohanraj %+ Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, 1716, 9th Avenue S, SHP # 590 D, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K web-based exercise %K user experience %K community health %K fitness facility %K tele-exercise %K physical disability %K physical activity %K exercise %K fitness %K virtual %K interface %K disability %K disabilities %K accessibility %K telehealth %K telemedicine %K eHealth %K digital health %K mixed methods study %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers. Objective: The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP. Methods: Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The “concurrent think-aloud” method was encouraged by the moderator to gauge participants’ thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS). Results: A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks #1 and #2 without errors but could not complete task #4. One participant completed task #5 with difficulty and another completed task #3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible. Conclusions: People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option. %M 38100173 %R 10.2196/49685 %U https://formative.jmir.org/2023/1/e49685 %U https://doi.org/10.2196/49685 %U http://www.ncbi.nlm.nih.gov/pubmed/38100173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49277 %T Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience %A Beesoon,Sanjay %A Drobot,Ashley %A Smokeyday,Melissa %A Ali,Al-Bakir %A Collins,Zoe %A Reynolds,Colin %A Berzins,Sandra %A Gibson,Alison %A Nelson,Gregg %+ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3260 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada, 1 5877170011, gregg.nelson@ahs.ca %K app %K digital health %K patient experience %K provider satisfaction %K application %K recovery %K cost-effective %K evaluation %K implementation %K gynecologic oncology %K colorectal surgery %K surgery %K care %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. Objective: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. Methods: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. Results: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. Conclusions: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world. %R 10.2196/49277 %U https://formative.jmir.org/2023/1/e49277/ %U https://doi.org/10.2196/49277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53132 %T Integrated Immunization Information System in Indonesia: Prototype Design Using Quantitative and Qualitative Data %A Rahmadhan,Muhamad Adhytia Wana Putra %A Handayani,Putu Wuri %+ Faculty of Computer Science, University of Indonesia, Jl Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K vaccination %K immunization %K immunization information system %K high-fidelity prototype %K Indonesia %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As the volume of immunization records increases, problems with fragmented records arise, especially since the majority of records in developing countries, including Indonesia, remain paper based. Implementing an immunization information system (IIS) offers a solution to this problem. Objective: In this study, we designed an integrated IIS prototype in Indonesia using the design science research (DSR) methodology. Methods: The stages of the DSR methodology followed in this study included identifying problems and motivating and defining objectives for a solution, design and development, demonstration, evaluation, communication, and drawing conclusions and suggestions. Specifically, this study began with problem formulation and a literature review. We then applied quantitative (questionnaire with 305 members of the public) and qualitative (interviews with 15 health workers including nurses, midwives, and doctors) data collection approaches. Results: The resulting high-fidelity prototype follows the 8 golden rules. There are 2 IIS designs, one for the public as immunization recipients and another for health workers. The functionalities include immunization history, schedule, recommendations, verification, certificates, reminders and recalls, coverage, monitoring, news, and reports of adverse events. Evaluation of the prototype was carried out through interviews and a questionnaire designed according to the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). The SUS value was 72.5 or “Good (Acceptable),” while the system usefulness, information quality, interface quality, and overall value on the PSSUQ were 2.65, 2.94, 2.48, and 2.71, respectively, which indicate it has an effective design. Conclusions: This provides a guide for health facilities, health regulators, and health application developers on how to implement an integrated IIS in Indonesia. %R 10.2196/53132 %U https://formative.jmir.org/2023/1/e53132/ %U https://doi.org/10.2196/53132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52519 %T Assessment of Heart Rate Monitoring During Exercise With Smart Wristbands and a Heart Rhythm Patch: Validation and Comparison Study %A Wang,Tse-Lun %A Wu,Hao-Yi %A Wang,Wei-Yun %A Chen,Chao-Wen %A Chien,Wu-Chien %A Chu,Chi-Ming %A Wu,Yi-Syuan %+ Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, PO Box 48, Kaohsiung City, 807, Taiwan, 886 73121101 ext 6020, pu1254@gmail.com %K running %K wearable device %K photoplethysmography %K heart rhythm patch, smart wristband %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of wearable devices into fitness routines, particularly in military settings, necessitates a rigorous assessment of their accuracy. This study evaluates the precision of heart rate measurements by locally manufactured wristbands, increasingly used in military academies, to inform future device selection for military training activities. Objective: This research aims to assess the reliability of heart rate monitoring in chest straps versus wearable wristbands. Methods: Data on heart rate and acceleration were collected using the Q-Band Q-69 smart wristband (Mobile Action Technology Inc) and compared against the Zephyr Bioharness standard measuring device. The Lin concordance correlation coefficient, Pearson product moment correlation coefficient, and intraclass correlation coefficient were used for reliability analysis. Results: Participants from a Northern Taiwanese medical school were enrolled (January 1-June 31, 2021). The Q-Band Q-69 demonstrated that the mean absolute percentage error (MAPE) of women was observed to be 13.35 (SD 13.47). Comparatively, men exhibited a lower MAPE of 8.54 (SD 10.49). The walking state MAPE was 7.79 for women and 10.65 for men. The wristband’s accuracy generally remained below 10% MAPE in other activities. Pearson product moment correlation coefficient analysis indicated gender-based performance differences, with overall coefficients of 0.625 for women and 0.808 for men, varying across walking, running, and cooldown phases. Conclusions: This study highlights significant gender and activity-dependent variations in the accuracy of the MobileAction Q-Band Q-69 smart wristband. Reduced accuracy was notably observed during running. Occasional extreme errors point to the necessity of caution in relying on such devices for exercise monitoring. The findings emphasize the limitations and potential inaccuracies of wearable technology, especially in high-intensity physical activities. %M 38096010 %R 10.2196/52519 %U https://formative.jmir.org/2023/1/e52519 %U https://doi.org/10.2196/52519 %U http://www.ncbi.nlm.nih.gov/pubmed/38096010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48704 %T Wearable Activity Trackers That Motivate Women to Increase Physical Activity: Mixed Methods Study %A Peterson,Neil E %A Bate,Danielle A %A Macintosh,Janelle LB %A Trujillo Tanner,Corinna %+ College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, 84602, United States, 1 8014224893, neil-peterson@byu.edu %K physical activity %K women %K motivation %K wearable activity trackers %K mobile health %K mHealth %K self-determination %K mobile phone %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is a significant public health concern, particularly among women in the United States. Wearable activity trackers (WATs) have been proposed as a potential solution to increase awareness of and engagement in physical activity (PA). However, to be effective, WATs must include features and designs that encourage daily use. Objective: This study aims to explore the features and designs of WATs that appeal to women and determine whether devices with these attributes are effective motivators for women to be physically active. Methods: A mixed methods study guided by the self-determination theory was conducted among 15 women. Participants trialed 3 WATs with influence in their respective accessory domains: Apple Watch for the wrist; Oura Ring for the finger; and Bellabeat Leaf Urban for multiple sites (it can be worn as a bracelet, necklace, or clip). Participants documented their daily PA levels and rated their satisfaction with each device’s comfort, features, and motivational effect. Focus groups were also conducted to gather additional feedback and experiences within the a priori areas of comfort, features, and motivation. Results: Behavioral Regulation in Exercise Questionnaire–2 scores indicated that most participants (14/15, 93%) were motivated at baseline (amotivation score: mean 0.13, SD 0.45), but on average, participants did not meet the national minimum PA guidelines according to the self-reported Physical Activity Vital Sign questionnaire (moderate to vigorous PA score: mean 144, SD 97.5 min/wk). Mean WAT wear time was 16.9 (SD 4.4) hours, 19.4 (SD 5.3) hours, and 20.4 (SD 4.7) hours for Apple Watch, Bellabeat Leaf Urban, and Oura Ring, respectively. During focus groups, participants reinforced their quantitative ratings and rankings of the WATs based on personal experiences. Participants shared a variety of both activity-related and non–activity-related features that they look for in a motivating device. When considering what the ideal WAT would be for a woman, participants suggested features of (1) comfort, (2) extended battery life, (3) durability, (4) immediate PA feedback, (5) intuitive PA sensing, and (6) programmability. Conclusions: This study is the first to specifically address women’s experiences with and preferences for different types of WATs. Those who work with women should realize how they view WATs and the role they play in motivation to be active. %M 38096000 %R 10.2196/48704 %U https://formative.jmir.org/2023/1/e48704 %U https://doi.org/10.2196/48704 %U http://www.ncbi.nlm.nih.gov/pubmed/38096000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48351 %T Development of Risk Prediction Models for Severe Periodontitis in a Thai Population: Statistical and Machine Learning Approaches %A Teza,Htun %A Pattanateepapon,Anuchate %A Lertpimonchai,Attawood %A Vathesatogkit,Prin %A J McKay,Gareth %A Attia,John %A Thakkinstian,Ammarin %+ Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Phayathai, Bangkok, 10400, Thailand, 66 2 201 1269, anuchate.gab@mahidol.ac.th %K periodontitis %K prediction %K machine learning %K repeated measures %K panel data %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Severe periodontitis affects 26% of Thai adults and 11.2% of adults globally and is characterized by the loss of alveolar bone height. Full-mouth examination by periodontal probing is the gold standard for diagnosis but is time- and resource-intensive. A screening model to identify those at high risk of severe periodontitis would offer a targeted approach and aid in reducing the workload for dentists. While statistical modelling by a logistic regression is commonly applied, optimal performance depends on feature selections and engineering. Machine learning has been recently gaining favor given its potential discriminatory power and ability to deal with multiway interactions without the requirements of linear assumptions. Objective: We aim to compare the performance of screening models developed using statistical and machine learning approaches for the risk prediction of severe periodontitis. Methods: This study used data from the prospective Electricity Generating Authority of Thailand cohort. Dental examinations were performed for the 2008 and 2013 surveys. Oral examinations (ie, number of teeth and oral hygiene index and plaque scores), periodontal pocket depth, and gingival recession were performed by dentists. The outcome of interest was severe periodontitis diagnosed by the Centre for Disease Control–American Academy of Periodontology, defined as 2 or more interproximal sites with a clinical attachment level ≥6 mm (on different teeth) and 1 or more interproximal sites with a periodontal pocket depth ≥5 mm. Risk prediction models were developed using mixed-effects logistic regression (MELR), recurrent neural network, mixed-effects support vector machine, and mixed-effects decision tree models. A total of 21 features were considered as predictive features, including 4 demographic characteristics, 2 physical examinations, 4 underlying diseases, 1 medication, 2 risk behaviors, 2 oral features, and 6 laboratory features. Results: A total of 3883 observations from 2086 participants were split into development (n=3112, 80.1%) and validation (n=771, 19.9%) sets with prevalences of periodontitis of 34.4% (n=1070) and 34.1% (n=263), respectively. The final MELR model contained 6 features (gender, education, smoking, diabetes mellitus, number of teeth, and plaque score) with an area under the curve (AUC) of 0.983 (95% CI 0.977-0.989) and positive likelihood ratio (LR+) of 11.9 (95% CI 8.8-16.3). Machine learning yielded lower performance than the MELR model, with AUC (95% CI) and LR+ (95% CI) values of 0.712 (0.669-0.754) and 2.1 (1.8-2.6), respectively, for the recurrent neural network model; 0.698 (0.681-0.734) and 2.1 (1.7-2.6), respectively, for the mixed-effects support vector machine model; and 0.662 (0.621-0.702) and 2.4 (1.9-3.0), respectively, for the mixed-effects decision tree model. Conclusions: The MELR model might be more useful than machine learning for large-scale screening to identify those at high risk of severe periodontitis for periodontal evaluation. External validation using data from other centers is required to evaluate the generalizability of the model. %M 38096008 %R 10.2196/48351 %U https://formative.jmir.org/2023/1/e48351 %U https://doi.org/10.2196/48351 %U http://www.ncbi.nlm.nih.gov/pubmed/38096008 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48689 %T Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial %A Stein,Jana %A Vöhringer,Max %A Wagner,Birgit %A Stammel,Nadine %A Nesterko,Yuriy %A Böttche,Maria %A Knaevelsrud,Christine %+ Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schloßstr. 1, Berlin, 12163, Germany, 49 30 303906 76, j.stein@ueberleben.org %K posttraumatic stress %K posttraumatic stress disorder %K PTSD %K Middle East %K North Africa %K Arabic %K Arabic-speaking people %K internet %K internet-based %K exposure %K cognitive restructuring %K randomized clinical trial %K RCT %K cognitive behavioral therapy %K CBT %K cognitive behavioral treatment %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. Objective: This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. Methods: In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. Results: Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. Conclusions: Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. Trial Registration: German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245 %M 38090792 %R 10.2196/48689 %U https://mental.jmir.org/2023/1/e48689 %U https://doi.org/10.2196/48689 %U http://www.ncbi.nlm.nih.gov/pubmed/38090792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49380 %T Thoughts and Experiences of Behçet Disease From Participants on a Reddit Subforum: Qualitative Online Community Analysis %A Li,Jenny Xiaoyu %A Yacyshyn,Elaine %+ Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada, 1 778 828 6868, jenny.li@alumni.ubc.ca %K Bechet disease %K Behçet %K online community %K Reddit %K vasculitis %K quality of life %K QoL %K qualitative %K community %K morbidity %K support %K diagnosis %K symptoms %K vascular %K vascular system %K vascular disease %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Behçet disease (BD) is a type of vasculitis with relapsing episodes and multisystemic clinical features, associated with significant morbidity and impact on patients’ lives. People affected by BD often participate in discussions of their illness experiences. In-person support groups have limited physical accessibility and a relative lack of anonymity; however, online communities have become increasingly popular. Objective: This study investigates the perspectives and experiences of people affected by BD by examining the content shared and discussed on a subforum of the website Reddit—a popular online space for anonymous discussions. Methods: All discussion threads posted between March 9, 2021, and March 12, 2022, including posts and comments, were examined from the subforum “r/Behcets,” an anonymous online community of 1100 members as of March 2022. A Grounded Theory analysis was completed to identify themes and subthemes, and notable quotes were extracted from the threads. Parameters extracted from each post included the number of comments, net upvotes, category, and subcategories. Two research team members read the posts separately to identify initial codes and themes to ensure data saturation was achieved. Results: Six recurring themes were identified: (1) finding connectedness and perspectives through shared experiences, (2) struggles of the diagnostic odyssey, (3) sharing or inquiring about symptoms, (4) expressing strong emotions relating to the experience of BD, (5) the impact of BD on quality of life and personal relationships, as well as (6) COVID-19 and the COVID-19 vaccination in relation to BD. Subthemes within each theme were also identified and explored. Conclusions: This novel study provides a qualitative exploration of the perspectives and experiences of people affected by BD, shared in the anonymous and accessible online community of Reddit. The study found that people impacted by an illness seek to connect and receive validation through shared conditions and experiences. By examining the content shared in r/Behcets, this study highlights the needs of people affected by BD, identifying gaps and areas for improvement in the in-person support they receive. %M 38085563 %R 10.2196/49380 %U https://formative.jmir.org/2023/1/e49380 %U https://doi.org/10.2196/49380 %U http://www.ncbi.nlm.nih.gov/pubmed/38085563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47426 %T Refinement and Usability Analysis of an eHealth App for Ankylosing Spondylitis as a Complementary Treatment to Physical Therapy: Development and Usability Study %A Nitschke,Marlies %A Nwosu,Obioma Bertrand %A Grube,Lara %A Knitza,Johannes %A Seifer,Ann-Kristin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Machine Learning and Data Analytics Lab, Department Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Carl-Thiersch-Straße 2b, Erlangen, 91052, Germany, 49 09131 85 27890, marlies.nitschke@fau.de %+ Department of Internal Medicine 3- Rheumatology & Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318543023, harriet.morf@uk-erlangen.de %K ankylosing spondylitis %K axial spondylarthritis %K DHA %K digital health application %K eHealth %K self-assessment %K Usability %K Yoga %K YogiTherapy %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile eHealth apps have been used as a complementary treatment to increase the quality of life of patients and provide new opportunities for the management of rheumatic diseases. Telemedicine, particularly in the areas of prevention, diagnostics, and therapy, has become an essential cornerstone in the care of patients with rheumatic diseases. Objective: This study aims to improve the design and technology of YogiTherapy and evaluate its usability and quality. Methods: We newly implemented the mobile eHealth app YogiTherapy with a modern design, the option to change language, and easy navigation to improve the app’s usability and quality for patients. After refinement, we evaluated the app by conducting a study with 16 patients with AS (4 female and 12 male; mean age 48.1, SD 16.8 y). We assessed the usability of YogiTherapy with a task performance test (TPT) with a think-aloud protocol and the quality with the German version of the Mobile App Rating Scale (MARS). Results: In the TPT, the participants had to solve 6 tasks that should be performed on the app. The overall task completion rate in the TPT was high (84/96, 88% completed tasks). Filtering for videos and navigating to perform an assessment test caused the largest issues during the TPT, while registering in the app and watching a yoga video were highly intuitive. Additionally, 12 (75%) of the 16 participants completed the German version of MARS. The quality of YogiTherapy was rated with an average MARS score of 3.79 (SD 0.51) from a maximum score of 5. Furthermore, results from the MARS questionnaire demonstrated a positive evaluation regarding functionality and aesthetics. Conclusions: The refined and tested YogiTherapy app showed promising results among most participants. In the future, the app could serve its function as a complementary treatment for patients with AS. For this purpose, surveys with a larger number of patients should still be conducted. As a substantial advancement, we made the app free and openly available on the iOS App and Google Play stores. %M 38085558 %R 10.2196/47426 %U https://formative.jmir.org/2023/1/e47426 %U https://doi.org/10.2196/47426 %U http://www.ncbi.nlm.nih.gov/pubmed/38085558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44768 %T Safety Evaluation in Iterative Development of Wearable Patches for Aripiprazole Tablets With Sensor: Pooled Analysis of Clinical Trials %A Jan,Michael %A Coppin-Renz,Antonia %A West,Robin %A Gallo,Christophe Le %A Cochran,Jeffrey M %A Heumen,Emiel van %A Fahmy,Michael %A Reuteman-Fowler,J Corey %+ Otsuka Pharma GmbH, Europa-Allee 52, Frankfurt am Main, 60327, Germany, 49 (0)151 6468280, acoppinrenz@otsuka-europe.com %K wearable sensor %K adhesive patch %K adverse events %K skin irritation %K product iteration %K mobile phone %K biocompatibility %K Abilify MyCite %K development %K sensors %K skin %K monitoring %K treatment %K schizophrenia %K bipolar disorder %K depressive disorder %K abrasions %K blisters %K dermatitis %K pain %K rash %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable sensors in digital health may pose a risk for skin irritation through the use of wearable patches. Little is known about how patient- and product-related factors impact the risk of skin irritation. Aripiprazole tablets with sensor (AS, Abilify MyCite; Otsuka America Pharmaceutical, Inc) is a digital medicine system indicated for the treatment of patients with schizophrenia, bipolar I disorder, and major depressive disorder. AS includes aripiprazole tablets with an embedded ingestible event marker, a wearable sensor attached to the skin through a wearable patch, a smartphone app, and a web-based portal. To continuously improve the final product, successive iterations of wearable patches were developed, including raisin patch version 4 (RP4), followed by disposable wearable sensor version 5 (DW5), and then reusable wearable sensor version 2 (RW2). Objective: This analysis pooled safety data from clinical studies in adult participants using the RP4, DW5, and RW2 wearable patches of AS and evaluated adverse events related to the use of wearable patches. Methods: Safety data from 12 studies in adults aged 18-65 years from May 2010 to August 2020 were analyzed. All studies evaluated safety, with studies less than 2 weeks also specifically examining human factors associated with the use of the components of AS. Healthy volunteers or patients with schizophrenia, bipolar I disorder, or major depressive disorder were enrolled; those who were exposed to at least 1 wearable patch were included in the safety analysis. Adverse events related to the use of a wearable patch were evaluated. Abrasions, blisters, dermatitis, discoloration, erythema, irritation, pain, pruritus, rash, and skin reactions were grouped as skin irritation events (SIEs). All statistical analyses were descriptive. Results: The analysis included 763 participants (mean [SD] age 42.6 [12.9] years; White: n=359, 47.1%; and male: n=420, 55%). Participants were healthy volunteers (n=269, 35.3%) or patients with schizophrenia (n=402, 52.7%), bipolar I disorder (n=57, 7.5%), or major depressive disorder (n=35, 4.6%). Overall, 13.6% (104/763) of the participants reported at least 1 SIE, all of which were localized to the wearable patch site. Incidence of ≥1 patch-related SIEs was seen in 18.1% (28/155), 14.2% (55/387), and 9.2% (28/306) of participants who used RP4, DW5, and RW2, respectively. Incidence of SIE-related treatment discontinuation was low, which is reported by 1.9% (3/155), 3.1% (12/387), and 1.3% (4/306) of participants who used RP4, DW5, and RW2, respectively. Conclusions: The incidence rates of SIEs reported as the wearable patch versions evolved from RP4 through RW2 suggest that information derived from reported adverse events may have informed product design and development, which could have improved both tolerability and wearability of successive products. Trial Registration: Clinicaltrials.gov NCT02091882, https://clinicaltrials.gov/study/NCT02091882; Clinicaltrials.gov NCT02404532, https://clinicaltrials.gov/study/NCT02404532; Clinicaltrials.gov NCT02722967, https://clinicaltrials.gov/study/NCT02722967; Clinicaltrials.gov NCT02219009, https://clinicaltrials.gov/study/NCT02219009; Clinicaltrials.gov NCT03568500, https://clinicaltrials.gov/study/NCT03568500; Clinicaltrials.gov NCT03892889, https://clinicaltrials.gov/study/NCT03892889 %M 38085556 %R 10.2196/44768 %U https://formative.jmir.org/2023/1/e44768 %U https://doi.org/10.2196/44768 %U http://www.ncbi.nlm.nih.gov/pubmed/38085556 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e52088 %T Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study %A Turesson,Christina %A Liedberg,Gunilla %A Björk,Mathilda %+ Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Kåkenhus, Bredgatan 32, Linköping, 581 85, Sweden, 46 11363602, christina.turesson@liu.se %K chronic pain %K digital support %K eHealth %K return-to-work %K user data %K mobile phone %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The digital app SWEPPE (sustainable worker, a digital support for persons with chronic pain and their employers) was developed to improve the support of people with chronic pain in their return-to-work process after sick leave and includes functions such as the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. Objective: This study aims to describe the use of the smartphone app SWEPPE among people with chronic pain who have participated in an interdisciplinary pain rehabilitation program. Methods: This is a case study including 16 people participating in a feasibility study. The analyses were based on user data collected for 3 months. Quantitative data regarding used functions were analyzed with descriptive statistics, and qualitative data of identified needs of support from the employer were grouped into 8 categories. Results: Self-monitoring was used by all participants (median 26, IQR 8-87 daily registrations). A total of 11 (N=16, 69%) participants set a work-related goal and performed weekly evaluations of goal fulfillment and ratings of their work ability. In total, 9 (56%) participants shared information with their employer and 2 contacted the coach. A total of 15 (94%) participants identified a total of 51 support interventions from their employer. Support to adapt to work assignments and support to adapt to work posture were the 2 biggest categories. The most common type of support identified by 53% (8/15) of the participants was the opportunity to take breaks and short rests. Conclusions: Participants used multiple SWEPPE functions, such as daily self-registration, goal setting, self-monitoring, and employer support identification. This shows the flexible nature of SWEPPE, enabling individuals to select functions that align with their needs. Additional research is required to investigate the extended use of SWEPPE and how employers use shared employee information. %M 38079212 %R 10.2196/52088 %U https://humanfactors.jmir.org/2023/1/e52088 %U https://doi.org/10.2196/52088 %U http://www.ncbi.nlm.nih.gov/pubmed/38079212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50579 %T Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study %A Hartch,Christa E %A Dietrich,Mary S %A Stolldorf,Deonni P %+ School of Nursing and Health Sciences, Manhattanville College, 2900 Purchase Street, Purchase, NY, 10577, United States, 1 914 323 5365, christa.hartch@mville.edu %K medication adherence %K medication self-efficacy %K mobile phone applications %K medically underserved populations %K mHealth %K mobile health %K app %K apps %K applications %K underserved %K adherence %K survey %K surveys %K chronic illness %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake. Objective: The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center. Methods: Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered. Results: A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive. Conclusions: Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses. %M 38079192 %R 10.2196/50579 %U https://formative.jmir.org/2023/1/e50579 %U https://doi.org/10.2196/50579 %U http://www.ncbi.nlm.nih.gov/pubmed/38079192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49179 %T Developing Message Strategies to Engage Racial and Ethnic Minority Groups in Digital Oral Self-Care Interventions: Participatory Co-Design Approach %A Carpenter,Stephanie M %A Greer,Zara M %A Newman,Rebecca %A Murphy,Susan A %A Shetty,Vivek %A Nahum-Shani,Inbal %+ College of Health Solutions, Arizona State University, 425 N 5th St, Phoenix, AZ, 85004, United States, 1 480 727 5740, Stephanie.M.Carpenter@asu.edu %K engagement %K oral health %K mobile health intervention %K mHealth intervention %K formative %K racial and ethnic minority group %K digital health %K mobile health %K mHealth %K message development %K health equity %K racial minority %K ethnic minority %K digital intervention %K dental care %K barrier %K oral self-care %K mobile phone %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevention of oral health diseases is a key public health issue and a major challenge for racial and ethnic minority groups, who often face barriers in accessing dental care. Daily toothbrushing is an important self-care behavior necessary for sustaining good oral health, yet engagement in regular brushing remains a challenge. Identifying strategies to promote engagement in regular oral self-care behaviors among populations at risk of poor oral health is critical. Objective: The formative research described here focused on creating messages for a digital oral self-care intervention targeting a racially and ethnically diverse population. Theoretically grounded strategies (reciprocity, reciprocity-by-proxy, and curiosity) were used to promote engagement in 3 aspects: oral self-care behaviors, an oral care smartphone app, and digital messages. A web-based participatory co-design approach was used to develop messages that are resource efficient, appealing, and novel; this approach involved dental experts, individuals from the general population, and individuals from the target population—dental patients from predominantly low-income racial and ethnic minority groups. Given that many individuals from racially and ethnically diverse populations face anonymity and confidentiality concerns when participating in research, we used an approach to message development that aimed to mitigate these concerns. Methods: Messages were initially developed with feedback from dental experts and Amazon Mechanical Turk workers. Dental patients were then recruited for 2 facilitator-mediated group webinar sessions held over Zoom (Zoom Video Communications; session 1: n=13; session 2: n=7), in which they provided both quantitative ratings and qualitative feedback on the messages. Participants interacted with the facilitator through Zoom polls and a chat window that was anonymous to other participants. Participants did not directly interact with each other, and the facilitator mediated sessions by verbally asking for message feedback and sharing key suggestions with the group for additional feedback. This approach plausibly enhanced participant anonymity and confidentiality during the sessions. Results: Participants rated messages highly in terms of liking (overall rating: mean 2.63, SD 0.58; reciprocity: mean 2.65, SD 0.52; reciprocity-by-proxy: mean 2.58, SD 0.53; curiosity involving interactive oral health questions and answers: mean 2.45, SD 0.69; curiosity involving tailored brushing feedback: mean 2.77, SD 0.48) on a scale ranging from 1 (do not like it) to 3 (like it). Qualitative feedback indicated that the participants preferred messages that were straightforward, enthusiastic, conversational, relatable, and authentic. Conclusions: This formative research has the potential to guide the design of messages for future digital health behavioral interventions targeting individuals from diverse racial and ethnic populations. Insights emphasize the importance of identifying key stimuli and tasks that require engagement, gathering multiple perspectives during message development, and using new approaches for collecting both quantitative and qualitative data while mitigating anonymity and confidentiality concerns. %M 38079204 %R 10.2196/49179 %U https://formative.jmir.org/2023/1/e49179 %U https://doi.org/10.2196/49179 %U http://www.ncbi.nlm.nih.gov/pubmed/38079204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53293 %T Evaluating Clinical Outcomes in Patients Being Treated Exclusively via Telepsychiatry: Retrospective Data Analysis %A Person,Cheryl %A O'Connor,Nicola %A Koehler,Lucy %A Venkatachalam,Kartik %A Gaveras,Georgia %+ Talkiatry, 109 W 27th Street Suite 5S, New York, NY, 10001, United States, 1 833 351 8255, cheryl.person@talkiatry.com %K telepsychiatry %K PHQ-8 %K GAD-7 %K clinical outcomes %K rural %K commercial insurance %K telehealth %K depression %K anxiety %K telemental health %K psychiatry %K Generalized Anxiety Disorder-7 %K Patient Health Questionnaire-8 %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are highly prevalent conditions in the United States. Despite the availability of suitable therapeutic options, limited access to high-quality psychiatrists represents a major barrier to treatment. Although telepsychiatry has the potential to improve access to psychiatrists, treatment efficacy in the telepsychiatry model remains unclear. Objective: Our primary objective was to determine whether there was a clinically meaningful change in 1 of 2 validated outcome measures of depression and anxiety—the Patient Health Questionnaire–8 (PHQ-8) or the Generalized Anxiety Disorder–7 (GAD-7)—after receiving at least 8 weeks of treatment in an outpatient telepsychiatry setting. Methods: We included treatment-seeking patients enrolled in a large outpatient telepsychiatry service that accepts commercial insurance. All analyzed patients completed the GAD-7 and PHQ-8 prior to their first appointment and at least once after 8 weeks of treatment. Treatments included comprehensive diagnostic evaluation, supportive psychotherapy, and medication management. Results: In total, 1826 treatment-seeking patients were evaluated for clinically meaningful changes in GAD-7 and PHQ-8 scores during treatment. Mean treatment duration was 103 (SD 34) days. At baseline, 58.8% (1074/1826) and 60.1% (1097/1826) of patients exhibited at least moderate anxiety and depression, respectively. In response to treatment, mean change for GAD-7 was –6.71 (95% CI –7.03 to –6.40) and for PHQ-8 was –6.85 (95% CI –7.18 to –6.52). Patients with at least moderate symptoms at baseline showed a 45.7% reduction in GAD-7 scores and a 43.1% reduction in PHQ-8 scores. Effect sizes for GAD-7 and PHQ-8, as measured by Cohen d for paired samples, were d=1.30 (P<.001) and d=1.23 (P<.001), respectively. Changes in GAD-7 and PHQ-8 scores correlated with the type of insurance held by the patients. Greatest reductions in scores were observed among patients with commercial insurance (45% and 43.9% reductions in GAD-7 and PHQ-8 scores, respectively). Although patients with Medicare did exhibit statistically significant reductions in GAD-7 and PHQ-8 scores from baseline (P<.001), these improvements were attenuated compared to those in patients with commercial insurance (29.2% and 27.6% reduction in GAD-7 and PHQ-8 scores, respectively). Pairwise comparison tests revealed significant differences in treatment responses in patients with Medicare versus commercial insurance (P<.001). Responses were independent of patient geographic classification (urban vs rural; P=.48 for GAD-7 and P=.07 for PHQ-8). The finding that treatment efficacy was comparable among rural and urban patients indicated that telepsychiatry is a promising approach to overcome treatment disparities that stem from geographical constraints. Conclusions: In this large retrospective data analysis of treatment-seeking patients using a telepsychiatry platform, we found robust and clinically significant improvement in depression and anxiety symptoms during treatment. The results provide further evidence that telepsychiatry is highly effective and has the potential to improve access to psychiatric care. %M 37991899 %R 10.2196/53293 %U https://formative.jmir.org/2023/1/e53293 %U https://doi.org/10.2196/53293 %U http://www.ncbi.nlm.nih.gov/pubmed/37991899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51277 %T Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial %A Turvey,Carolyn %A Fuhrmeister,Lindsey %A Klein,Dawn %A McCoy,Kimberly %A Moeckli,Jane %A Stewart Steffensmeier,Kenda R %A Suiter,Natalie %A Van Tiem,Jen %+ Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, United States, 1 3193216799, Carolyn.Turvey@va.gov %K depression %K text messaging %K medication adherence %K medication %K medications %K adherence %K antidepressant %K antidepressants %K depressive %K text message %K text messages %K messaging %K SMS %K veteran %K veterans %K military %K randomized controlled trial %K RCT %K controlled trials %K mental health %K psychiatry %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. Objective: This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. Methods: This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. Results: The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). Conclusions: A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. Trial Registration: ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849 %M 38064267 %R 10.2196/51277 %U https://formative.jmir.org/2023/1/e51277 %U https://doi.org/10.2196/51277 %U http://www.ncbi.nlm.nih.gov/pubmed/38064267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43096 %T Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study %A Struik,Laura %A Christianson,Kyla %A Khan,Shaheer %A Sharma,Ramona H %+ School of Nursing, University of British Columbia Okanagan, ART 140, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508647879, laura.struik@ubc.ca %K qualitative research %K tobacco use %K smoking %K vaping %K cessation %K eHealth %K individuals who smoke %K users %K tobacco %K e-cigarettes %K cigarettes %K web-based %K support %K behavioral %K smartphone app %K social media %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. Objective: The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. Methods: Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). Results: Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. Conclusions: The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use. %M 38064266 %R 10.2196/43096 %U https://formative.jmir.org/2023/1/e43096 %U https://doi.org/10.2196/43096 %U http://www.ncbi.nlm.nih.gov/pubmed/38064266 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41974 %T Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study %A Tacey,Alexander %A Behne,Jack %A Patten,Rhiannon K %A Ngo,Minh Truc %A Thomas,Rees %A Ancilleri,Jessica %A Bone,Chelsea %A Paredes Castro,Angela %A McCarthy,Helen %A Harkin,Katherine %A Gilmartin-Thomas,Julia FM %A Takla,Amir %A Downie,Calum %A Mulcahy,Jane %A Ball,Michelle %A Sharples,Jenny %A Dash,Sarah %A Lawton,Amy %A Wright,Breanna %A Sleeth,Peter %A Kostecki,Tina %A Sonn,Christopher %A McKenna,Michael J %A Apostolopoulos,Vasso %A Lane,Rebecca %A Said,Catherine M %A De Gori,Mary %A McAinch,Andrew %A Tran,Phong %A Levinger,Itamar %A Parker,Alexandra %A Woessner,Mary N %A Pascoe,Michaela %+ Institute for Health and Sport (iHeS), Victoria University, Ballarat Road, Footscray, Melbourne, 3011, Australia, 61 421 692 161, mary.woessner@vu.edu.au %K osteoarthritis %K web intervention %K eHealth %K orthopedic waitlist %K human-centered design %K self-management %K knee pain %K hip pain %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial. %M 38064257 %R 10.2196/41974 %U https://formative.jmir.org/2023/1/e41974 %U https://doi.org/10.2196/41974 %U http://www.ncbi.nlm.nih.gov/pubmed/38064257 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51812 %T Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study %A Abraham,Olufunmilola %A McCarthy,Tyler James %A Zaborek,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescent %K opioid %K medication safety %K serious games %K gamification %K health behavior %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. Objective: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. Methods: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. Results: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents’ and parents’ concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. Conclusions: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies. %M 38060287 %R 10.2196/51812 %U https://formative.jmir.org/2023/1/e51812 %U https://doi.org/10.2196/51812 %U http://www.ncbi.nlm.nih.gov/pubmed/38060287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50027 %T Traceable Research Data Sharing in a German Medical Data Integration Center With FAIR (Findability, Accessibility, Interoperability, and Reusability)-Geared Provenance Implementation: Proof-of-Concept Study %A Gierend,Kerstin %A Waltemath,Dagmar %A Ganslandt,Thomas %A Siegel,Fabian %+ Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621383 ext 8087, kerstin.gierend@medma.uni-heidelberg.de %K provenance %K traceability %K data management %K metadata %K data integrity %K data integration center %K medical informatics %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondary investigations into digital health records, including electronic patient data from German medical data integration centers (DICs), pave the way for enhanced future patient care. However, only limited information is captured regarding the integrity, traceability, and quality of the (sensitive) data elements. This lack of detail diminishes trust in the validity of the collected data. From a technical standpoint, adhering to the widely accepted FAIR (Findability, Accessibility, Interoperability, and Reusability) principles for data stewardship necessitates enriching data with provenance-related metadata. Provenance offers insights into the readiness for the reuse of a data element and serves as a supplier of data governance. Objective: The primary goal of this study is to augment the reusability of clinical routine data within a medical DIC for secondary utilization in clinical research. Our aim is to establish provenance traces that underpin the status of data integrity, reliability, and consequently, trust in electronic health records, thereby enhancing the accountability of the medical DIC. We present the implementation of a proof-of-concept provenance library integrating international standards as an initial step. Methods: We adhered to a customized road map for a provenance framework, and examined the data integration steps across the ETL (extract, transform, and load) phases. Following a maturity model, we derived requirements for a provenance library. Using this research approach, we formulated a provenance model with associated metadata and implemented a proof-of-concept provenance class. Furthermore, we seamlessly incorporated the internationally recognized Word Wide Web Consortium (W3C) provenance standard, aligned the resultant provenance records with the interoperable health care standard Fast Healthcare Interoperability Resources, and presented them in various representation formats. Ultimately, we conducted a thorough assessment of provenance trace measurements. Results: This study marks the inaugural implementation of integrated provenance traces at the data element level within a German medical DIC. We devised and executed a practical method that synergizes the robustness of quality- and health standard–guided (meta)data management practices. Our measurements indicate commendable pipeline execution times, attaining notable levels of accuracy and reliability in processing clinical routine data, thereby ensuring accountability in the medical DIC. These findings should inspire the development of additional tools aimed at providing evidence-based and reliable electronic health record services for secondary use. Conclusions: The research method outlined for the proof-of-concept provenance class has been crafted to promote effective and reliable core data management practices. It aims to enhance biomedical data by imbuing it with meaningful provenance, thereby bolstering the benefits for both research and society. Additionally, it facilitates the streamlined reuse of biomedical data. As a result, the system mitigates risks, as data analysis without knowledge of the origin and quality of all data elements is rendered futile. While the approach was initially developed for the medical DIC use case, these principles can be universally applied throughout the scientific domain. %M 38060305 %R 10.2196/50027 %U https://formative.jmir.org/2023/1/e50027 %U https://doi.org/10.2196/50027 %U http://www.ncbi.nlm.nih.gov/pubmed/38060305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47847 %T The Adoption of AI in Mental Health Care–Perspectives From Mental Health Professionals: Qualitative Descriptive Study %A Zhang,Melody %A Scandiffio,Jillian %A Younus,Sarah %A Jeyakumar,Tharshini %A Karsan,Inaara %A Charow,Rebecca %A Salhia,Mohammad %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R Fraser Elliot Building RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.wiljer@uhn.ca %K artificial intelligence %K education %K mental health %K behavioral health %K educators %K curriculum %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI. Objective: A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products. Methods: A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited. Results: A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care. Conclusions: AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study’s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere. %M 38060307 %R 10.2196/47847 %U https://formative.jmir.org/2023/1/e47847 %U https://doi.org/10.2196/47847 %U http://www.ncbi.nlm.nih.gov/pubmed/38060307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49786 %T The Implementation of a Virtual Emergency Department: Multimethods Study Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework %A Shuldiner,Jennifer %A Srinivasan,Diya %A Desveaux,Laura %A Hall,Justin N %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 6474720232, jennshuldiner@gmail.com %K emergency care %K virtual care %K implementation science %K mixed methods evaluation %K emergency department %K pilot %K evaluation %K triage %K digital emergency department %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: While the COVID-19 pandemic dramatically increased virtual care uptake across many health settings, it remains significantly underused in urgent care. Objective: This study evaluated the implementation of a pilot virtual emergency department (VED) at an Ontario hospital that connected patients to emergency physicians through a web-based portal. We sought to (1) assess the acceptability of the VED model, (2) evaluate whether the VED was implemented as intended, and (3) explore the impact on quality of care, access to care, and continuity of care. Methods: This evaluation used a multimethods approach informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included semistructured interviews with patients and physicians as well as postvisit surveys from patients. Interviews were transcribed and analyzed using thematic analysis. Data from the surveys were described using summary statistics. Results: From December 2020 to December 2021, the VED had a mean of 153 (SD 25) visits per month. Among them, 67% (n=677) were female, and 75% (n=758) had a family physician. Patients reported that the VED provided high-quality, timely access to care and praised the convenience, shorter appointments, and benefit of the calm, safe space afforded through virtual appointments. In instances where patients were directed to come into the emergency department (ED), physicians were able to provide a “warm handoff” to improve efficiency. This helped manage patient expectations, and the direct advice of the ED physician reassured them that the visit was warranted. There was broad initial uptake of VED shifts among ED physicians with 60% (n=22) completing shifts in the first 2 months and 42% (n=15) completing 1 or more shifts per month over the course of the pilot. There were no difficulties finding sufficient ED physicians for shifts. Most physicians enjoyed working in the VED, saw value for patients, and were motivated by patient satisfaction. However, some physicians were hesitant as they felt their expertise and skills as ED physicians were underused. The VED was implemented using an iterative staged approach with increased service capabilities over time, including access to ultrasounds, virtual follow-ups after a recent ED visit, and access to blood work, urine tests, and x-rays (at the hospital or a local community laboratory). Physicians recognized the value in supporting patients by advising on the need for an in-person visit, booking a diagnostic test, or referring them to a specialist. Conclusions: The VED had the support of physicians and facilitated care for low-acuity presentations with immediate benefits for patients. It has the potential to benefit the health care system by seeing patients through the web and guiding patients to in-person care only when necessary. Long-term sustainability requires a focus on understanding digital equity and enhanced access to rapid testing or investigations. %M 38051562 %R 10.2196/49786 %U https://formative.jmir.org/2023/1/e49786 %U https://doi.org/10.2196/49786 %U http://www.ncbi.nlm.nih.gov/pubmed/38051562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46866 %T Designing a Clinician-Centered Wearable Data Dashboard (CarePortal): Participatory Design Study %A Sadhu,Shehjar %A Solanki,Dhaval %A Brick,Leslie A %A Nugent,Nicole R %A Mankodiya,Kunal %+ University of Rhode Island, 45 Upper College Rd, Kingston, RI, 02881, United States, 1 7746412663, shehjar_sadhu@uri.edu %K digital health %K wearables %K smart watch %K smartwatch %K symptom monitoring %K mobile health %K mHealth %K participatory design %K stress management %K monitoring %K eHealth %K wearable technology %K remote monitoring %K physical stress %K psychological stress %K stress %K data interpretation %K visualization %K questionnaire %K decision-making %K mobile phone %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The recent growth of eHealth is unprecedented, especially after the COVID-19 pandemic. Within eHealth, wearable technology is increasingly being adopted because it can offer the remote monitoring of chronic and acute conditions in daily life environments. Wearable technology may be used to monitor and track key indicators of physical and psychological stress in daily life settings, providing helpful information for clinicians. One of the key challenges is to present extensive wearable data to clinicians in an easily interpretable manner to make informed decisions. Objective: The purpose of this research was to design a wearable data dashboard, named CarePortal, to present analytic visualizations of wearable data that are meaningful to clinicians. The study was divided into 2 main research objectives: to understand the needs of clinicians regarding wearable data interpretation and visualization and to develop a system architecture for a web application to visualize wearable data and related analytics. Methods: We used a wearable data set collected from 116 adolescent participants who experienced trauma. For 2 weeks, participants wore a Microsoft Band that logged physiological sensor data such as heart rate (HR). A total of 834 days of HR data were collected. To design the CarePortal dashboard, we used a participatory design approach that interacted directly with clinicians (stakeholders) with backgrounds in clinical psychology and neuropsychology. A total of 8 clinicians were recruited from the Rhode Island Hospital and the University of Massachusetts Memorial Health. The study involved 5 stages of participatory workshops and began with an understanding of the needs of clinicians. A User Experience Questionnaire was used at the end of the study to quantitatively evaluate user experience. Physiological metrics such as daily and hourly maximum, minimum, average, and SD of HR and HR variability, along with HR-based activity levels, were identified. This study investigated various data visualization graphing methods for wearable data, including radar charts, stacked bar plots, scatter plots combined with line plots, simple bar plots, and box plots. Results: We created a CarePortal dashboard after understanding the clinicians’ needs. Results from our workshops indicate that overall clinicians preferred aggregate information such as daily HR instead of continuous HR and want to see trends in wearable sensor data over a period (eg, days). In the User Experience Questionnaire, a score of 1.4 was received, which indicated that CarePortal was exciting to use (question 5), and a similar score was received, indicating that CarePortal was the leading edge (question 8). On average, clinicians reported that CarePortal was supportive and can be useful in making informed decisions. Conclusions: We concluded that the CarePortal dashboard integrated with wearable sensor data visualization techniques would be an acceptable tool for clinicians to use in the future. %M 38051573 %R 10.2196/46866 %U https://formative.jmir.org/2023/1/e46866 %U https://doi.org/10.2196/46866 %U http://www.ncbi.nlm.nih.gov/pubmed/38051573 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46611 %T An Active Model of Research Translation for the General Public: Content Analysis of a YouTube-Based Health Podcast %A Tsulukidze,Maka %A Grande,Stuart W %A Naslund,John A %+ Department of Health Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, 10501 FGCU Blvd S, Fort Myers, FL, 33965, United States, 1 239 590 7496, mtsulukidze@fgcu.edu %K evidence translation %K user engagement %K consumer education %K online health information %K disseminating science %K health education %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Online health information seeking is changing the way people engage with health care and the health system. Recent changes in practices related to seeking, accessing, and disseminating scientific research, and in particular health information, have enabled a high level of user engagement. Objective: This study aims to examine an innovative model of research translation, The Huberman Lab Podcast (HLP), developed by Andrew Huberman, Professor of Neurobiology and Ophthalmology at the Stanford School of Medicine. The HLP leverages social media to deliver health information translated into specific, actionable practices and health strategies directly to the general public. This research characterizes the HLP as an Active Model of Research Translation and assesses its potential as a framework for replicability and wider adoption. Methods: We applied conventional content analysis of the YouTube transcript data and directed content analysis of viewers’ YouTube comments to 23 HLP episodes released from January to October 2021, reflecting the time of data analysis. We selected 7 episodes and a welcome video, to describe and identify key characteristics of the HLP model. We analyzed viewer comments for 18 episodes to determine whether viewers found the HLP content valuable, accessible, and easy to implement. Results: The key HLP features are direct-to-the-consumer, zero-cost, bilingual, and actionable content. We identified 3 main organizing categories and 10 subcategories as the key elements of the HLP: (1) Why: Educate and Empower and Bring Zero Cost to Consumer Information to the General Public; (2) What: Tools and Protocols; Underlying Mechanisms; and Grounded in Science; (3) How: Linear and Iterative Knowledge Building Process; Lecture-Style Sessions; Interactive and Consumer Informed; Easily Accessible; and Building the Community. Analysis of viewers’ comments found strong consumer support for the key HLP model elements. Conclusions: This Active Model of Research Translation offers a way to synthesize scientific evidence and deliver it directly to end users in the form of actionable tools and education. Timely evidence translation using effective consumer engagement and education techniques appears to improve access and confidence related to health information use and reduces challenges to understanding and applying health information received from health providers. Framing complex content in an approachable manner, engaging the target audience, encouraging participation, and ensuring open access to the content meet current recommendations on innovative practices for leveraging social media or other digital platforms for disseminating science and research findings to the general public, and are likely key contributors to HLP impact and potential for success. The model offers a replicable framework for translating and disseminating scientific evidence. Similar active models of research translation can have implications for accessing health information and implementing health strategies for improved outcomes. Areas for further investigation are specific and measurable impacts on health, usability, and relevance of the model for reaching marginalized and high-risk populations. %M 38051560 %R 10.2196/46611 %U https://formative.jmir.org/2023/1/e46611 %U https://doi.org/10.2196/46611 %U http://www.ncbi.nlm.nih.gov/pubmed/38051560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48987 %T Implementing Telemedicine in Clinical Practice in the First Digital Hematology Unit: Feasibility Study %A Santamaria,Amparo %A Antón Maldonado,Cristina %A Sánchez-Quiñones,Beatriz %A Ibarra Vega,Nataly %A Ayo González,Maikel %A Gonzalez Cabezas,Pedro %A Carrasco Moreno,Rafael %+ Hematology Department, University Hospital Vinalopó, Carrer Tonico Sansano Mora, 14, Alicante, 03293, Spain, 34 966 67 98 00, masantamaria@vinaloposalud.com %K telemedicine %K digital unit %K hybrid hematology department %K hematology %K hybrid %K implementation %K telehealth %K monitor %K monitoring %K remote care %K virtual care %K hematological %K hematologist %K hematologists %K service %K services %K delivery %K holistic %K digital health intervention %K digital transformation %D 2023 %7 4.12.2023 %9 Short Paper %J JMIR Form Res %G English %X Background: Currently, there are no telemedicine models that fully integrate all areas of hematology into daily practice. Objective: The objectives of this feasibility study were to assess the practicality of implementing telemedicine into our clinical practice in the first Digital Hematology Unit and propose an innovative integrative design for clinical practice. Methods: We designed the Digital Hematology Unit, which is a specific physical space dedicated to carrying out telemedicine and monitoring patients in a holistic way. Also, a satisfaction questionnaire was performed and health care indicators were measured. Results: In 2021, there were 1331 first visits and 7534 follow-up visits. Of the first visits, 12.2% (n=163) were face-to-face and 87.8% (n=1168) were telematic. For follow-up visits, 29.9% (n=2251) were face-to-face and 70.1% (n=5283) were telematic. The health care management indicators showed that we had a waiting time of less than 4 days and took less than 4 hours to answer interconsultations among specialists. Moreover, patients reported a high level of satisfaction with the services provided. Conclusions: Our Digital Hematology Unit, as a case of success, serves as an example of how innovative digital solutions can contribute to the quality of care and excellence in health care achieved through a digital transformation process led by hematologists. %M 38048143 %R 10.2196/48987 %U https://formative.jmir.org/2023/1/e48987 %U https://doi.org/10.2196/48987 %U http://www.ncbi.nlm.nih.gov/pubmed/38048143 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49718 %T Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study %A McNaughton Reyes,H Luz %A Armora Langoni,Eliana G %A Sharpless,Laurel %A Moracco,Kathryn E %A Benavides,Quetzabel %A Foshee,Vangie A %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 9199663215, mcnaught@email.unc.edu %K dating violence %K adolescents %K family-based prevention %K web-based delivery %K feasibility and acceptability %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. Objective: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. Methods: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. Results: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. Conclusions: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. %M 38039070 %R 10.2196/49718 %U https://formative.jmir.org/2023/1/e49718 %U https://doi.org/10.2196/49718 %U http://www.ncbi.nlm.nih.gov/pubmed/38039070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44705 %T Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study %A Shea,Amanda A %A Thornburg,Jonathan %A Vitzthum,Virginia J %+ Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology/Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 250 984 3033, dr.vj.vitzthum@gmail.com %K mobile health %K mHealth %K femtech %K reproductive health %K menstrual health %K sexual health %K survey modalities %K menstrual tracking app %K India %K South Africa %K United States %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors—notably, high costs, considerable effort, and the sensitivity of these topics—impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods. Objective: The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA. Methods: In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India). Results: Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples’ consistency across countries regarding users’ demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app’s users. Conclusions: MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research. %M 38039064 %R 10.2196/44705 %U https://formative.jmir.org/2023/1/e44705 %U https://doi.org/10.2196/44705 %U http://www.ncbi.nlm.nih.gov/pubmed/38039064 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50522 %T User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial %A Buck,Benjamin %A Wingerson,Mary %A Whiting,Erica %A Snyder,Jaime %A Monroe-DeVita,Maria %A Ben-Zeev,Dror %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98105, United States, 1 206 221 8518, buckbe@uw.edu %K caregiving %K psychosis %K mobile health %K mHealth %K user-centered design %K mobile phone %K artificial intelligence %K AI %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. Objective: The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. Methods: We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. Results: In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). Conclusions: To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis. %M 38032692 %R 10.2196/50522 %U https://mental.jmir.org/2023/1/e50522 %U https://doi.org/10.2196/50522 %U http://www.ncbi.nlm.nih.gov/pubmed/38032692 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46242 %T The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study %A Kim,Sunghak %A Jung,Timothy %A Sohn,Dae Kyung %A Chae,Yoon %A Kim,Young Ae %A Kang,Seung Hyun %A Park,Yujin %A Chang,Yoon Jung %+ Division of Cancer Control and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 10 8729 5835, eunice.ncc@gmail.com %K metaverse %K virtual reality %K cancer education %K cancer care %K digital health %K cancer treatment %K patient care %K cross-sectional survey %K digital health intervention %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care. Objective: This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability. Methods: We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users’ experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform. Results: Responses from 70 Korean participants (male: n=19, 27% and female: n=51, 73%) were analyzed. More than half (n=37, 54%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49%) and no difficulty in wearing and operating the device (n=30, 43%). Furthermore, more than half (n=50, 72%) of the participants reported that Dr. Meta would help provide non–face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59%) and recommended it to others (n=42, 60%). Conclusions: We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non–face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care. %M 38032697 %R 10.2196/46242 %U https://games.jmir.org/2023/1/e46242 %U https://doi.org/10.2196/46242 %U http://www.ncbi.nlm.nih.gov/pubmed/38032697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51423 %T User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study %A Pozuelo,Julia R %A Moffett,Bianca D %A Davis,Meghan %A Stein,Alan %A Cohen,Halley %A Craske,Michelle G %A Maritze,Meriam %A Makhubela,Princess %A Nabulumba,Christine %A Sikoti,Doreen %A Kahn,Kathleen %A Sodi,Tholene %A , %A van Heerden,Alastair %A O’Mahen,Heather A %+ Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, 641 Huntington Avenue, Boston, MA, 02115, United States, 1 617 432 1707, julia_ruizpozuelo@hms.harvard.edu %K depression %K adolescents %K mental health app %K behavioral activation %K user-centered design %K low- and middle-income countries %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms. %M 38032691 %R 10.2196/51423 %U https://formative.jmir.org/2023/1/e51423 %U https://doi.org/10.2196/51423 %U http://www.ncbi.nlm.nih.gov/pubmed/38032691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47145 %T Patient and Physician Perspectives on the Use of a Connected Ecosystem for Diabetes Management: International Cross-Sectional Observational Study %A Benito-Garcia,Elizabeth %A Vega,Julio %A Daza,Eric J %A Lee,Wei-Nchih %A Kennedy,Adee %A Chantelot,Jean-Marc %+ Sanofi, 54 Rue La Boétie, Paris, 75008, France, 33 0153774000, Jean-Marc.Chantelot@sanofi.com %K type 2 diabetes mellitus %K insulin treatment %K connected ecosystems %K surveys %K diabetes %K diabetic %K ecosystem %K ecosystems %K telehealth %K telemedicine %K eHealth %K digital health %K health technology %K adoption %K perception %K attitude %K intention %K acceptance %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Collaboration between people with type 2 diabetes (T2DM) and their health care teams is important for optimal control of the disease and outcomes. Digital technologies could potentially tie together several health care-related devices and platforms into connected ecosystems (CES), but attitudes about CES are unknown. Objective: We surveyed convenience samples of patients and physicians to better understand which patient characteristics are associated with higher likelihoods of (1) participating in a potential CES program, as self-reported by patients with T2DM and (2) clinical benefit from participation in a potential CES program, as reported by physicians. Methods: Adults self-reporting a diagnosis of T2DM and current insulin use (n=197), and 33 physicians whose practices included ≥20% of such patients, were enrolled in the United States, France, and Germany. We surveyed both groups about the likelihood of patient participation in a CES. We then examined the associations between patients’ clinical and sociodemographic characteristics and this likelihood. We also described characteristics of patients likely to clinically benefit from CES use, according to physicians. Results: Compared with patients in Germany and France, US patients were younger (mean age 45.3 [SD 11.9] years vs 61.9 [SD 9.2] and 65.8 [SD 9.4] years, respectively), more often female, more highly educated, and more often working full-time. In all, 51 (44.7%) US patients, 16 (36.4%) German patients, and 18 (46.3%) French patients indicated strong interest in a CES program, and 115 (78.7%) reported currently using ≥1 connected device or app. However, physicians believed that only 11.3%-19.2% of their patients were using connected devices or apps to manage their disease. Physicians also reported infrequently recommending or prescribing connected devices to their patients, although ≥80% (n=28) of them thought that a CES could help support their patients in managing their disease. The factors most predictive of patient likelihood of participating in a CES program were cost, inclusion of medication reminders, and linking blood glucose levels to behaviors such as eating and exercise. In all countries, the most common patient expectations for a CES program were that it could help them eat more healthfully, increase their physical activity, increase their understanding of how blood glucose relates to behavior such as exercise and eating, and reduce stress. Physicians thought that newly diagnosed patients, sicker patients—those who had been hospitalized for diabetes, were currently using insulin, or who had any comorbid condition—and patients who were nonadherent to treatment were most likely to benefit from CES use. Conclusions: In this study, there was a high degree of interest in the future use of CES, although additional education is needed among both patients with T2DM and their physicians to achieve the full potential of such systems to improve self-management and clinical care for the disease. %M 38032701 %R 10.2196/47145 %U https://formative.jmir.org/2023/1/e47145 %U https://doi.org/10.2196/47145 %U http://www.ncbi.nlm.nih.gov/pubmed/38032701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45128 %T User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study %A Adams,Zachary W %A Marriott,Brigid R %A Karra,Swathi %A Linhart-Musikant,Elizabeth %A Raymond,Jodi L %A Fischer,Lydia J %A Bixler,Kristina A %A Bell,Teresa M %A Bryan,Eric A %A Hulvershorn,Leslie A %+ Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, United States, 1 3172780591, zwadams@iu.edu %K access-to-care %K addiction %K adolescent %K behavior %K health disorder %K opioid use disorder %K opioid %K personalized care %K telehealth %K telemedicine %K trauma %K user %K youth %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients’ behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. Objective: This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. Methods: We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients’ postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Results: Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging–delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients’ behavioral health in the months after discharge. Conclusions: Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial. %M 38032728 %R 10.2196/45128 %U https://formative.jmir.org/2023/1/e45128 %U https://doi.org/10.2196/45128 %U http://www.ncbi.nlm.nih.gov/pubmed/38032728 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50867 %T Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study %A Ajayi,Toluwalase %A Pawelek,Jeff %A Bhargava,Hansa %A Faksh,Arij %A Radin,Jennifer %+ Scripps Research Translational Institute, Scripps Research, 3344 North Torrey Pines Ct., La Jolla, CA, 92037, United States, 1 8587842096, tajayi@scripps.edu %K prenatal care %K maternal health %K digital study %K underrepresented in biomedical research %K pregnant %K pregnancy %K medications %K vaccinations %K vitamins %D 2023 %7 28.11.2023 %9 Short Paper %J JMIR Form Res %G English %X Background: Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care—including the use of medications, immunizations, and prenatal vitamins—are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. Objective: We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. Methods: We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. Results: Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. Conclusions: A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities. %M 38015604 %R 10.2196/50867 %U https://formative.jmir.org/2023/1/e50867 %U https://doi.org/10.2196/50867 %U http://www.ncbi.nlm.nih.gov/pubmed/38015604 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46592 %T Treatment Responsivity in Adolescents With Disruptive Behavior Problems: Co-Creation of a Virtual Reality–Based Add-On Intervention %A Klein Schaarsberg,Renée E %A Ribberink,Amber Z %A Osinga,Babette %A van Dam,Levi %A Lindauer,Ramón J L %A Popma,Arne %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 0208901000, r.e.kleinschaarsberg@amsterdamumc.nl %K virtual reality %K role-playing %K cognitive behavioral therapy %K co-creation %K disruptive behavior %K mentalization %K adolescence %K mental health %K child %K youth %K clinical practice %K intervention %D 2023 %7 28.11.2023 %9 Early Report %J JMIR Form Res %G English %X Background: We developed Street Temptations (ST) as an add-on intervention to increase the treatment responsivity of adolescents with disruptive behavior problems. ST’s primary aim is to improve adolescents’ mentalizing abilities in order to help them engage in and benefit from psychotherapy. Additionally, virtual reality (VR) is used to work in a more visual, less verbal, fashion. Objective: By recapping the lessons learned while developing ST so far, we aim to design the following study on ST. Furthermore, we aim to enhance the development and study of new health care interventions in clinical practice, together with adolescents as their end users. Methods: We followed an iterative co-creation process to develop a prototype of ST, in collaboration with adolescents and professionals from a secured residential facility in Amsterdam, the Netherlands. The prototype was tested during a pilot phase, involving 2 test runs, in which 4 adolescents and 4 professionals participated. Qualitative data were collected through interviews with the adolescents and by conducting a group interview with the professionals, in order to gain first insights into ST’s usability, feasibility, and its added value to clinical practice. In between the first and second test runs, the prototype was enhanced. On the basis of the complete pilot phase, we reflected on the future development and implementation of ST to design a subsequent study. Results: Over the course of 6 months, ST’s first prototype was developed during multiple creative sessions. Included was the development of a short 360° VR video, to serve as a base for the mentalization exercises. The final version of ST consisted of 7 individual therapy sessions, incorporating both the VR video and a VR StreetView app. On the basis of the qualitative data collected during the pilot phase, we found preliminary signs of ST’s potential to support adolescents’ perspective-taking abilities specifically. Additionally, using VR to focus on real-life situations that adolescents encounter in their daily lives possibly helps to facilitate communication. However, several challenges and requests concerning the VR hardware and software and the implementation of ST emerged, pointing toward further development of ST as an add-on intervention. These challenges currently limit large-scale implementation, resulting in specific requirements regarding a subsequent study. Conclusions: In order to gather more extensive information to shape further development and study treatment effects, a small-scale and individually oriented research design seems currently more suitable than a more standard between-subjects design. Using the reflection on the lessons learned described in this report, a research protocol for a forthcoming study on ST has been developed. By presenting our co-creation journey thus far, we hope to be of inspiration for a more co-creative mindset and in that way contribute to the mutual reinforcement of science and clinical practice. %M 38015607 %R 10.2196/46592 %U https://formative.jmir.org/2023/1/e46592 %U https://doi.org/10.2196/46592 %U http://www.ncbi.nlm.nih.gov/pubmed/38015607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47762 %T The Readability and Quality of Web-Based Patient Information on Nasopharyngeal Carcinoma: Quantitative Content Analysis %A Tan,Denise Jia Yun %A Ko,Tsz Ki %A Fan,Ka Siu %+ Department of Surgery, Royal Stoke University Hospital, Newcastle Rd, Stoke on Trent, ST4 6QG, United Kingdom, 44 7378977812, tszkiko95@gmail.com %K nasopharyngeal cancer %K internet information %K readability %K Journal of the American Medical Association %K JAMA %K DISCERN %K artificial intelligence %K AI %D 2023 %7 27.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nasopharyngeal carcinoma (NPC) is a rare disease that is strongly associated with exposure to the Epstein-Barr virus and is characterized by the formation of malignant cells in nasopharynx tissues. Early diagnosis of NPC is often difficult owing to the location of initial tumor sites and the nonspecificity of initial symptoms, resulting in a higher frequency of advanced-stage diagnoses and a poorer prognosis. Access to high-quality, readable information could improve the early detection of the disease and provide support to patients during disease management. Objective: This study aims to assess the quality and readability of publicly available web-based information in the English language about NPC, using the most popular search engines. Methods: Key terms relevant to NPC were searched across 3 of the most popular internet search engines: Google, Yahoo, and Bing. The top 25 results from each search engine were included in the analysis. Websites that contained text written in languages other than English, required paywall access, targeted medical professionals, or included nontext content were excluded. Readability for each website was assessed using the Flesch Reading Ease score and the Flesch-Kincaid grade level. Website quality was assessed using the Journal of the American Medical Association (JAMA) and DISCERN tools as well as the presence of a Health on the Net Foundation seal. Results: Overall, 57 suitable websites were included in this study; 26% (15/57) of the websites were academic. The mean JAMA and DISCERN scores of all websites were 2.80 (IQR 3) and 57.60 (IQR 19), respectively, with a median of 3 (IQR 2-4) and 61 (IQR 49-68), respectively. Health care industry websites (n=3) had the highest mean JAMA score of 4 (SD 0). Academic websites (15/57, 26%) had the highest mean DISCERN score of 77.5. The Health on the Net Foundation seal was present on only 1 website, which also achieved a JAMA score of 3 and a DISCERN score of 50. Significant differences were observed between the JAMA score of hospital websites and the scores of industry websites (P=.04), news service websites (P<.048), charity and nongovernmental organization websites (P=.03). Despite being a vital source for patients, general practitioner websites were found to have significantly lower JAMA scores compared with charity websites (P=.05). The overall mean readability scores reflected an average reading age of 14.3 (SD 1.1) years. Conclusions: The results of this study suggest an inconsistent and suboptimal quality of information related to NPC on the internet. On average, websites presented readability challenges, as written information about NPC was above the recommended reading level of sixth grade. As such, web-based information requires improvement in both quality and accessibility, and healthcare providers should be selective about information recommended to patients, ensuring they are reliable and readable. %M 38010802 %R 10.2196/47762 %U https://formative.jmir.org/2023/1/e47762 %U https://doi.org/10.2196/47762 %U http://www.ncbi.nlm.nih.gov/pubmed/38010802 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50516 %T Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial %A Nazem,Sarra %A Barnes,Sean M %A Forster,Jeri E %A Hostetter,Trisha A %A Monteith,Lindsey L %A Kramer,Emily B %A Gaeddert,Laurel A %A Brenner,Lisa A %+ Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, 795 Willow Road, Building 334, Menlo Park, CA, 94025, United States, 1 650 796 8208, Sarra.Nazem@va.gov %K cognitive behavioral therapy %K insomnia %K internet intervention %K online intervention %K randomized controlled trial %K RCT %K RCTs %K sleep %K treatment %K veteran %K veterans %K veterans’ health %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. Objective: The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. Methods: We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. Results: Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of –3.47 (95% CI –4.78 to –2.16), –3.80 (95% CI –5.34 to –2.27), and –3.42 (95% CI –4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. Conclusions: Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. Trial Registration: ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870 %M 37999953 %R 10.2196/50516 %U https://mental.jmir.org/2023/1/e50516 %U https://doi.org/10.2196/50516 %U http://www.ncbi.nlm.nih.gov/pubmed/37999953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53268 %T A Brief, Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety and Little-to-No Meditation Experience (“healing attempt"): Replication and Extension Study %A Jones,Grant %A Castro-Ramirez,Franchesca %A Al-Suwaidi,Maha %A McGuire,Taylor %A Herrmann,Felipe %+ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K music %K song %K psychotherapy %K self-compassion %K ethnic %K cultural %K single-case experiment %K race %K anxiety %K digital health intervention %K Black %K digital health %K low income %K racial disparity %K mental health %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Race-based anxiety is a critical health issue within the Black community. Mindfulness interventions hold promise for treating race-based anxiety in Black Americans; however, there are many barriers that prevent Black Americans from using these treatments, such as low cultural relevance, significant time burdens, and excessive costs. Objective: This study is a replication and extension of findings that “healing attempt”—a brief (<60-minute), digital, music-based mindfulness intervention—is a feasible and acceptable intervention for race-based anxiety in Black Americans. In this study, we tested this research question among those with little-to-no meditation experience. Methods: The participants were 4 Black American adults with elevated race-based trait anxiety and little-to-no meditation experience. We used a series of multiple-baseline single-case experiments and conducted study visits on Zoom (Zoom Video Communications) to assess whether the intervention can decrease state anxiety and increase mindfulness and self-compassion in Black Americans. We also assessed feasibility and acceptability using quantitative and qualitative scales. Results: In line with our hypotheses, “healing attempt” increased mindfulness/self-compassion (Tau-U range: 0.57-0.86; P<.001) and decreased state anxiety (Tau-U range: –0.93 to –0.66; P<.001), with high feasibility and acceptability (the average likelihood of recommending “healing attempt” was 88 out of 100). Conclusions: “healing attempt” may represent a feasible intervention for race-based anxiety in Black Americans with elevated race-based anxiety and little or no mindfulness experience. Future between-subjects randomized feasibility trials can assess whether the intervention can give rise to lasting improvements in race-based anxiety, mindfulness, and self-compassion. Trial Registration: OSF Registries osf.io/k5m93; https://osf.io/k5m93 %M 37999941 %R 10.2196/53268 %U https://formative.jmir.org/2023/1/e53268 %U https://doi.org/10.2196/53268 %U http://www.ncbi.nlm.nih.gov/pubmed/37999941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51507 %T Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study %A Althobiani,Malik A %A Ranjan,Yatharth %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard James Butler %A Porter,Joanna C %A Hurst,John R %A Folarin,Amos A %+ National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 2078480924, amos.folarin@kcl.ac.uk %K remote monitoring %K home health care %K mHealth %K mobile health %K apps %K applications %K wearables %K passive data collection %K data collection %K retention %K engagement %K attrition %K dropout %K spirometry %K oximetry %K home based %K machine learning %K artificial intelligence %K chronic obstructive pulmonary disease %K COPD %K pulmonary %K lungs %K respiratory %K interstitial lung disease %K ILD %K COVID-19 %K respiratory diseases %K lung %K chronic %K SARS-CoV-2 %K monitoring %K observational %K cohort %K feasibility %K usability %K acceptability %K community based %K self-management %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. Objective: This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. Methods: In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post–COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses–base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. Results: Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8% of the day), 123.91 (SD 33.73) hours weekly (72.6% of the week), and 463.82 (SD 156.70) hours monthly (64.4% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59%) were performed. Of these, 90.3% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. Conclusions: Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. International Registered Report Identifier (IRRID): RR2-10.2196/28873 %M 37999935 %R 10.2196/51507 %U https://formative.jmir.org/2023/1/e51507 %U https://doi.org/10.2196/51507 %U http://www.ncbi.nlm.nih.gov/pubmed/37999935 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48926 %T A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial %A Ghosh,Arka %A Cohen,Katherine A %A Jans,Laura %A Busch,Carly A %A McDanal,Riley %A Yang,Yuanyuan %A Cooper,Katelyn M %A Schleider,Jessica L %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, 21st Fl, Chicago, IL, 60611, United States, 1 3125033403, arka.ghosh@northwestern.edu %K single-session intervention %K fear of negative evaluation %K active learning course %K pilot randomized controlled trial %K intervention %K college student %K science course %K active learning %K negative evaluation %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student’s sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. Objective: This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way. Methods: To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus. Results: In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of –2 to +2) and had a high completion rate (>97%). Conclusions: This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class. Trial Registration: OSF Registries osf.io/4ca68 http://osf.io/4ca68 %M 37995114 %R 10.2196/48926 %U https://mental.jmir.org/2023/1/e48926 %U https://doi.org/10.2196/48926 %U http://www.ncbi.nlm.nih.gov/pubmed/37995114 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e48063 %T Effects of a Gamified Agent-Based System for Personalized Elderly Care: Pilot Usability Study %A Martinho,Diogo %A Crista,Vítor %A Carneiro,João %A Matsui,Kenji %A Corchado,Juan Manuel %A Marreiros,Goreti %+ Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Polytechnic of Porto - School of Engineering (ISEP), R. Dr. António Bernardino de Almeida 431, Porto, 4249-015, Portugal, 351 911007406, diepm@isep.ipp.pt %K gamification %K cognitive assistants %K elderly care %K coaching system %K older people %K technology %K virtual assistant %K cognitive %K usability %K intervention %K physical activity %K agent-based system %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The global percentage of older people has increased significantly over the last decades. Information and communication technologies have become essential to develop and motivate them to pursue healthier ways of living. This paper examines a personalized coaching health care service designed to maintain living conditions and active aging among older people. Among the technologies the service includes, we highlight the use of both gamification and cognitive assistant technologies designed to support older people and an application combining a cognitive virtual assistant to directly interact with the older person and provide feedback on their current health condition and several gamification techniques to motivate the older person to stay engaged with the application and pursuit of healthier daily habits. Objective: This pilot study aimed to investigate the feasibility and usability of a gamified agent-based system for older people and obtain preliminary results on the effectiveness of the intervention regarding physical activity health outcomes. Methods: The study was designed as an intervention study comparing pre- and posttest results. The proposed gamified agent-based system was used by 12 participants over 7 days (1 week), and step count data were collected with access to the Google Fit application programming interface. Step count data after the intervention were compared with average step count data before the intervention (average daily values over a period of 4 weeks before the intervention). A　1-tailed Student t test was used to determine the relationship between the dependent and independent variables. Usability was measured using the System Usability Scale questionnaire, which was answered by 8 of the 12 participants in the study. Results: The posttest results showed significant pre- to posttest changes (P=.30; 1-tailed Student t test) with a moderate effect size (Cohen d=0.65). The application obtained an average usability score of 78. Conclusions: The presented pilot was validated, showing the positive health effects of using gamification techniques and a virtual cognitive assistant. Additionally, usability metrics considered for this study confirmed high adherence and interest from most participants in the pilot. %M 37995116 %R 10.2196/48063 %U https://games.jmir.org/2023/1/e48063 %U https://doi.org/10.2196/48063 %U http://www.ncbi.nlm.nih.gov/pubmed/37995116 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52454 %T Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study %A Keim-Malpass,Jessica %A Lunsford,Christopher %A Letzkus,Lisa C %A Scheer,Eleanore %A Valdez,Rupa S %+ Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, VA, 22901, United States, 1 4349245105, jlk2t@virginia.edu %K anticipatory symptom management %K children with medical complexity %K social network %K qualitative %K self-management %K care coordination %K precision health %K disease progression models %K disability %K networked models of disease %K social networking %K web-based network %K web-based networks %K social networks %K symptom management %K family management %K coordinated care %K precision %K pediatric %K pediatrics %K child %K children %K caregiver %K caregivers %K social support %K interview %K interviews %K family %K informal care %K caregiving %K conceptual %K grounded theory %K constructivist %K situational analysis %K model %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. Objective: The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network. Methods: This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children’s Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here. Results: In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes. Conclusions: The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development. International Registered Report Identifier (IRRID): RR2-10.2196/14810 %M 37801346 %R 10.2196/52454 %U https://formative.jmir.org/2023/1/e52454 %U https://doi.org/10.2196/52454 %U http://www.ncbi.nlm.nih.gov/pubmed/37801346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34232 %T Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App %A Nurmi,Johanna %A Knittle,Keegan %A Naughton,Felix %A Sutton,Stephen %A Ginchev,Todor %A Khattak,Fida %A Castellano-Tejedor,Carmina %A Lusilla-Palacios,Pilar %A Ravaja,Niklas %A Haukkala,Ari %+ Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, L363, Jyväskylä, 40014, Finland, 358 504698252, keegan.p.knittle@jyu.fi %K smartphone %K daily steps %K activity tracker %K activity bracelet %K motivational interviewing %K self-efficacy %K self-regulation %K biofeedback %K N-of-1 %K automated %K digitalized %K behavior change %K intervention %K ecological momentary assessment %K within-person design %K intensive longitudinal multilevel modeling %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. Objective: This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability–based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. Methods: In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). Results: All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=−1524; P<.001) on daily steps. Conclusions: The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs. %M 37995122 %R 10.2196/34232 %U https://formative.jmir.org/2023/1/e34232 %U https://doi.org/10.2196/34232 %U http://www.ncbi.nlm.nih.gov/pubmed/37995122 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e33147 %T CareKnowDo—A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial %A Reston,Riley Elizabeth %A Caskey,Fergus J %A Hole,Barnaby %A Udayaraj,Udaya %A Weinman,John %+ Atlantis Health, 1st Floor, Building 3, 566 Chiswick High Road, London, W4 5YA, United Kingdom, 44 7727735151, riley.reston@atlantishealth.com %K kidney disease %K chronic %K blood pressure %K randomized controlled trial %K telemedicine %K mobile health %K mHealth %K self-management %K guideline adherence %K medication adherence %K illness beliefs %K medication beliefs %K health psychology %K preventative medicine %K qualitative research %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. Objective: The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). Methods: A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51%) integrated with PV or standard care (PV alone: 30/61, 49%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. Results: Of the 1392 patients screened in local kidney clinics, 269 (19.32%) met the basic inclusion criteria; the first 22.7% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). Conclusions: A tailored digital and nurse call–based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Trial Registration: NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/ %M 37995117 %R 10.2196/33147 %U https://formative.jmir.org/2023/1/e33147 %U https://doi.org/10.2196/33147 %U http://www.ncbi.nlm.nih.gov/pubmed/37995117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45021 %T Internet-Based Inquiries From Users With the Intention to Overdose With Over-the-Counter Drugs: Qualitative Analysis of Yahoo! Chiebukuro %A Kariya,Azusa %A Okada,Hiroshi %A Suzuki,Shota %A Dote,Satoshi %A Nishikawa,Yoshitaka %A Araki,Kazuo %A Takahashi,Yoshimitsu %A Nakayama,Takeo %+ Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9477, kariya.azusa.57m@st.kyoto-u.ac.jp %K abuse %K consumer-generated media %K CGM %K overdose %K over-the-counter drug %K OTC drug %K question and answer site %K Q and A site %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public concern with regard to over-the-counter (OTC) drug abuse is growing rapidly across countries. OTC drug abuse has serious effects on the mind and body, such as poisoning symptoms, and often requires specialized treatments. In contrast, there is concern about people who potentially abuse OTC drugs whose symptoms are not serious enough to consult medical institutions or drug addiction rehabilitation centers yet are at high risk of becoming drug dependent in the future. Objective: Consumer-generated media (CGM), which allows users to disseminate information, is being used by people who abuse (and those who are trying to abuse) OTC drugs to obtain information about OTC drug abuse. This study aims to analyze the content of CGM to explore the questions of people who potentially abuse OTC drugs. Methods: The subject of this research was Yahoo! Chiebukuro, the largest question and answer website in Japan. A search was performed using the names of drugs commonly used in OTC drug abuse and the keywords overdose and OD, and the number of questions posted on the content of OTC drug abuse was counted. Furthermore, a thematic analysis was conducted by extracting text data on the most abused antitussive and expectorant drug, BRON. Results: The number of questions about the content of overdose medications containing the keyword BRON has increased sharply as compared with other product names. Furthermore, 467 items of question data that met the eligibility criteria were obtained from 528 items of text data on BRON; 26 codes, 6 categories, and 3 themes were generated from the 578 questions contained in these items. Questions were asked about the effects they would gain from abusing OTC drugs and the information they needed to obtain the effects they sought, as well as about the effects of abuse on their bodies. Moreover, there were questions on how to stop abusing and what is needed when seeking help from a health care provider if they become dependent. It has become clear that people who abuse OTC drugs have difficulty in consulting face-to-face with others, and CGM is used as a means to obtain the necessary information anonymously. Conclusions: On CGM, people who abused or tried to abuse OTC drugs were asking questions about their abuse expectations and anxieties. In addition, when they became dependent, they sought advice to quit their abuse. CGM was used to exchange information about OTC drug abuse, and many questions on anxieties and hesitations were posted. This study suggests that it is necessary to produce and disseminate information on OTC drug abuse, considering the situation of those who abuse or are willing to abuse OTC drugs. Support from pharmacies and drugstores would also be essential to reduce opportunities for OTC drug abuse. %M 37991829 %R 10.2196/45021 %U https://formative.jmir.org/2023/1/e45021 %U https://doi.org/10.2196/45021 %U http://www.ncbi.nlm.nih.gov/pubmed/37991829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43260 %T Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study %A Miller,Ian %A Peake,Emily %A Strauss,Gabriel %A Vierra,Elise %A Koepsell,Xin %A Shalchi,Brandon %A Padmanabhan,Aarthi %A Lake,Jessica %+ Big Health Inc, 461 Bush St #200, San Francisco, CA, 94108, United States, 1 415 971 2900, jessica.lake@bighealth.com %K depression %K adolescents %K young adults %K cognitive behavioral therapy %K behavioral activation %K digital health %K mobile interventions %K mobile phone %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents. Methods: A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8. Results: The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program’s ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points. Conclusions: The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681 %M 37991839 %R 10.2196/43260 %U https://formative.jmir.org/2023/1/e43260 %U https://doi.org/10.2196/43260 %U http://www.ncbi.nlm.nih.gov/pubmed/37991839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45875 %T A Web-Based COVID-19 Tool for Testing Residents in Retirement Homes: Development Study %A Davoodi,Mansoor %A Batista,Ana %A Mertel,Adam %A Senapati,Abhishek %A Abdussalam,Wildan %A Vyskocil,Jiri %A Barbieri,Giuseppe %A Fan,Kai %A Schlechte-Welnicz,Weronika %A M Calabrese,Justin %+ Center for Advanced Systems Understanding, Untermarkt 20, Görlitz, 02826, Germany, 49 3581375237, m.davoodi-monfared@hzdr.de %K application %K COVID-19 %K optimized testing %K pandemic %K retirement home %K web application %D 2023 %7 21.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term care facilities have been widely affected by the COVID-19 pandemic. Empirical evidence demonstrated that older people are the most impacted and are at higher risk of mortality after being infected. Regularly testing care facility residents is a practical approach to detecting infections proactively. In many cases, the care staff must perform the tests on the residents while also providing essential care, which in turn causes imbalances in their working time. Once an outbreak occurs, suppressing the spread of the virus in retirement homes (RHs) is challenging because the residents are in contact with each other, and isolation measures cannot be widely enforced. Regular testing strategies, on the other hand, have been shown to effectively prevent outbreaks in RHs. However, high-frequency testing may consume substantial staff working time, which results in a trade-off between the time invested in testing and the time spent providing essential care to residents. Objective: We developed a web application (Retirement Home Testing Optimizer) to assist RH managers in identifying effective testing schedules for residents. The outcome of the app, called the “testing strategy,” is based on dividing facility residents into groups and then testing no more than 1 group per day. Methods: We created the web application by incorporating influential factors such as the number of residents and staff, the average rate of contacts, the amount of time spent to test, and constraints on the test interval and size of groups. We developed mixed integer nonlinear programming models for balancing staff workload in long-term care facilities while minimizing the expected detection time of a probable infection inside the facility. Additionally, by leveraging symmetries in the problem, we proposed a fast and efficient local search method to find the optimal solution. Results: Considering the number of residents and staff and other practical constraints of the facilities, the proposed application computes the optimal trade-off testing strategy and suggests the corresponding grouping and testing schedule for residents. The current version of the application is deployed on the server of the Where2Test project and is accessible on their website. The application is open source, and all contents are offered in English and German. We provide comprehensive instructions and guidelines for easy use and understanding of the application’s functionalities. The application was launched in July 2022, and it is currently being tested in RHs in Saxony, Germany. Conclusions: Recommended testing strategies by our application are tailored to each RH and the goals set by the managers. We advise the users of the application that the proposed model and approach focus on the expected scenarios, that is, the expected risk of infection, and they do not guarantee the avoidance of worst-case scenarios. %M 37988136 %R 10.2196/45875 %U https://formative.jmir.org/2023/1/e45875 %U https://doi.org/10.2196/45875 %U http://www.ncbi.nlm.nih.gov/pubmed/37988136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51422 %T Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study %A Cheng,Abby L %A Agarwal,Mansi %A Armbrecht,Melissa A %A Abraham,Joanna %A Calfee,Ryan P %A Goss,Charles W %+ Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St Louis, MO, 63110, United States, 1 3147472823, chengal@wustl.edu %K digital mental health intervention %K chronic musculoskeletal pain %K anxiety %K depression %K pain interference %K physical function %K behavioral activation %K pain acceptance %K sleep quality %K mediation analysis %K behavioral mechanism %K chronic pain %K digital health intervention %K mobile phone %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood. Objective: The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health. Methods: In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants’ engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale–Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P<.20 was considered significant for this pilot study. Results: Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect –0.4, 80% CI –0.7 to –0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well. Conclusions: In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health. Trial Registration: ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722 %M 37976097 %R 10.2196/51422 %U https://formative.jmir.org/2023/1/e51422 %U https://doi.org/10.2196/51422 %U http://www.ncbi.nlm.nih.gov/pubmed/37976097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48209 %T A Novel System for the Device-Based Measurement of Physical Activity, Sedentary Behavior, and Sleep (Motus): Usability Evaluation %A Crowley,Patrick %A Kildedal,Rasmus %A Vindelev,Simon Overvad %A Jacobsen,Sandra Schade %A Larsen,Jon Roslyng %A Johansson,Peter J %A Aadahl,Mette %A Straker,Leon %A Stamatakis,Emmanuel %A Holtermann,Andreas %A Mork,Paul Jarle %A Gupta,Nidhi %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 40357831, rak@nfa.dk %K usability %K accelerometry %K development %K accelerometer %K design %K mhealth %K mobile health %K app %K application %K diary %K thematic analysis %K monitor %K monitoring %K physical activity %K exercise %K sedentary %K sleep %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Device-based measurements of physical behavior, using the current methods, place a large burden on participants. The Motus system could reduce this burden by removing the necessity for in-person meetings, replacing diaries written on paper with digital diaries, and increasing the automation of feedback generation. Objective: This study aims to describe the development of the Motus system and evaluate its potential to reduce participant burden in a two-phase usability evaluation. Methods: Motus was developed around (1) a thigh-worn accelerometer with Bluetooth data transfer; (2) a smartphone app containing an attachment guide, a digital diary, and facilitating automated data transfer; (3) a cloud infrastructure for data storage; (4) an analysis software to generate feedback for participants; and (5) a web-based app for administrators. We recruited 19 adults with a mean age of 45 (SD 11; range 27-63) years, of which 11 were female, to assist in the two-phase evaluation of Motus. A total of 7 participants evaluated the usability of mockups for a smartphone app in phase 1. Participants interacted with the app while thinking aloud, and any issues raised were classified as critical, serious, or minor by observers. This information was used to create an improved and functional smartphone app for evaluation in phase 2. A total of 12 participants completed a 7-day free-living measurement with Motus in phase 2. On day 1, participants attempted 20 system-related tasks under observation, including registration on the study web page, reading the information letter, downloading and navigating the smartphone app, attaching an accelerometer on the thigh, and completing a diary entry for both work and sleep hours. Task completion success and any issues encountered were noted by the observer. On completion of the 7-day measurement, participants provided a rating from 0 to 100 on the System Usability Scale and participated in a semistructured interview aimed at understanding their experience in more detail. Results: The task completion rate for the 20 tasks was 100% for 13 tasks, >80% for 4 tasks, and <50% for 3 tasks. The average rating of system usability was 86 on a 0-100 scale. Thematic analysis indicated that participants perceived the system as easy to use and remember, and subjectively pleasing overall. Participants with shift work reported difficulty with entering sleep hours, and 66% (8/12) of the participants experienced slow data transfer between the app and the cloud infrastructure. Finally, a few participants desired a greater degree of detail in the generated feedback. Conclusions: Our two-phase usability evaluation indicated that the overall usability of the Motus system is high in free-living. Issues around the system’s slow data transfer, participants with atypical work shifts, and the degree of automation and detail of generated feedback should be addressed in future iterations of the Motus system. International Registered Report Identifier (IRRID): RR2-10.2196/35697 %M 37976096 %R 10.2196/48209 %U https://formative.jmir.org/2023/1/e48209 %U https://doi.org/10.2196/48209 %U http://www.ncbi.nlm.nih.gov/pubmed/37976096 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51334 %T mHealth Intervention to Promote Physical Activity Among Employees Using a Deep Learning Model for Passive Monitoring of Depression and Anxiety: Single-Arm Feasibility Trial %A Watanabe,Kazuhiro %A Okusa,Shoichi %A Sato,Mitsuhiro %A Miura,Hideki %A Morimoto,Masahiro %A Tsutsumi,Akizumi %+ Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, 252-0374, Japan, 81 427789352, kzwatanabe-tky@umin.ac.jp %K eHealth %K behavioral change %K mobile phone %K smartphone %K mHealth %K mobile health %K app %K apps %K applications %K monitor %K monitoring %K physical activity %K exercise %K fitness %K application %K workplace %K distress %K depression %K depressive %K anxiety %K mental health %K worker %K workers %K employee %K employees %K occupational health %K satisfaction %K feasibility %K acceptability %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity effectively prevents depression and anxiety. Although mobile health (mHealth) technologies offer promising results in promoting physical activity and improving mental health, conflicting evidence exists on their effectiveness, and employees face barriers to using mHealth services. To address these problems, we recently developed a smartphone app named ASHARE to prevent depression and anxiety in the working population; it uses a deep learning model for passive monitoring of depression and anxiety from information about physical activity. Objective: This study aimed to preliminarily investigate (1) the effectiveness of the developed app in improving physical activity and reducing depression and anxiety and (2) the app’s implementation outcomes (ie, its acceptability, appropriateness, feasibility, satisfaction, and potential harm). Methods: We conducted a single-arm interventional study. From March to April 2023, employees aged ≥18 years who were not absent were recruited. The participants were asked to install and use the app for 1 month. The ideal usage of the app was for the participants to take about 5 minutes every day to open the app, check the physical activity patterns and results of an estimated score of psychological distress, and increase their physical activity. Self-reported physical activity (using the Global Physical Activity Questionnaire, version 2) and psychological distress (using the 6-item Kessler Psychological Distress Scale) were measured at baseline and after 1 month. The duration of physical activity was also recorded digitally. Paired t tests (two-tailed) and chi-square tests were performed to evaluate changes in these variables. Implementation Outcome Scales for Digital Mental Health were also measured for acceptability, appropriateness, feasibility, satisfaction, and harm. These average scores were assessed by comparing them with those reported in previous studies. Results: This study included 24 employees. On average, the app was used for 12.54 days (44.8% of this study’s period). After using the app, no significant change was observed in physical activity (–12.59 metabolic equivalent hours per week, P=.31) or psychological distress (–0.43 metabolic equivalent hours per week, P=.93). However, the number of participants with severe psychological distress decreased significantly (P=.01). The digitally recorded duration of physical activity increased during the intervention period (+0.60 minutes per day, P=.08). The scores for acceptability, appropriateness, and satisfaction were lower than those in previous mHealth studies, whereas those for feasibility and harm were better. Conclusions: The ASHARE app was insufficient in promoting physical activity or improving psychological distress. At this stage, the app has many issues that are to be addressed in terms of both implementation and effectiveness. The main reason for this low effectiveness might be the poor evaluation of the implementation outcomes by app users. Improving acceptability, appropriateness, and satisfaction are identified as key issues to be addressed in future implementation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000050430; https://tinyurl.com/mrx5ntcmrecptno=R000057438 %M 37976094 %R 10.2196/51334 %U https://formative.jmir.org/2023/1/e51334 %U https://doi.org/10.2196/51334 %U http://www.ncbi.nlm.nih.gov/pubmed/37976094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47101 %T Web-Based Content on Diet and Nutrition Written in Japanese: Infodemiology Study Based on Google Trends and Google Search %A Murakami,Kentaro %A Shinozaki,Nana %A Kimoto,Nana %A Onodera,Hiroko %A Oono,Fumi %A McCaffrey,Tracy A %A Livingstone,M Barbara E %A Okuhara,Tsuyoshi %A Matsumoto,Mai %A Katagiri,Ryoko %A Ota,Erika %A Chiba,Tsuyoshi %A Nishida,Yuki %A Sasaki,Satoshi %+ Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113 0033, Japan, 81 3 5841 7872, kenmrkm@m.u-tokyo.ac.jp %K diet %K nutrition %K information %K internet %K web %K Japanese language %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The increased availability of content of uncertain integrity obtained through the internet is a major concern. To date, however, there has been no comprehensive scrutiny of the fitness-for-purpose of web-based content on diet and nutrition. Objective: This cross-sectional study aims to describe diet- and nutrition-related web-based content written in Japanese, identified via a systematic extraction strategy using Google Trends and Google Search. Methods: We first identified keywords relevant for extracting web-based content (eg, blogs) on diet and nutrition written in Japanese using Google Trends. This process included identification of 638 seed terms, identification of approximately 1500 pairs of related queries (top) and search terms, the top 10% of which were extracted to identify 160 relevant pairs of related queries (top) and search terms, and identification of 107 keywords for search. We then extracted relevant web-based content using Google Search. Results: The content (N=1703) examined here was extracted following a search based on 107 keywords. The most common themes included food and beverages (390/1703, 22.9%), weight management (366/1703, 21.49%), health benefits (261/1703, 15.33%), and healthy eating (235/1703, 13.8%). The main disseminators were information technology companies and mass media (474/1703, 27.83%), food manufacturers (246/1703, 14.45%), other (236/1703, 13.86%), and medical institutions (214/1703, 12.57%). Less than half of the content (790/1703, 46.39%) clearly indicated the involvement of editors or writers. More than half of the content (983/1703, 57.72%) was accompanied by one or more types of advertisement. The proportion of content with any type of citation reference was 40.05% (682/1703). The themes and disseminators of content were significantly associated with the involvement of editors or writers, accompaniment with advertisement, and citation of reference. In particular, content focusing on weight management was more likely to clearly indicate the involvement of editors or writers (212/366, 57.9%) and to be accompanied by advertisement (273/366, 74.6%), but less likely to have references cited (128/366, 35%). Content from medical institutions was less likely to have citation references (62/214, 29%). Conclusions: This study highlights concerns regarding the authorship, conflicts of interest (advertising), and the scientific credibility of web-based diet- and nutrition-related information written in Japanese. Nutrition professionals and experts should take these findings seriously because exposure to nutritional information that lacks context or seems contradictory can lead to confusion and backlash among consumers. However, more research is needed to draw firm conclusions about the accuracy and quality of web-based diet- and nutrition-related content and whether similar results can be obtained in other major mass media or social media outlets and even other languages. %M 37971794 %R 10.2196/47101 %U https://formative.jmir.org/2023/1/e47101 %U https://doi.org/10.2196/47101 %U http://www.ncbi.nlm.nih.gov/pubmed/37971794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51398 %T Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals %A Rheinberger,Demee %A Baffsky,Rachel %A McGillivray,Lauren %A Zbukvic,Isabel %A Dadich,Ann %A Larsen,Mark Erik %A Lin,Ping-I %A Gan,Daniel Z Q %A Kaplun,Catherine %A Wilcox,Holly C %A Eapen,Valsamma %A Middleton,Paul M %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, Sydney, NSW, 2031, Australia, 61 0415677477, m.torok@unsw.edu.au %K mobile health %K mHealth %K digital health %K mental health %K suicide prevention %K self-harm %K young people %K hospitals %K mobile phone %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. Objective: This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. Methods: We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. Results: Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. Conclusions: Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation. %M 37971790 %R 10.2196/51398 %U https://formative.jmir.org/2023/1/e51398 %U https://doi.org/10.2196/51398 %U http://www.ncbi.nlm.nih.gov/pubmed/37971790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47356 %T Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations %A Wickwire,Emerson M %A Collen,Jacob %A Capaldi,Vincent F %A Williams,Scott G %A Assefa,Samson Z %A Adornetti,Julianna P %A Huang,Kathleen %A Venezia,Janet M %A Jones,Rachell L %A Johnston,Christine W %A Thomas,Connie %A Thomas,Mary Ann %A Mounts,Charles %A Drake,Christopher L %A Businelle,Michael S %A Grandner,Michael A %A Manber,Rachel %A Albrecht,Jennifer S %+ Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 100 N Greene St, 2nd Floor, Baltimore, MD, 21201, United States, 1 410 706 4771, ewickwire@som.umaryland.edu %K sleep %K sleep disorders %K insomnia %K obstructive sleep apnea %K telehealth %K remote monitoring %K monitoring %K patient engagement %K sleep %K effectiveness %K effective care %K behavioral %K care %K application %K wearables %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. Objective: The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. Methods: Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. Results: In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. Conclusions: Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted. %M 37971788 %R 10.2196/47356 %U https://formative.jmir.org/2023/1/e47356 %U https://doi.org/10.2196/47356 %U http://www.ncbi.nlm.nih.gov/pubmed/37971788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49251 %T Fostering Patient-Clinician Communication to Promote Rapid HIV, Hepatitis B Virus, and Hepatitis C Virus Diagnostic Testing: Conceptual Development of a Multilingual App %A Brown,Carter %A Roucoux,Guillaume %A Rousset-Torrente,Olivia %A Ali,Saleh %A Yombo-Kokule,Lisa %A Chaplin,John %A Chassany,Olivier %A Duracinsky,Martin %+ Épidémiologie Clinique et Évaluation Économique appliquées aux Populations Vulnérables (UMR-S 1123), Université Paris Cité, 1 Parvis Notre Dame - Place Jean-Paul II, Paris, 75004, France, 33 0140274664, duracinsky.m@gmail.com %K app development %K agile development %K mobile health %K mHealth %K user-centered design %K communication barriers %K migrants %K HIV %K AIDS %K hepatitis %K rapid diagnostic testing %K public health %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Migrants are disproportionately affected by HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Clinicians, at times, fail to offer rapid diagnostic testing (RDT) for these viruses when a language barrier exists in the patient-clinician relationship, therefore creating missed testing opportunities. Although their effectiveness has been demonstrated elsewhere, conventional, in-person interpreters are costly and underused in practice. Furthermore, clinicians often call upon ad hoc interpreters, which introduces complexities in the clinical relationship. Digital solutions exist to diminish the burden of language barriers; however, the challenges of developing a multilingual and multicultural app have yet to be documented with respect to RDT in the nonfrancophone migrant population in France. Objective: Our goal was to design a multilingual app to overcome language barriers, health literacy barriers, and fears related to being tested to promote RDT of HIV, HBV, and HCV in the nonfrancophone migrant population in France. Methods: A combination of qualitative methods, agile development, and user-centered design was used. We conducted 2 focus groups (FGs) with 12 participants, including physicians, nurses, and social workers conducting RDT, as well as 1 modified Delphi survey with 68 participants including physicians and nurses. FGs explored the content (risk factors and medical history), functions (cultural adaptation and instant translation), and interface ergonomics (graphics and font) needed in the app. The Delphi presented 95 content items that the researchers sought to include in the app. Results: Using FGs to inform the Delphi survey, we scientifically determined the app’s content consisting of 95 items using expert consensus, developed a mock-up, and conducted initial user testing. We created an app that contains both migrant and clinician interfaces and includes a sociodemographic, risk assessment, health literacy, and testing barrier questionnaires available in 11 languages. Educational content is related to HIV, HBV, and HCV, along with the ability to understand whether the migrant agrees to be tested. Conclusions: This study allowed us to conceptualize a multilingual app that aims to increase the acceptance of RDT for HIV, HBV, and HCV. The specific features of the Assistant intelligent au dépistage des allophones app were designed to overcome the testing barriers in the nonfrancophone migrant population. The next phase will be an implementation study, as we intend to validate our app. %M 37971810 %R 10.2196/49251 %U https://formative.jmir.org/2023/1/e49251 %U https://doi.org/10.2196/49251 %U http://www.ncbi.nlm.nih.gov/pubmed/37971810 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50998 %T Potential Schizophrenia Disease-Related Genes Prediction Using Metagraph Representations Based on a Protein-Protein Interaction Keyword Network: Framework Development and Validation %A Yu,Shirui %A Wang,Ziyang %A Nan,Jiale %A Li,Aihua %A Yang,Xuemei %A Tang,Xiaoli %+ Institute of Medical Information, Chinese Academy of Medical Sciences, No 69 Dongdan North Street, Beijing, 100005, China, 86 10 52328902, tang.xiaoli@imicams.ac.cn %K disease gene prediction %K metagraph %K protein representations %K schizophrenia %K keyword network %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Schizophrenia is a serious mental disease. With increased research funding for this disease, schizophrenia has become one of the key areas of focus in the medical field. Searching for associations between diseases and genes is an effective approach to study complex diseases, which may enhance research on schizophrenia pathology and lead to the identification of new treatment targets. Objective: The aim of this study was to identify potential schizophrenia risk genes by employing machine learning methods to extract topological characteristics of proteins and their functional roles in a protein-protein interaction (PPI)-keywords (PPIK) network and understand the complex disease–causing property. Consequently, a PPIK-based metagraph representation approach is proposed. Methods: To enrich the PPI network, we integrated keywords describing protein properties and constructed a PPIK network. We extracted features that describe the topology of this network through metagraphs. We further transformed these metagraphs into vectors and represented proteins with a series of vectors. We then trained and optimized our model using random forest (RF), extreme gradient boosting, light gradient boosting machine, and logistic regression models. Results: Comprehensive experiments demonstrated the good performance of our proposed method with an area under the receiver operating characteristic curve (AUC) value between 0.72 and 0.76. Our model also outperformed baseline methods for overall disease protein prediction, including the random walk with restart, average commute time, and Katz models. Compared with the PPI network constructed from the baseline models, complementation of keywords in the PPIK network improved the performance (AUC) by 0.08 on average, and the metagraph-based method improved the AUC by 0.30 on average compared with that of the baseline methods. According to the comprehensive performance of the four models, RF was selected as the best model for disease protein prediction, with precision, recall, F1-score, and AUC values of 0.76, 0.73, 0.72, and 0.76, respectively. We transformed these proteins to their encoding gene IDs and identified the top 20 genes as the most probable schizophrenia-risk genes, including the EYA3, CNTN4, HSPA8, LRRK2, and AFP genes. We further validated these outcomes against metagraph features and evidence from the literature, performed a features analysis, and exploited evidence from the literature to interpret the correlation between the predicted genes and diseases. Conclusions: The metagraph representation based on the PPIK network framework was found to be effective for potential schizophrenia risk genes identification. The results are quite reliable as evidence can be found in the literature to support our prediction. Our approach can provide more biological insights into the pathogenesis of schizophrenia. %M 37966892 %R 10.2196/50998 %U https://formative.jmir.org/2023/1/e50998 %U https://doi.org/10.2196/50998 %U http://www.ncbi.nlm.nih.gov/pubmed/37966892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50210 %T Digital Personal Health Coaching Platform for Promoting Human Papillomavirus Infection Vaccinations and Cancer Prevention: Knowledge Graph-Based Recommendation System %A Ammar,Nariman %A Olusanya,Olufunto A %A Melton,Chad %A Chinthala,Lokesh %A Huang,Xiaolei %A White,Brianna M %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street - R492, Memphis, TN, United States, 1 9012875863, ashabann@uthsc.edu %K health information exchanges %K knowledge graphs %K recommender systems %K personal health libraries %K vaccine promotion %K cancer prevention %K personal health informatics %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health promotion can empower populations to gain more control over their well-being by using digital interventions that focus on preventing the root causes of diseases. Digital platforms for personalized health coaching can improve health literacy and information-seeking behavior, leading to better health outcomes. Personal health records have been designed to enhance patients’ self-management of a disease or condition. Existing personal health records have been mostly designed and deployed as a supplementary service that acts as views into electronic health records. Objective: We aim to overcome some of the limitations of electronic health records. This study aims to design and develop a personal health library (PHL) that generates personalized recommendations for human papillomavirus (HPV) vaccine promotion and cancer prevention. Methods: We have designed a proof-of-concept prototype of the Digital Personal Health Librarian, which leverages machine learning; natural language processing; and several innovative technological infrastructures, including the Semantic Web, social linked data, web application programming interfaces, and hypermedia-based discovery, to generate a personal health knowledge graph. Results: We have designed and implemented a proof-of-the-concept prototype to showcase and demonstrate how the PHL can be used to store an individual’s health data, for example, a personal health knowledge graph. This is integrated with web-scale knowledge to support HPV vaccine promotion and prevent HPV-associated cancers among adolescents and their caregivers. We also demonstrated how the Digital Personal Health Librarian uses the PHL to provide evidence-based insights and knowledge-driven explanations that are personalized and inform health decision-making. Conclusions: Digital platforms such as the PHL can be instrumental in improving precision health promotion and education strategies that address population-specific needs (ie, health literacy, digital competency, and language barriers) and empower individuals by facilitating knowledge acquisition to make healthy choices. %M 37966885 %R 10.2196/50210 %U https://formative.jmir.org/2023/1/e50210 %U https://doi.org/10.2196/50210 %U http://www.ncbi.nlm.nih.gov/pubmed/37966885 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48950 %T Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study %A Lunde,Pernille %A Skoglund,Gyri %A Olsen,Cecilie Fromholt %A Hilde,Gunvor %A Bong,Way Kiat %A Nilsson,Birgitta Blakstad %+ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, P44, PB 4, Street Olavs Plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K mobile phone app %K smartphone %K lifestyle %K usability %K diabetes %K diabetic %K mobile health %K smartphone %K app %K apps %K application %K applications %K think-aloud %K think aloud %K user experience %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. %M 37966894 %R 10.2196/48950 %U https://humanfactors.jmir.org/2023/1/e48950 %U https://doi.org/10.2196/48950 %U http://www.ncbi.nlm.nih.gov/pubmed/37966894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47404 %T Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study %A Park,Linda S %A Kornfield,Rachel %A Yezihalem,Mihret %A Quanbeck,Andrew %A Mellinger,Jessica %A German,Margarita %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way #200, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@fammed.wisc.edu %K alcohol-associated liver disease %K ALD %K alcohol use disorder %K AUD %K mobile health %K mHealth %K digital tools %K alcohol cessation %K usability test %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD. Objective: This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs. Methods: We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month. Results: First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week. Conclusions: Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns. %M 37966869 %R 10.2196/47404 %U https://formative.jmir.org/2023/1/e47404 %U https://doi.org/10.2196/47404 %U http://www.ncbi.nlm.nih.gov/pubmed/37966869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50870 %T A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial %A Su,Yan %A Wu,Kuan-Ching %A Chien,Shao-Yun %A Naik,Aishwarya %A Zaslavsky,Oleg %+ School of Nursing, University of Washington, 1959 NE Pacific Ave, Box 357266, Seattle, WA, 98195-7266, United States, 1 206 849 3301, ozasl@uw.edu %K frailty %K healthy eating %K mobile %K mHealth %K mobile health %K app %K apps %K clinical trial %K Mediterranean diet %K metabolic health %K diet %K dietary %K RCT %K randomized controlled trial %K randomized %K controlled trial %K controlled trials %K frail %K eating %K food %K nutrition %K adherence %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. Objective: This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, “Olitor,” designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. Methods: The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called “Olitor” and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. Results: The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR –0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. Conclusions: This pilot study revealed the potential of the mobile intervention “Olitor” in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. Trial Registration: ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712 %M 37966877 %R 10.2196/50870 %U https://formative.jmir.org/2023/1/e50870 %U https://doi.org/10.2196/50870 %U http://www.ncbi.nlm.nih.gov/pubmed/37966877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50460 %T High School Teachers’ Experiences of Consumer Technologies for Stress Management During the COVID-19 Pandemic: Qualitative Study %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %+ UCL Interaction Centre, Department of Computer Science, University College London, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 (0)20 3108 705, julia.manning@ucl.ac.uk %K teachers %K stress %K self-management %K digital health %K technology %K qualitative %K secondary schools %K high schools %K wearables %K context %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress in education is an adverse reaction that teachers have to excessive pressures or other types of demands placed on them. Consumer digital technologies are already being used by teachers for stress management, albeit not in a systematic way. Understanding teachers’ experiences and the long-term use of technologies to support stress self-management in the educational context is essential for meaningful insight into the value, opportunity, and benefits of use. Objective: The aim of this study was first to understand teachers’ experiences of consumer technologies for stress management. They were chosen by teachers from a taxonomy tailored to their stress management. The second aim was to explore whether their experiences of use evolved over time as teachers transitioned from working at home during lockdown to working full time on school premises. Methods: A longitudinal study intended for 6 weeks in the summer term (2020) was extended because of COVID-19 into the autumn term, lasting up to 27 weeks. Teachers chose to use a Withings smartwatch or the Wysa, Daylio, or Teacher Tapp apps. In total, 2 semistructured interviews and web-based surveys were conducted with 8 teachers in South London in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. The interviews were analyzed by creating case studies and conducting cross-case analysis. Results: The teachers described that the data captured or shared by the technology powerfully illustrated the physical and psychosocial toll of their work. This insight gave teachers permission to destress and self-care. The social-emotional confidence generated also led to empathy toward colleagues, and a virtuous cycle of knowledge, self-compassion, permission, and stress management action was demonstrated. Although the COVID-19 pandemic added a new source of stress, it also meant that teachers’ stress management experiences could be contrasted between working from home and then back in school. More intentional self-care was demonstrated when back in school, sometimes without the need to refer to the data or technology. Conclusions: The findings of this study demonstrate that taking a situated approach to understand the real-world, existential significance and value of data generates contextually informed insights. Where a strategic personal choice of consumer technology is enabled for high school heads of year, the data generated are perceived as holistic, with personal and professional salience, and are motivational in the educational context. Technology adoption was aided by the pandemic conditions of home working, and this flexibility would otherwise need workplace facilitation. These findings add to the value proposition of technologies for individual stress management and workforce health outcomes pertinent to educators, policy makers, and designers. %M 37966873 %R 10.2196/50460 %U https://formative.jmir.org/2023/1/e50460 %U https://doi.org/10.2196/50460 %U http://www.ncbi.nlm.nih.gov/pubmed/37966873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50193 %T Classifying Schizophrenia Cases by Artificial Neural Network Using Japanese Web-Based Survey Data: Case-Control Study %A He,Yupeng %A Matsunaga,Masaaki %A Li,Yuanying %A Kishi,Taro %A Tanihara,Shinichi %A Iwata,Nakao %A Tabuchi,Takahiro %A Ota,Atsuhiko %+ Department of Public Health, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan, 81 562 93 2476, yupeng.he@fujita-hu.ac.jp %K artificial neural network %K schizophrenia %K prevalence %K Japan %K web-based survey %K mental health %K psychosis %K machine learning %K epidemiology %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In Japan, challenges were reported in accurately estimating the prevalence of schizophrenia among the general population. Retrieving previous studies, we investigated that patients with schizophrenia were more likely to experience poor subjective well-being and various physical, psychiatric, and social comorbidities. These factors might have great potential for precisely classifying schizophrenia cases in order to estimate the prevalence. Machine learning has shown a positive impact on many fields, including epidemiology, due to its high-precision modeling capability. It has been applied in research on mental disorders. However, few studies have applied machine learning technology to the precise classification of schizophrenia cases by variables of demographic and health-related backgrounds, especially using large-scale web-based surveys. Objective: The aim of the study is to construct an artificial neural network (ANN) model that can accurately classify schizophrenia cases from large-scale Japanese web-based survey data and to verify the generalizability of the model. Methods: Data were obtained from a large Japanese internet research pooled panel (Rakuten Insight, Inc) in 2021. A total of 223 individuals, aged 20-75 years, having schizophrenia, and 1776 healthy controls were included. Answers to the questions in a web-based survey were formatted as 1 response variable (self-report diagnosed with schizophrenia) and multiple feature variables (demographic, health-related backgrounds, physical comorbidities, psychiatric comorbidities, and social comorbidities). An ANN was applied to construct a model for classifying schizophrenia cases. Logistic regression (LR) was used as a reference. The performances of the models and algorithms were then compared. Results: The model trained by the ANN performed better than LR in terms of area under the receiver operating characteristic curve (0.86 vs 0.78), accuracy (0.93 vs 0.91), and specificity (0.96 vs 0.94), while the model trained by LR showed better sensitivity (0.63 vs 0.56). Comparing the performances of the ANN and LR, the ANN was better in terms of area under the receiver operating characteristic curve (bootstrapping: 0.847 vs 0.773 and cross-validation: 0.81 vs 0.72), while LR performed better in terms of accuracy (0.894 vs 0.856). Sleep medication use, age, household income, and employment type were the top 4 variables in terms of importance. Conclusions: This study constructed an ANN model to classify schizophrenia cases using web-based survey data. Our model showed a high internal validity. The findings are expected to provide evidence for estimating the prevalence of schizophrenia in the Japanese population and informing future epidemiological studies. %M 37966882 %R 10.2196/50193 %U https://formative.jmir.org/2023/1/e50193 %U https://doi.org/10.2196/50193 %U http://www.ncbi.nlm.nih.gov/pubmed/37966882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47312 %T Personalized Coaching via Texting for Behavior Change to Understand a Healthy Lifestyle Intervention in a Naturalistic Setting: Mixed Methods Study %A Bäccman,Charlotte %A Bergkvist,Linda %A Wästlund,Erik %+ Service Research Center (CTF), Karlstad University, Universitetsgatan 2, Karlstad, 65188, Sweden, 46 547002519, charlotte.baccman@kau.se %K digital health intervention %K behavior change %K personalized SMS coaching %K Capability, Opportunity, Motivation–Behavior %K COM-B %K physical activity %K mixed methods design %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalized SMS coaching has shown great promise in supporting behavior changes. Objective: This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation–Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden. Methods: The study used a mixed methods design in which clients acted as their own controls. The participants were clients (n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and (3) pseudonymized texting conversations between the fitness consultants and clients. Results: Overall, the results showed that personalized SMS coaching was effective in supporting the clients’ behavior changes. The quantitative analysis showed how the clients’ capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients. Conclusions: Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention. %M 37966893 %R 10.2196/47312 %U https://formative.jmir.org/2023/1/e47312 %U https://doi.org/10.2196/47312 %U http://www.ncbi.nlm.nih.gov/pubmed/37966893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48637 %T Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study %A Wada,Aya %A Nakamura,Yasuka %A Kawajiri,Maiko %A Takeishi,Yoko %A Yoshida,Mikako %A Yoshizawa,Toyoko %+ Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1, Sendai, Miyagi, 9800872, Japan, 81 227177957, ynaka@tohoku.ac.jp %K work %K pregnancy %K occupation %K occupational health %K mHealth %K mobile application %K feasibility %K usability %K longitudinal %K observational study %K pregnancy %K Japan %K mobile health %K occupational health and safety %K ergonomics %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. Objective: This study aims to verify the feasibility and usability of the Job Adjustment mobile app. Methods: A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. Results: The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). Conclusions: The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. Trial Registration: UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas %M 37962945 %R 10.2196/48637 %U https://formative.jmir.org/2023/1/e48637 %U https://doi.org/10.2196/48637 %U http://www.ncbi.nlm.nih.gov/pubmed/37962945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44763 %T Machine Learning Algorithms Predict Successful Weaning From Mechanical Ventilation Before Intubation: Retrospective Analysis From the Medical Information Mart for Intensive Care IV Database %A Kim,Jinchul %A Kim,Yun Kwan %A Kim,Hyeyeon %A Jung,Hyojung %A Koh,Soonjeong %A Kim,Yujeong %A Yoon,Dukyong %A Yi,Hahn %A Kim,Hyung-Jun %+ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea, 82 31 787 7844, dr.hjkim@snubh.org %K algorithms %K clinical decision-making %K intensive care units %K noninvasive ventilation %K organ dysfunction scores %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The prediction of successful weaning from mechanical ventilation (MV) in advance of intubation can facilitate discussions regarding end-of-life care before unnecessary intubation. Objective: We aimed to develop a machine learning–based model that predicts successful weaning from ventilator support based on routine clinical and laboratory data taken before or immediately after intubation. Methods: We used the Medical Information Mart for Intensive Care IV database, which is an open-access database covering 524,740 admissions of 382,278 patients in Beth Israel Deaconess Medical Center, United States, from 2008 to 2019. We selected adult patients who underwent MV in the intensive care unit (ICU). Clinical and laboratory variables that are considered relevant to the prognosis of the patient in the ICU were selected. Data collected before or within 24 hours of intubation were used to develop machine learning models that predict the probability of successful weaning within 14 days of ventilator support. Developed models were integrated into an ensemble model. Performance metrics were calculated by 5-fold cross-validation for each model, and a permutation feature importance and Shapley additive explanations analysis was conducted to better understand the impacts of individual variables on outcome prediction. Results: Of the 23,242 patients, 19,025 (81.9%) patients were successfully weaned from MV within 14 days. Using the preselected 46 clinical and laboratory variables, the area under the receiver operating characteristic curve of CatBoost classifier, random forest classifier, and regularized logistic regression classifier models were 0.860 (95% CI 0.852-0.868), 0.855 (95% CI 0.848-0.863), and 0.823 (95% CI 0.813-0.832), respectively. Using the ensemble voting classifier using the 3 models above, the final model revealed the area under the receiver operating characteristic curve of 0.861 (95% CI 0.853-0.869), which was significantly better than that of Simplified Acute Physiology Score II (0.749, 95% CI 0.742-0.756) and Sequential Organ Failure Assessment (0.588, 95% CI 0.566-0.609). The top features included lactate and anion gap. The model’s performance achieved a plateau with approximately the top 21 variables. Conclusions: We developed machine learning algorithms that can predict successful weaning from MV in advance to intubation in the ICU. Our models can aid the appropriate management for patients who hesitate to decide on ventilator support or meaningless end-of-life care. %M 37962939 %R 10.2196/44763 %U https://formative.jmir.org/2023/1/e44763 %U https://doi.org/10.2196/44763 %U http://www.ncbi.nlm.nih.gov/pubmed/37962939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49174 %T Facilitated WhatsApp Support Groups for Youth Living With HIV in Nairobi, Kenya: Single-Arm Pilot Intervention Study %A Ronen,Keshet %A Mugo,Cyrus %A Kaggiah,Anne %A Seeh,David %A Kumar,Manasi %A Guthrie,Brandon L %A Moreno,Megan A %A John-Stewart,Grace %A Inwani,Irene %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 206 685 4363, keshet@uw.edu %K HIV %K mHealth %K social media %K youth %K adolescent %K social support %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile technology can support HIV care, but studies in youth are limited. In 2014, youth receiving HIV care at several health care facilities in Nairobi, Kenya spontaneously formed peer support groups using the social media platform WhatsApp. Objective: Inspired by youth-initiated groups, we aimed to evaluate the use of WhatsApp to deliver a social support intervention to improve HIV treatment and psychosocial outcomes in youth. We developed a facilitated WhatsApp group intervention (named Vijana-SMART), which was grounded in social support theory and guided by the design recommendations of youth living with HIV. This paper evaluates the intervention’s acceptability and pre-post changes in health outcomes. Methods: The intervention involved interactive WhatsApp groups facilitated by study staff for 6 months, with each group having approximately 25 members. Study staff sent weekly structured messages, and the message content was based on social support theory and encouraged unstructured peer-to-peer messaging and support. We conducted a single-arm pilot among 55 youth living with HIV aged 14-24 years recruited from a government health care facility serving a mixed-income area of Nairobi. At enrollment and follow-up, self-report questionnaires assessed acceptability; antiretroviral therapy (ART) information, motivation, and behavioral skills (IMB); depression; social support; stigma; resilience; and ART adherence. All participants received the intervention. We used generalized estimating equations (GEEs) clustered by participant to evaluate changes in scores from baseline to follow-up, and correlates of participant WhatsApp messaging. Results: The median participant age was 18 years, and 67% (37/55) were female. Intervention acceptability was high. All participants reported that it was helpful, and 73% (38/52) sent ≥1 WhatsApp message. Messaging levels varied considerably between participants and were higher during school holidays, earlier in the intervention period, and among youth aged ≥18 years. IMB scores increased from enrollment to follow-up (66.9% to 71.3%; P<.001). Stigma scores also increased (8.3% to 16.7%; P=.001), and resilience scores decreased (75.0% to 70.0%; P<.001). We found no significant change in ART adherence, social support, or depression. We detected a positive association between the level of messaging during the study and the resilience score, but no significant association between messaging and other outcomes. Once enrolled, it was common for participants to change their phone numbers or leave the groups and request to be added back, which may present implementation challenges at a larger scale. Conclusions: Increased IMB scores following WhatsApp group participation may improve HIV outcomes. Increased stigma and decreased resilience were unintended consequences and may reflect transient effects of group sharing of challenging experiences, which should be addressed in larger randomized evaluations. WhatsApp groups present a promising and acceptable modality to deliver supportive interventions to youth living with HIV beyond the clinic, and further evaluation is warranted. Trial Registration: ClinicalTrials.gov (NCT05634265); https://clinicaltrials.gov/study/NCT05634265 %M 37955957 %R 10.2196/49174 %U https://formative.jmir.org/2023/1/e49174 %U https://doi.org/10.2196/49174 %U http://www.ncbi.nlm.nih.gov/pubmed/37955957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50328 %T A Mobile App That Addresses Interpretability Challenges in Machine Learning–Based Diabetes Predictions: Survey-Based User Study %A Hendawi,Rasha %A Li,Juan %A Roy,Souradip %+ North Dakota State University, 1340 Administration Ave, Fargo, ND, 58105, United States, 1 (701) 231 8011, j.li@ndsu.edu %K disease prediction %K explainable AI %K artificial intelligence %K knowledge graph %K machine learning %K ontology %K diabetes %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning approaches, including deep learning, have demonstrated remarkable effectiveness in the diagnosis and prediction of diabetes. However, these approaches often operate as opaque black boxes, leaving health care providers in the dark about the reasoning behind predictions. This opacity poses a barrier to the widespread adoption of machine learning in diabetes and health care, leading to confusion and eroding trust. Objective: This study aimed to address this critical issue by developing and evaluating an explainable artificial intelligence (AI) platform, XAI4Diabetes, designed to empower health care professionals with a clear understanding of AI-generated predictions and recommendations for diabetes care. XAI4Diabetes not only delivers diabetes risk predictions but also furnishes easily interpretable explanations for complex machine learning models and their outcomes. Methods: XAI4Diabetes features a versatile multimodule explanation framework that leverages machine learning, knowledge graphs, and ontologies. The platform comprises the following four essential modules: (1) knowledge base, (2) knowledge matching, (3) prediction, and (4) interpretation. By harnessing AI techniques, XAI4Diabetes forecasts diabetes risk and provides valuable insights into the prediction process and outcomes. A structured, survey-based user study assessed the app’s usability and influence on participants’ comprehension of machine learning predictions in real-world patient scenarios. Results: A prototype mobile app was meticulously developed and subjected to thorough usability studies and satisfaction surveys. The evaluation study findings underscore the substantial improvement in medical professionals’ comprehension of key aspects, including the (1) diabetes prediction process, (2) data sets used for model training, (3) data features used, and (4) relative significance of different features in prediction outcomes. Most participants reported heightened understanding of and trust in AI predictions following their use of XAI4Diabetes. The satisfaction survey results further revealed a high level of overall user satisfaction with the tool. Conclusions: This study introduces XAI4Diabetes, a versatile multi-model explainable prediction platform tailored to diabetes care. By enabling transparent diabetes risk predictions and delivering interpretable insights, XAI4Diabetes empowers health care professionals to comprehend the AI-driven decision-making process, thereby fostering transparency and trust. These advancements hold the potential to mitigate biases and facilitate the broader integration of AI in diabetes care. %M 37955948 %R 10.2196/50328 %U https://formative.jmir.org/2023/1/e50328 %U https://doi.org/10.2196/50328 %U http://www.ncbi.nlm.nih.gov/pubmed/37955948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46128 %T Feasibility of a Text Messaging–Integrated and Chatbot-Interfaced Self-Management Program for Symptom Control in Patients With Gastrointestinal Cancer Undergoing Chemotherapy: Pilot Mixed Methods Study %A Gomaa,Sameh %A Posey,James %A Bashir,Babar %A Basu Mallick,Atrayee %A Vanderklok,Eleanor %A Schnoll,Max %A Zhan,Tingting %A Wen,Kuang-Yi %+ Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, United States, 1 215 503 4623, kuang-yi.wen@jefferson.edu %K chemotherapy %K gastrointestinal cancer %K digital health %K text messaging %K chatbot %K side effect management %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Outpatient chemotherapy often leaves patients to grapple with a range of complex side effects at home. Leveraging tailored evidence-based content to monitor and manage these symptoms remains an untapped potential among patients with gastrointestinal (GI) cancer. Objective: This study aims to bridge the gap in outpatient chemotherapy care by integrating a cutting-edge text messaging system with a chatbot interface. This approach seeks to enable real-time monitoring and proactive management of side effects in patients with GI cancer undergoing intravenous chemotherapy. Methods: Real-Time Chemotherapy-Associated Side Effects Monitoring Supportive System (RT-CAMSS) was developed iteratively, incorporating patient-centered inputs and evidence-based information. It synthesizes chemotherapy knowledge, self-care symptom management skills, emotional support, and healthy lifestyle recommendations. In a single-arm 2-month pilot study, patients with GI cancer undergoing chemotherapy received tailored intervention messages thrice a week and a weekly Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events–based symptom assessment via a chatbot interface. Baseline and postintervention patient surveys and interviews were conducted. Results: Out of 45 eligible patients, 34 were enrolled (76% consent rate). The mean age was 61 (SD 12) years, with 19 (56%) being females and 21 (62%) non-Hispanic White. The most common cancer type was pancreatic (n=18, 53%), followed by colon (n=12, 35%) and stomach (n=4, 12%). In total, 27 (79% retention rate) participants completed the postintervention follow-up. In total, 20 patients texted back at least once to seek additional information, with the keyword “chemo” or “support” texted the most. Among those who used the chatbot system checker, fatigue emerged as the most frequently reported symptom (n=15), followed by neuropathy (n=7). Adjusted for multiple comparisons, patients engaging with the platform exhibited significantly improved Patient Activation Measure (3.70, 95% CI –6.919 to –0.499; P=.02). Postintervention interviews and satisfaction surveys revealed that participants found the intervention was user-friendly and were provided with valuable information. Conclusions: Capitalizing on mobile technology communication holds tremendous scalability for enhancing health care services. This study presents initial evidence of the engagement and acceptability of RT-CAMSS, warranting further evaluation in a controlled clinical trial setting. %M 37948108 %R 10.2196/46128 %U https://formative.jmir.org/2023/1/e46128 %U https://doi.org/10.2196/46128 %U http://www.ncbi.nlm.nih.gov/pubmed/37948108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51998 %T Active Tuberculosis Screening via a Mobile Health App in Myanmar: Incremental Cost-Effectiveness Evaluation %A Htet,Kyaw Ko Ko %A Phyu,Aye Nyein %A Zayar,Nyi Nyi %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand, 66 74 451165, cvirasak@gmail.com %K mobile app %K tuberculosis screening %K TB screening %K cost effectiveness %K mHealth %K mobile health %K app %K apps %K application %K applications %K cost %K costs %K economic %K economics %K TB %K tuberculosis %K screening %K communicable %K x-ray %K imaging %K radiography %K decision tree %K detect %K detection %K detecting %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A mobile app that calculates a tuberculosis (TB) risk score based on individual social and pathological characteristics has been shown to be a better predictor of the risk of contracting TB than conventionally used TB signs and symptoms (TBSS) in Myanmar, where the TB burden is high. Its cost-effectiveness, however, has not yet been assessed. Objective: This study aimed to determine the incremental costs of this mobile app and of chest x-rays (CXRs) in averting disability-adjusted life years (DALYs) among missed cases of active TB in the population being screened. Methods: Elements of incremental costs and effectiveness of 3 initial TB screening strategies were examined, including TBSS followed by CXR, the mobile app followed by CXR, and universal CXR. The incremental cost-effectiveness ratio (ICER; ie, the additional cost for each additional DALY averted) was compared to TBSS screening. Based on the latest 2020 gross domestic product (GDP) per capita of Myanmar (US $1477.50), the ICER was compared to willingness-to-pay (WTP) thresholds of 1, 2, and 3 times the GDP per capita. Probabilistic sensitivity analysis was conducted with a Monte Carlo simulation to compute the levels of probability that the ICER for each strategy was below each WTP threshold. Results: For each 100,000 population, the incremental cost compared to TBSS of active TB screening was US $345,942 for the mobile app and US $1,810,712 for universal CXR. The incremental effectiveness was 325 DALYs averted for the mobile app and 576 DALYs averted for universal CXR. For the mobile app, the estimated ICER was US $1064 (72% of GDP per capita) per 1 DALY averted. Furthermore, 100% of the simulated values were below an additional cost of 1 times the GDP per capita for 1 additional DALY averted. The universal CXR strategy has an estimated ICER of US $3143 (2.1 times the GDP per capita) per 1 DALY averted and an additional 77.2% DALYs averted compared to the app (ie, 576 – 325 / 325 DALYs); however, 0.5% of the simulated values were higher than an additional expenditure of 3 times the GDP per capita. Conclusions: Based on the status of the economy in 2020, the mobile app strategy is affordable for Myanmar. The universal CXR strategy, although it could prevent an additional 77% of DALYs, is probably unaffordable. Compared to the TBSS strategy, the mobile app system based on social and pathological characteristics of TB has potential as a TB screening tool to identify missing TB cases and to reduce TB morbidity and mortality, thereby helping to achieve the global goal of “End TB” in resource-limited settings with a high TB burden. %M 37948119 %R 10.2196/51998 %U https://formative.jmir.org/2023/1/e51998 %U https://doi.org/10.2196/51998 %U http://www.ncbi.nlm.nih.gov/pubmed/37948119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48671 %T A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation %A Feldacker,Caryl %A Mugwanya,Raymond %A Irongo,Daniel %A Kathumba,Daneck %A Chiwoko,Jane %A Kitsao,Emmanuel %A Sippell,Kenn %A Wasunna,Beatrice %A Jonas,Kingsley %A Samala,Bernadette %A Mwakanema,Daniel %A Oni,Femi %A Jafa,Krishna %A Tweya,Hannock %+ Department of Global Health, University of Washington, HMC #359932, 325 9th Avenue, Seattle, WA, 98104-2499, United States, 1 206 744 8493, cfeld@uw.edu %K antiretroviral therapy %K differentiated service delivery %K digital innovations %K Malawi %K mobile electronic medical record systems %K monitoring and evaluation %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. Objective: This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. Methods: Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT’s real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT’s EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington’s International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, “community-based ART retention and suppression” (CARES). CARES aims to bring EMRS-like provider benefits to NCAP’s DSD clients. Results: CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. Conclusions: Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage. %M 37948102 %R 10.2196/48671 %U https://formative.jmir.org/2023/1/e48671 %U https://doi.org/10.2196/48671 %U http://www.ncbi.nlm.nih.gov/pubmed/37948102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46203 %T Acceptability, Usefulness, and Ease of Use of an Enhanced Video Directly Observed Treatment System for Supporting Patients With Tuberculosis in Kampala, Uganda: Explanatory Qualitative Study %A Sekandi,Juliet Nabbuye %A McDonald,Adenike %A Nakkonde,Damalie %A Zalwango,Sarah %A Kasiita,Vicent %A Kaggwa,Patrick %A Kakaire,Robert %A Atuyambe,Lynn %A Buregyeya,Esther %+ Department of Epidemiology and Biostatistics, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 7065425257, jsekandi@uga.edu %K digital adherence technologies %K tuberculosis %K video directly observed therapy %K acceptability %K directly observed therapy %K DOT %K Uganda %K treatment %K digital %K technology acceptance model %K social support %K privacy %K stigma %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In tuberculosis (TB) control, nonadherence to treatment persists as a barrier. The traditional method of ensuring adherence, that is, directly observed therapy, faces significant challenges that hinder its widespread adoption. Digital adherence technologies such as video directly observed therapy (VDOT) are emerging as promising solutions. However, as these novel technologies gain momentum, a critical gap is the lack of comprehensive studies evaluating their efficacy and the unique experiences of patients in Africa. Objective: The aim of this study was to assess patients’ experiences that affected acceptability, usefulness, and ease of use with an enhanced VDOT system during monitoring of TB treatment. Methods: We conducted individual open-ended interviews in a cross-sectional exit qualitative study in Kampala, Uganda. Thirty participants aged 18-65 years who had completed the VDOT randomized trial were purposively selected to represent variability in sex, adherence level, and HIV status. We used a hybrid process of deductive and inductive coding to identify content related to the experience of study participation with VDOT. Codes were organized into themes and subthemes, which were used to develop overarching categories guided by constructs adapted from the modified Technology Acceptance Model for Resource-Limited Settings. We explored participants’ experiences regarding the ease of use and usefulness of VDOT, thereby identifying the facilitators and barriers to its acceptability. Perceived usefulness refers to the benefits users expect from the technology, while perceived ease of use refers to how easily users navigate its various features. We adapted by shifting from assessing perceived to experienced constructs. Results: The participants’ mean age was 35.3 (SD 12) years. Of the 30 participants, 15 (50%) were females, 13 (43%) had low education levels, and 22 (73%) owned cellphones, of which 10 (45%) had smartphones. Nine (28%) were TB/HIV-coinfected, receiving antiretroviral therapy. Emergent subthemes for facilitators of experienced usefulness and ease of VDOT use were SMS text message reminders, technology training support to patients by health care providers, timely patient-provider communication, family social support, and financial incentives. TB/HIV-coinfected patients reported the added benefit of adherence support for their antiretroviral medication. The external barriers to VDOT’s usefulness and ease of use were unstable electricity, technological malfunctions in the app, and lack of cellular network coverage in rural areas. Concerns about stigma, disease disclosure, and fear of breach in privacy and confidentiality affected the ease of VDOT use. Conclusions: Overall, participants had positive experiences with the enhanced VDOT. They found the enhanced VDOT system user-friendly, beneficial, and acceptable, particularly due to the supportive features such as SMS text message reminders, incentives, technology training by health care providers, and family support. However, it is crucial to address the barriers related to technological infrastructure as well as the privacy, confidentiality, and stigma concerns related to VDOT. %M 37948121 %R 10.2196/46203 %U https://formative.jmir.org/2023/1/e46203 %U https://doi.org/10.2196/46203 %U http://www.ncbi.nlm.nih.gov/pubmed/37948121 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45725 %T A Guided, Internet-Based Stress Management Intervention for University Students With High Levels of Stress: Feasibility and Acceptability Study %A Amanvermez,Yagmur %A Karyotaki,Eirini %A Cuijpers,Pim %A Ciharova,Marketa %A Donker,Marianne %A Hurks,Petra %A Salemink,Elske %A Spinhoven,Philip %A Struijs,Sascha %A de Wit,Leonore M %+ Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, TIAS Building, Room 508, Tilburg, 5037 AB, Netherlands, 31 134663665, y.amanvermez@tilburguniversity.edu %K internet-based interventions %K stress management %K university students %K e–mental health %K feasibility study %K stress %K digital interventions %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Transitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood. Objective: This study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress. Methods: A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale–10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire–8) and usability (System Usability Scale–10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale–10), depressive symptoms (Patient Health Questionnaire–9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis. Results: Of 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=−0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience. Conclusions: The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. Trial Registration: Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889 International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2021.100369 %M 37948106 %R 10.2196/45725 %U https://formative.jmir.org/2023/1/e45725 %U https://doi.org/10.2196/45725 %U http://www.ncbi.nlm.nih.gov/pubmed/37948106 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47895 %T Reduction of Mental Health–Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis %A Gliske,Kate %A Ballard,Jaime %A Berry,Katie R %A Killian,Michael %A Kroll,Elizabeth %A Fenkel,Caroline %+ Charlie Health Inc, 233 East Main Street, Suite 233, Bozeman, MT, 59715-5045, United States, 1 19523341411, kgliske@umn.edu %K mental health %K emergency room %K emergency department %K ED %K readmission %K intensive outpatient treatment %K IOP %K pediatric %K youth %K young adult %K emergency %K evaluation %K readmission %K sexual identity %K race %K ethnicity %K care %K outpatient %K treatment %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth’s mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED’s in order to prevent readmissions. Objective: The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Methods: Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Results: Mental health–related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health–related ED admissions at IOP intake reported no mental health–related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. Conclusions: This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults. %M 37943600 %R 10.2196/47895 %U https://formative.jmir.org/2023/1/e47895 %U https://doi.org/10.2196/47895 %U http://www.ncbi.nlm.nih.gov/pubmed/37943600 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42916 %T Feasibility of Using Research Electronic Data Capture (REDCap) to Collect Daily Experiences of Parent-Child Dyads: Ecological Momentary Assessment Study %A El Dahr,Yola %A Perquier,Florence %A Moloney,Madison %A Woo,Guyyunge %A Dobrin-De Grace,Roksana %A Carvalho,Daniela %A Addario,Nicole %A Cameron,Emily E %A Roos,Leslie E %A Szatmari,Peter %A Aitken,Madison %+ Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 34091, madison.aitken@camh.ca %K ambulatory assessment %K children %K ecological momentary assessment %K longitudinal %K parents %K survey %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intensive longitudinal data collection, including ecological momentary assessment (EMA), has the potential to reduce recall biases, collect more ecologically valid data, and increase our understanding of dynamic associations between variables. EMA is typically administered using an application that is downloaded on participants’ devices, which presents cost and privacy concerns that may limit its use. Research Electronic Data Capture (REDCap), a web-based survey application freely available to nonprofit organizations, may allow researchers to overcome these barriers; however, at present, little guidance is available to researchers regarding the setup of EMA in REDCap, especially for those who are new to using REDCap or lack advanced programming expertise. Objective: We provide an example of a simplified EMA setup in REDCap. This study aims to demonstrate the feasibility of this approach. We provide information on survey completion and user behavior in a sample of parents and children recruited across Canada. Methods: We recruited 66 parents and their children (aged 9-13 years old) from an existing longitudinal cohort study to participate in a study on risk and protective factors for children’s mental health. Parents received survey prompts (morning and evening) by email or SMS text message for 14 days, twice daily. Each survey prompt contained 2 sections, one for parents and one for children to complete. Results: The completion rates were good (mean 82%, SD 8%) and significantly higher on weekdays than weekends and in dyads with girls than dyads with boys. Children were available to respond to their own survey questions most of the time (in 1134/1498, 75.7% of surveys submitted). The number of assessments submitted was significantly higher, and response times were significantly faster among participants who selected SMS text message survey notifications compared to email survey notifications. The average response time was 47.0 minutes after the initial survey notification, and the use of reminder messages increased survey completion. Conclusions: Our results support the feasibility of using REDCap for EMA studies with parents and children. REDCap also has features that can accommodate EMA studies by recruiting participants across multiple time zones and providing different survey delivery methods. Offering the option of SMS text message survey notifications and reminders may be an important way to increase completion rates and the timeliness of responses. REDCap is a potentially useful tool for researchers wishing to implement EMA in settings in which cost or privacy are current barriers. Researchers should weigh these benefits with the potential limitations of REDCap and this design, including staff time to set up, monitor, and clean the data outputs of the project. %M 37943593 %R 10.2196/42916 %U https://formative.jmir.org/2023/1/e42916 %U https://doi.org/10.2196/42916 %U http://www.ncbi.nlm.nih.gov/pubmed/37943593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48435 %T The Efficacy of an mHealth App in Facilitating Weight Loss Among Japanese Fitness Center Members: Regression Analysis Study %A Eguchi,Akifumi %A Kawamura,Yumi %A Kawashima,Takayuki %A Ghaznavi,Cyrus %A Ishimura,Keiko %A Kohsaka,Shun %A Matsuo,Satoru %A Mizuno,Shinichiro %A Sasaki,Yuki %A Takahashi,Arata %A Tanoue,Yuta %A Yoneoka,Daisuke %A Miyata,Hiroaki %A Nomura,Shuhei %+ Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, 81 3 5363 3774, s-nomura@keio.jp %K digital health %K gym attendance %K Japan %K real-world data %K smartphone application %K weight loss %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-tracking smartphone apps have emerged as promising tools to encourage healthy behaviors. In this longitudinal study, we used gym use data from members of a major fitness club that operates gyms throughout Japan from January 2014 to December 2019. Objective: Our objective was to assess the extent to which a health and fitness self-tracking mobile app introduced to gym members on January 1, 2018, contributed to their weight loss. The app allows users to input information regarding diet, sleep, weight, and gym exercise so that they can receive personalized feedback from an artificial intelligence chatbot to improve their health behaviors. Methods: We used linear regression to quantify the association between app use and weight loss. The primary outcome of the study was the weight loss achieved by each gym user, which was calculated as the difference between their initial and final weights in kilograms, as recorded in the app. Individuals who did not attend the gym or failed to use the mobile app at least twice during the study period were excluded from the analysis. The model accounted for age, gender, distance between the gym and the member’s residence, average weekly number of times a member used the gym, user’s gym membership length in weeks, average weekly number of times a member input information into the app, and the number of weeks that the app was used at least once. Results: Data from 26,589 participants were analyzed. Statistically significant associations were detected between weight loss and 2 metrics related to app use: the average weekly frequency of use and the total number of weeks in which the app was used at least once. One input per week was found to be associated with a loss of 62.1 (95% CI 53.8-70.5) g, and 1 week of app use was associated with 21.7 (95% CI 20.5-22.9) g of weight loss from the day of the first input to that of the final input to the app. Furthermore, the average number of times that a member used the gym weekly was also shown to be statistically significantly associated with weight loss: 1 use per week was associated with 255.5 (95% CI 228.5-282.6) g of weight loss. Conclusions: This empirical study demonstrated a significant association between weight loss among gym members and not only the frequency of weekly gym use but also the use of a health and fitness self-tracking app. However, further work is needed to examine the mechanisms through which mobile apps affect health behaviors and to identify the specific app features that are most effective in promoting weight loss. %M 37938885 %R 10.2196/48435 %U https://formative.jmir.org/2023/1/e48435 %U https://doi.org/10.2196/48435 %U http://www.ncbi.nlm.nih.gov/pubmed/37938885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49102 %T An Automated Electronic System in a Motorized Wheelchair for Telemonitoring: Mixed Methods Study Based on Internet of Things %A Câmara Gradim,Luma Carolina %A Santana,André Luiz Maciel %A Archanjo José,Marcelo %A Zuffo,Marcelo Knörich %A Lopes,Roseli de Deus %+ Polytechnic School, Interdisciplinary Center for Interactive Technologies and Institute of Advanced Studies, University of Sao Paulo, Tv. do Labirinto, 436, Butantã, São Paulo, 05508-020, Brazil, 55 16993305775, luma.gradim@gmail.com %K eHealth systems %K telemonitoring %K inertial measurement unit %K IMU %K sensors %K Internet of Things %K IoT %K pressure injury %K wheelchair %K mobile phone %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Wheelchair positioning systems can prevent postural deficits and pressure injuries. However, a more effective professional follow-up is needed to assess and monitor positioning according to the specificities and clinical conditions of each user. Objective: This study aims to present the concept of an electronic system embedded in a motorized wheelchair, based on the Internet of Things (IoT), for automated positioning as part of a study on wheelchairs and telemonitoring. Methods: We conducted a mixed methods study with a user-centered design approach, interviews with 16 wheelchair users and 66 professionals for the development of system functions, and a formative assessment of 5 participants with descriptive analysis to design system concepts. Results: We presented a new wheelchair system with hardware and software components developed based on coparticipation with singular components in an IoT architecture. In an IoT solution, the incorporation of sensors from the inertial measurement unit was crucial. These sensors were vital for offering alternative methods to monitor and control the tilt and recline functions of a wheelchair. This monitoring and control could be achieved autonomously through a smartphone app. In addition, this capability addressed the requirements of real users. Conclusions: The technologies presented in this system can benefit telemonitoring and favor real feedback, allowing quality provision of health services to wheelchair users. User-centered development favored development with specific functions to meet the real demands of users. We emphasize the importance of future studies on the correlation between diagnoses and the use of the system in a real environment to help professionals in treatment. %M 37776327 %R 10.2196/49102 %U https://formative.jmir.org/2023/1/e49102 %U https://doi.org/10.2196/49102 %U http://www.ncbi.nlm.nih.gov/pubmed/37776327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45624 %T Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis %A Padhye,Rashmi %A Sahasrabudhe,Shruti D %A Orme,Mark W %A Pina,Ilaria %A Dhamdhere,Dipali %A Borade,Suryakant %A Bhakare,Meenakshi %A Ahmed,Zahira %A Barton,Andy %A Modi,Mahavir %A Malcolm,Dominic %A Salvi,Sundeep %A Singh,Sally J %+ Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Mulshi Road, Lavale, Pune, 412115, India, 91 020 61930000 ext 3514, rashmi.deshpande.gr@siu.edu.in %K COPD %K chronic obstructive pulmonary disease %K asthma %K patients’ suffering %K self-management %K digital mode of PR %K integrating yoga with PR %K thematic qualitative analysis %K knowledge about PR %K barriers to PR %K chronic respiratory diseases %K CRD %K India %K pulmonary rehabilitation %K medical professional %K treatment %K inhaler %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. Objective: This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. Methods: In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. Results: The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term “pulmonary rehabilitation,” but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. Conclusions: Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR “culturally congruent” and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence. %M 37934558 %R 10.2196/45624 %U https://formative.jmir.org/2023/1/e45624 %U https://doi.org/10.2196/45624 %U http://www.ncbi.nlm.nih.gov/pubmed/37934558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42194 %T Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial %A Weber,Antonia %A Shevchenko,Yury %A Gerhardt,Sarah %A Hoffmann,Sabine %A Kiefer,Falk %A Vollstädt-Klein,Sabine %+ Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68159, Germany, 49 1792011684, sabine.vollstaedt-klein@zi-mannheim.de %K alcohol approach bias %K alcohol attentional bias %K alcohol use disorder %K alcohol %K attention %K cognitive bias modification therapy %K craving %K cue-exposure therapy %K decision-making training %K decision-making %K incentive salience %K serious games %K therapy %K training %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. Objective: This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. Methods: In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. Results: We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. Conclusions: The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. Trial Registration: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476 %M 37934561 %R 10.2196/42194 %U https://formative.jmir.org/2023/1/e42194 %U https://doi.org/10.2196/42194 %U http://www.ncbi.nlm.nih.gov/pubmed/37934561 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e45068 %T Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial %A Kerber,André %A Beintner,Ina %A Burchert,Sebastian %A Knaevelsrud,Christine %+ Department of Clinical-Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 63093, andre.kerber@fu-berlin.de %K patient empowerment %K mental health–related self-management skills %K help-seeking attitude %K mental health literacy %K internet-based interventions %K unguided %K self-guided %K transdiagnostic mental health app %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. Objective: This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. Methods: Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health–related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. Results: We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. Conclusions: A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. Trial Registration: German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531 %M 37930749 %R 10.2196/45068 %U https://mental.jmir.org/2023/1/e45068 %U https://doi.org/10.2196/45068 %U http://www.ncbi.nlm.nih.gov/pubmed/37930749 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49715 %T Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial %A Lv,Nan %A Kannampallil,Thomas %A Xiao,Lan %A Ronneberg,Corina R %A Kumar,Vikas %A Wittels,Nancy E %A Ajilore,Olusola A %A Smyth,Joshua M %A Ma,Jun %+ Department of Medicine, University of Illinois Chicago, Room 466 (MC 275), 1747 W. Roosevelt Rd, Chicago, IL, 60608, United States, 1 3124139830, maj2015@uic.edu %K user interaction %K treatment alliance %K treatment response %K voice assistant %K depression %K anxiety %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. Objective: This study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both. Methods: In a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant’s voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response. Results: Participants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=–0.02 to –0.46) and GAD-7 (r=0.03 to –0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=–1.13, 95% CI –2.16 to –0.10) and GAD-7 (β=–1.17, 95% CI –2.13 to –0.20) scores. Conclusions: The participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy. Trial Registration: ClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104 %M 37930781 %R 10.2196/49715 %U https://humanfactors.jmir.org/2023/1/e49715 %U https://doi.org/10.2196/49715 %U http://www.ncbi.nlm.nih.gov/pubmed/37930781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50872 %T Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study %A Berry,Michael %A Taylor,Lauren %A Huang,Zhuoran %A Chwyl,Christina %A Kerrigan,Stephanie %A Forman,Evan %+ Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19103, United States, 1 (267) 961 2578, mpb334@drexel.edu %K mobile health technology %K weight loss %K tailored messaging %K lifestyle modification %K mobile health %K mHealth %K messaging %K weight loss %K intervention %K overweight %K obesity %K qualitative %K thematic analysis %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users’ subjective experiences while receiving automated messaging–based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 %M 37930786 %R 10.2196/50872 %U https://formative.jmir.org/2023/1/e50872 %U https://doi.org/10.2196/50872 %U http://www.ncbi.nlm.nih.gov/pubmed/37930786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48864 %T Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis %A Bravata,Dena M %A Kim,Joseph %A Russell,Daniel W %A Goldman,Ron %A Pace,Elizabeth %+ Department of Human Development & Family Studies, Iowa State University, 86 Lebaron Hall, Ames, IA, 50011, United States, 1 515 294 6316, jkim7@iastate.edu %K peer-support %K social isolation %K loneliness %K companionship %K depression %K anxiety %K quality of life %K occupational health %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. Objective: We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Methods: Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. Results: In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Conclusions: Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources. %M 37930770 %R 10.2196/48864 %U https://formative.jmir.org/2023/1/e48864 %U https://doi.org/10.2196/48864 %U http://www.ncbi.nlm.nih.gov/pubmed/37930770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48079 %T A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial %A Lim,Siriwan %A Athilingam,Ponrathi %A Lahiri,Manjari %A Cheung,Peter Pak Moon %A He,Hong-Gu %A Lopez,Violeta %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012759, nursl@nus.edu.sg %K patient empowerment %K rheumatoid arthritis %K intervention %K feasibility study %K adherence %K chronic %K arthritis %K rheumatism %K medication %K prescription %K drug %K mapping %K design %K development %K web based %K internet based %K web-based tool %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen. Objective: This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA. Methods: The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP. Results: The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants. Conclusions: The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA. %M 37930758 %R 10.2196/48079 %U https://formative.jmir.org/2023/1/e48079 %U https://doi.org/10.2196/48079 %U http://www.ncbi.nlm.nih.gov/pubmed/37930758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46968 %T Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis %A Foley,Gillian %A Ricciardelli,Rosemary %+ Fisheries and Marine Institute, Memorial University of Newfoundland, 155 Ridge Road, St. John's, NL, A1C 5R3, Canada, 1 709 778 0578, rricciardell@mun.ca %K peer support %K apps %K mobile health technology %K mobile health %K mHealth %K public safety personnel %K correctional workers %K police officers %K emergency workers %K first responders %K mental health %K Canada %K digital health %K intervention %K peers %K mobile app %K peer support apps %K web-based %K web-based communities %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Research supports that public safety personnel (PSP) are regularly exposed to potentially psychologically traumatic events and occupational stress, which can compromise their well-being. To help address PSP well-being and mental health, peer support is increasingly being adopted (and developed) in PSP organizations. Peer support apps have been developed to connect the peer and peer supporter anonymously and confidentially, but little is known about their effectiveness, utility, and uptake. Objective: We designed this study to evaluate the functionality and use of the PeerConnect app, which is a vehicle for receiving and administering peer support. The app connects peers but also provides information (eg, mental health screening tools, newsfeed) to users; thus, we wanted to understand why PSP adopted or did not adopt the app and the app’s perceived utility. Our intention was to determine if the app served the purpose of connectivity for PSP organizations implementing peer support. Methods: A sample of PSP (N=23) participated in an interview about why they used or did not use the app. We first surveyed participants across PSP organizations in Ontario, Canada, and at the end of the survey invited participants to participate in a follow-up interview. Of the 23 PSP interviewed, 16 were PeerConnect users and 7 were nonusers. After transcribing all audio recordings of the interviews, we used an emergent theme approach to analyze themes within and across responses. Results: PSP largely viewed PeerConnect positively, with the Connect feature being most popular (this feature facilitated peer support), followed by the Newsfeed and Resources. App users appreciated the convenience of the app and felt the app helped reduce the stigma around peer support use and pressure on peer supporters while raising awareness of wellness. PSP who did not use the app attributed their nonuse to disinterest or uncertainty about the need for a peer support app and the web-based nature of the app. To increase app adoption, participants recommended increased communication and promotion of the app by the services and continued efforts to combat mental health stigma. Conclusions: We provide contextual information about a peer support app’s functionality and use. Our findings demonstrate that PSP are open to the use of mental health and peer support apps, but more education is required to reduce mental health stigma. Future research should continue to evaluate peer support apps for PSP to inform their design and ensure they are fulfilling their purpose. %M 37930765 %R 10.2196/46968 %U https://formative.jmir.org/2023/1/e46968 %U https://doi.org/10.2196/46968 %U http://www.ncbi.nlm.nih.gov/pubmed/37930765 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46912 %T A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study %A Aneni,Kammarauche %A Fernandes,Claudia-Santi F %A Hoerner,Lily A %A Szapary,Claire %A Pendergrass Boomer,Tyra M %A Fiellin,Lynn E %+ Department of Internal Medicine, Yale University School of Medicine, 2 Church Street South, Suite 515, New Haven, CT, 06519, United States, 1 203 785 2885, lynn.sullivan@yale.edu %K videogames %K serious games %K opioid misuse %K mental health %K adolescents %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. Objective: This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. Methods: We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. Results: We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. Conclusions: PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner. %M 37921851 %R 10.2196/46912 %U https://games.jmir.org/2023/1/e46912 %U https://doi.org/10.2196/46912 %U http://www.ncbi.nlm.nih.gov/pubmed/37921851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51824 %T Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial %A Cluxton-Keller,Fallon %A Hegel,Mark T %A Donnelly,Craig L %A Bruce,Martha L %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu %K perinatal depression %K family conflict %K family therapy %K family %K conflict %K depression %K depressive %K perinatal %K pregnant %K pregnancy %K video %K videos %K feasibility %K safety %K acceptability %K tolerability %K tolerable %K families %K satisfaction %K resilience %K psychotherapy %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act–compliant videoconferencing technology (VCT). Objective: This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. Methods: This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. Results: On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. Conclusions: The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST’s preliminary effectiveness upon completion of outcome data collection. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 %M 37921846 %R 10.2196/51824 %U https://formative.jmir.org/2023/1/e51824 %U https://doi.org/10.2196/51824 %U http://www.ncbi.nlm.nih.gov/pubmed/37921846 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50304 %T Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis %A Soehnchen,Clarissa %A Rietz,Annika %A Weirauch,Vera %A Meister,Sven %A Henningsen,Maike %+ HealthCare Department, Fraunhofer Institute for Software and System Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 2302926, clarissa.soehnchen@uni-wh.de %K sexual health information %K sexual health education %K sub-Saharan Africa %K women %K semistructured interviews %K requirements engineering analysis %K user-centered design %K youth, slum %K health education %K sexual health %K digital health %K stigmatization %K reproductive health services %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. %M 37921860 %R 10.2196/50304 %U https://formative.jmir.org/2023/1/e50304 %U https://doi.org/10.2196/50304 %U http://www.ncbi.nlm.nih.gov/pubmed/37921860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36324 %T Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study %A Moon,Hui-Woun %A Park,Da Som Me %A Jung,Se Young %+ Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 0114, imsyjung@gmail.com %K care %K caregiving %K instrument development %K elderly %K quality of life %K ergonomics %K focus groups %K musculoskeletal %K usability %K feasibility %K digital health intervention %K digital health %K health intervention %K nursing %K electronic medical record %D 2023 %7 30.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses’ opinions of smart devices that provide integrated nursing for patients’ urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses’ work efficiency, reduce their burden, and extend to caregivers and guardians. %M 37902820 %R 10.2196/36324 %U https://formative.jmir.org/2023/1/e36324 %U https://doi.org/10.2196/36324 %U http://www.ncbi.nlm.nih.gov/pubmed/37902820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48857 %T Varenicline Combined With Oral Nicotine Replacement Therapy and Smartphone-Based Medication Reminders for Smoking Cessation: Feasibility Randomized Controlled Trial %A Sifat,Munjireen %A Hébert,Emily T %A Ahluwalia,Jasjit S %A Businelle,Michael S %A Waring,Joseph J C %A Frank-Pearce,Summer G %A Bryer,Chase %A Benson,Lizbeth %A Madison,Stefani %A Planas,Lourdes G %A Baranskaya,Irina %A Kendzor,Darla E %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 215 955 8874, mys519@jefferson.edu %K mHealth %K smartphone-based medication reminders %K varenicline combined with oral nicotine replacement therapy %K smoking cessation %K medication adherence %K smoking %K smoker %K smoke %K cessation %K quit %K quitting %K nicotine %K nicotine replacement therapy %K NRT %K randomized %K controlled trial %K mobile phone %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. Objective: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. Methods: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. Results: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. Conclusions: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. Trial Registration: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966 %M 37889541 %R 10.2196/48857 %U https://formative.jmir.org/2023/1/e48857 %U https://doi.org/10.2196/48857 %U http://www.ncbi.nlm.nih.gov/pubmed/37889541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46905 %T A Hybrid Decision Tree and Deep Learning Approach Combining Medical Imaging and Electronic Medical Records to Predict Intubation Among Hospitalized Patients With COVID-19: Algorithm Development and Validation %A Nguyen,Kim-Anh-Nhi %A Tandon,Pranai %A Ghanavati,Sahar %A Cheetirala,Satya Narayana %A Timsina,Prem %A Freeman,Robert %A Reich,David %A Levin,Matthew A %A Mazumdar,Madhu %A Fayad,Zahi A %A Kia,Arash %+ Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, 1255 5th Ave, Suite C-2, New York, NY, 10029, United States, 1 8572851577, kim-anh-nhi.nguyen@mountsinai.org %K COVID-19 %K medical imaging %K machine learning %K chest radiograph %K mechanical ventilation %K electronic health records %K intubation %K decision trees %K hybrid model %K clinical informatics %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Early prediction of the need for invasive mechanical ventilation (IMV) in patients hospitalized with COVID-19 symptoms can help in the allocation of resources appropriately and improve patient outcomes by appropriately monitoring and treating patients at the greatest risk of respiratory failure. To help with the complexity of deciding whether a patient needs IMV, machine learning algorithms may help bring more prognostic value in a timely and systematic manner. Chest radiographs (CXRs) and electronic medical records (EMRs), typically obtained early in patients admitted with COVID-19, are the keys to deciding whether they need IMV. Objective: We aimed to evaluate the use of a machine learning model to predict the need for intubation within 24 hours by using a combination of CXR and EMR data in an end-to-end automated pipeline. We included historical data from 2481 hospitalizations at The Mount Sinai Hospital in New York City. Methods: CXRs were first resized, rescaled, and normalized. Then lungs were segmented from the CXRs by using a U-Net algorithm. After splitting them into a training and a test set, the training set images were augmented. The augmented images were used to train an image classifier to predict the probability of intubation with a prediction window of 24 hours by retraining a pretrained DenseNet model by using transfer learning, 10-fold cross-validation, and grid search. Then, in the final fusion model, we trained a random forest algorithm via 10-fold cross-validation by combining the probability score from the image classifier with 41 longitudinal variables in the EMR. Variables in the EMR included clinical and laboratory data routinely collected in the inpatient setting. The final fusion model gave a prediction likelihood for the need of intubation within 24 hours as well. Results: At a prediction probability threshold of 0.5, the fusion model provided 78.9% (95% CI 59%-96%) sensitivity, 83% (95% CI 76%-89%) specificity, 0.509 (95% CI 0.34-0.67) F1-score, 0.874 (95% CI 0.80-0.94) area under the receiver operating characteristic curve (AUROC), and 0.497 (95% CI 0.32-0.65) area under the precision recall curve (AUPRC) on the holdout set. Compared to the image classifier alone, which had an AUROC of 0.577 (95% CI 0.44-0.73) and an AUPRC of 0.206 (95% CI 0.08-0.38), the fusion model showed significant improvement (P<.001). The most important predictor variables were respiratory rate, C-reactive protein, oxygen saturation, and lactate dehydrogenase. The imaging probability score ranked 15th in overall feature importance. Conclusions: We show that, when linked with EMR data, an automated deep learning image classifier improved performance in identifying hospitalized patients with severe COVID-19 at risk for intubation. With additional prospective and external validation, such a model may assist risk assessment and optimize clinical decision-making in choosing the best care plan during the critical stages of COVID-19. %M 37883177 %R 10.2196/46905 %U https://formative.jmir.org/2023/1/e46905 %U https://doi.org/10.2196/46905 %U http://www.ncbi.nlm.nih.gov/pubmed/37883177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46494 %T Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation %A Xu,Yi %A Yang,Hongshen %A Jin,Zhou %A Xiang,Jian %A Xu,Haiyun %A Pokay,Yili Huang %A Mao,Haibo %A Cai,Xugong %A Wu,Yili %A Wang,Deborah Baofeng %+ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, 1 Shengjin Road, Huanglong Residential District, Wenzhou, 325000, China, 86 13757707429, debbiebwang@msn.com %K adolescents %K digital mental health clinic %K emotional distress %K mental health service %K secondary school %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. %M 37883144 %R 10.2196/46494 %U https://formative.jmir.org/2023/1/e46494 %U https://doi.org/10.2196/46494 %U http://www.ncbi.nlm.nih.gov/pubmed/37883144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48143 %T Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis %A Engineer,Margi %A Kot,Sushant %A Dixon,Emma %+ Computer Science Department, Clemson University, 105 Sikes Hall, Clemson, SC, 29634, United States, 1 (864) 656 3311, mengine@g.clemson.edu %K natural language processing %K consumer health information %K readability %K Alzheimer disease and related dementias %K caregivers %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. Objective: In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. Methods: We assessed the text’s readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. Results: The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. Conclusions: Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia. %M 37878351 %R 10.2196/48143 %U https://formative.jmir.org/2023/1/e48143 %U https://doi.org/10.2196/48143 %U http://www.ncbi.nlm.nih.gov/pubmed/37878351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48245 %T Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study %A Fletcher,Kathryn %A Moran-Pryor,Alex %A Robert-Hendren,Dominique %+ Hello Sunday Morning, 103 Alexander Street Crows Nest NSW, Sydney, 2065, Australia, 61 1300 403 196, kat.fletcher@hellosundaymorning.org %K web-based %K screening %K alcohol use %K brief intervention %K well-being %K psychological distress %K digital health %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. Objective: We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. Methods: The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking—both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. Results: A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. Conclusions: Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem. %M 37874615 %R 10.2196/48245 %U https://formative.jmir.org/2023/1/e48245 %U https://doi.org/10.2196/48245 %U http://www.ncbi.nlm.nih.gov/pubmed/37874615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47813 %T Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners %A Yan,Xinghui %A Newman,Mark W %A Park,Sun Young %A Sander,Angelle %A Choi,Sung Won %A Miner,Jennifer %A Wu,Zhenke %A Carlozzi,Noelle %+ Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex 2800 Plymouth Rd., Building NCRC B14, Ann Arbor, MI, 48108, United States, 1 734 764 0644, carlozzi@umich.edu %K mHealth intervention %K mobile health %K behavior change %K qualitative study %K user adherence %K behavioral messages %K general well-being %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners’ decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants’ thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one’s ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people’s perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 %M 37874621 %R 10.2196/47813 %U https://formative.jmir.org/2023/1/e47813 %U https://doi.org/10.2196/47813 %U http://www.ncbi.nlm.nih.gov/pubmed/37874621 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45395 %T Evaluating the Effect of Artificial Liver Support on Acute-on-Chronic Liver Failure Using the Quantitative Difference Algorithm: Retrospective Study %A Huang,Tinghuai %A Huang,Jianwei %A Liu,Timon Cheng-Yi %A Li,Meng %A She,Rui %A Liu,Liyu %A Qu,Hongguang %A Liang,Fei %A Cao,Yuanjing %A Chen,Yuanzheng %A Tang,Lu %+ Department of Gastroenterology, The Fifth Affiliated Hospital of Guangzhou Medical University, No.621 Guangwan Road, Huangpu District, Guangzhou, 510700, China, 86 13609742686, gmu_jianwei_huang@163.com %K double plasma molecular absorption system %K DPMAS %K acute-on-chronic liver failure %K quantitative difference %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Liver failure, including acute-on-chronic liver failure (ACLF), occurs mainly in young adults and is associated with high mortality and resource costs. The prognosis evaluation is a crucial part of the ACLF treatment process and should run through the entire diagnosis process. As a recently proposed novel algorithm, the quantitative difference (QD) algorithm holds promise for enhancing the prognosis evaluation of ACLF. Objective: This study aims to examine whether the QD algorithm exhibits comparable or superior performance compared to the Model for End-Stage Liver Disease (MELD) in the context of prognosis evaluation. Methods: A total of 27 patients with ACLF were categorized into 2 groups based on their treatment preferences: the conventional treatment (n=12) and the double plasma molecular absorption system (DPMAS) with conventional treatment (n=15) groups. The prognosis evaluation was performed by the MELD and QD scoring systems. Results: A significant reduction was observed in alanine aminotransferase (P=.02), aspartate aminotransferase (P<.001), and conjugated bilirubin (P=.002), both in P values and QD value (Lτ>1.69). A significant decrease in hemoglobin (P=.01), red blood cell count (P=.01), and total bilirubin (P=.02) was observed in the DPMAS group, but this decrease was not observed in QD (Lτ≤1.69). Furthermore, there was a significant association between MELD and QD values (P<.001). Significant differences were observed between groups based on patients’ treatment outcomes. Additionally, the QD algorithm can also demonstrate improvements in patient fatigue. DPMAS can reduce alanine aminotransferase, aspartate aminotransferase, and unconjugated bilirubin. Conclusions: As a dynamic algorithm, the QD scoring system can evaluate the therapeutic effects in patients with ACLF, similar to MELD. Nevertheless, the QD scoring system surpasses the MELD by incorporating a broader range of indicators and considering patient variability. %M 37874632 %R 10.2196/45395 %U https://formative.jmir.org/2023/1/e45395 %U https://doi.org/10.2196/45395 %U http://www.ncbi.nlm.nih.gov/pubmed/37874632 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47151 %T A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial %A Skeen,Simone J %A Tokarz,Stephanie %A Gasik,Rayna E %A Solano,Chelsea McGettigan %A Smith,Ethan A %A Sagoe,Momi Binaifer %A Hudson,Lauryn V %A Steele,Kara %A Theall,Katherine P %A Clum,Gretchen A %+ Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, 22nd Fl, New Orleans, LA, 70112, United States, 1 504 988 1847, sskeen@tulane.edu %K mobile health %K mHealth %K HIV %K traumatic stress %K posttraumatic growth %K coping %K geospatial %K just-in-time adaptive intervention %K JITAI %K just-in-time %K posttraumatic %K medication adherence %K mental well-being %K viral suppression %K coping %K development %K design %K acceptability %K feasibility %K mobile phone %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV—1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. Objective: To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. Methods: The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. Results: Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. Conclusions: By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. Trial Registration: ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714 International Registered Report Identifier (IRRID): PRR1-10.2196/47151 %M 37874637 %R 10.2196/47151 %U https://www.researchprotocols.org/2023/1/e47151 %U https://doi.org/10.2196/47151 %U http://www.ncbi.nlm.nih.gov/pubmed/37874637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49407 %T mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach %A Kgasi,Mmamolefe %A Chimbo,Bester %A Motsi,Lovemore %+ Faculty of ICT, Tshwane University of Technology, Department of End User Computing, Pretoria, South Africa, 27 715633727, kgasimr@tut.ac.za %K diabetes %K mobile health %K mHealth %K self-monitoring %K self-management %K chronic diseases %K health care provision %D 2023 %7 23.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. Objective: This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. Methods: This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. Results: Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients’ change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. Conclusions: On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes. %M 37870902 %R 10.2196/49407 %U https://formative.jmir.org/2023/1/e49407 %U https://doi.org/10.2196/49407 %U http://www.ncbi.nlm.nih.gov/pubmed/37870902 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51702 %T Social Support–Seeking Strategies on Social Media at the Intersection of Lesbian, Gay, Bisexual, Transgender, and Queer Identity, Race, and Ethnicity: Insights for Intervention From a Qualitative Study %A Gordon,Jacob D %A Whitfield,Darren L %A Mammadli,Tural %A Escobar-Viera,César G %+ Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, 625 N Michigan Avenue, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 5408, jacobdgordon@gmail.com %K intersectionality %K LGBTQ+ %K minority stress %K sexual and gender minorities %K social media %K social support %K lesbian, gay, bisexual, transgender, and queer %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience a disproportionately higher prevalence of mental health challenges when compared to their heterosexual and cisgender counterparts. Moreover, they exhibit increased engagement with social media platforms relative to their peers. Understanding the intersectional dynamics of their identities is crucial in elucidating effective and safe approaches to garnering social support through social media channels. This exploration holds significance for informing future research endeavors and shaping targeted interventions to address the unique mental health needs of LGBTQ+ individuals. Objective: The purpose of this study was to explore the strategies used by Black, Hispanic, and non-Hispanic White LGBTQ+ young adults to acquire social support from social media. The study aimed to examine how these strategies may differ by race and ethnicity. Methods: We conducted semistructured interviews with LGBTQ+ young adults aged between 18 and 30 years recruited in the United States from social media. Of 52 participants, 12 (23%) were Black, 12 (23%) were Hispanic, and 28 (54%) were non-Hispanic White. Thematic analysis was used to analyze the collected data. Results: The analysis uncovered both divergent and convergent strategies among participants of different races and ethnicities. Black and Hispanic young adults exhibited a preference for connecting with individuals who shared similar identities, seeking safety and tailored advice. Conversely, non-Hispanic White participants demonstrated minimal preference for identity-based advice. Seeking support from anonymous sources emerged as a strategy to avoid unwanted disclosure among Hispanic participants. Furthermore, all participants emphasized the importance of content filtering with family members to cultivate positive and supportive social media experiences. Conclusions: This study sheds light on the strategies used by LGBTQ+ individuals of different racial and ethnic backgrounds to seek social support from social media platforms. The findings underscore the importance of considering race and ethnicity when examining social support–seeking behaviors on social media in LGBTQ+ populations. The identified strategies provide valuable insights for the development of interventions that aim to leverage social support from social media to benefit the mental health of Black, Hispanic, and non-Hispanic White LGBTQ+ young adults. %M 37862069 %R 10.2196/51702 %U https://formative.jmir.org/2023/1/e51702 %U https://doi.org/10.2196/51702 %U http://www.ncbi.nlm.nih.gov/pubmed/37862069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45715 %T Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews %A Kaburi,Basil Benduri %A Wyss,Kaspar %A Kenu,Ernest %A Asiedu-Bekoe,Franklin %A Hauri,Anja M %A Laryea,Dennis Odai %A Klett-Tammen,Carolina J %A Leone,Frédéric %A Walter,Christin %A Krause,Gérard %+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, Braunschweig, 38124, Germany, 49 5316181 ext 3147, BasilBenduri.Kaburi@helmholtz-hzi.de %K implementation %K Surveillance Outbreak Response Management and Analysis System %K SORMAS %K barriers %K facilitators %K digital disease surveillance %K outbreak response %K COVID-19 %K pandemic %K Ghana %K mobile phone %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. Objective: This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Methods: Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. Results: The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. Conclusions: The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding. %M 37862105 %R 10.2196/45715 %U https://formative.jmir.org/2023/1/e45715 %U https://doi.org/10.2196/45715 %U http://www.ncbi.nlm.nih.gov/pubmed/37862105 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45678 %T Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study %A Toh,Sean Han Yang %A Lee,Sze Chi %A Sündermann,Oliver %+ Intellect Private Limited Company, 171 Tras St, #02-179 Union Building, Singapore, 079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health apps %K mHealth apps %K behavioral health coaching %K behavioral coaching %K app-based coaching %K self-help %K employees %K well-being %K mood %K stress %K public health %K preventive interventions %K positive psychology %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. Objective: Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. Methods: Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect’s BHC services were assigned to the “Coaching” condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as “Control” participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on “Perceived Usefulness of the BHC session” and “Working Alliance with my Coach” were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. Results: Growth curve analyses revealed significant time by group interaction effects for composite well-being, where “Coaching” users reported significantly greater improvements in well-being than “Control” participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among “Coaching” participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in “Usefulness of the BHC session” (β=.078, 95% Cl .043-.118; P<.001) and “Working Alliance” (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051). Conclusions: We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health. %M 37862086 %R 10.2196/45678 %U https://formative.jmir.org/2023/1/e45678 %U https://doi.org/10.2196/45678 %U http://www.ncbi.nlm.nih.gov/pubmed/37862086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45173 %T A Digital Gaming Intervention to Strengthen the Social Networks of Older Dutch Adults: Mixed Methods Process Evaluation of a Digitally Conducted Randomized Controlled Trial %A Janssen,Jeroen %A Châtel,Bas %A Den Heijer,Nora %A Tieben,Rob %A Deen,Menno %A Corten,Rense %A Peeters,Geeske %A Olde Rikkert,Marcel %+ Department of Geriatric Medicine, Radboud University Medical Center, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 243616772, jeroen.janssen@radboudumc.nl %K eHealth %K gerontology %K loneliness %K mixed methods %K mobile games %K qualitative research %K serious games %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely. Objective: We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults. Methods: We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment. Results: In total, 371 people aged 18 years or older signed up for the RCT, of which 64% (238/371) were aged 65 years or older. Of the total sample, 20% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires. Conclusions: Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires. %M 37862093 %R 10.2196/45173 %U https://formative.jmir.org/2023/1/e45173 %U https://doi.org/10.2196/45173 %U http://www.ncbi.nlm.nih.gov/pubmed/37862093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42788 %T Predicting the Risk of Total Hip Replacement by Using A Deep Learning Algorithm on Plain Pelvic Radiographs: Diagnostic Study %A Chen,Chih-Chi %A Wu,Cheng-Ta %A Chen,Carl P C %A Chung,Chia-Ying %A Chen,Shann-Ching %A Lee,Mel S %A Cheng,Chi-Tung %A Liao,Chien-Hung %+ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Trauma Center, 5, Fuxin Street, Kweishiang District, Taoyuan City, Taoyuan, 333, Taiwan, 886 3 3281200 ext 3651, atong89130@gmail.com %K osteoarthritis %K orthopedic procedure %K artificial intelligence %K AI %K deep learning %K machine learning %K orthopedic %K pelvic %K radiograph %K predict %K hip replacement %K surgery %K convolutional neural network %K CNN %K algorithm %K surgical %K medical image %K medical imaging %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Total hip replacement (THR) is considered the gold standard of treatment for refractory degenerative hip disorders. Identifying patients who should receive THR in the short term is important. Some conservative treatments, such as intra-articular injection administered a few months before THR, may result in higher odds of arthroplasty infection. Delayed THR after functional deterioration may result in poorer outcomes and longer waiting times for those who have been flagged as needing THR. Deep learning (DL) in medical imaging applications has recently obtained significant breakthroughs. However, the use of DL in practical wayfinding, such as short-term THR prediction, is still lacking. Objective: In this study, we will propose a DL-based assistant system for patients with pelvic radiographs to identify the need for THR within 3 months. Methods: We developed a convolutional neural network–based DL algorithm to analyze pelvic radiographs, predict the hip region of interest (ROI), and determine whether or not THR is required. The data set was collected from August 2008 to December 2017. The images included 3013 surgical hip ROIs that had undergone THR and 1630 nonsurgical hip ROIs. The images were split, using split-sample validation, into training (n=3903, 80%), validation (n=476, 10%), and testing (n=475, 10%) sets to evaluate the algorithm performance. Results: The algorithm, called SurgHipNet, yielded an area under the receiver operating characteristic curve of 0.994 (95% CI 0.990-0.998). The accuracy, sensitivity, specificity, and F1-score of the model were 0.977, 0.920, 0932, and 0.944, respectively. Conclusions: The proposed approach has demonstrated that SurgHipNet shows the ability and potential to provide efficient support in clinical decision-making; it can assist physicians in promptly determining the optimal timing for THR. %M 37862084 %R 10.2196/42788 %U https://formative.jmir.org/2023/1/e42788 %U https://doi.org/10.2196/42788 %U http://www.ncbi.nlm.nih.gov/pubmed/37862084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47374 %T Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study %A Hægermark,Emil Aale %A Kongshaug,Nina %A Raj,Sunil Xavier %A Hofsli,Eva %A Faxvaag,Arild %+ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7491, Norway, 47 98069390, echaeger@stud.ntnu.no %K mobile health %K mHealth %K user-centered design %K usability testing %K cancer %K side effects %K cytostatic treatment %K intervention %K mobile app %K usability %K user interface %K user %K smartphone %K mobile phone %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers’ overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. %M 37856183 %R 10.2196/47374 %U https://formative.jmir.org/2023/1/e47374 %U https://doi.org/10.2196/47374 %U http://www.ncbi.nlm.nih.gov/pubmed/37856183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44065 %T Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study %A Solomon,Jeffrey %A Dauber-Decker,Katherine %A Richardson,Safiya %A Levy,Sera %A Khan,Sundas %A Coleman,Benjamin %A Persaud,Rupert %A Chelico,John %A King,D'Arcy %A Spyropoulos,Alex %A McGinn,Thomas %+ Institute of Health System Science, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, United States, 1 516 600 1422, jsolomon6@northwell.edu %K clinical decision support system %K cloud based %K decision support %K development %K EHR %K electronic health record %K evidence-based medicine %K health information technology %K platform %K user-centered design %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods: We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results: The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells’ criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform’s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells’ criteria tool will be reported in a future publication. Conclusions: The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics “nudges” on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint. %M 37856193 %R 10.2196/44065 %U https://formative.jmir.org/2023/1/e44065 %U https://doi.org/10.2196/44065 %U http://www.ncbi.nlm.nih.gov/pubmed/37856193 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48365 %T Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data %A Ryan,Arthur T %A Stearns-Yoder,Kelly A %A Brenner,Lisa A %+ Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, United States, 1 720 723 7493, arthur.t.ryan@gmail.com %K digital intervention %K unguided %K web-based %K internet-delivered %K mental health %K veterans %K Google Analytics %K insomnia %K anger %K depression %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively. Objective: This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population. Methods: Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported. Results: In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12% (7068/29,306) of those users. Each UDMHI’s age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28%). Most users (27,789/29,748, 93.41%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61% (775/29,748) of total users. Conclusions: Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers. %M 37851501 %R 10.2196/48365 %U https://formative.jmir.org/2023/1/e48365 %U https://doi.org/10.2196/48365 %U http://www.ncbi.nlm.nih.gov/pubmed/37851501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51019 %T First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis %A Bladt,Lola %A Kashtiara,Ardavan %A Platteau,Wouter %A De Wachter,Stefan %A De Win,Gunter %+ Product Development, Faculty of Design Sciences, University of Antwerp, Paardenmarkt 90/94, Antwerp, 2000, Belgium, 32 497848014, lola.bladt@uantwerpen.be %K lower urinary tract symptoms %K home uroflowmetry %K automated bladder diary %K homeflow %K hospiflow %K mobile phone %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. Objective: In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). Methods: A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. Results: The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual’s plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was −3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of −19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. Conclusions: Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow. %M 37847531 %R 10.2196/51019 %U https://formative.jmir.org/2023/1/e51019 %U https://doi.org/10.2196/51019 %U http://www.ncbi.nlm.nih.gov/pubmed/37847531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46209 %T Virtual Reality Meditation for Fatigue in Persons With Rheumatoid Arthritis: Mixed Methods Pilot Study %A Dreesmann,Nathan J %A Buchanan,Diana %A Tang,Hsin-Yi Jean %A Furness III,Thomas %A Thompson,Hilaire %+ Virtual Therapeutics, 13905 NE 128th St, Suite 200, Kirkland, WA, 98034, United States, 1 (425) 821 8001, nathan.dreesmann@vthera.com %K anxiety %K chronic pain %K depression %K fatigue %K feasibility study %K feasibility %K head-mounted display %K meditation %K mixed method %K mood %K pain %K rheumatoid arthritis %K symptom %K virtual reality %K VR %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective symptom management is crucial to enhancing the quality of life for individuals with chronic diseases. Health care has changed markedly over the past decade as immersive, stand-alone, and wearable technologies including virtual reality have become available. One chronic pain population that could benefit from such an intervention is individuals with rheumatoid arthritis (RA). Recent pharmacologic advances in the management of RA have led to a decrease in inflammatory symptoms (eg, chronic pain) or even disease remission, yet up to 70% of patients with RA still suffer from fatigue. While VR-delivered behavior, meditation, and biofeedback programs show promise for pain and anxiety management, there is little information on the use of virtual reality meditation (VRM) for fatigue management among individuals with RA. Objective: This study aims to (1) examine the feasibility of implementing a study protocol that uses VRM, (2) determine the acceptability of using VRM for fatigue management in an outpatient population, and (3) identify barriers and contextual factors that might impact VRM use for fatigue management in outpatients with RA. Methods: We used a convergent, mixed methods design and enrolled adults aged 18 years or older with a clinical diagnosis of RA. Patient-Reported Outcome Measure Information System (PROMIS) measures of fatigue, depression, anxiety, pain behavior, and physical function were assessed alongside the brief mood introspection scale at baseline and weekly for 4 weeks. VRM use across the 4-week study period was automatically stored on headsets and later extracted for analysis. Semistructured interview questions focused on feedback regarding the participant’s experience with RA, previous experience of fatigue, strategies participants use for fatigue management, and the participant’s experience using VRM and recommendations for future use. Results: A total of 13 participants completed this study. Most participants completed all study surveys and measures (11/13, 84% and 13/13, 100%, respectively) and were active participants in interviews at the beginning and end of the program. Participants used VRM an average of 8.9 (SD 8.5) times over the course of the 4-week program. Most participants enjoyed VRM, found it relaxing, or recommended its use (12/13, 92%), but 8 (62%) noted barriers and conceptual factors that impacted VRM use. On average, participants saw decreases in PROMIS fatigue (–6.4, SD 5.1), depression (–5.6, SD 5.7), anxiety (–4.5, SD 6), and pain behavior (–3.9, SD 5.3), and improvements in PROMIS physical function (1.5, SD 2.7) and Brief Mood Introspection Scale mood (5.3, SD 6.7) over the course of this 4-week study. Conclusions: While this study’s implementation was feasible, VRM’s acceptability as an adjunctive modality for symptom management in RA is contingent on effectively overcoming barriers to use and thoughtfully addressing the contextual factors of those with RA to ensure successful intervention deployment. Trial Registration: ClinicalTrials.gov NCT04804462; https://classic.clinicaltrials.gov/ct2/show/NCT04804462 %M 37847542 %R 10.2196/46209 %U https://formative.jmir.org/2023/1/e46209 %U https://doi.org/10.2196/46209 %U http://www.ncbi.nlm.nih.gov/pubmed/37847542 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51103 %T Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study %A Zapata,Juan Pablo %A Hirshfield,Sabina %A Nelson,Kimberly %A Horvath,Keith %A John,Steven A %+ Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, United States, 1 4149557744, sjohn@mcw.edu %K mobile health %K eHealth %K minority health %K male adolescents %K HIV prevention %K sexual health %K support %K HIV testing %K prevention %K decision-making %K men %K sexual minority men %K youth %K adolescent %K mobile simulation %K virtual simulation %K user-friendly %K design %K implementation %K mobile phone %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. Objective: In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. Methods: From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. Results: A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men’s preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. Conclusions: Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants’ desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention. %M 37713640 %R 10.2196/51103 %U https://formative.jmir.org/2023/1/e51103 %U https://doi.org/10.2196/51103 %U http://www.ncbi.nlm.nih.gov/pubmed/37713640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47443 %T Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study %A Levy,Amanda N %A Nittas,Vasileios %A Wray,Tyler B %+ Department of Computer Science, Brown University, 115 Waterman St, Providence, RI, 02906, United States, 1 401 863 7600, amanda_levy@brown.edu %K counseling treatment %K phobias %K PTSD %K patient perspective %K in vivo exposures %K virtual reality %K exposure therapy %K anxiety %K psychotherapy %K effectiveness %K digital therapy %K affective disorders %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychotherapy, and particularly exposure therapy, has been proven to be an effective treatment for many anxiety disorders, including social and specific phobias, as well as posttraumatic stress disorders. Currently, exposures are underused and mostly delivered in vivo. Virtual reality exposure therapy (VRET) offers a more flexible delivery mechanism that has the potential to address some of the implementation barriers of in vivo exposures while retaining effectiveness. Yet, there is little evidence on how patients perceive different exposure therapy methods. Objective: This study aims to explore the perceptions of individuals with anxiety disorders toward in vivo and VRET. Our findings can inform therapists about the degree of patient interest in both methods while exploring the demand for VRET as an alternative and novel treatment approach. Methods: Web-based survey assessing the (1) interest in, (2) willingness to use, (3) comfort with, (4) enthusiasm toward, and (5) perceived effectiveness of exposure therapy when delivered in vivo and through VR. Participants included individuals with specific phobia, social phobia, posttraumatic stress disorder, or acute stress disorder or reaction. Participants were presented with educational videos about in vivo and VRET and asked to provide their perceptions quantitatively and qualitatively through a rated scale and free-text responses. Results: In total, 184 surveys were completed and analyzed, in which 82% (n=151) of participants reported being willing to receive in vivo exposures and 90.2% (n=166) reported willingness to receive VRET. Participants reported higher interest in, comfort with, enthusiasm toward, and perceived effectiveness of VRET compared to in vivo. Most reported in vivo concerns were linked to (1) increased anxiety, (2) feelings of embarrassment or shame, and (3) exacerbation of current condition. Most reported VRET concerns were linked to (1) risk of side effects including increased anxiety, (2) efficacy uncertainty, and (3) health insurance coverage. The most frequently mentioned VRET benefits include (1) privacy, (2) safety, (3) the ability to control exposures, (4) comfort, (5) the absence of real-life consequences, (6) effectiveness, and (7) customizability to a wider variety of exposures. Conclusions: On average, our participants expressed positive perceptions toward exposure therapy, with slightly more positive perceptions of VRET over in vivo exposures. Despite valid personal concerns and some misconceptions, our findings emphasize that VRET provides an opportunity to get much-needed therapy to patients in ways that are more acceptable and less concerning. %M 37843884 %R 10.2196/47443 %U https://formative.jmir.org/2023/1/e47443 %U https://doi.org/10.2196/47443 %U http://www.ncbi.nlm.nih.gov/pubmed/37843884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45977 %T Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study %A Ross,Edgar %A Al Ozairi,Ebaa %A Al qabandi,Naeema %A Jamison,Robert %+ Atrius Healthcare, Harvard Medical School, 20 Wall Street, Burlington, MA, 01803-4758, United States, 1 617 657 6410, edgarross245@gmail.com %K SMS %K short text message interventions: mHealth %K smartphone %K type 2 diabetes prevention %K social media %K friends and family %K percolation theory %K diabetes %K prevention %K risk %K development %K pilot study %K social network %K theory modeling %K disease control %K initiative %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: We evaluated the outcomes of a pilot SMS text messaging–based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait. Objective: The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns. Methods: SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding. Results: A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign. Conclusions: SMS text messaging–based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots. %M 37843911 %R 10.2196/45977 %U https://formative.jmir.org/2023/1/e45977 %U https://doi.org/10.2196/45977 %U http://www.ncbi.nlm.nih.gov/pubmed/37843911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48023 %T Accuracy of ChatGPT on Medical Questions in the National Medical Licensing Examination in Japan: Evaluation Study %A Yanagita,Yasutaka %A Yokokawa,Daiki %A Uchida,Shun %A Tawara,Junsuke %A Ikusaka,Masatomi %+ Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan, 81 43 222 7171 ext 6438, y.yanagita@gmail.com %K artificial intelligence %K ChatGPT %K GPT-4 %K AI %K National Medical Licensing Examination %K Japanese %K NMLE %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: ChatGPT (OpenAI) has gained considerable attention because of its natural and intuitive responses. ChatGPT sometimes writes plausible-sounding but incorrect or nonsensical answers, as stated by OpenAI as a limitation. However, considering that ChatGPT is an interactive AI that has been trained to reduce the output of unethical sentences, the reliability of the training data is high and the usefulness of the output content is promising. Fortunately, in March 2023, a new version of ChatGPT, GPT-4, was released, which, according to internal evaluations, was expected to increase the likelihood of producing factual responses by 40% compared with its predecessor, GPT-3.5. The usefulness of this version of ChatGPT in English is widely appreciated. It is also increasingly being evaluated as a system for obtaining medical information in languages other than English. Although it does not reach a passing score on the national medical examination in Chinese, its accuracy is expected to gradually improve. Evaluation of ChatGPT with Japanese input is limited, although there have been reports on the accuracy of ChatGPT’s answers to clinical questions regarding the Japanese Society of Hypertension guidelines and on the performance of the National Nursing Examination. Objective: The objective of this study is to evaluate whether ChatGPT can provide accurate diagnoses and medical knowledge for Japanese input. Methods: Questions from the National Medical Licensing Examination (NMLE) in Japan, administered by the Japanese Ministry of Health, Labour and Welfare in 2022, were used. All 400 questions were included. Exclusion criteria were figures and tables that ChatGPT could not recognize; only text questions were extracted. We instructed GPT-3.5 and GPT-4 to input the Japanese questions as they were and to output the correct answers for each question. The output of ChatGPT was verified by 2 general practice physicians. In case of discrepancies, they were checked by another physician to make a final decision. The overall performance was evaluated by calculating the percentage of correct answers output by GPT-3.5 and GPT-4. Results: Of the 400 questions, 292 were analyzed. Questions containing charts, which are not supported by ChatGPT, were excluded. The correct response rate for GPT-4 was 81.5% (237/292), which was significantly higher than the rate for GPT-3.5, 42.8% (125/292). Moreover, GPT-4 surpassed the passing standard (>72%) for the NMLE, indicating its potential as a diagnostic and therapeutic decision aid for physicians. Conclusions: GPT-4 reached the passing standard for the NMLE in Japan, entered in Japanese, although it is limited to written questions. As the accelerated progress in the past few months has shown, the performance of the AI will improve as the large language model continues to learn more, and it may well become a decision support system for medical professionals by providing more accurate information. %M 37831496 %R 10.2196/48023 %U https://formative.jmir.org/2023/1/e48023 %U https://doi.org/10.2196/48023 %U http://www.ncbi.nlm.nih.gov/pubmed/37831496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47903 %T Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy–Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach %A Wang,Liying %A Yuwen,Weichao %A Hua,Wenzhe %A Chen,Lingxiao %A Forsythe Cox,Vibh %A Zheng,Huang %A Ning,Zhen %A Zhao,Zhuojun %A Liu,Zhaoyu %A Jiang,Yunzhang %A Li,Xinran %A Guo,Yawen %A Simoni,Jane M %+ Department of Psychology, University of Washington, 3921 W Stevens Way NE, Seattle, WA, 98195, United States, 1 (206) 543 2640, liyingw@uw.edu %K intervention mapping %K participatory approach %K cultural adaptation %K dialectical behavior therapy %K DBT %K men who have sex with men %K MSM %K coping skill training %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health–based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)–informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user’s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. %M 37831497 %R 10.2196/47903 %U https://formative.jmir.org/2023/1/e47903 %U https://doi.org/10.2196/47903 %U http://www.ncbi.nlm.nih.gov/pubmed/37831497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43977 %T Effect of Personalized Email-Based Reminders on Participants’ Timeliness in an Online Education Program: Randomized Controlled Trial %A Bälter,Olle %A Jemstedt,Andreas %A Javan Abraham,Feben %A Persson Osowski,Christine %A Mugisha,Reuben %A Bälter,Katarina %+ Division of Media Technology and Interaction Design, Kungliga Tekniska Högskolan - Royal Institute of Technology, Stockholm, Sweden, 46 707666341, ob1@kth.se %K online learning %K personal reminders %K timeliness %K self-regulated learning %K adult education %K education %K students %K learning %K email %K online %K tool %K intervention %K program %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students’ study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one’s studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was—adding a few words with the page number the student ought to be on to a reminder—we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming. %M 37831487 %R 10.2196/43977 %U https://formative.jmir.org/2023/1/e43977 %U https://doi.org/10.2196/43977 %U http://www.ncbi.nlm.nih.gov/pubmed/37831487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44556 %T Exploring Young Adults’ Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students %A Kang,Annie %A Hetrick,Sarah %A Cargo,Tania %A Hopkins,Sarah %A Ludin,Nicola %A Bodmer,Sarah %A Stevenson,Kiani %A Holt-Quick,Chester %A Stasiak,Karolina %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Road Avenue, Grafton, Auckland, 1142, New Zealand, 64 99233890, k.stasiak@auckland.ac.nz %K chatbot %K mental health %K COVID-19 %K young adults %K acceptability %K qualitative methods %D 2023 %7 12.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. Objective: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement. Methods: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). Results: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Conclusions: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered. %M 37527545 %R 10.2196/44556 %U https://formative.jmir.org/2023/1/e44556 %U https://doi.org/10.2196/44556 %U http://www.ncbi.nlm.nih.gov/pubmed/37527545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48362 %T A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study %A Tsirmpas,Charalampos %A Nikolakopoulou,Maria %A Kaplow,Sharon %A Andrikopoulos,Dimitrios %A Fatouros,Panagiotis %A Kontoangelos,Konstantinos %A Papageorgiou,Charalabos %+ Feel Therapeutics Inc., 479 Jessie Street, San Francisco, CA, CA94103, United States, 1 3124784041, dimitris@feeltherapeutics.com %K precision medicine %K internet-based intervention %K mobile apps %K major depressive disorder %K anxiety disorders %K attention-deficit/hyperactivity disorder %K personalized medicine %K comorbidity %K quality of life %K mobile phone %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. Objective: This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants’ engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. Methods: This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire–9, Generalized Anxiety Disorder–7, and Barkley Adult ADHD Rating Scale–IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. Results: The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. Conclusions: The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy. %M 37819688 %R 10.2196/48362 %U https://formative.jmir.org/2023/1/e48362 %U https://doi.org/10.2196/48362 %U http://www.ncbi.nlm.nih.gov/pubmed/37819688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48946 %T Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study %A Ndlovu,Kagiso %A Stein,Nate %A Gaopelo,Ruth %A Annechino,Michael %A Molwantwa,Mmoloki C %A Monkge,Mosadikhumo %A Forrestel,Amy %A Williams,Victoria L %+ Department of Computer Science, University of Botswana, Private Bag UB 0022, Gaborone, 00267, Botswana, 267 71786953 ext 5700, kaygndlovu@gmail.com %K VisualDx %K eHealth %K technology acceptance model %K clinical decision support %K Botswana %K dermatology %K mobile phone %D 2023 %7 10.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx—an exemplar CDSS—was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology. Objective: This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. Methods: The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. Results: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. Conclusions: Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries. %M 37815861 %R 10.2196/48946 %U https://formative.jmir.org/2023/1/e48946 %U https://doi.org/10.2196/48946 %U http://www.ncbi.nlm.nih.gov/pubmed/37815861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48395 %T HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study %A Metzler-Baddeley,Claudia %A Busse,Monica %A Drew,Cheney %A Pallmann,Philip %A Cantera,Jaime %A Ioakeimidis,Vasileios %A Rosser,Anne %+ Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Road, Cathays, Cardiff, CF24 4HQ, United Kingdom, 44 29 208 ext 70705, Metzler-BaddeleyC@cardiff.ac.uk %K Huntington disease %K electronic health %K intervention %K training application %K rhythm %K timing %K drumming %K movement %K cognition %K integrated knowledge translation %K gamification %K Template for Intervention Description and Replication (TIDieR) %K TIDieR %K mobile phone %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users’ performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. %M 37801351 %R 10.2196/48395 %U https://formative.jmir.org/2023/1/e48395 %U https://doi.org/10.2196/48395 %U http://www.ncbi.nlm.nih.gov/pubmed/37801351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48152 %T Mental Health Self-Tracking Preferences of Young Adults With Depression and Anxiety Not Engaged in Treatment: Qualitative Analysis %A Beltzer,Miranda L %A Meyerhoff,Jonah %A Popowski,Sarah A %A Mohr,David C %A Kornfield,Rachel %+ Center for Behavior Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 6585, miranda.beltzer@northwestern.edu %K self-tracking %K self-monitoring %K self-help %K depression %K anxiety %K young adults %K mHealth %K technology %K qualitative analysis %K focus group %K personal informatics %K mood %K thematic analysis %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the high prevalence of anxiety and depression among young adults, many do not seek formal treatment. Some may turn to digital mental health tools for support instead, including to self-track moods, behaviors, and other variables related to mental health. Researchers have sought to understand processes and motivations involved in self-tracking, but few have considered the specific needs and preferences of young adults who are not engaged in treatment and who seek to use self-tracking to support mental health. Objective: This study seeks to assess the types of experiences young adults not engaged in treatment have had with digital self-tracking for mood and other mental health data and to assess how young adults not seeking treatment want to engage in self-tracking to support their mental health. Methods: We conducted 2 online asynchronous discussion groups with 50 young adults aged 18 years to 25 years who were not engaged in treatment. Participants were recruited after indicating moderate to severe symptoms of depression or anxiety on screening surveys hosted on the website of Mental Health America. Participants who enrolled in the study responded anonymously to discussion prompts on a message board, as well as to each other’s responses, and 3 coders performed a thematic analysis of their responses. Results: Participants had mixed experiences with self-tracking in the past, including disliking when tracking highlighted unwanted behaviors and discontinuing tracking for a variety of reasons. They had more positive past experiences tracking behaviors and tasks they wanted to increase, using open-ended journaling, and with gamified elements to increase motivation. Participants highlighted several design considerations they wanted self-tracking tools to address, including building self-understanding; organization, reminders, and structure; and simplifying the self-tracking experience. Participants wanted self-tracking to help them identify their feelings and how their feelings related to other variables like sleep, exercise, and events in their lives. Participants also highlighted self-tracking as useful for motivating and supporting basic activities and tasks of daily living during periods of feeling overwhelmed or low mood and providing a sense of accomplishment and stability. Although self-tracking can be burdensome, participants were interested and provided suggestions for simplifying the process. Conclusions: These young adults not engaged in treatment reported interest in using self-tracking to build self-understanding as a goal in and of itself or as a first step in contemplating and preparing for behavior change or treatment-seeking. Alexithymia, amotivation, and feeling overwhelmed may serve both as barriers to self-tracking and opportunities for self-tracking to help. %M 37801349 %R 10.2196/48152 %U https://formative.jmir.org/2023/1/e48152 %U https://doi.org/10.2196/48152 %U http://www.ncbi.nlm.nih.gov/pubmed/37801349 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47267 %T Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing %A Andrews,Nicole Emma %A Ireland,David %A Vijayakumar,Pranavie %A Burvill,Lyza %A Hay,Elizabeth %A Westerman,Daria %A Rose,Tanya %A Schlumpf,Mikaela %A Strong,Jenny %A Claus,Andrew %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, Surgical Treatment and Rehabilitation Service (STARS), 296 Herston Rd, Herston, 4029, Australia, 61 418762617, n.andrews@uq.edu.au %K chronic pain %K education %K neurophysiology %K neuroscience %K conversation agent %K chatbot %K age %K young adult %K adolescence %K adolescent %K pain %K patient education %K usability %K acceptability %K mobile health %K mHealth %K mobile app %K health app %K youth %K mobile phone %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. Objective: This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. Methods: Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. Results: Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores’ speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores’ speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores’ speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). Conclusions: This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone. %M 37801342 %R 10.2196/47267 %U https://formative.jmir.org/2023/1/e47267 %U https://doi.org/10.2196/47267 %U http://www.ncbi.nlm.nih.gov/pubmed/37801342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48372 %T Feasibility and Usability of a Mobile App–Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study %A Young,Nathan P %A Ridgeway,Jennifer L %A Haddad,Tufia C %A Harper,Sarah B %A Philpot,Lindsey M %A Christopherson,Laura A %A McColley,Samantha M %A Phillips,Sarah A %A Brown,Julie K %A Zimmerman,Kelly S %A Ebbert,Jon O %+ Integrated Community Specialty Practice, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 284 2844, young.nathan@mayo.edu %K migraine %K mobile app %K smartphone %K care model %K feasibility %K usability %K digital health %K remote monitoring %K care plan %K pilot %K mobile health %K mHealth %K mobile phone %K patient-reported outcomes %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app–based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. Objective: This study aims to describe a novel electronic health record–integrated mobile app–based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Methods: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. Results: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). Conclusions: We describe the successful implementation of an electronic health record–integrated mobile app–based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care. %M 37796560 %R 10.2196/48372 %U https://formative.jmir.org/2023/1/e48372 %U https://doi.org/10.2196/48372 %U http://www.ncbi.nlm.nih.gov/pubmed/37796560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46350 %T The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study %A Hermsen,Sander %A Van Abswoude,Femke %A Steenbergen,Bert %+ Precision Health and Nutrition Group, OnePlanet Research Centre, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 317 791 009, sander.hermsen@imec.nl %K active living %K adolescents %K physical activity %K digital health %K mobile phone %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Participation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). Objective: This study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. Methods: A total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. Results: The study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others’) negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. Conclusions: This study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together. %M 37796582 %R 10.2196/46350 %U https://formative.jmir.org/2023/1/e46350 %U https://doi.org/10.2196/46350 %U http://www.ncbi.nlm.nih.gov/pubmed/37796582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46951 %T Digital Storytelling Intervention to Promote Human Papillomavirus Vaccination Among At-Risk Asian Immigrant Populations: Pilot Intervention Study %A Chen,Angela Chia-Chen %A Kim,Sunny Wonsun %A Ou,Lihong %A Todd,Michael %A Larkey,Linda %+ College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing, MI, 48824, United States, 1 5173555148, chenang6@msu.edu %K digital storytelling %K human papillomavirus %K immigrants %K Korean %K Vietnamese %K vaccination %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) calls for researchers to address this public health concern through HPV vaccination. Despite disparities in HPV-associated cancers in Korean Americans and Vietnamese Americans, their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Objective: The aim of this quasi-experimental single-group study was to assess the feasibility, acceptability, and preliminary effects of a culturally and linguistically congruent digital storytelling intervention on Korean American and Vietnamese American mothers’ attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by their child’s sex (boy vs girl) and by ethnicity (Korean American vs Vietnamese American). Methods: Participants were recruited via multiple avenues (eg, ethnic minority community organizations, social media, and flyers posted in local Asian supermarkets and nail salons). Web-based, valid, and reliable measures were administered to collect data preintervention and postintervention. Descriptive statistics, paired and independent sample t tests, the chi-square test, and the McNemar test were used to describe the distributions of variables and to examine the differences between subgroups and changes in key variables over time. Logistic regression models were used to examine associations of mothers’ HPV- and vaccine-related attitudes with vaccination intention and to explore if the association between attitudes and vaccination intention differed by the target children’s sex or ethnicity. Results: In our sample of 50 Korean American mothers (mean age 42.8, SD 4.8 years) and 114 Vietnamese American mothers (mean age 41.5, SD 5.4 years), 36% (18/50) of Korean American and 51% (58/114) of Vietnamese American mothers reported that their children received free or reduced-price lunches at school. After the intervention, mothers’ attitudes toward HPV and the vaccine (t163=2.49, P=.01) and intention to vaccinate their children improved significantly (X21=18.38, P<.001). The measure of mothers’ negative attitudes toward HPV and the vaccine was significantly associated with higher vaccination intention (odds ratio 0.27, 95% CI 0.14-0.51; P<.001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, and HPV communication with health care providers). Findings did not suggest that a child’s sex or ethnicity moderated the association between attitudes and vaccination intention. Conclusions: This remotely delivered intervention using digital stories was feasible and acceptable, and showed preliminary effects on promoting Korean American and Vietnamese American mothers’ intention to vaccinate their children against HPV. Future research that uses a randomized controlled trial design with a larger and more diverse sample and includes children’s vaccination status will help understand the effect of the intervention. %M 36877658 %R 10.2196/46951 %U https://formative.jmir.org/2023/1/e46951 %U https://doi.org/10.2196/46951 %U http://www.ncbi.nlm.nih.gov/pubmed/36877658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46757 %T Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial %A Gómez-Restrepo,Carlos %A Sarmiento-Suárez,María José %A Alba-Saavedra,Magda %A Calvo-Valderrama,Maria Gabriela %A Rincón-Rodríguez,Carlos Javier %A Bird,Victoria Jane %A Priebe,Stefan %A van Loggerenberg,Francois %+ Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Academic Centre, Newham Centre for Mental Health, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 02075404210, f.vanloggerenberg@qmul.ac.uk %K mental health %K digital intervention %K psychosocial intervention %K armed conflict %K adolescents %K school %K DIALOG+ %K DIALOG+S %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post–armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 %M 37792465 %R 10.2196/46757 %U https://formative.jmir.org/2023/1/e46757 %U https://doi.org/10.2196/46757 %U http://www.ncbi.nlm.nih.gov/pubmed/37792465 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e43843 %T Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study %A Bucher Della Torre,Sophie %A Lages,Marlene %A Dias,Sara S %A Guarino,Maria P %A Braga-Pontes,Cátia %+ Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, Carouge, 1227, Switzerland, 41 225586604, sophie.bucher@hesge.ch %K vegetable %K food preference %K serious games %K video game %K children %K child %K pediatric %K obesity prevention %K pilot study %K gaming %K educational game %K nutrition %K diet %K healthy eating %K food consumption %K food intake %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake. Objective: This pilot study aimed first to translate the digital game “Veggies4myHeart” into French and to assess its influence on young children’s preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms. Methods: During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview. Results: A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children’s declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools. Conclusions: In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake. %M 37788064 %R 10.2196/43843 %U https://games.jmir.org/2023/1/e43843 %U https://doi.org/10.2196/43843 %U http://www.ncbi.nlm.nih.gov/pubmed/37788064 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50492 %T Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study %A Vidal,Elizabeth %A Castro-Gutierrez,Eveling %A Arisaca,Robert %A Paz-Valderrama,Alfredo %A Albiol-Pérez,Sergio %+ Universidad Nacional de San Agustín de Arequipa, Av. Venezuela s/n, Arequipa, 54, Peru, 51 986451412, evidald@unsa.edu.pe %K serious game %K virtual motor rehabilitation %K ecologic virtual system %K fine motor rehabilitation %K virtual reality %K rare diseases %K children with epileptic encephalopathy %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living. Objective: This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE. Methods: The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction. Results: The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist’s evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value. Conclusions: The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology. %M 37788071 %R 10.2196/50492 %U https://formative.jmir.org/2023/1/e50492 %U https://doi.org/10.2196/50492 %U http://www.ncbi.nlm.nih.gov/pubmed/37788071 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50374 %T An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study %A Lin,Yu Kuei %A Aikens,James E %A de Zoysa,Nicole %A Hall,Diana %A Funnell,Martha %A Nwankwo,Robin %A Kloss,Kate %A DeJonckheere,Melissa J %A Pop-Busui,Rodica %A Piatt,Gretchen A %A Amiel,Stephanie A %A Piette,John D %+ Department of Internal Medicine, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, United States, 1 7342321573, yuklin@med.umich.edu %K behavioral intervention %K CGM %K continuous glucose monitor %K design %K develop %K development %K diabetes %K diabetic %K glucose %K hypoglycemia %K hypoglycemic %K messaging %K mHealth %K mobile health %K self-management %K SMS text message %K text message %K type 1 diabetes %K type 1 %K user-centered %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. Objective: This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. Methods: We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data–connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. Results: The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients’ own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. Conclusions: A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program’s efficacy for future clinical implementation. %M 37788058 %R 10.2196/50374 %U https://formative.jmir.org/2023/1/e50374 %U https://doi.org/10.2196/50374 %U http://www.ncbi.nlm.nih.gov/pubmed/37788058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48301 %T Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial %A Brunet,Jennifer %A Sharma,Sitara %A Price,Jenson %A Black,Melissa %+ School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall # 339, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 3068, jennifer.brunet@uottawa.ca %K behavior change %K motivation %K overweight %K obese %K physical activity %K women %K digital %K randomized trial %K mobile phone %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)–driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese. Objective: This substudy explores users’ perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations. Methods: A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ≥25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively. Results: The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was “enjoyable” and “helpful”; quantitative data corroborated this, as 71% (10/14) said that the monitor was “very valuable/absolutely valuable,” 71% (10/14) would “very probably/definitely” still use one, and 86% (12/14) wore it for ≥5 days per week for ≥8 hours per day and checked it “occasionally/frequently/very frequently.” Potential threats to acceptability included “long” and “text-heavy” emails; lack of personal contact; and cumbersome, unaesthetic monitors. Conclusions: Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 International Registered Report Identifier (IRRID): RR2-10.1177/20552076221093134 %M 37788048 %R 10.2196/48301 %U https://formative.jmir.org/2023/1/e48301 %U https://doi.org/10.2196/48301 %U http://www.ncbi.nlm.nih.gov/pubmed/37788048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48232 %T Assumptions, Perceptions, and Experiences of Behavioral Health Providers Using Telemedicine: Qualitative Study %A Ainslie,Marcy %A Corvini,Marguerite %A Chadbourne,Jennifer %+ Department of Nursing, University of New Hampshire, Hewitt Hall, #241, 4 Library Way, Durham, NH, 03824, United States, 1 603 862 1261, marcy.ainslie@unh.edu %K telemedicine %K behavioral health %K implementation research %K implementation %K adoption %K telepsychiatry %K mental health %K psychiatry %K clinicians %K providers %K telehealth %K provider %K clinician %K integration %K recommendations %K recommendation %K guidelines %K guideline %K perspective %K experience %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The urgent and reactive implementation of telemedicine during the pandemic does not represent a long-term, strategic, and proactive approach to optimizing this technology. The assumptions, perceptions, and experiences of the behavioral health providers using telemedicine can inform system-wide and institutional-level strategies to promote longitudinal maintenance of care delivery, which can reduce the use of high-cost care due to new symptom onset and symptom exacerbation related to service interruptions. Objective: We aim to identify the assumptions, perspectives, and experiences of behavioral health clinicians and providers using telemedicine to inform the development of an optimized, sustainable approach to telemedicine implementation. Methods: This qualitative study applies the domains of the Consolidated Framework for Implementation Research (CFIR) to structure data collection and analysis from behavioral health providers using telemedicine via an audiovisual connection in the New England region. In total, 12 providers across levels of care were recruited for a 60-minute interview, developed from the CFIR interview guide. Atlas Ti Qualitative Software (version 23; ATLAS.ti Scientific Software Development GmbH) was used to coordinate and facilitate coding among 3 reviewers. Deductive coding was provided from the CFIR interview guide, allowing for data to be categorized by domain and construct. Constructs were analyzed for descriptive themes and tabulated for response frequency. Uncoded data were reviewed and coded in vivo to explore variables contributing to participant perceptions of experience with telemedicine use. Descriptive themes, then analytical themes, were identified. Analytical themes and tabulated frequency of response data were summarized. Finally, a sentiment analysis was completed to derive tone and meaning from the data. Results: Results are reported within the CFIR domains: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. The findings with ≥90% agreement include “best practice standards were not known”; “telemedicine was believed to be efficient and time-saving for the patient and provider, maximizing productivity and thus increasing access to care”; “telemedicine provided an additional option for patients to access services, promoting sustained continuity and timeliness of care”; “participants did not identify any clear goals related to telemedicine use”; “demonstrated positive affective responses to telemedicine use”; “expressed high efficacy with telemedicine utilization”; and “strong leadership support.” Conclusions: These findings support the development of interstate compacts advancing licensure across state lines; payment parity across modalities of care to ensure the financial vitality of behavioral health services; improved dissemination of telehealth training and resources, and telehealth training in academic programs of the health professions; seamless, dynamic workflows to accommodate the changing needs of patient and care continuity; emergency response protocols; and community partnerships to provide private spaces needed for a therapeutic encounter. Future research exploring the patient’s experience with telemedicine is needed for all stakeholders to be represented in developing a sustainable, integrated system. %M 37788059 %R 10.2196/48232 %U https://formative.jmir.org/2023/1/e48232 %U https://doi.org/10.2196/48232 %U http://www.ncbi.nlm.nih.gov/pubmed/37788059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46491 %T Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study %A Green,James B %A Rodriguez,Joey %A Keshavan,Matcheri %A Lizano,Paulo %A Torous,John %+ Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, United States, 1 508 397 0853, jgreen8@bidmc.harvard.edu %K psychosis %K digital health %K digital mental health %K coordinated specialty care %K digital navigator %K clinical high risk %K schizophrenia %K implementation science %K technology %K mobile phone %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective: In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods: Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode–psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results: In total, 5 patients (ASPIRE: n=3, 60%; CEDAR: n=2, 40%) were included: 3 (60%) White individuals, 2 (40%) male and 2 (40%) female patients, and 1 (20%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions: Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care. %M 37788066 %R 10.2196/46491 %U https://formative.jmir.org/2023/1/e46491 %U https://doi.org/10.2196/46491 %U http://www.ncbi.nlm.nih.gov/pubmed/37788066 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44187 %T Assessing Serious Spinal Pathology Using Bayesian Network Decision Support: Development and Validation Study %A Hill,Adele %A Joyner,Christopher H %A Keith-Jopp,Chloe %A Yet,Barbaros %A Tuncer Sakar,Ceren %A Marsh,William %A Morrissey,Dylan %+ Sport and Exercise Medicine, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, United Kingdom, 44 2078825010, d.morrissey@qmul.ac.uk %K artificial intelligence %K back pain %K Bayesian network %K expert consensus %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Identifying and managing serious spinal pathology (SSP) such as cauda equina syndrome or spinal infection in patients presenting with low back pain is challenging. Traditional red flag questioning is increasingly criticized, and previous studies show that many clinicians lack confidence in managing patients presenting with red flags. Improving decision-making and reducing the variability of care for these patients is a key priority for clinicians and researchers. Objective: We aimed to improve SSP identification by constructing and validating a decision support tool using a Bayesian network (BN), which is an artificial intelligence technique that combines current evidence and expert knowledge. Methods: A modified RAND appropriateness procedure was undertaken with 16 experts over 3 rounds, designed to elicit the variables, structure, and conditional probabilities necessary to build a causal BN. The BN predicts the likelihood of a patient with a particular presentation having an SSP. The second part of this study used an established framework to direct a 4-part validation that included comparison of the BN with consensus statements, practice guidelines, and recent research. Clinical cases were entered into the model and the results were compared with clinical judgment from spinal experts who were not involved in the elicitation. Receiver operating characteristic curves were plotted and area under the curve were calculated for accuracy statistics. Results: The RAND appropriateness procedure elicited a model including 38 variables in 3 domains: risk factors (10 variables), signs and symptoms (17 variables), and judgment factors (11 variables). Clear consensus was found in the risk factors and signs and symptoms for SSP conditions. The 4-part BN validation demonstrated good performance overall and identified areas for further development. Comparison with available clinical literature showed good overall agreement but suggested certain improvements required to, for example, 2 of the 11 judgment factors. Case analysis showed that cauda equina syndrome, space-occupying lesion/cancer, and inflammatory condition identification performed well across the validation domains. Fracture identification performed less well, but the reasons for the erroneous results are well understood. A review of the content by independent spinal experts backed up the issues with the fracture node, but the BN was otherwise deemed acceptable. Conclusions: The RAND appropriateness procedure and validation framework were successfully implemented to develop the BN for SSP. In comparison with other expert-elicited BN studies, this work goes a step further in validating the output before attempting implementation. Using a framework for model validation, the BN showed encouraging validity and has provided avenues for further developing the outputs that demonstrated poor accuracy. This study provides the vital first step of improving our ability to predict outcomes in low back pain by first considering the problem of SSP. International Registered Report Identifier (IRRID): RR2-10.2196/21804 %M 37788068 %R 10.2196/44187 %U https://formative.jmir.org/2023/1/e44187 %U https://doi.org/10.2196/44187 %U http://www.ncbi.nlm.nih.gov/pubmed/37788068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44170 %T Evaluating the Acceptability and Feasibility of a Sexual Health–Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study %A Goueth,Rose %A Darney,Blair %A Hoffman,Aubri %A Eden,Karen B %+ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034944502, gouethr@ochin.org %K decision aid %K contraception %K decision-making %K user-centered design %K young adults %K pilot study %K feasibility %K acceptability %K development %K support %K tool %K survey %K sexual health %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid—Healthy Sex Choices—designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as “good.” Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. %M 37788070 %R 10.2196/44170 %U https://formative.jmir.org/2023/1/e44170 %U https://doi.org/10.2196/44170 %U http://www.ncbi.nlm.nih.gov/pubmed/37788070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44028 %T Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study %A Metting,Esther %A van Luenen,Sanne %A Baron,Anna-Jetske %A Tran,Anthony %A van Duinhoven,Stijn %A Chavannes,Niels H %A Hevink,Maud %A Lüers,Jos %A Kocks,Janwillem %+ Data Science Center in Health, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands, e.i.metting@rug.nl %K elderly people %K usability %K asthma %K chronic obstructive pulmonary disease %K website %K navigation %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called “digital divide” due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. Objective: This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. Methods: This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. Results: We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. Conclusions: It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group. %M 37788072 %R 10.2196/44028 %U https://formative.jmir.org/2023/1/e44028 %U https://doi.org/10.2196/44028 %U http://www.ncbi.nlm.nih.gov/pubmed/37788072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36596 %T The Effect of a Digital Mental Health Program on Anxiety and Depression Symptoms: Retrospective Analysis of Clinical Severity %A Dzubur,Eldin %A Yu,Jessica %A Hoffman,Julia %A Painter,Stefanie %A James,Roberta %A Shah,Bimal %+ Teladoc Health, 2 Manhattanville Rd, Purchase, NY, 10577, United States, 1 3123307236, spainter@teladoc.com %K digital health %K mental health %K anxiety %K depression %K digital mental health %K program usage %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence-based digital health programs have shown efficacy in being primary tools to improve emotional and mental health, as well as offering supplementary support to individuals undergoing psychotherapy for anxiety, depression, and other mental health disorders. However, information is lacking about the dose response to digital mental health interventions. Objective: The objective of the study was to examine the effect of time in program and program usage on symptom change among individuals enrolled in a real-world comprehensive digital mental health program (myStrength) who are experiencing severe anxiety or depression. Methods: Eligible participants (N=18,626) were adults aged 18 years and older who were enrolled in myStrength for at least four weeks as part of their employee wellness benefit program, who completed baseline, the 2-week, 2-month, and 6-month surveys querying symptoms of anxiety (Generalized Anxiety Disorder–7 [GAD-7]) and depression (Patient Health Questionnaire–9 [PHQ-9]). Linear growth curve models were used to analyze the effect of average weekly program usage on subsequent GAD-7 and PHQ-9 scores for participants with scores indicating severe anxiety (GAD-7≥15) or depression (PHQ-9≥15). All models were adjusted for baseline score and demographics. Results: Participants in the study (N=1519) were 77.4% female (1176/1519), had a mean age of 45 years (SD 14 years), and had an average enrollment time of 3 months. At baseline, participants reported an average of 9.39 (SD 6.04) on the GAD-7 and 11.0 (SD 6.6) on the PHQ-9. Those who reported 6-month results had an average of 8.18 (SD 6.15) on the GAD-7 and 9.18 (SD 6.79) on the PHQ-9. Participants with severe scores (n=506) experienced a significant improvement of 2.97 (SE 0.35) and 3.97 (SE 0.46) at each time point for anxiety and depression, respectively (t=–8.53 and t=–8.69, respectively; Ps<.001). Those with severe baseline scores also saw a reduction of 0.27 (SE 0.08) and 0.25 (SE 0.09) points in anxiety and depression, respectively, for each additional program activity per week (t=–3.47 and t=–2.66, respectively; Ps<.05). Conclusions: For participants with severe baseline scores, the study found a clinically significant reduction of approximately 9 points for anxiety and 12 points for depression after 6 months of enrollment, suggesting that interventions targeting mental health must maintain active, ongoing engagement when symptoms are present and be available as a continuous resource to maximize clinical impact, specifically in those experiencing severe anxiety or depression. Moreover, a dosing effect was shown, indicating improvement in outcomes among participants who engaged with the program every other day for both anxiety and depression. This suggests that digital mental health programs that provide both interesting and evidence-based activities could be more successful in further improving mental health outcomes. %M 37788069 %R 10.2196/36596 %U https://formative.jmir.org/2023/1/e36596 %U https://doi.org/10.2196/36596 %U http://www.ncbi.nlm.nih.gov/pubmed/37788069 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47617 %T Individualized Virtual Reality for Increasing Self-Compassion: Evaluation Study %A Halim,Ilona %A Stemmet,Lehan %A Hach,Sylvia %A Porter,Richard %A Liang,Hai-Ning %A Vaezipour,Atiyeh %A Henry,Julie D %A Baghaei,Nilufar %+ School of Electrical Engineering and Computer Science, The University of Queensland, Staff House Road, St Lucia, 4072, Australia, 61 450150234, n.baghaei@uq.edu.au %K individualized virtual reality %K mental health %K self-compassion %K depression %K depressive symptoms %K mobile phone %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are common and debilitating mental disorders with severe negative repercussions at both individual and societal levels. Although virtual reality (VR) has emerged as a safe and effective tool for the treatment of anxiety disorders, studies of the therapeutic application of VR to treat depression are more limited. Objective: The purpose of this study was to test whether a novel type of individualized VR (iVR) can be used to improve self-compassion and decrease depressive symptoms and to evaluate the usability and acceptability of this approach, as rated by participants. The iVR system was designed and developed based on the feedback obtained from a previous study, with improved appearance and feel of the avatar and enhanced graphical quality. Methods: A total of 36 young adult participants were recruited from a university community social media site. Participants were aware that the study was investigating a treatment for depression but were not recruited based on depression diagnosis. Participants were asked to complete 2 iVR sessions, spaced 2 weeks apart. At baseline and upon completion of each iVR session, participants were asked to complete validated measures of self-compassion and depression. Upon completion of both iVR sessions, additional measures were administered to assess participants’ perceptions about the perceived usability and system acceptability of the iVR approach. Results: Self-compassion was assessed at the beginning of session 1 (preintervention baseline) and at the end of session 1 (postintervention assessment). Owing to COVID-19 constraints, 36% (13/36) of the participants were unable to complete the follow-up iVR session. Self-compassion was assessed again for the remaining 64% (23/36) of the participants at the end of session 2 (postintervention assessment). Within-group analyses revealed that self-compassion was significantly increased at the end of both session 1 (P=.01) and session 2 (P=.03) relative to baseline. There was also a nonsignificant trend for depressive symptoms to be low at the end of session 2 relative to baseline. Both quantitative and qualitative participant data supported the iVR approach as being acceptable and usable. Conclusions: Although these data must be treated as preliminary owing to the small sample size and potential selection bias, the data provide encouraging initial evidence that iVR might be a useful tool to enhance self-compassion and reduce depressive symptoms, highlighting the need for randomized controlled trials in the future. %M 37782537 %R 10.2196/47617 %U https://mental.jmir.org/2023/1/e47617 %U https://doi.org/10.2196/47617 %U http://www.ncbi.nlm.nih.gov/pubmed/37782537 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46521 %T Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test %A Graves,Jennifer S %A Elantkowski,Marcin %A Zhang,Yan-Ping %A Dondelinger,Frank %A Lipsmeier,Florian %A Bernasconi,Corrado %A Montalban,Xavier %A Midaglia,Luciana %A Lindemann,Michael %+ F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 61 687 79 09, florian.lipsmeier@roche.com %K multiple sclerosis %K smartphone sensor %K digital health technology tools %K upper extremity function %K hand-motor dexterity %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. Objective: This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. Methods: Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)–based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). Results: We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). Conclusions: The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. Trial Registration: ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911 %M 37782540 %R 10.2196/46521 %U https://formative.jmir.org/2023/1/e46521 %U https://doi.org/10.2196/46521 %U http://www.ncbi.nlm.nih.gov/pubmed/37782540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49898 %T Parkinson Disease Recognition Using a Gamified Website: Machine Learning Development and Usability Study %A Parab,Shubham %A Boster,Jerry %A Washington,Peter %+ Department of Information & Computer Sciences, University of Hawaii at Manoa, 2500 Campus Rd, Honolulu, HI, 96822, United States, 1 1 512 680 0926, pyw@hawaii.edu %K Parkinson disease %K digital health %K machine learning %K remote screening %K accessible screening %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Parkinson disease (PD) affects millions globally, causing motor function impairments. Early detection is vital, and diverse data sources aid diagnosis. We focus on lower arm movements during keyboard and trackpad or touchscreen interactions, which serve as reliable indicators of PD. Previous works explore keyboard tapping and unstructured device monitoring; we attempt to further these works with structured tests taking into account 2D hand movement in addition to finger tapping. Our feasibility study uses keystroke and mouse movement data from a remotely conducted, structured, web-based test combined with self-reported PD status to create a predictive model for detecting the presence of PD. Objective: Analysis of finger tapping speed and accuracy through keyboard input and analysis of 2D hand movement through mouse input allowed differentiation between participants with and without PD. This comparative analysis enables us to establish clear distinctions between the two groups and explore the feasibility of using motor behavior to predict the presence of the disease. Methods: Participants were recruited via email by the Hawaii Parkinson Association (HPA) and directed to a web application for the tests. The 2023 HPA symposium was also used as a forum to recruit participants and spread information about our study. The application recorded participant demographics, including age, gender, and race, as well as PD status. We conducted a series of tests to assess finger tapping, using on-screen prompts to request key presses of constant and random keys. Response times, accuracy, and unintended movements resulting in accidental presses were recorded. Participants performed a hand movement test consisting of tracing straight and curved on-screen ribbons using a trackpad or mouse, allowing us to evaluate stability and precision of 2D hand movement. From this tracing, the test collected and stored insights concerning lower arm motor movement. Results: Our formative study included 31 participants, 18 without PD and 13 with PD, and analyzed their lower limb movement data collected from keyboards and computer mice. From the data set, we extracted 28 features and evaluated their significances using an extra tree classifier predictor. A random forest model was trained using the 6 most important features identified by the predictor. These selected features provided insights into precision and movement speed derived from keyboard tapping and mouse tracing tests. This final model achieved an average F1-score of 0.7311 (SD 0.1663) and an average accuracy of 0.7429 (SD 0.1400) over 20 runs for predicting the presence of PD. Conclusions: This preliminary feasibility study suggests the possibility of using technology-based limb movement data to predict the presence of PD, demonstrating the practicality of implementing this approach in a cost-effective and accessible manner. In addition, this study demonstrates that structured mouse movement tests can be used in combination with finger tapping to detect PD. %M 37773607 %R 10.2196/49898 %U https://formative.jmir.org/2023/1/e49898 %U https://doi.org/10.2196/49898 %U http://www.ncbi.nlm.nih.gov/pubmed/37773607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49473 %T A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders %A Willemsen,Romy Fleur %A Meijer,Eline %A van den Berg,Liselot Nicoline %A van der Burg,Luuk %A Chavannes,Niels Henrik %A Aardoom,Jiska Joelle %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 611769454, j.j.aardoom@lumc.nl %K eHealth %K health apps %K health app platform %K prevention %K public health %K health platform %K health promotion %K digital health %K app evaluation %K Framework Method %K focus group %K focus groups %K evaluate %K evaluation %K platform %K acceptability %K feasibility %K mHealth %K mobile health %K app %K apps %K application %K applications %K mobile phone %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. Objective: The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. Methods: This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. Results: A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. Conclusions: This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health. %M 37773608 %R 10.2196/49473 %U https://formative.jmir.org/2023/1/e49473 %U https://doi.org/10.2196/49473 %U http://www.ncbi.nlm.nih.gov/pubmed/37773608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48976 %T A Web-Based Tool to Report Adverse Drug Reactions by Community Pharmacists in Australia: Usability Testing Study %A Fossouo Tagne,Joel %A Yakob,Reginald Amin %A Mcdonald,Rachael %A Wickramasinghe,Nilmini %+ School of Health Sciences and Biostatistics, Swinburne University of Technology, John Street, Hawthorn, Melbourne, 3122, Australia, 61 0412478610, jfossouo@gmail.com %K ADR %K adverse drug reaction %K pharmacovigilance %K community pharmacy %K digital health evaluation %K usability testing %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse drug reactions (ADRs) are unintended and harmful events associated with medication use. Despite their significance in postmarketing surveillance, quality improvement, and drug safety research, ADRs are vastly underreported. Enhanced digital-based communication of ADR information to regulators and among care providers could significantly improve patient safety. Objective: This paper presents a usability evaluation of the commercially available GuildCare Adverse Event Recording system, a web-based ADR reporting system widely used by community pharmacists (CPs) in Australia. Methods: We developed a structured interview protocol encompassing remote observation, think-aloud moderating techniques, and retrospective questioning to gauge the overall user experience, complemented by the System Usability Scale (SUS) assessment. Thematic analysis was used to analyze field notes from the interviews. Results: A total of 7 CPs participated in the study, who perceived the system to have above-average usability (SUS score of 68.57). Nonetheless, the structured approach to usability testing unveiled specific functional and user interpretation issues, such as unnecessary information, lack of system clarity, and redundant data fields—critical insights not captured by the SUS results. Design elements like drop-down menus, free-text entry, checkboxes, and prefilled or auto-populated data fields were perceived as useful for enhancing system navigation and facilitating ADR reporting. Conclusions: The user-centric design of technology solutions, like the one discussed herein, is crucial to meeting CPs’ information needs and ensuring effective ADR reporting. Developers should adopt a structured approach to usability testing during the developmental phase to address identified issues comprehensively. Such a methodological approach may promote the adoption of ADR reporting systems by CPs and ultimately enhance patient safety. %M 37773620 %R 10.2196/48976 %U https://formative.jmir.org/2023/1/e48976 %U https://doi.org/10.2196/48976 %U http://www.ncbi.nlm.nih.gov/pubmed/37773620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47065 %T The Perception of Health Care Practitioners Regarding Telemedicine During COVID-19 in Saudi Arabia: Mixed Methods Study %A Alqurashi,Heba %A Mohammed,Rafiuddin %A AlGhanmi,Amany Shlyan %A Alanazi,Farhan %+ Public Health Department, College of Health Sciences, Saudi Electronic University, Prince Mohammed Ibn Salman Ibn Abdulaziz Road, Dammam, 32256, Saudi Arabia, 966 112613500, h.alqurashi@seu.edu.sa %K telemedicine %K health care practitioners %K COVID-19 %K Saudi Arabia %K mobile phone %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine is a rapidly evolving field that uses information and communication technology to provide remote health care services, such as diagnosis, treatment, consultation, patient monitoring, and medication delivery. With advancements in technology, telemedicine has become increasingly popular during the COVID-19 lockdown and has expanded beyond remote consultations via telephone or video to include comprehensive and reliable services. The integration of telemedicine platforms can enable patients and health care providers to communicate more efficiently and effectively. Objective: This study aims to investigate the awareness, knowledge, requirements, and perceptions of health care practitioners in Saudi Arabia during the pandemic health crisis from the end-user perspective. The findings of this study will inform policy makers regarding the sustainability of telemedicine and how it affects the process of provision of health care and improves the patients’ journey. Methods: This study adopted a mixed methods design with a quantitative-based cross-sectional design and qualitative interviews to assess the perceptions of various health care professionals working in outpatient departments that have a telemedicine system that was used during the COVID-19 pandemic. For both approaches, ethics approval was obtained, and informed consent forms were signed. In total, 81 completed questionnaires were used in this study. In the second phase, general interviews were conducted with managerial staff and health care professionals to obtain their view of telemedicine services in their hospitals. Results: The study revealed that most participants (67/81, 83%) were familiar with telemedicine technology, and the study proved to be statistically significant at P<.05 with a proportion of the participants (52/81, 64%) believing that continuous training was essential for its effective use. The study also found that consultations (55/153, 35.9%) and monitoring patients (35/153, 22.9%) were the major components of telemedicine used by health care professionals, with telephones being the most commonly used mode of interaction with patients (74/117, 63.2%). In addition, 54% (44/81) of the respondents expressed concerns about patient privacy and confidentiality, highlighting this as a major issue. Furthermore, the majority of participants (58/81, 72%) reported the necessity of implementing national standards essential for telemedicine technology in Saudi Arabia. The interviews conducted as part of the study revealed 5 major themes: culture, barriers and difficulties, communication, implementation, and evaluation. These themes highlighted the importance of a culture of acceptance and flexibility, effective communication, and ongoing evaluation of telemedicine technologies in health care systems. Conclusions: This study provides a crucial message with insights into the perceptions and experiences of health care professionals with telemedicine during the COVID-19 pandemic in Saudi Arabia. %M 37768720 %R 10.2196/47065 %U https://formative.jmir.org/2023/1/e47065 %U https://doi.org/10.2196/47065 %U http://www.ncbi.nlm.nih.gov/pubmed/37768720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44696 %T Health Care Providers’ Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype %A Holuszko,Olivia May %A Abdulcadir,Jasmine %A Abbott,Daisy %A Clancy,Jennifer %+ School of Simulation & Visualisation, Glasgow School of Art, The Hub, Pacific Quay, Glasgow, G51 1EA, United Kingdom, 44 7401237315, oliviamayh@gmail.com %K FGM/C %K 3D %K interactive %K patients %K consultation %K web app %K health care provider %K female genital mutilation or cutting %K vulva %K anatomy %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. Objective: The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. Methods: We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs’ willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. Results: All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient’s genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app’s perceived usefulness to clinical practice and beyond. Conclusions: Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C. %M 37768712 %R 10.2196/44696 %U https://formative.jmir.org/2023/1/e44696 %U https://doi.org/10.2196/44696 %U http://www.ncbi.nlm.nih.gov/pubmed/37768712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51088 %T Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study %A Hadjistavropoulos,Heather D %A Reiser,Sarah J %A Beahm,Janine D %A McCall,Hugh C %A Dena,Isabelle %A Phillips,Abby R %A Scheltgen,Melissa %A Sekhar,Shimona %A Cox,Marilyn %A Cramm,Heidi %A Reid,Nathalie %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, Heather.Hadjistavropoulos@uregina.ca %K internet-delivered cognitive behavioral therapy %K ICBT %K internet interventions %K transdiagnostic %K spouses and significant others %K public safety personnel %K formative evaluation %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. Objective: This study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group. Methods: SSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT. Results: Clients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP. Conclusions: Findings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada. %M 37756033 %R 10.2196/51088 %U https://formative.jmir.org/2023/1/e51088 %U https://doi.org/10.2196/51088 %U http://www.ncbi.nlm.nih.gov/pubmed/37756033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50239 %T A Spiritual Self-Care Mobile App (Skylight) for Mental Health, Sleep, and Spiritual Well-Being Among Generation Z and Young Millennials: Cross-Sectional Survey %A Park,Susanna Y %A Huberty,Jennifer %A Yourell,Jacqlyn %A McAlister,Kelsey L %A Beatty,Clare C %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84180, United States, 1 7202515121, syjpark@gmail.com %K Gen Z %K millennial %K spirituality %K spiritual self-care %K mental health %K sleep %K mobile health %K mHealth %K digital health %K spiritual %K self-care %K app %K apps %K mental wellness %K mental well-being %K young adult %K young adults %K engagement %K perception %K perceptions %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet “explosion.” They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials. Objective: The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Methods: Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes. Results: Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: β=–2.01; P=.02; high use: β=–2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. Conclusions: This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials. %M 37597179 %R 10.2196/50239 %U https://formative.jmir.org/2023/1/e50239 %U https://doi.org/10.2196/50239 %U http://www.ncbi.nlm.nih.gov/pubmed/37597179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46473 %T Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study %A Forman-Hoffman,Valerie L %A Pirner,Maddison C %A Flom,Megan %A Kirvin-Quamme,Andrew %A Durden,Emily %A Kissinger,Jennifer A %A Robinson,Athena %+ Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, United States, 1 415 273 9742, valerie_hoffman@woebothealth.com %K adoption %K anxiety %K chatbot %K cognitive behavioral therapy %K conversational agent %K CBT %K depression %K digital health %K medically underserved area %K mental health %K mhealth %K mobile app %K mobile health %K mobile phone %K mood %K psychotherapy %K relational agent %K rural %K satisfaction %K smartphone app %K smartphone %K underserved %K usage %K vulnerable %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent–guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 %M 37756047 %R 10.2196/46473 %U https://formative.jmir.org/2023/1/e46473 %U https://doi.org/10.2196/46473 %U http://www.ncbi.nlm.nih.gov/pubmed/37756047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48398 %T Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study %A Lumini,Maria José %A Sousa,Maria Rui %A Salazar,Berta %A Martins,Teresa %+ Nursing School of Porto, Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Rede de Investigação em Saúde (RISE), Rua Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal, 351 00351225 073 50, lumini@esenf.pt %K caregivers %K education %K COVID-19 %K distance %K effectiveness %K skill %K safe care %K health system %K older people %K family %K social isolation %K massive open online courses %K care challenges %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study’s aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care–related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling–dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers’ association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers‘ knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants’ satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC’s structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers’ knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. %M 37747772 %R 10.2196/48398 %U https://formative.jmir.org/2023/1/e48398 %U https://doi.org/10.2196/48398 %U http://www.ncbi.nlm.nih.gov/pubmed/37747772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44402 %T An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility %A Oladele,David Ayoola %A Iwelunmor,Juliet %A Gbajabiamila,Titilola %A Obiezu-Umeh,Chisom %A Okwuzu,Jane Ogoamaka %A Nwaozuru,Ucheoma %A Musa,Adesola Zaidat %A Tahlil,Kadija %A Idigbe,Ifeoma %A Ong,Jason %A Tang,Weiming %A Tucker,Joseph %A Ezechi,Oliver %+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 314 7458150, david.oladele@slu.edu %K adolescent %K adolescents and young adults %K Africa %K AYA %K development %K feasibility %K HIV self-testing %K HIV %K HIVST %K information system %K Nigeria %K platform %K testing %K think aloud %K unstructured supplementary service data %K usability %K user-centered %K USSD %K young adult %K youth %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform’s usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. %M 37747780 %R 10.2196/44402 %U https://formative.jmir.org/2023/1/e44402 %U https://doi.org/10.2196/44402 %U http://www.ncbi.nlm.nih.gov/pubmed/37747780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46458 %T Efficacy of a Text-Based Mental Health Coaching App in Improving the Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial %A Lim,Yee Siew %A Quek,Jia Hui %A Ching,Xiu Wei %A Lim,Dominic Tao Ran %A Lim,Kean Ghee %A Thuraisingham,Chandramani %A George,Parikial Philip %+ International Medical University (IMU), Jalan Rasah, Bukit Rasah, Seremban, 70300, Malaysia, 60 67677798, lim.yeesiew@outlook.com %K digital mental health %K mobile health %K randomized control trial %K mobile phone %K mental health %K Depression, Anxiety, and Stress Scale–21 items %K DASS-21 %K Asia %K Malaysia %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one’s mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. Objective: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. Methods: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale–21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. Results: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. Conclusions: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. Trial Registration: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277 %M 37738081 %R 10.2196/46458 %U https://formative.jmir.org/2023/1/e46458 %U https://doi.org/10.2196/46458 %U http://www.ncbi.nlm.nih.gov/pubmed/37738081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45665 %T Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Survey Study %A Youssef,Yasmin %A Scherer,Julian %A Niemann,Marcel %A Ansorg,Jörg %A Back,David Alexander %A Gehlen,Tobias %+ Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany, 49 0341 9717004, yasmin.youssef@medizin.uni-leipzig.de %K communication %K digitalization %K Facebook %K Germany %K implementation %K Instagram %K management %K musculoskeletal %K orthopedic surgeon %K orthopedic %K orthopedics and traumatology %K patient %K physician %K questionnaire %K social media management %K social media %K social networking %K surgeon %K trauma surgeon %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has gained importance in the health care sector as a means of communication and a source of information for physicians and patients. However, the scope of professional SM use by orthopedic and trauma surgeons remains largely unknown. Objective: This study presents an overview of professional SM use among orthopedic and trauma surgeons in Germany in terms of the platforms used, frequency of use, and SM content management. Methods: We developed a web-based questionnaire with 33 variables and 2 separate sections based on a review of current literature. This study analyzed the first section of the questionnaire and included questions on demographics, type of SM used, frequency of use, and SM content management. Statistical analysis was performed using SPSS (version 26.0). Subgroup analysis was performed for sex, age groups (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Differences between groups were assessed with a chi-square test for categorical data. Results: A total of 208 participants answered the questionnaire (166/208, 79.8% male), of whom 70.2% (146/208) were younger than 60 years and 77.4% (161/208) worked in a practice. All participants stated that they use SM for private and professional purposes. On average, participants used 1.6 SM platforms for professional purposes. More than half had separate SM accounts for private and professional use. The most frequently used SM platforms were messenger apps (119/200, 59.5%), employment-oriented SM (60/200, 30%), and YouTube (54/200, 27%). All other SM, including Facebook and Instagram, were only used by a minority of the participants. Women and younger participants were more likely to use Instagram (P<.001 and P=.03, respectively). The participants working in a hospital were more likely to use employment-oriented SM (P=.02) and messenger apps (P=.009) than participants working in a practice. In a professional context, 20.2% (39/193) of the participants produced their own content on SM, 24.9% (48/193) used SM daily, 39.9% (77/193) used SM during work, and 13.8% (26/188) stated that they checked the number of followers they had. Younger participants were more likely to have participated in professional SM training and to have separate private and professional accounts (P=.04 and P=.02, respectively). Younger participants tended toward increased production of their own content (P=.06). Conclusions: SM is commonly used for professional purposes by orthopedic and trauma surgeons in Germany. However, it seems that professional SM use is not exploited to its full potential, and a structured implementation into daily professional work routines is still lacking. SM can have a profound impact on medical practices and communication, so orthopedic and trauma surgeons in Germany should consider increasing their SM presence by actively contributing to SM. %M 37738084 %R 10.2196/45665 %U https://formative.jmir.org/2023/1/e45665 %U https://doi.org/10.2196/45665 %U http://www.ncbi.nlm.nih.gov/pubmed/37738084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49043 %T Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process %A Büscher,Rebekka %A Sander,Lasse B %A Nuding,Mattis %A Baumeister,Harald %A Teismann,Tobias %+ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstr. 29, Freiburg, 79085, Germany, 49 76120395204, rebekka.buescher@mps.uni-freiburg.de %K blended care %K digital interventions %K video therapy %K suicidal ideation %K personalized treatment %K cognitive behavioral therapy %K CBT %K suicide %K suicidal %K digital intervention %K digital health %K video %K web-based module %K blended %K self-help %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns. Objective: Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale. Methods: First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program. Results: The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual’s needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers. Conclusions: This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment. %M 37733414 %R 10.2196/49043 %U https://formative.jmir.org/2023/1/e49043 %U https://doi.org/10.2196/49043 %U http://www.ncbi.nlm.nih.gov/pubmed/37733414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43963 %T Development and Integration of Machine Learning Algorithm to Identify Peripheral Arterial Disease: Multistakeholder Qualitative Study %A Wang,Sabrina M %A Hogg,H D Jeffry %A Sangvai,Devdutta %A Patel,Manesh R %A Weissler,E Hope %A Kellogg,Katherine C %A Ratliff,William %A Balu,Suresh %A Sendak,Mark %+ Duke Institute for Health Innovation, 200 Morris St, Durham, NC, 27701, United States, 1 (919) 684 4389, mark.sendak@duke.edu %K machine learning %K implementation %K integration %K support %K quality %K peripheral arterial disease %K algorithm %K efficacy %K structure %K barrier %K clinical %K engagement %K development %K translation %K detection %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning (ML)–driven clinical decision support (CDS) continues to draw wide interest and investment as a means of improving care quality and value, despite mixed real-world implementation outcomes. Objective: This study aimed to explore the factors that influence the integration of a peripheral arterial disease (PAD) identification algorithm to implement timely guideline-based care. Methods: A total of 12 semistructured interviews were conducted with individuals from 3 stakeholder groups during the first 4 weeks of integration of an ML-driven CDS. The stakeholder groups included technical, administrative, and clinical members of the team interacting with the ML-driven CDS. The ML-driven CDS identified patients with a high probability of having PAD, and these patients were then reviewed by an interdisciplinary team that developed a recommended action plan and sent recommendations to the patient’s primary care provider. Pseudonymized transcripts were coded, and thematic analysis was conducted by a multidisciplinary research team. Results: Three themes were identified: positive factors translating in silico performance to real-world efficacy, organizational factors and data structure factors affecting clinical impact, and potential challenges to advancing equity. Our study found that the factors that led to successful translation of in silico algorithm performance to real-world impact were largely nontechnical, given adequate efficacy in retrospective validation, including strong clinical leadership, trustworthy workflows, early consideration of end-user needs, and ensuring that the CDS addresses an actionable problem. Negative factors of integration included failure to incorporate the on-the-ground context, the lack of feedback loops, and data silos limiting the ML-driven CDS. The success criteria for each stakeholder group were also characterized to better understand how teams work together to integrate ML-driven CDS and to understand the varying needs across stakeholder groups. Conclusions: Longitudinal and multidisciplinary stakeholder engagement in the development and integration of ML-driven CDS underpins its effective translation into real-world care. Although previous studies have focused on the technical elements of ML-driven CDS, our study demonstrates the importance of including administrative and operational leaders as well as an early consideration of clinicians’ needs. Seeing how different stakeholder groups have this more holistic perspective also permits more effective detection of context-driven health care inequities, which are uncovered or exacerbated via ML-driven CDS integration through structural and organizational challenges. Many of the solutions to these inequities lie outside the scope of ML and require coordinated systematic solutions for mitigation to help reduce disparities in the care of patients with PAD. %M 37733427 %R 10.2196/43963 %U https://formative.jmir.org/2023/1/e43963 %U https://doi.org/10.2196/43963 %U http://www.ncbi.nlm.nih.gov/pubmed/37733427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49591 %T Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation %A Haque,Saira %A DeStefano,Sydney %A Banger,Alison %A Rutledge,Regina %A Romaire,Melissa %+ RTI International, 3040 E Cornwallis Drive, Research Triangle Park, NC, 27709, United States, 1 919 541 6000, mromaire@rti.org %K telehealth %K virtual care %K rural health %K critical access hospital %K access %K telehealth impact %K methods evaluation %K mixed methods %K thematic analysis %K cost efficiency %K telehealth cost %K qualitative analysis %K claims analysis %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. Objective: We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. Methods: We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. Results: CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. Conclusions: The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability. %M 37728991 %R 10.2196/49591 %U https://formative.jmir.org/2023/1/e49591 %U https://doi.org/10.2196/49591 %U http://www.ncbi.nlm.nih.gov/pubmed/37728991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47178 %T Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders %A Cliffe,Bethany %A Gore-Rodney,Jessica %A Linton,Myles-Jay %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, BS8 1QU, United Kingdom, 44 01179289000, bethany.cliffe@bristol.ac.uk %K digital interventions %K smartphone app %K suicide prevention %K mental health %K mobile phone %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. Objective: The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. Methods: A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Results: Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) “progress” is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. Conclusions: This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians. %M 37728967 %R 10.2196/47178 %U https://formative.jmir.org/2023/1/e47178 %U https://doi.org/10.2196/47178 %U http://www.ncbi.nlm.nih.gov/pubmed/37728967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48739 %T An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback %A Caldwell,Sylvia %A Flickinger,Tabor %A Hodges,Jacqueline %A Waldman,Ava Lena D %A Garofalini,Chloe %A Cohn,Wendy %A Dillingham,Rebecca %A Castel,Amanda %A Ingersoll,Karen %+ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, PO Box 801075, Charlottesville, VA, 22908-1075, United States, 1 540 292 5831, sab6ce@virginia.edu %K HIV %K mobile health %K mHealth %K cluster randomized controlled trial %K formative %K adaptation %K qualitative methods %K smartphone %K mobile phone %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. Objective: This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. Methods: We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Results: Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Conclusions: Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks’ efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID): RR2-10.2196/37748 %M 37725419 %R 10.2196/48739 %U https://formative.jmir.org/2023/1/e48739 %U https://doi.org/10.2196/48739 %U http://www.ncbi.nlm.nih.gov/pubmed/37725419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47811 %T Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes %A Marini,Christina %A Cruz,Jocelyn %A Payano,Leydi %A Flores,Ronaldo Patino %A Arena,Gina-Maria %A Mandal,Soumik %A Leven,Eric %A Mann,Devin %A Schoenthaler,Antoinette %+ Department of Neurology, NYU Langone, 222 East 41st Street, New York, NY, 10017, United States, 1 9738651627, christina.marini@nyulangone.org %K mobile health %K mHealth %K patient-reported outcomes %K diabetes %K qualitative %K patient engagement %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients’ self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients’ self-management behaviors. Objective: This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients’ adoption of self-management behaviors, as well as elicit suggestions for improvement. Methods: This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. Results: The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients’ reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients’ attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). Conclusions: This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change. %M 37725427 %R 10.2196/47811 %U https://formative.jmir.org/2023/1/e47811 %U https://doi.org/10.2196/47811 %U http://www.ncbi.nlm.nih.gov/pubmed/37725427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45484 %T User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study %A Chen,Nai-Jung %A Huang,Chiu-Mieh %A Fan,Ching-Chih %A Lu,Li-Ting %A Lin,Fen-He %A Liao,Jung-Yu %A Guo,Jong-Long %+ Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, No. 162, Sec. 1, Heping East Road, Taipei, 106, Taiwan, 886 2 7749 1737, jonglong@ntnu.edu.tw %K chronic kidney disease %K chatbot %K health education %K push notification %K users’ evaluation %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. Objective: The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants’ user experiences will form the basis for program design improvements. Methods: Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Results: Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. Conclusions: The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users’ evaluation is satisfactory. Trial Registration: ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517 %M 37725429 %R 10.2196/45484 %U https://formative.jmir.org/2023/1/e45484 %U https://doi.org/10.2196/45484 %U http://www.ncbi.nlm.nih.gov/pubmed/37725429 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45510 %T A Series of Personalized Virtual Light Therapy Interventions for Fatigue: Feasibility Randomized Crossover Trial for N-of-1 Treatment %A Butler,Mark %A D’Angelo,Stefani %A Ahn,Heejoon %A Chandereng,Thevaa %A Miller,Danielle %A Perrin,Alexandra %A Romain,Anne-Marie N %A Scatoni,Ava %A Friel,Ciaran P %A Cheung,Ying-Kuen %A Davidson,Karina W %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 130 East 59th Street, Suite 14C, New York, NY, 10022, United States, 1 9084140238, markbutler@northwell.edu %K virtual light therapy interventions %K fatigue %K light therapy %K primary care %K feasibility %K acceptability %K effectiveness %K usability %K seasonal affective disorder %K phototherapy %K photoradiation %K photochemotherapy %K color therapy %K heliotherapy %K photothermal therapy %K UV therapy %K chromotherapy %K color light therapy %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common symptoms treated in primary care and can lead to deficits in mental health and functioning. Light therapy can be an effective treatment for symptoms of fatigue; however, the feasibility, scalability, and individual-level heterogeneity of light therapy for fatigue are unknown. Objective: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a series of personalized (N-of-1) interventions for the virtual delivery of bright light (BL) therapy and dim light (DL) therapy versus usual care (UC) treatment for fatigue in 60 participants. Methods: Participants completed satisfaction surveys comprising the System Usability Scale (SUS) and items assessing satisfaction with the components of the personalized trial. Symptoms of fatigue were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) daily, PROMIS weekly, and ecological momentary assessment (EMA) questionnaires delivered 3 times daily. Comparisons of fatigue between the BL, DL, and UC treatment periods were conducted using generalized linear mixed model analyses between participants and generalized least squares analyses within individual participants. Results: Participants rated the usability of the personalized trial as acceptable (average SUS score=78.9, SD 15.6), and 92% (49/53) of those who completed satisfaction surveys stated that they would recommend the trial to others. The levels of fatigue symptoms measured using the PROMIS daily fatigue measure were lower or improved in the BL (B=−1.63, 95% CI −2.63 to −0.63) and DL (B=−1.44, 95% CI −2.50 to −0.38) periods relative to UC. The treatment effects of BL and DL on the PROMIS daily measure varied among participants. Similar findings were demonstrated for the PROMIS weekly and EMA measures of fatigue symptoms. Conclusions: The participant scores on the SUS and satisfaction surveys suggest that personalized N-of-1 trials of light therapy for fatigue symptoms are both feasible and acceptable. Both interventions produced significant (P<.05) reductions in participant-reported PROMIS and EMA fatigue symptoms relative to UC. However, the heterogeneity of these treatment effects across participants indicated that the effect of light therapy was not uniform. This heterogeneity along with high ratings of usability and satisfaction support the use of personalized N-of-1 research designs in evaluating the effect of light therapy on fatigue for each patient. Furthermore, the results of this trial provide additional support for the use of a series of personalized N-of-1 research trials. Trial Registration: ClinicalTrials.gov NCT04707846; https://clinicaltrials.gov/ct2/show/NCT04707846 %M 37721795 %R 10.2196/45510 %U https://formative.jmir.org/2023/1/e45510 %U https://doi.org/10.2196/45510 %U http://www.ncbi.nlm.nih.gov/pubmed/37721795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45490 %T A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study %A Pienkowska,Anita %A Ang,Chin-Siang %A Mammadova,Maleyka %A Mahadzir,Muhammad Daniel Azlan %A Car,Josip %+ Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Ave, Singapore, 308232, Singapore, 65 69047022, anita.pienkowska@ntu.edu.sg %K diabetes %K health apps %K co-design %K chatbot %K type 2 diabetes %K self-management %K mobile health %K mHealth %K chronic disease %K digital education %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. Objective: The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. Methods: A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants’ perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. Results: Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. Conclusions: Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life. %M 37721799 %R 10.2196/45490 %U https://formative.jmir.org/2023/1/e45490 %U https://doi.org/10.2196/45490 %U http://www.ncbi.nlm.nih.gov/pubmed/37721799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e33810 %T A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study %A Krasuska,Marta %A Davidson,Emma M %A Beune,Erik %A Jenum,Anne Karen %A Gill,Jason MR %A Stronks,Karien %A van Valkengoed,Irene GM %A Diaz,Esperanza %A Sheikh,Aziz %+ Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom, 44 131 650 8102, emma.davidson@ed.ac.uk %K diabetes %K diet %K ethnic minority populations %K Pakistani %K physical activity %K prevention %K South Asian %K text messages %K women %K women’s health %K health intervention %K digital health %K mobile health %K minority %K exercise %K text message %K text messaging %K SMS %K development %K formative %K diabetes mellitus %D 2023 %7 15.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide “friendly encouragement,” “companionship,” and a “focus on the individual” and also for the text messages to “set achievable goals” and include “information on cooking healthy meals.” We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message–based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland. %M 37713245 %R 10.2196/33810 %U https://formative.jmir.org/2023/1/e33810 %U https://doi.org/10.2196/33810 %U http://www.ncbi.nlm.nih.gov/pubmed/37713245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47666 %T Understanding Physical Activity Determinants in an HIV Self-Management Intervention: Qualitative Analysis Guided by the Theory of Planned Behavior %A Sanabria,Gabriella %A Bushover,Brady %A Ashrafnia,Sarah %A Cordoba,Evette %A Schnall,Rebecca %+ Division of Scholarship and Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K HIV/AIDS %K mobile Health %K mHealth %K fitness tracker %K physical activity %K self-management %K HIV %K AIDS %K activity %K mortality %K app %K fitness %K qualitative %K tracking %K behavior %K mobile phone %D 2023 %7 14.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with HIV have long life expectancy and are experiencing more comorbid conditions, being at an increased risk for developing cardiovascular disease (CVD) and diabetes, further exacerbated due to the HIV or inflammatory process. One effective intervention shown to decrease mortality and improve health outcomes related to CVD and diabetes in people living with HIV is increased regular physical activity. However, people living with HIV often fall short of the daily recommended physical activity levels. While studies show that mobile health (mHealth) can potentially help improve people’s daily activity levels and reduce mortality rates due to comorbid conditions, these studies do not specifically focus on people living with HIV. As such, it is essential to understand how mHealth interventions, such as wearables, can improve the physical activity of people living with HIV. Objective: This study aimed to understand participants’ experiences wearing a fitness tracker and an app to improve their physical activity. Methods: In total, 6 focus groups were conducted with participants who completed the control arm of a 6-month randomized controlled trial (ClinicalTrials.gov NCT03205982). The control arm received daily walk step reminders to walk at least 5000 steps per day and focused on the overall wellness of the individual. The analysis of the qualitative focus groups used inductive content analysis using the theory of planned behavior as a framework to guide and organize the analysis. Results: In total, 41 people living with HIV participated in the focus groups. The majority (n=26, 63%) of participants reported their race as Black or African American, and 32% (n=13) of them identified their ethnicity as Hispanic or Latino. In total, 9 major themes were identified and organized following the theory of planned behavior constructs. Overall, 2 major themes (positive attitude toward tracking steps and tracking steps is motivating) related to attitudes toward the behavior, 2 major themes (social support or motivation from the fitness tracker and app and encouragement from family and friends) related to participant’s subjective norms, 1 theme (you can adjust your daily habits with time) related to perceived behavioral control, 2 themes (reach their step goal and have a healthier lifestyle) related to participant’s intention, and 2 themes (continuing to walk actively and regularly wearing the fitness tracker) related to participant’s changed behavior. Participants highlighted how the mHealth interface with the avatar and daily step tracking motivated them to both begin and continue to engage in physical activity by adjusting their daily routines. Conclusions: Findings from this study illustrate how features of mHealth apps may motivate people living with HIV to start and continue sustained engagement in physical activities. This sustained increase in physical activity is crucial for reducing the risk of comorbid conditions such as diabetes or CVD. Trial Registration: ClinicalTrials.gov NCT03205982; https://classic.clinicaltrials.gov/ct2/show/NCT03205982 %M 37707942 %R 10.2196/47666 %U https://formative.jmir.org/2023/1/e47666 %U https://doi.org/10.2196/47666 %U http://www.ncbi.nlm.nih.gov/pubmed/37707942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43099 %T The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study %A Wang,Jitao %A Wu,Zhenke %A Choi,Sung Won %A Sen,Srijan %A Yan,Xinghui %A Miner,Jennifer A %A Sander,Angelle M %A Lyden,Angela K %A Troost,Jonathan P %A Carlozzi,Noelle E %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48103, United States, 1 7347638917, carlozzi@med.umich.edu %K caregiver %K just-in-time adaptive intervention %K JITAI %K mobile health intervention %K health-related quality of life %K HRQOL %K intervention %K self-management %K quality of life %K psychological %K effectiveness %K acceptability %K feasibility %K design %K anxiety %K depression %K quality of life %K QOL %K affect %K medication %K pharma %K rehab %K wearable %K ubiquitous %K accelerometer %K sleep %K polysomnography %K PROMIS Anxiety %K PROMIS Depression %K computer adaptive test %K CAT %K generalized estimating equations %K GEE %K weighted and centered least square %K WCLS %D 2023 %7 14.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers’ health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. Objective: The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. Methods: We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. Results: We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of –6.31 (95% CI –11.76 to –0.12; P=.046). In addition, we found that the caregiver groups and the participants’ levels of depression in the previous week moderated JITAI efficacy. Conclusions: This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 %M 37707948 %R 10.2196/43099 %U https://formative.jmir.org/2023/1/e43099 %U https://doi.org/10.2196/43099 %U http://www.ncbi.nlm.nih.gov/pubmed/37707948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41610 %T Patients With Rare Diseases and the Power of Online Support Groups: Implications for the Medical Community %A Ashtari,Sadaf %A Taylor,Adam %+ Information Systems and Business Analytics department, California State University, Sacramento, 6000 J Street, Tahoe Hall 2086, Sacramento, CA, 95819, United States, 1 9162787102, sadaf.ashtari@csus.edu %K application development %K chronic pain %K database %K EDS %K Ehlers-Danlos syndrome %K genetic disorders %K health care provider %K information technology %K online peer support group %K privacy and security %D 2023 %7 14.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have shown positive tangible health benefits from using online support communities for informational support, daily living support, and emotional support. The specifics of how these communities can be improved have not been studied in detail. Objective: This study will investigate various sources of information that patients with genetic disorders use to learn more about their condition. We will be using patients with Ehlers-Danlos Syndrome (EDS) as a typical representation of the wider group of patients with genetic disorders. This study will also investigate the benefits and disadvantages of web-based platforms and how they can be improved. Methods: We used quantitative and qualitative analyses in this study. We undertook a web-based questionnaire survey and semistructured qualitative interviews through Zoom. Questionnaire results were analyzed using descriptive analysis. Thematic coding with constant comparison was used for interview transcript analysis. Results: A total of 436 respondents completed some or all of the survey. The majority of participants are female (386/413, 93.46%), and 24% (99/413) of them are in the age range of 25-34 years. Around 81% (336/413) of the participants have some type of college degree, and 55% (227/413) of them have graduate degrees. About 49.31% (204/413) of them are not currently employed. Most patients stated that their health care providers did not give accurate and complete information to them regarding their health situation (mean 2.87, SD 1.34). Also, patients perceived their providers as not knowledgeable regarding web-based communities that discuss patients’ conditions (mean 1.93, SD 1.15). Patients are confident in using health care resources available in web-based health communities (mean 3.78, SD 1.13). We interviewed 30 participants. The demographics of the interviewees were aligned with those of the survey participants. A total of 9 different themes were identified based on the Qualtrics survey and qualitative interviews. Participants shared the pros and cons of different online support groups that they were using and gave suggestions for improvement. They requested a centralized database with different categories of resources classified based on different diseases. They also emphasized the importance of search features and the ability to find relevant information with a hashtag. Furthermore, they elaborated on the privacy and security concerns they have regarding web-based support group platforms. Conclusions: Patients with rare diseases are finding information not available from their health care providers in community support groups. The medical community and web developers have a great opportunity to help these people by engaging with their web-based communities. %M 37707878 %R 10.2196/41610 %U https://formative.jmir.org/2023/1/e41610 %U https://doi.org/10.2196/41610 %U http://www.ncbi.nlm.nih.gov/pubmed/37707878 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49115 %T Impact on Knowledge, Competence, and Performance of a Faculty-Led Web-Based Educational Activity for Type 2 Diabetes and Obesity: Questionnaire Study Among Health Care Professionals and Analysis of Anonymized Patient Records %A Okemah,Jennifer %A Neunie,Sola %A Noble,Alexander %A Wysham,Carol %+ Rockwood Center for Diabetes and Endocrinology, 400 E 5th Ave #4, Spokane, WA, 99202, United States, 1 509 838 2531, Carol.Wysham@multicare.org %K continuing medical education %K incretin-based therapy %K multidisciplinary care %K obesity %K overweight %K type 2 diabetes %K patient data %K diabetes management %K patient education %K chronic disease %K web-based education %K digital education %K health education %K diabetes %K diabetes mellitus %K survey %K web-based survey %K education %K glycemic %D 2023 %7 13.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Strategies for managing type 2 diabetes (T2D) and obesity are evolving with the introduction of targeted therapies, including incretin-based dual agonists and growing knowledge of the importance of multidisciplinary care. Accessible, effective continuing medical education (CME) activities are required to ensure that health care professionals (HCPs) understand and can implement the most recent data to optimize patient outcomes. Objective: We aimed to measure changes in knowledge, competence, and self-reported performance and quantitatively evaluate changes in performance using anonymized patient data following participation in a web-based educational activity. The faculty-led CME-accredited activity was based on incretin-based dual agonists and patient education on T2D and obesity. The remaining educational gaps in this field were also identified. Methods: A CME-accredited, web-based, multidisciplinary (touchMDT) educational activity titled “The future for glycemic control and weight loss in T2D and obesity: Incretin-based dual-agonists and optimizing patient education” was developed. HCP knowledge, competence, and performance were assessed before and after the activity against Moore’s expanded outcomes framework (levels 1-5), using self-reported questionnaires and by analyzing anonymized patient record data. Results: For evaluating knowledge and competence (50 respondents before and 50 learners after the activity), the mean number of correctly answered questions was significantly higher post activity (median 5.0, IQR 4.0-6.0 to 6.0, IQR 5.0-7.0; mean 4.98, SD 1.22 to 5.78, SD 1.13; P<.001). Modest, nonsignificant improvements in self-reported performance (N=50 respondents preactivity; N=50 learners postactivity) from before to after the activity were observed (median 4.0, IQR 3.25-4.0 to 4.0, IQR 4.0-4.0; mean 3.64, SD 0.69 to 3.76, SD 0.48; P=.32). PPatient data analysis indicated that patients were being treated more intensively postactivity: before the activity, the most commonly used treatment regimens were metformin monotherapy (13/50, 26%) and dual therapy with metformin plus injectable glucagon-like peptide-1 (GLP-1) receptor agonist (RA; 11/50, 22%); post activity, this changed to dual therapy with metformin plus injectable GLP-1 RA (12/50, 24%) and triple therapy with metformin plus injectable GLP-1 RA plus sodium-glucose cotransporter-2 inhibitor (SGLT2i; 10/50, 20%). In addition, there was an increased number of referrals to a combination of specialists (physicians referred 27%, 8/30 of patients to ≥2 specialists before the activity and 36%, 10/28 to ≥2 specialists post activity). The remaining educational gaps included understanding the biology and psychology of obesity, efficacy and safety data for incretin-based dual agonists, and the role of the diabetes educator or diabetes care and education specialist in managing T2D and obesity. Conclusions: This short, web-based CME activity on the management of T2D and obesity led to improvements in HCP knowledge, competence, and performance. Several remaining unmet needs were identified, which can be used to inform the content of future educational activities in this disease area. %M 37703084 %R 10.2196/49115 %U https://formative.jmir.org/2023/1/e49115 %U https://doi.org/10.2196/49115 %U http://www.ncbi.nlm.nih.gov/pubmed/37703084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42756 %T Identification of Risk Groups for and Factors Affecting Metabolic Syndrome in South Korean Single-Person Households Using Latent Class Analysis and Machine Learning Techniques: Secondary Analysis Study %A Lee,Ji-Soo %A Lee,Soo-Kyoung %+ Big Data Convergence and Open Sharing System, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 889 5710, soo1005s@gmail.com %K latent class analysis %K machine learning %K metabolic syndrome %K risk factor %K single-person households %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid increase of single-person households in South Korea is leading to an increase in the incidence of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases, due to lifestyle changes. It is necessary to analyze the complex effects of metabolic syndrome risk factors in South Korean single-person households, which differ from one household to another, considering the diversity of single-person households. Objective: This study aimed to identify the factors affecting metabolic syndrome in single-person households using machine learning techniques and categorically characterize the risk factors through latent class analysis (LCA). Methods: This cross-sectional study included 10-year secondary data obtained from the National Health and Nutrition Examination Survey (2009-2018). We selected 1371 participants belonging to single-person households. Data were analyzed using SPSS (version 25.0; IBM Corp), Mplus (version 8.0; Muthen & Muthen), and Python (version 3.0; Plone & Python). We applied 4 machine learning algorithms (logistic regression, decision tree, random forest, and extreme gradient boost) to identify important factors and then applied LCA to categorize the risk groups of metabolic syndromes in single-person households. Results: Through LCA, participants were classified into 4 groups (group 1: intense physical activity in early adulthood, group 2: hypertension among middle-aged female respondents, group 3: smoking and drinking among middle-aged male respondents, and group 4: obesity and abdominal obesity among middle-aged respondents). In addition, age, BMI, obesity, subjective body shape recognition, alcohol consumption, smoking, binge drinking frequency, and job type were investigated as common factors that affect metabolic syndrome in single-person households through machine learning techniques. Group 4 was the most susceptible and at-risk group for metabolic syndrome (odds ratio 17.67, 95% CI 14.5-25.3; P<.001), and obesity and abdominal obesity were the most influential risk factors for metabolic syndrome. Conclusions: This study identified risk groups and factors affecting metabolic syndrome in single-person households through machine learning techniques and LCA. Through these findings, customized interventions for each generational risk factor for metabolic syndrome can be implemented, leading to the prevention of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases. In conclusion, this study contributes to the prevention of metabolic syndrome in single-person households by providing new insights and priority groups for the development of customized interventions using classification. %M 37698907 %R 10.2196/42756 %U https://formative.jmir.org/2023/1/e42756 %U https://doi.org/10.2196/42756 %U http://www.ncbi.nlm.nih.gov/pubmed/37698907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47388 %T Digital Platform for Continuous Monitoring of Patients Using a Smartwatch: Longitudinal Prospective Cohort Study %A Bin,Kaio Jia %A De Pretto,Lucas Ramos %A Sanchez,Fábio Beltrame %A De Souza e Castro,Fabio Pacheco Muniz %A Ramos,Vinicius Delgado %A Battistella,Linamara Rizzo %+ Instituto de Medicina Física e Reabilitação, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Domingo de Soto, 100, Jardim Vila Mariana, São Paulo, 04116-040, Brazil, 55 1151807987, kaiobin@gmail.com %K smartwatch %K digital health %K telemedicine %K wearable %K telemonitoring %K mobile health %K General Data Protection Regulation %K GDPR %K Lei Geral de Proteção de Dados %K LGPD %K digital platform %K clinical intervention %K sensitive data %K clinical trial %K mobile phone %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the COVID-19 pandemic, there has been a boost in the digital transformation of the human society, where wearable devices such as a smartwatch can already measure vital signs in a continuous and naturalistic way; however, the security and privacy of personal data is a challenge to expanding the use of these data by health professionals in clinical follow-up for decision-making. Similar to the European General Data Protection Regulation, in Brazil, the Lei Geral de Proteção de Dados established rules and guidelines for the processing of personal data, including those used for patient care, such as those captured by smartwatches. Thus, in any telemonitoring scenario, there is a need to comply with rules and regulations, making this issue a challenge to overcome. Objective: This study aimed to build a digital solution model for capturing data from wearable devices and making them available in a safe and agile manner for clinical and research use, following current laws. Methods: A functional model was built following the Brazilian Lei Geral de Proteção de Dados (2018), where data captured by smartwatches can be transmitted anonymously over the Internet of Things and be identified later within the hospital. A total of 80 volunteers were selected for a 24-week follow-up clinical trial divided into 2 groups, one group with a previous diagnosis of COVID-19 and a control group without a previous diagnosis of COVID-19, to measure the synchronization rate of the platform with the devices and the accuracy and precision of the smartwatch in out-of-hospital conditions to simulate remote monitoring at home. Results: In a 35-week clinical trial, >11.2 million records were collected with no system downtime; 66% of continuous beats per minute were synchronized within 24 hours (79% within 2 days and 91% within a week). In the limit of agreement analysis, the mean differences in oxygen saturation, diastolic blood pressure, systolic blood pressure, and heart rate were −1.280% (SD 5.679%), −1.399 (SD 19.112) mm Hg, −1.536 (SD 24.244) mm Hg, and 0.566 (SD 3.114) beats per minute, respectively. Furthermore, there was no difference in the 2 study groups in terms of data analysis (neither using the smartwatch nor the gold-standard devices), but it is worth mentioning that all volunteers in the COVID-19 group were already cured of the infection and were highly functional in their daily work life. Conclusions: On the basis of the results obtained, considering the validation conditions of accuracy and precision and simulating an extrahospital use environment, the functional model built in this study is capable of capturing data from the smartwatch and anonymously providing it to health care services, where they can be treated according to the legislation and be used to support clinical decisions during remote monitoring. %M 37698916 %R 10.2196/47388 %U https://formative.jmir.org/2023/1/e47388 %U https://doi.org/10.2196/47388 %U http://www.ncbi.nlm.nih.gov/pubmed/37698916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48670 %T A Web-Based, Mail-Order Sexually Transmitted Infection Testing Program: Qualitative Analysis of User Feedback %A Edwards,Abagail %A Nuño,Aries %A Kemp,Christopher %A Tillett,Emily %A Armington,Gretchen %A Fink,Rachel %A Hamill,Matthew M %A Manabe,Yukari C %+ Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington St, Baltimore, MD, 21211, United States, 1 443 499 8483, aedwar64@jh.edu %K sexually transmitted infection %K STI %K HIV %K direct-to-consumer screening and testing %K web-based systems %K feedback %K web-based %K user %K testing program %D 2023 %7 11.9.2023 %9 Short Paper %J JMIR Form Res %G English %X Background: The incidence of sexually transmitted infections (STIs) is increasing in the United States. The COVID-19 pandemic resulted in significant reductions in access to health care services, including STI testing and treatment, leading to underreporting of STI cases and a need for alternatives to clinic-based testing. Moreover, concerns around confidentiality, accessibility, and stigma continue to limit access to clinic-based STI testing, particularly for high-priority populations. IWantTheKit (IWTK) is a web-based platform that mails free, confidential, self-administered sample collection kits for testing for gonorrhea, chlamydia (both genital and extragenital sites), and vaginal trichomonas. Individuals visiting the IWTK website may select genital, pharyngeal, and rectal samples for chlamydia and gonorrhea testing. Vaginal samples are tested for trichomoniasis. Self-collected samples are processed in a College of American Pathologists–accredited laboratory, and results are posted to an individual’s secure digital account. Objective: This study aimed to (1) describe users’ experience with the IWTK service through analysis of routine data and (2) optimize retention among current users and expand reach among high-priority populations by responding to user needs through programmatic and functional changes to the IWTK service. Methods: Free-text entries were submitted by IWTK users via a confidential “Contact Us” page on the IWTK website from May 17, 2021, to January 31, 2022. All entries were deidentified prior to analysis. Two independent analysts coded these entries using a predefined codebook developed inductively for thematic analysis. Results: A total of 254 free-text entries were analyzed after removing duplicates and nonsensical entries. Themes emerged regarding the functionality of the website and personal experiences using IWTK’s services. Users’ submissions included requests related to order status, address changes, replacement of old kits, clinical information (eg, treatment options and symptom reports), and reported risk behaviors. Conclusions: This analysis demonstrates how routine data can be used to propose potential programmatic improvements. IWTK implemented innovations on the website based on the study results to improve users’ experience, including a tracking system for orders, address verification for each order, a physical drop box, additional textual information, direct linkage to care navigation, and printable results. Web-based, mail-order STI testing programs can leverage user feedback to optimize implementation and retention among current users and potentially expand reach among high-priority populations. This analysis is supported by other data that demonstrate how comprehensive support and follow-up care for individuals testing positive are critical components of any self-testing service. Additional formal assessments of the IWTK user experience and efforts to optimize posttesting linkage to care may be needed. %M 37695644 %R 10.2196/48670 %U https://formative.jmir.org/2023/1/e48670 %U https://doi.org/10.2196/48670 %U http://www.ncbi.nlm.nih.gov/pubmed/37695644 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47409 %T Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis %A Scholze,Danielle A %A Gosdin,Melissa M %A Perez,Susan L %A Schweitzer,Julie B %+ Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2825 50th St, Sacramento, CA, 95817, United States, 1 916 703 0450, jschweitzer@ucdavis.edu %K ADHD %K pediatric %K adult %K mobile phone %K developmental disorder %K neurodevelopmental %K mental disorder %K information-seeking %K information need %K attention deficit disorder %K hyperactive %K hyperactivity %K interview %K focus group %K think-aloud %K web-based %K online content %K user experience %K information behavior %K web design %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child’s needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. Objective: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. Methods: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. Results: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. Conclusions: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format. %M 37695648 %R 10.2196/47409 %U https://formative.jmir.org/2023/1/e47409 %U https://doi.org/10.2196/47409 %U http://www.ncbi.nlm.nih.gov/pubmed/37695648 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46081 %T Older Veterans’ Experiences of a Multicomponent Telehealth Program: Qualitative Program Evaluation Study %A Rauzi,Michelle R %A Mealer,Meredith L %A Abbate,Lauren M %A Stevens-Lapsley,Jennifer E %A Nearing,Kathryn A %+ Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 13121 E 17th Ave, Aurora, CO, 80045, United States, 1 303 724 9590, michelle.rauzi@cuanschutz.edu %K telehealth %K multimorbidity %K older adults %K veteran health %K physical therapy %D 2023 %7 8.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are 8.8 million American veterans aged >65 years. Older veterans often have multiple health conditions that increase their risk of social isolation and loneliness, disability, adverse health events (eg, hospitalization and death), mental illness, and heavy health care use. This population also exhibits low levels of physical function and daily physical activity, which are factors that can negatively influence health. Importantly, these are modifiable risk factors that are amenable to physical therapy intervention. We used a working model based on the dynamic biopsychosocial framework and social cognitive theory to conceptualize the multifactorial needs of older veterans with multiple health conditions and develop a novel, 4-component telehealth program to address their complex needs. Objective: This study aims to describe veterans’ experiences of a multicomponent telehealth program and identify opportunities for quality and process improvement. We conducted qualitative interviews with telehealth program participants to collect their feedback on this novel program; explore their experience of program components; and document perceived outcomes and the impact on their daily life, relationships, and quality of life. Methods: As part of a multimethod program evaluation, semistructured interviews were conducted with key informants who completed ≥8 weeks of the 12-week multicomponent telehealth program for veterans aged ≥50 years with at least 3 medical comorbidities. Interviews were audio recorded and transcribed. Data were analyzed by a team of 2 coders using a directed content analysis approach and Dedoose software was used to assist with data analysis. Results: Of the 21 individuals enrolled in the program, 15 (71%) met the inclusion criteria for interviews. All 15 individuals completed 1-hour interviews. A total of 6 main conceptual domains were identified: technology, social networks, therapeutic relationship, patient attributes, access, and feasibility. Themes associated with each domain detail participant experiences of the telehealth program. Key informants also provided feedback related to different components of the program, leading to adaptations for the biobehavioral intervention, group sessions (transition from individual to group sessions and group session dynamics), and technology supports. Conclusions: Findings from this program evaluation identified quality and process improvements, which were made before rigorously testing the intervention in a larger population through a randomized controlled trial. The findings may inform adaptations of similar programs in different contexts. Further research is needed to develop a deeper understanding of how program components influence social health and longer-term behavior change. %M 37682595 %R 10.2196/46081 %U https://formative.jmir.org/2023/1/e46081 %U https://doi.org/10.2196/46081 %U http://www.ncbi.nlm.nih.gov/pubmed/37682595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45161 %T Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study %A Chong,Min K %A Hickie,Ian B %A Cross,Shane P %A McKenna,Sarah %A Varidel,Mathew %A Capon,William %A Davenport,Tracey A %A LaMonica,Haley M %A Sawrikar,Vilas %A Guastella,Adam %A Naismith,Sharon L %A Scott,Elizabeth M %A Iorfino,Frank %+ Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 291142199, min.chong@sydney.edu.au %K clinical staging %K digital health solution %K online diagnosis %K service transformation %K staged care %K stratified care %K youth mental health %D 2023 %7 8.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals’ risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. Objective: The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. Methods: We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm’s allocation based on a multidimensional self-report questionnaire. Results: Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts’ ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. Conclusions: This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention. %M 37682588 %R 10.2196/45161 %U https://formative.jmir.org/2023/1/e45161 %U https://doi.org/10.2196/45161 %U http://www.ncbi.nlm.nih.gov/pubmed/37682588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47917 %T Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: Latent Profile Analysis %A Gliske,Kate %A Berry,Katie R %A Ballard,Jaime %A Schmidt,Clare %A Kroll,Elizabeth %A Kohlmeier,Jonathan %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health Inc, 233 E Main St, Ste 233, Bozeman, MT, 59715-5045, United States, 1 9523341411, kgliske@umn.edu %K youth %K young adult %K virtual %K mental health %K intensive outpatient treatment %K latent profile analysis %K personalized treatment %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. Objective: This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. Methods: Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. Results: Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66%; high acuity+moderate self-harm: n=203, 6.94%; high acuity+high self-harm: n=326, 11.15%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low–self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate–self-harm and high-acuity+high–self-harm profiles (ꭓ23=27.6, P<.001). Individuals in the high-acuity+low–self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (ꭓ23=13.4, P=.004). Finally, those in the high-acuity+high–self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (ꭓ23=71.12, P<.001). Conclusions: This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations. %M 37676700 %R 10.2196/47917 %U https://formative.jmir.org/2023/1/e47917 %U https://doi.org/10.2196/47917 %U http://www.ncbi.nlm.nih.gov/pubmed/37676700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43825 %T Leveraging the Black Girls Run Web-Based Community as a Supportive Community for Physical Activity Engagement: Mixed Methods Study %A Kalinowski,Jolaade %A Idiong,Christie %A Blackman-Carr,Loneke %A Cooksey Stowers,Kristen %A Davis,Shardé %A Pan,Cindy %A Chhabra,Alisha %A Eaton,Lisa %A Gans,Kim M %A Alexander,Jay Ell %A Pagoto,Sherry %+ Department of Human Development and Family Sciences, The University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, United States, 1 2032518421, jolaade.kalinowski@uconn.edu %K physical activity %K social media %K women’s health %K African American women %K mHealth %K mobile health %K Facebook %K African American %K exercise %K web-based community %K web-based communities %K content analysis %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: About 59%-73% of Black women do not meet the recommended targets for physical activity (PA). PA is a key modifiable lifestyle factor that can help mitigate risk for chronic diseases such as obesity, diabetes, and hypertension that disproportionately affect Black women. Web-based communities focused on PA have been emerging in recent years as web-based gathering spaces to provide support for PA in specific populations. One example is Black Girls Run (BGR), which is devoted to promoting PA in Black women. Objective: The purpose of this study was to describe the content shared on the BGR public Facebook page to provide insight into how web-based communities engage Black women in PA and inform the development of web-based PA interventions for Black women. Methods: Using Facebook Crowdtangle, we collected posts (n=397) and associated engagement data from the BGR public Facebook page for the 6-month period between June 1, 2021, and December 31, 2021. We pooled data in Dedoose to analyze the qualitative data and conducted a content analysis of qualitative data. We quantified types of posts, post engagement, and compared post types on engagement: “like,” “love,” “haha,” “wow,” “care,” “sad,” “angry,” “comments,” and “shares.” Results: The content analysis revealed 8 categories of posts: shout-outs to members for achievements (n=122, 31%), goals or motivational (n=65, 16%), announcements (n=63, 16%), sponsored or ads (n=54, 14%), health related (n=47, 11%), the lived Black experience (n=23, 6%), self-care (n=15, 4%), and holidays or greetings (n=8, 2%). The 397 posts attracted a total of 55,354 engagements (reactions, comments, and shares). Associations between the number of engagement and post categories were analyzed using generalized linear models. Shout-out posts (n=22,268) elicited the highest average of total user engagement of 181.7 (SD 116.7), followed by goals or motivational posts (n=11,490) with an average total engagement of 160.1 (SD 125.2) and announcements (n=7962) having an average total engagement of 129.9 (SD 170.7). Significant statistical differences were found among the total engagement of posts (χ72=80.99, P<.001), “like” (χ72=119.37, P<.001), “love” (χ72=63.995, P<.001), “wow” (χ72=23.73, P<.001), “care” (χ72=35.06, P<.001), “comments” (χ72=80.55, P<.001), and “shares” (χ72=71.28, P<.001). Conclusions: The majority of content on the BGR Facebook page (n=250, 63%) was focused on celebrating member achievements, motivating members to get active, and announcing and promoting active events. These types of posts attracted 75% of total post engagement. BGR appears to be a rich web-based community that offers social support for PA as well as culturally relevant health and social justice content. Web-based communities may be uniquely positioned to engage minoritized populations in health behavior. Further research should explore how and if web-based communities such as BGR can be interwoven into health interventions and health promotion. %M 37676722 %R 10.2196/43825 %U https://formative.jmir.org/2023/1/e43825 %U https://doi.org/10.2196/43825 %U http://www.ncbi.nlm.nih.gov/pubmed/37676722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49384 %T Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study %A Huffman,Landry %A Lawrence-Sidebottom,Darian %A Huberty,Jennifer %A Beatty,Clare %A Roots,Monika %A Roots,Kurt %A Parikh,Amit %A Guerra,Rachael %+ Bend Health Inc, 155 Windsor Ct, Athens, GA, 30606, United States, 1 7708619131, landry.huffman@bendhealth.com %K service satisfaction %K satisfaction %K patient-provider %K adolescent %K child %K children %K youth %K mental health %K perceived usefulness %K internet-based coaching %K coach %K coaching %K internet-based therapy %K collaborative care %K digital mental health intervention %K mental health %K engagement %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants’ satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs. Objective: To address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children’s and adolescents’ engagement in the DMHI. Methods: Members (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members. Results: This study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. Conclusions: This study provides valuable preliminary evidence that caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs. %M 37672321 %R 10.2196/49384 %U https://formative.jmir.org/2023/1/e49384 %U https://doi.org/10.2196/49384 %U http://www.ncbi.nlm.nih.gov/pubmed/37672321 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e48254 %T Assessing Health Students' Attitudes and Usage of ChatGPT in Jordan: Validation Study %A Sallam,Malik %A Salim,Nesreen A %A Barakat,Muna %A Al-Mahzoum,Kholoud %A Al-Tammemi,Ala'a B %A Malaeb,Diana %A Hallit,Rabih %A Hallit,Souheil %+ Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Queen Rania Al-Abdullah Street-Aljubeiha, Amman, 11942, Jordan, 962 0791845186, malik.sallam@ju.edu.jo %K artificial intelligence %K machine learning %K education %K technology %K healthcare %K survey %K opinion %K knowledge %K practices %K KAP %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: ChatGPT is a conversational large language model that has the potential to revolutionize knowledge acquisition. However, the impact of this technology on the quality of education is still unknown considering the risks and concerns surrounding ChatGPT use. Therefore, it is necessary to assess the usability and acceptability of this promising tool. As an innovative technology, the intention to use ChatGPT can be studied in the context of the technology acceptance model (TAM). Objective: This study aimed to develop and validate a TAM-based survey instrument called TAME-ChatGPT (Technology Acceptance Model Edited to Assess ChatGPT Adoption) that could be employed to examine the successful integration and use of ChatGPT in health care education. Methods: The survey tool was created based on the TAM framework. It comprised 13 items for participants who heard of ChatGPT but did not use it and 23 items for participants who used ChatGPT. Using a convenient sampling approach, the survey link was circulated electronically among university students between February and March 2023. Exploratory factor analysis (EFA) was used to assess the construct validity of the survey instrument. Results: The final sample comprised 458 respondents, the majority among them undergraduate students (n=442, 96.5%). Only 109 (23.8%) respondents had heard of ChatGPT prior to participation and only 55 (11.3%) self-reported ChatGPT use before the study. EFA analysis on the attitude and usage scales showed significant Bartlett tests of sphericity scores (P<.001) and adequate Kaiser-Meyer-Olkin measures (0.823 for the attitude scale and 0.702 for the usage scale), confirming the factorability of the correlation matrices. The EFA showed that 3 constructs explained a cumulative total of 69.3% variance in the attitude scale, and these subscales represented perceived risks, attitude to technology/social influence, and anxiety. For the ChatGPT usage scale, EFA showed that 4 constructs explained a cumulative total of 72% variance in the data and comprised the perceived usefulness, perceived risks, perceived ease of use, and behavior/cognitive factors. All the ChatGPT attitude and usage subscales showed good reliability with Cronbach α values >.78 for all the deduced subscales. Conclusions: The TAME-ChatGPT demonstrated good reliability, validity, and usefulness in assessing health care students’ attitudes toward ChatGPT. The findings highlighted the importance of considering risk perceptions, usefulness, ease of use, attitudes toward technology, and behavioral factors when adopting ChatGPT as a tool in health care education. This information can aid the stakeholders in creating strategies to support the optimal and ethical use of ChatGPT and to identify the potential challenges hindering its successful implementation. Future research is recommended to guide the effective adoption of ChatGPT in health care education. %M 37578934 %R 10.2196/48254 %U https://mededu.jmir.org/2023/1/e48254 %U https://doi.org/10.2196/48254 %U http://www.ncbi.nlm.nih.gov/pubmed/37578934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43995 %T Using Clinician-Patient WeChat Group Communication Data to Identify Symptom Burdens in Patients With Uterine Fibroids Under Focused Ultrasound Ablation Surgery Treatment: Qualitative Study %A Zhang,Jiayuan %A Xu,Wei %A Lei,Cheng %A Pu,Yang %A Zhang,Yubo %A Zhang,Jingyu %A Yu,Hongfan %A Su,Xueyao %A Huang,Yanyan %A Gong,Ruoyan %A Zhang,Lijun %A Shi,Qiuling %+ School of Public Health, Chongqing Medical University, No 1, Medical College Road, Yuzhong District, Chongqing, 400016, China, 86 18290585397, qshi@cqmu.edu.cn %K social media %K group chats %K text mining %K free texts %K symptom burdens %K WeChat %K natural language processing %K NLP %D 2023 %7 1.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unlike research project–based health data collection (questionnaires and interviews), social media platforms allow patients to freely discuss their health status and obtain peer support. Previous literature has pointed out that both public and private social platforms can serve as data sources for analysis. Objective: This study aimed to use natural language processing (NLP) techniques to identify concerns regarding the postoperative quality of life and symptom burdens in patients with uterine fibroids after focused ultrasound ablation surgery. Methods: Screenshots taken from clinician-patient WeChat groups were converted into free texts using image text recognition technology and used as the research object of this study. From 408 patients diagnosed with uterine fibroids in Chongqing Haifu Hospital between 2010 and 2020, we searched for symptom burdens in over 900,000 words of WeChat group chats. We first built a corpus of symptoms by manually coding 30% of the WeChat texts and then used regular expressions in Python to crawl symptom information from the remaining texts based on this corpus. We compared the results with a manual review (gold standard) of the same records. Finally, we analyzed the relationship between the population baseline data and conceptual symptoms; quantitative and qualitative results were examined. Results: A total of 408 patients with uterine fibroids were included in the study; 190,000 words of free text were obtained after data cleaning. The mean age of the patients was 39.94 (SD 6.81) years, and their mean BMI was 22.18 (SD 2.78) kg/m2. The median reporting times of the 7 major symptoms were 21, 26, 57, 2, 18, 30, and 49 days. Logistic regression models identified preoperative menstrual duration (odds ratio [OR] 1.14, 95% CI 5.86-6.37; P=.009), age of menophania (OR –1.02 , 95% CI 11.96-13.47; P=.03), and the number (OR 2.34, 95% CI 1.45-1.83; P=.04) and size of fibroids (OR 0.12, 95% CI 2.43-3.51; P=.04) as significant risk factors for postoperative symptoms. Conclusions: Unstructured free texts from social media platforms extracted by NLP technology can be used for analysis. By extracting the conceptual information about patients’ health-related quality of life, we can adopt personalized treatment for patients at different stages of recovery to improve their quality of life. Python-based text mining of free-text data can accurately extract symptom burden and save considerable time compared to manual review, maximizing the utility of the extant information in population-based electronic health records for comparative effectiveness research. %M 37656501 %R 10.2196/43995 %U https://formative.jmir.org/2023/1/e43995 %U https://doi.org/10.2196/43995 %U http://www.ncbi.nlm.nih.gov/pubmed/37656501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40197 %T Utility of Smartphone-Based Digital Phenotyping Biomarkers in Assessing Treatment Response to Transcranial Magnetic Stimulation in Depression: Proof-of-Concept Study %A Kelkar,Radhika Suneel %A Currey,Danielle %A Nagendra,Srilakshmi %A Mehta,Urvakhsh Meherwan %A Sreeraj,Vanteemar S %A Torous,John %A Thirthalli,Jagadisha %+ National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India, 91 8026995805, urvakhsh@gmail.com %K theta burst stimulation %K treatment response %K predictive biomarker %K outcome %K digital phenotyping %K transcranial magnetic stimulation %K TMS %K depression %K smartphone %K mobile phone %D 2023 %7 1.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Identifying biomarkers of response to transcranial magnetic stimulation (TMS) in treatment-resistant depression is a priority for personalizing care. Clinical and neurobiological determinants of treatment response to TMS, while promising, have limited scalability. Therefore, evaluating novel, technologically driven, and potentially scalable biomarkers, such as digital phenotyping, is necessary. Objective: This study aimed to examine the potential of smartphone-based digital phenotyping and its feasibility as a predictive biomarker of treatment response to TMS in depression. Methods: We assessed the feasibility of digital phenotyping by examining the adherence and retention rates. We used smartphone data from passive sensors as well as active symptom surveys to determine treatment response in a naturalistic course of TMS treatment for treatment-resistant depression. We applied a scikit-learn logistic regression model (l1 ratio=0.5; 2-fold cross-validation) using both active and passive data. We analyzed related variance metrics throughout the entire treatment duration and on a weekly basis to predict responders and nonresponders to TMS, defined as ≥50% reduction in clinician-rated symptom severity from baseline. Results: The adherence rate was 89.47%, and the retention rate was 73%. The area under the curve for correct classification of TMS response ranged from 0.59 (passive data alone) to 0.911 (both passive and active data) for data collected throughout the treatment course. Importantly, a model using the average of all features (passive and active) for the first week had an area under the curve of 0.7375 in predicting responder status at the end of the treatment. Conclusions: The results of our study suggest that it is feasible to use digital phenotyping data to assess response to TMS in depression. Early changes in digital phenotyping biomarkers, such as predicting response from the first week of data, as shown in our results, may also help guide the treatment course. %M 37656496 %R 10.2196/40197 %U https://formative.jmir.org/2023/1/e40197 %U https://doi.org/10.2196/40197 %U http://www.ncbi.nlm.nih.gov/pubmed/37656496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49806 %T Mobile Technology to Monitor and Support Health and Well-Being: Qualitative Study of Perspectives and Design Suggestions From Patients Undergoing Hematopoietic Cell Transplantation %A Caparso,Cinzia %A Ozkan,Gwynne %A Kluge,Maxwell %A Salim,Humza %A Khaghany,Aidan %A Blok,Amanda %A Choi,Sung Won %+ Department of Systems, Populations and Leadership Center for Improving Patient and Population Health, University of Michigan School of Nursing, 426 N Ingalls St., Ann Arbor, MI, 48014, United States, 1 586 219 1449, ccaparso@umich.edu %K hematopoietic stem cell transplantation %K bone marrow %K surgery %K surgical %K recovery %K mobile apps %K mHealth %K mobile health %K app %K apps %K qualitative research %K qualitative %K experience %K experiences %K perception %K perceptions %K stem cell %K stem cells %K transplant %K transplantation %K transplants %K hematopoietic %K positive psychology %K psychology %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, hematopoietic stem cell transplant (HCT) surpasses 22,000 procedures annually. Due to the demanding and time-intensive process of an HCT, patients and family care partners face unique challenges involving their health and well-being. Positive psychology interventions (PPIs) may offer potential solutions to help boost health and well-being. Objective: This study aimed to explore and understand patients’ experiences and perceptions about the use of the Roadmap 2.0 app, specifically its PPI features, during the acute phase of HCT. Methods: From an ongoing randomized controlled trial, HCT patients (n=17) were recruited to participate in semistructured qualitative interviews between October 2022 and January 2023 within a large academic medical center in the Midwestern states. Using a qualitative descriptive approach, interviews were conducted in person or via Zoom. The data were analyzed through constant comparative analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: The majority of the participants reported Roadmap 2.0 as easy to use and enjoyed the ability to track their health data (eg, steps, mood, sleep; 9/17). Regarding the use of PPIs during the acute phase of treatment, 88% of the participants reported interest in participating in PPIs, specifically the Pleasant Activity Scheduling (11/17) followed by Gratitude Journaling (7/17) activities. Additionally, participants provided recommendations on adapting Roadmap 2.0. The major recommendations were (1) “Working Together: Need for Dyadic Involvement,” (2) “Connectivity with Other Patients,” and (3) “Gap in Nutritional Support.” Participants (10/17) expressed the importance of caregiver involvement in activities beyond treatment-related management for maintaining healthy patient-caregiver dyadic relationships. They also expressed their desire for connectivity with other patients undergoing HCT, primarily for comparing experiences and discussing topics such as symptom management (8/17). Lastly, participants identified a gap in nutritional support during the HCT process and expressed interest in an intervention that could promote healthy eating through education and notification reminders (9/17). Conclusions: Participants openly expressed their eagerness to participate in research studies that foster connection and positive relationships with their caregivers as well as with other HCT patients. They emphasized the significance of having access to nutritional support or guidance and highlighted the potential benefits of using mobile technology to enhance these collective efforts. Trial Registration: ClinicalTrials.gov NCT04094844; https://clinicaltrials.gov/study/NCT04094844 International Registered Report Identifier (IRRID): RR2-10.2196/19288 %M 37651172 %R 10.2196/49806 %U https://formative.jmir.org/2023/1/e49806 %U https://doi.org/10.2196/49806 %U http://www.ncbi.nlm.nih.gov/pubmed/37651172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47126 %T Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study %A Listiyandini,Ratih Arruum %A Andriani,Annisa %A Kusristanti,Chandradewi %A Moulds,Michelle %A Mahoney,Alison %A Newby,Jill M %+ School of Psychology, Faculty of Science, University of New South Wales, Mathews Building, Entry Via Gate 11 Botany Street, Sydney, 2052, Australia, 61 2 9385 3041, r.listiyandini@unsw.edu.au %K psychological distress %K mindfulness %K cultural adaptation %K internet-delivered %K students %K Indonesia %K mobile phone %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed. Objective: In this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students’ psychological distress. Methods: To assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire. Results: In study 1, most Indonesian university students (240/248, 96.8%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9%) preferred the length of the program to be 3 to 4 sessions, with 45.8% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students’ emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program’s delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created. Conclusions: This study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs’ content and delivery. Future research is now needed to evaluate the clinical benefit of this program. %M 37651168 %R 10.2196/47126 %U https://formative.jmir.org/2023/1/e47126 %U https://doi.org/10.2196/47126 %U http://www.ncbi.nlm.nih.gov/pubmed/37651168 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42101 %T Usefulness of Self-Assessment of Gastrointestinal Symptoms: Web-Based Study in Anhui, China %A Guan,Xiaoqin %A Xue,Qun %A Ma,Huan %A Li,Guocheng %A Xu,Xiuze %A Zhang,Kexin %A Tang,Mengsha %A Liu,Rong %A Wang,Debin %A Shen,Xingrong %+ School of Health Service Management, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui, 230032, China, 86 13505612172, xinrongshen@sina.com %K gastrointestinal symptoms %K health care seeking %K symptoms reporting %K web-based self-assessment %K China %D 2023 %7 30.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Gastrointestinal symptoms (GISs) are caused by a combination of biopsychosocial factors and are highly prevalent worldwide. Given their complex nature, coupled with ineffective communication of diagnoses by physicians, patients with intimate GISs often feel stigmatized. This, in turn, can inhibit their ability to express their thoughts and feelings adequately, leading them to over- or underreport their symptoms. Moreover, selective service-seeking for and reporting of GISs have a direct bearing on the stage of disease at presentation and, consequently, on the overall prognosis. Objective: This study aimed to investigate the usefulness of a web-based self-assessment of GISs as a supplementary means to cope with potential over- or underreporting during routine consultations. Methods: GIS data were collected using a novel web-based self-assessment tool (n=475) and from nonparticipative observation of doctor-patient consultations (n=447) and household surveys (n=10,552) in Anhui, China. Data analysis focused primarily on the description of the composition of respondents and the occurrence rates of GISs by sociodemographics, and by symptom solicitation methods and settings. Chi-square power tests were used when necessary to compare differences in the occurrence rates between relevant groups. The level of significance for the 2-sided test was set at α<.05. Results: The average occurrence rates of both upper and lower GISs derived from the web-based self-assessment were higher than those from the observation (upper GISs: n=661, 20.9% vs n=382, 14.2%; P<.001; lower GISs: n=342, 12.9% vs n=250, 10.8%; P=.02). The differences in 6 of the 9 upper GISs and 3 of the 11 lower GISs studied were tested with statistical significance (P<.05); moreover, a higher frequency rate was recorded for symptoms with statistical significance via self-assessment than via observation. For upper GISs, the self-assessed versus observed differences ranged from 17.1% for bloating to 100% for bad mood after a meal, while for lower GISs, the differences ranged from −50.5% for hematochezia or melena to 100% for uncontrollable stool. Stomachache, regurgitation, and dysphagia had higher occurrence rates among participants of the self-assessment group than those of the household survey group (20% vs 12.7%, 14% vs 11%, and 3% vs 2.3%, respectively), while the opposite was observed for constipation (5% vs 10.9%), hematochezia or melena (4% vs 5%), and anorexia (4% vs 5.2%). All differences noted in the self-assessed occurrence rates of specific, persistent GISs between sociodemographic groups were tested for nonsignificance (P>.05), while the occurrence rates of any of the 6 persistent GISs among respondents aged 51-60 years was statistically higher than that among other age groups (P=.03). Conclusions: The web-based self-assessment tool piloted in this study is useful and acceptable for soliciting more comprehensive GISs, especially symptoms with concerns about stigmatization, privacy, and shame. Further studies are needed to integrate the web-based self-assessment with routine consultations and to evaluate its efficacy. %M 37583117 %R 10.2196/42101 %U https://formative.jmir.org/2023/1/e42101 %U https://doi.org/10.2196/42101 %U http://www.ncbi.nlm.nih.gov/pubmed/37583117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45004 %T Adapting the Diabetes Prevention Program for Older Adults: Descriptive Study %A Beasley,Jeannette M %A Johnston,Emily A %A Costea,Denisa %A Sevick,Mary Ann %A Rogers,Erin S %A Jay,Melanie %A Zhong,Judy %A Chodosh,Joshua %+ Department of Nutrition and Food Studies, New York University Steinhardt School of School of Culture, Education, and Human Development, 411 Lafayette Street, 526, New York, NY, 10003, United States, 1 2129985782, jbeasley@nyu.edu %K aging %K diabetes prevention program %K nutrition %K diet %K physical activity %K weight loss %K weight %K exercise %K diabetes %K prevention %K diabetic %K ageing %K older adult %K online intervention %K digital intervention %K virtual delivery %K lifestyle coach %K group-based intervention %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prediabetes affects 26.4 million people aged 65 years or older (48.8%) in the United States. Although older adults respond well to the evidence-based Diabetes Prevention Program, they are a heterogeneous group with differing physiological, biomedical, and psychosocial needs who can benefit from additional support to accommodate age-related changes in sensory and motor function. Objective: The purpose of this paper is to describe adaptations of the Centers for Disease Control and Prevention’s Diabetes Prevention Program aimed at preventing diabetes among older adults (ages ≥65 years) and findings from a pilot of 2 virtual sessions of the adapted program that evaluated the acceptability of the content. Methods: The research team adapted the program by incorporating additional resources necessary for older adults. A certified lifestyle coach delivered 2 sessions of the adapted content via videoconference to 189 older adults. Results: The first session had a 34.9% (38/109) response rate to the survey, and the second had a 34% (30/88) response rate. Over three-quarters (50/59, 85%) of respondents agreed that they liked the virtual program, with 82% (45/55) agreeing that they would recommend it to a family member or a friend. Conclusions: This data will be used to inform intervention delivery in a randomized controlled trial comparing in-person versus virtual delivery of the adapted program. %M 37642989 %R 10.2196/45004 %U https://formative.jmir.org/2023/1/e45004 %U https://doi.org/10.2196/45004 %U http://www.ncbi.nlm.nih.gov/pubmed/37642989 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46508 %T Evaluating a Smartphone App (MeT4VeT) to Support the Mental Health of UK Armed Forces Veterans: Feasibility Randomized Controlled Trial %A Parkes,Steven %A Croak,Bethany %A Brooks,Samantha K %A Stevelink,Sharon A M %A Leightley,Daniel %A Fear,Nicola T %A Rafferty,Laura %A Greenberg,Neil %+ King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 0207848 ext 5335, steven.j.parkes@kcl.ac.uk %K military %K veteran %K mental health %K military to civilian transition %K digital health %K mobile apps %K smartphone %K mobile phone %K mobile health %K mHealth %K digital intervention %K support %K app %K feasibility %K acceptability %K engagement %K usability %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. Objective: A feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. Methods: Participants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. Results: In total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. Conclusions: The results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. Trial Registration: ClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT05993676 %M 37639295 %R 10.2196/46508 %U https://mental.jmir.org/2023/1/e46508 %U https://doi.org/10.2196/46508 %U http://www.ncbi.nlm.nih.gov/pubmed/37639295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43993 %T Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study %A Wong,Willis %A Ming,David %A Pateras,Sara %A Fee,Casey Holmes %A Coleman,Cara %A Docktor,Michael %A Shah,Nirmish %A Antonelli,Richard %+ Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, United States, 1 4088398691, williswong1993@gmail.com %K mobile health %K mHealth %K complex care %K care coordination %K digital health tools %K simulation %K family-centered design %K user-centered design %K participatory design %K co-design %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Care for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record–integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. Objective: This study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. Methods: Caregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non–English-speaking users. Results: A Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. Conclusions: Internet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development. %M 37639303 %R 10.2196/43993 %U https://formative.jmir.org/2023/1/e43993 %U https://doi.org/10.2196/43993 %U http://www.ncbi.nlm.nih.gov/pubmed/37639303 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40260 %T A Digital Counselor-Delivered Intervention for Substance Use Among People With HIV: Development and Usability Study %A Hutton,Heidi E %A Aggarwal,Saavitri %A Gillani,Afroza %A Chander,Geetanjali %+ Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, United States, 1 443 287 2874, hhutton@jhmi.edu %K computer-delivered intervention %K HIV %K substance use %K virtual counselor %K motivational interviewing %K people with HIV %K substance misuse %K virtual intervention %K evidence-based care %K engagement %K health outcome %K support %K behavioral intervention %K medical counseling %K patient care %K virtual care %K counseling %K mHealth %K telecounseling %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes. Objective: We aim to develop and pilot a digital counselor–delivered brief intervention for people with HIV who use drugs, called “C-Raven,” which is theory grounded and uses evidence-based practices for behavior change. Methods: Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor. Results: Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a “Raven,” digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again. Conclusions: CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants’ ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care. %M 37639294 %R 10.2196/40260 %U https://formative.jmir.org/2023/1/e40260 %U https://doi.org/10.2196/40260 %U http://www.ncbi.nlm.nih.gov/pubmed/37639294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49738 %T Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study %A Persson,Dan Roland %A Zhukouskaya,Katiarina %A Wegener,Anne-Marie Karin %A Jørgensen,Lene Kølle %A Bardram,Jakob Eyvind %A Bækgaard,Per %+ Department of Applied Mathematics and Computer Science, Technical University of Denmark, Richard Petersens Plads, 321, room 112, Kgs. Lyngby, 2800, Denmark, 45 93511423, danrp@dtu.dk %K cocreation %K co-creation %K participatory design %K diabetes %K type 2 diabetes mellitus %K T2DM %K chronic illness %K personalized self-care %K mobile health %K mHealth %K eHealth %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient’s perspective. Objective: The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user’s perspective. The goal was to address the patients’ expressed real-world needs by having the users themselves choose the scope and format of the solutions. Methods: Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. Results: The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. Conclusions: Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making. %M 37624633 %R 10.2196/49738 %U https://formative.jmir.org/2023/1/e49738 %U https://doi.org/10.2196/49738 %U http://www.ncbi.nlm.nih.gov/pubmed/37624633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44810 %T Comparing Literature- and Subreddit-Derived Laboratory Values in Polycystic Ovary Syndrome (PCOS): Validation of Clinical Data Posted on PCOS Reddit Forums %A Emanuel,Rebecca H K %A Docherty,Paul D %A Lunt,Helen %A Campbell,Rebecca E %+ Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand, 64 33692230, rebecca.emanuel@pg.canterbury.ac.nz %K androgens %K clinical treatment %K cohort %K laboratory tests %K medical intervention %K metabolic markers %K online forum %K ovary %K PCOS %K polycystic ovary syndrome %K reddit %K reproductive hormones %K reproductive %K social media %K validation study %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects 4% to 21% of people with ovaries. Inaccessibility or dissatisfaction with clinical treatment for PCOS has led to some individuals with the condition discussing their experiences in specialized web-based forums. Objective: This study explores the feasibility of using such web-based forums for clinical research purposes by gathering and analyzing laboratory test results posted in an active PCOS forum, specifically the PCOS subreddit hosted on Reddit. Methods: We gathered around 45,000 posts from the PCOS subreddit. A random subset of 5000 posts was manually read, and the presence of laboratory test results was labeled. These labeled posts were used to train a machine learning model to identify which of the remaining posts contained laboratory results. The laboratory results were extracted manually from the identified posts. These self-reported laboratory test results were compared with values in the published literature to assess whether the results were concordant with researcher-published values for PCOS cohorts. A total of 10 papers were chosen to represent published PCOS literature, with selection criteria including the Rotterdam diagnostic criteria for PCOS, a publication date within the last 20 years, and at least 50 participants with PCOS. Results: Overall, the general trends observed in the laboratory test results from the PCOS web-based forum were consistent with clinically reported PCOS. A number of results, such as follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone, were concordant with published values for patients with PCOS. The high consistency of these results among the literature and when compared to the subreddit suggests that follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone are more consistent across PCOS phenotypes than other test results. Some results, such as testosterone, sex hormone–binding globulin, and homeostasis model assessment–estimated insulin resistance index, were between those of PCOS literature values and normal values, as defined by clinical testing limits. Interestingly, other results, including dehydroepiandrosterone sulfate, luteinizing hormone, and fasting glucose, appeared to be slightly more dysregulated than those reported in the literature. Conclusions: The differences between the forum-posted results and those published in the literature may be due to the selection process in clinical studies and the possibility that the forum disproportionally describes PCOS phenotypes that are less likely to be alleviated with medical intervention. However, the degree of concordance in most laboratory test values implied that the PCOS web-based forum participants were representative of research-identified PCOS cohorts. This validation of the PCOS subreddit grants the possibility for more research into the contents of the subreddit and the idea of undertaking similar research using the contents of other medical internet forums. %M 37624626 %R 10.2196/44810 %U https://formative.jmir.org/2023/1/e44810 %U https://doi.org/10.2196/44810 %U http://www.ncbi.nlm.nih.gov/pubmed/37624626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43676 %T Acceptability of the LetSync App Wireframes for an mHealth Intervention to Improve HIV Care Engagement and Treatment Among Black Partnered Sexual Minority Men: Findings from In-Depth Qualitative Interviews %A Becker,Nozipho %A Kim,Hyunjin C %A Bright,Darius J %A Williams III,Robert %A Anguera,Joaquin A %A Arnold,Emily A %A Saberi,Parya %A Neilands,Torsten B %A Pollack,Lance M %A Tan,Judy Y %+ Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States, 1 415 502 1000 ext 17163, judy.tan@ucsf.edu %K digital health %K mobile health %K mHealth %K mobile app %K app %K Black sexual minority men %K couples %K HIV care engagement %K HIV treatment %K United States %K mobile phone %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care. Objective: We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app. Methods: We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement. Results: Participants indicated interest in the future LetSync app and noted that the wireframes’ features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users’ engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner’s health needs, including access to and use of health care services; and facilitate participants’ ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV. Conclusions: Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services. %M 37624634 %R 10.2196/43676 %U https://formative.jmir.org/2023/1/e43676 %U https://doi.org/10.2196/43676 %U http://www.ncbi.nlm.nih.gov/pubmed/37624634 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48113 %T An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study %A Gautam,Kamal %A Paudel,Kiran %A Jacobs,Jerome %A Wickersham,Jeffrey A %A Ikhtiaruddin,Wan Mohd %A Azwa,Iskandar %A Saifi,Rumana %A Lim,Sin How %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K chemsex %K party and play %K sexualized drug use %K PartyPack %K harm reduction tool %K men who have sex with men %K Malaysia %K health promotion %K sexual health %K mHealth intervention %K HIV prevention %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chemsex—the use of psychoactive drugs to enhance the sexual experience—is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)–delivered safer chemsex package (“PartyPack”) as a sexual harm reduction strategy among men who have sex with men in Malaysia—a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. %M 37616034 %R 10.2196/48113 %U https://formative.jmir.org/2023/1/e48113 %U https://doi.org/10.2196/48113 %U http://www.ncbi.nlm.nih.gov/pubmed/37616034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46650 %T Pacing Variation in Multistage Ultramarathons: Internet-Based Cross-Sectional Study %A Fariod,Mielad %A Olher,Rafael Reis %A Sousa,Caio Victor %A Scheer,Volker %A Cuk,Ivan %A Nikolaidis,Pantelis Theodoros %A Thuany,Mabliny %A Weiss,Katja %A Knechtle,Beat %+ Medbase St Gallen Am Vadianplatz, Vadianstrasse 26, St Gallen, 9001, Switzerland, 41 715340131, beat.knechtle@hispeed.ch %K ultramarathon %K pacing %K gender difference %K performance %K variation %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Ultramarathon running is the most popular ultraendurance competition in terms of the number of races and runners competing annually worldwide; however, no study has compared pacing and performance over a long period. Objective: This study analyzes the pacing of successful finishers and nonfinishers in multistage ultramarathons worldwide. Methods: A total of 4079 athletes (men=3288; women=791) competing in 99 multistage ultramarathon events from 1983 to 2021 were analyzed, including the number of participants, age, gender, rank, and running speed of successful finishers. Results: The results showed a significant increase in the number of events (n=338) and a significant increase in the number of finishers and nonfinishers (n=5575) in the ultramarathons worldwide during this period. The general linear models (GLMs) of pacing variation showed nonsignificant effects for gender (F1,36.2=2.5; P=.127; ηp2=0.063) and age group (F10,10=0.6; P=.798; ηp2=0.367), but it showed a significant interaction (gender × age) effect (F10,2689=2.3; P=.008; ηp2=0.009). Post hoc analyses showed that men have a higher pacing variation than women in the under 30 years (U30), U35, U45, and U50 groups. Additionally, the fastest women’s age group (U35) had the lowest pacing variation. The GLM of pacing variation by gender and event distance showed significant effects for both gender (F1,3=18.5; P<.001; ηp2=0.007) and distance (F2,3=20.1; P<.001; ηp2=0.015). Post hoc analyses showed a growing pacing variation with increasing race distance for both men and women. In addition, men had a higher variation in long events. Furthermore, there was a significant main effect for both genders (F1,3=33.7; P<.001; ηp2=0.012) and rank (F1,3=136.6; P<.001; ηp2=0.048) on performance, with men being faster than women. Pacing varied greatly due to gender (F1,3=4.0; P=.047; ηp2=0.001), with a lower (ie, more even) pacing variation for male athletes in the top 3 finishers. Male nonfinishers showed a higher performance than female nonfinishers (F1,1340=25.6; P<.001), and no difference was identified for pacing variation (F1,789=1.5; P=.228) based on gender. In addition, a weak but significant correlation (r=–0.130; P<.001) was identified between the average running speed and pacing variation for both female and male nonfinishers. Conclusions: In summary, multistage ultramarathon competitions showed an increasing number of competitors and a higher performance challenge. Men have a higher pacing (ie, less even) variation than women, especially observed in longer events. A higher pacing variation was associated with lower performance for men, women, and nonfinishers. %M 37610796 %R 10.2196/46650 %U https://formative.jmir.org/2023/1/e46650 %U https://doi.org/10.2196/46650 %U http://www.ncbi.nlm.nih.gov/pubmed/37610796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46043 %T Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study %A Frisby,Caitlin %A Eikelboom,Robert H %A Mahomed-Asmail,Faheema %A Kuper,Hannah %A Moore,David R %A de Kock,Tersia %A Manchaiah,Vinaya %A Swanepoel,De Wet %+ Department of Speech-Language Pathology and Audiology, University of Pretoria, cnr Lynnwood Road and Roper Street, Pretoria, 0028, South Africa, 27 012 420 2357, dewet.swanepoel@up.ac.za %K community-based rehabilitation %K community health care worker %K text message %K messaging %K motivational %K reminder %K acclimatization %K technology use %K hearing aid acclimatization %K hearing aid %K hearing loss %K low- and middle-income countries %K LMIC %K low income %K developing country %K low resource %K hearing %K audiology %K mobile health %K mHealth %K health care workers %K usability %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. %M 37610802 %R 10.2196/46043 %U https://formative.jmir.org/2023/1/e46043 %U https://doi.org/10.2196/46043 %U http://www.ncbi.nlm.nih.gov/pubmed/37610802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47335 %T Barriers and Enablers for Implementation of an Artificial Intelligence–Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews %A Nair,Monika %A Andersson,Jonas %A Nygren,Jens M %A Lundgren,Lina E %+ School of Business, Innovation and Sustainability, Halmstad University, Kristian IV:s väg 3, Halmstad, 30118, Sweden, 46 707227544, lina.lundgren@hh.se %K implementation %K AI systems %K health care %K interviews %K artificial Intelligence %K AI %K decision support tool %K readmission %K prediction %K heart failure %K digital tool %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. Objective: This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Methods: Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Results: Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Conclusions: Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process. %M 37610799 %R 10.2196/47335 %U https://formative.jmir.org/2023/1/e47335 %U https://doi.org/10.2196/47335 %U http://www.ncbi.nlm.nih.gov/pubmed/37610799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45986 %T A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience %A Edwards,Colin %A Borton,Rebecca %A Ross,Anita %A Molloy,Fiona %+ patientMpower Ltd, 10-13 Thomas St, The Digital Hub, Dublin, D08PX8H, Ireland, 353 872599131, colin.edwards@merlinconsulting.ie %K cervical dystonia %K electronic health journal %K user experience %K user acceptance testing %K botulinum toxin %K diary %K acceptability %K user testing %K symptom control %K spasm %K muscle pain %K spasmodic torticollis %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient’s recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. Objective: The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. Methods: In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. Results: A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74%) recorded data for ≥12 weeks and 21 patients (21/34, 62%) for ≥16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients’ perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients’ symptoms did not appear to change after treatment. Conclusions: This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection. %M 37610807 %R 10.2196/45986 %U https://formative.jmir.org/2023/1/e45986 %U https://doi.org/10.2196/45986 %U http://www.ncbi.nlm.nih.gov/pubmed/37610807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43258 %T A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study %A Brown-Johnson,Cati G %A Lessios,Anna Sophia %A Thomas,Samuel %A Kim,Mirini %A Fukaya,Eri %A Wu,Siqi %A Kling,Samantha M R %A Brown,Gretchen %A Winget,Marcy %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 3180 Porter Dr, Palo Alto, CA, 94304, United States, 1 650 736 3394, catibj@stanford.edu %K nursing %K telehealth %K telemedicine %K follow-up %K wound care %K capacity building %K mobile phone %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care–certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care–specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients’ technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. %M 37610798 %R 10.2196/43258 %U https://formative.jmir.org/2023/1/e43258 %U https://doi.org/10.2196/43258 %U http://www.ncbi.nlm.nih.gov/pubmed/37610798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47574 %T User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study %A Nguyen,Thinh Hoang %A Cunha,Priscila Pereira %A Rowland,Annabelle Friedman %A Orenstein,Evan %A Lee,Tricia %A Kandaswamy,Swaminathan %+ Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30322, United States, 1 443 720 9337, swaminathan.kandaswamy@emory.edu %K clinical decision support %K peanut %K peanut introduction %K early peanut introduction %K allergy %K electronic health records %K simulation %K user-centered design %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities. Objective: In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting. Methods: We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS. Results: Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60% with CDS and 0/15, 0% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E–mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P<.001), and providing an emergency treatment plan (P=.003) with CDS guidance. All providers gave at least an adequate score for ease of use of the CDS tool in the after-visit summary. Conclusions: User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in a simulation. %M 37606983 %R 10.2196/47574 %U https://formative.jmir.org/2023/1/e47574 %U https://doi.org/10.2196/47574 %U http://www.ncbi.nlm.nih.gov/pubmed/37606983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46415 %T Internet-Based Recruitment and Retention of Young Adults With Type 1 Diabetes: Cross-Sectional Study %A Griggs,Stephanie %A Ash,Garrett I %A Pignatiello,Grant %A Papik,AnnMarie %A Huynh,Johnathan %A Leuchtag,Mary %A Hickman Jr,Ronald L %+ Case Western Reserve University Frances Payne Bolton School of Nursing, 2120 Cornell Road, Cleveland, OH, 44145, United States, 1 216 385 1244, stephanie.griggs@case.edu %K type 1 diabetes %K internet-based recruitment %K young adult %K diabetes %K diabetic %K type 1 %K recruit %K research platform %K T1D %K social media %K research subject %K research participant %K study participant %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple research strategies are required to recruit and engage a representative cohort of young adults in diabetes research. In this report, we describe an approach for internet-based recruitment for a repeated-measures descriptive study. Objective: The objective of this cross-sectional study was to determine whether internet-based recruitment through multiple social media platforms, a clinical research platform, and cooperation with community partnerships—College Diabetes Network and Beyond Type 1—would serve as an effective way to recruit a representative sample of young adults aged 18-25 years with type 1 diabetes (T1D). Methods: We conducted a repeated-measures descriptive study. We captured enrollment rates and participant characteristics acquired from each social media platform through survey data and Facebook analytics. This study was advertised via paid postings across a combination of different social media platforms (eg, Facebook, Instagram, Twitter, and Reddit). We used quarterly application postings, quarterly newsletters, and participation in the ResearchMatch registry to identify potentially eligible participants from February 3, 2021, to June 6, 2022. Results: ResearchMatch proved to be the most cost-effective strategy overall, yielding the highest gender and racial diversity compared to other internet platforms (eg, Facebook, Instagram, Twitter, and Reddit), application postings (eg, Beyond Type 1), and newsletters (eg, College Diabetes Network and a local area college). However, we propose that the combination of these approaches yielded a larger, more diverse sample compared to any individual strategy. Our recruitment cost was US $16.69 per eligible participant, with a 1.27% conversion rate and a 30% eligibility rate. Conclusions: Recruiting young adults with T1D across multiple internet-based platforms was an effective strategy to yield a moderately diverse sample. Leveraging various recruitment strategies is necessary to produce a representative sample of young adults with T1D. As the internet becomes a larger forum for study recruitment, participants from underrepresented backgrounds may continue engaging in research through advertisements on the internet and other internet-based recruitment platforms. %M 37606985 %R 10.2196/46415 %U https://formative.jmir.org/2023/1/e46415 %U https://doi.org/10.2196/46415 %U http://www.ncbi.nlm.nih.gov/pubmed/37606985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42561 %T Qualitative Evaluation of Family Caregivers’ Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality %A Meyer,Kylie %A Gonzalez,Alexander %A Benton,Donna %+ Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States, 1 216 368 1928, knm77@case.edu %K aging %K Alzheimer’s %K Alzheimer %K caregiver %K caregiving %K dementia: digital health %K digital intervention %K family care %K informal care %K intervention %K older adult %K quality of care %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships. Objective: The purpose of this study is to describe caregivers’ experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing. Methods: Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis. Results: Our findings indicate that caregivers were overall satisfied with KINDER’s focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program’s multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion. Conclusions: Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers’ comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities. %M 37606980 %R 10.2196/42561 %U https://formative.jmir.org/2023/1/e42561 %U https://doi.org/10.2196/42561 %U http://www.ncbi.nlm.nih.gov/pubmed/37606980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48332 %T Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study %A Park,Sangil %A Woo,Ho Geol %A Kim,Soeun %A Kim,Sunyoung %A Lim,Hyunjung %A Yon,Dong Keon %A Rhee,Sang Youl %+ Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 10 3163 1218, yonkkang@gmail.com %K hypertension %K blood pressure %K diabetes %K glucose %K digital health technology %K effectiveness %K application %K blood glucose %K systolic %K diastolic %K management %K consumer %K cost %K monitoring %D 2023 %7 21.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (−5.4 mm Hg, 95% CI −7.0 to −3.9) and DBP (−2.4 mm Hg, 95% CI −3.4 to −1.4) in participants without hypertension and FBG level in all participants (those without diabetes, −4.4 mg/dL, 95% CI −7.9 to −1.0 and those with diabetes, −3.2 mg/dL, 95% CI −5.4 to −1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (−10.9 mg/dL, 95% CI −31.1 to −5.3) compared to those using only a digital health app (P=.006). Conclusions: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring. %M 37603401 %R 10.2196/48332 %U https://formative.jmir.org/2023/1/e48332 %U https://doi.org/10.2196/48332 %U http://www.ncbi.nlm.nih.gov/pubmed/37603401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45820 %T Diagnostic Accuracy and Confidence in Management of Forearm and Hand Fractures Among Foundation Doctors in the Accident and Emergency Department: Survey Study %A Gompels,Ben %A Rusby,Tobin %A Limb,Richard %A Ralte,Peter %+ Wirral University Teaching Hospital, Arrowe Park Road, Liverpool, CH49 5PE, United Kingdom, 44 01516785111, bdg30@cam.ac.uk %K education %K diagnostic accuracy %K doctor %K fracture %K x-ray %K radiograph %K diagnostic error %K patient safety %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate interpretation of radiographs is crucial for junior doctors in the accident and emergency (A&E) department (the emergency medicine department). However, it remains a significant challenge and a leading cause of diagnostic errors. Objective: This study aimed to evaluate the accuracy and confidence of foundation doctors (doctors within their first 2 years of qualifying) in correctly interpreting and managing forearm and hand fractures on plain radiographs. Methods: A total of 42 foundation doctors with less than 2 years of experience and no prior emergency medicine training who worked in a large district general hospital participated in a web-based questionnaire. The questionnaire consisted of 3 case studies: distal radius fracture, scaphoid fracture, and a normal radiograph. Respondents were required to identify the presence or absence of a fracture, determine the fracture location, suggest appropriate management, and rate their confidence on a Likert scale. Results: Overall, 48% (61/126) of respondents accurately identified the presence and location of fractures. The correct management option was chosen by 64% (81/126) of respondents. The median diagnostic confidence score was 4 of 10, with a mean diagnostic certainty of 4.4 of 10. Notably, respondents exhibited a significantly lower confidence score for the normal radiograph compared to the distal radius fracture radiograph (P=.01). Conclusions: This study reveals diagnostic uncertainty among foundation doctors in interpreting plain radiographs, with a notable inclination toward overdiagnosing fractures. The findings emphasize the need for close supervision and senior support to mitigate diagnostic errors. Further training and educational interventions are warranted to improve the accuracy and confidence of junior doctors in radiographic interpretation. This study has several limitations, including a small sample size and reliance on self-reported data. The findings may not be generalizable to other health care settings or specialties. Future research should aim for larger, more diverse samples and explore the impact of specific educational interventions on diagnostic accuracy and confidence. %M 37594796 %R 10.2196/45820 %U https://formative.jmir.org/2023/1/e45820 %U https://doi.org/10.2196/45820 %U http://www.ncbi.nlm.nih.gov/pubmed/37594796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44924 %T Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis %A Fletcher,Richard %A Regan,Casey %A Dizon,Jason %A Leigh,Lucy %+ School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 429 152 405, richard.fletcher@newcastle.edu.au %K attrition %K dropout %K text-based program %K parenting %K fathers %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back “STOP” to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions. Objective: This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers. Methods: Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021. Results: Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included “other reasons” (83/202, 41.1%), followed by “not helpful” (47/202, 23.3%) and “too busy” (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked. Conclusions: Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers’ role may be an important consideration in reducing fathers’ disengagement. %M 37594788 %R 10.2196/44924 %U https://formative.jmir.org/2023/1/e44924 %U https://doi.org/10.2196/44924 %U http://www.ncbi.nlm.nih.gov/pubmed/37594788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46326 %T Effectiveness of an Internet-Based Self-Guided Program to Treat Depression in a Sample of Brazilian Users: Randomized Controlled Trial %A Lopes,Rodrigo T %A da Rocha,Gustavo Chapetta %A Svacina,Maria Adriana %A Meyer,Björn %A Šipka,Dajana %A Berger,Thomas %+ University of Bern, Fabrikstrasse, 8, Clinical Psychology and Psychotherapy Department, Bern, 3012, Switzerland, 41 0787574701, rodrigo.lopes@psy.unibe.ch %K depression %K internet-based interventions %K self-guided interventions %K cognitive behavioral therapy %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is undertreated in Brazil. Deprexis is a self-guided internet-based program used to treat depressive symptoms based on empirically supported integrative and cognitive behavioral therapy. Evidence from a meta-analysis supports Deprexis’ efficacy in German-speaking countries and the United States, but no study has been conducted using this program in countries with low literacy rates and large social disparities. Furthermore, few studies have investigated whether internet-based interventions ameliorate the psychological processes that might underlie depressive symptomatology, such as low perceived self-efficacy. Objective: The main objective of this study was to replicate in Brazil previously reported effects of Deprexis on depressive symptom reduction. Therefore, the main research question was whether Deprexis is effective in reducing depressive symptoms and the general psychological state in Brazilian users with moderate and severe depression in comparison with a control group that does not receive access to Deprexis. A secondary research question was whether the use of Deprexis affects perceptions of self-efficacy. Methods: We interviewed 312 participants recruited over the internet and randomized 189 participants with moderate to severe depression (according to the Patient Health Questionnaire–9 and a semistructured interview) to an intervention condition (treatment as usual plus immediate access to Deprexis for 90 days, n=94) or to a control condition (treatment as usual and delayed access to Deprexis, after 8 weeks, n=95). Results: Participants from the immediate access group logged in at Deprexis an average of 14.81 (SD 12.16) times. The intention-to-treat analysis using a linear mixed model showed that participants who received Deprexis improved significantly more than participants assigned to the delayed access control group on the primary depression self-assessment measure (Patient Health Questionnaire–9; Cohen d=0.80; P<.001) and secondary outcomes, such as general psychological state measure (Clinical Outcome in Routine Evaluation–Outcome Measurement; Cohen d=0.82; P<.001) and the perceived self-efficacy measure (Cohen d=0.63; P<.001). The intention-to-treat analyses showed that 21% (20/94) of the participants achieved remission compared with 7% (7/95) in the control group (P<.001). The deterioration rates were lower in the immediate access control group. The dropout rate was high, but no differences in demographic and clinical variables were found. Participants reported a medium to high level of satisfaction with Deprexis. Conclusions: These results replicate previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months in depressed samples of Brazilian users. From a public health perspective, this is important information to expand the reach of internet-based interventions for those who really need them, especially in countries with less access to mental health care. This extends previous research by showing significant effects on perceived self-efficacy. Trial Registration: Registro Brasileiro de Ensaios Clíncos (ReBec) RBR-6kk3bx UTN U1111-1212-8998; https://ensaiosclinicos.gov.br/rg/RBR-6kk3bx/ International Registered Report Identifier (IRRID): RR2-10.1590/1516-4446-2019-0582 %M 37590052 %R 10.2196/46326 %U https://formative.jmir.org/2023/1/e46326 %U https://doi.org/10.2196/46326 %U http://www.ncbi.nlm.nih.gov/pubmed/37590052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45717 %T Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study %A Lee,Frank %A Jain,Jennifer Payaal %A Duthely,Lunthita M %A Ikeda,Janet %A Santos,Glenn-Milo %+ Center on Substance Use and Health, San Francisco Department of Public Health, 25 Van Ness Ave, San Francisco, CA, 94102, United States, 1 8587361717, franklee@berkeley.edu %K Amazon Mechanical Turk %K stimulant use %K alcohol use %K craving %K men who have sex with men %K MSM %K depression %K affect %K HIV %K public health %K gender minority %K psychosocial %K addiction %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. Objective: We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. Methods: Participants who were aged ≥18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. Results: Of 272 participants, 201 (73.9%) identified as male, 134 (49.2%) were MSM, 52 (19.1%) were from racial and ethnic minoritized communities, and 158 (58%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR] 4.61, 95% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95% CI 1.01-1.04), a higher depression score (aOR 1.06, 95% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95% CI 0.037-0.13). Conclusions: Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations. %M 37590045 %R 10.2196/45717 %U https://formative.jmir.org/2023/1/e45717 %U https://doi.org/10.2196/45717 %U http://www.ncbi.nlm.nih.gov/pubmed/37590045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49284 %T A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study %A Jones,Grant %A Herrmann,Felipe %A Nock,Matthew K %+ Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K single-case experiment %K race %K anxiety %K mindfulness %K digital health intervention %K low income %K Black community %K racial disparity %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. Objective: The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. Methods: This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. Results: Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range –0.75 to –0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). Conclusions: This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts. %M 37585252 %R 10.2196/49284 %U https://formative.jmir.org/2023/1/e49284 %U https://doi.org/10.2196/49284 %U http://www.ncbi.nlm.nih.gov/pubmed/37585252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43526 %T Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial %A Law,Yik Wa %A Lok,Rita Hui Ting %A Chiang,Byron %A Lai,Carmen Chui Shan %A Tsui,Sik Hon Matthew %A Chung,Pui Yin Joseph %A Leung,Siu Chung %+ Department of Social Work and Social Administration, University of Hong Kong, RM534, The Jockey Club Tower,, The Centennial Campus, HKU, Pokfulam, Hong Kong, Hong Kong, 852 93029863, flawhk@hku.hk %K self-harm %K suicidal ideation %K volunteers %K mobile app %K thwarted belongingness %K suicide %K youth %K community %K support %K treatment %K effectiveness %K risk %K patient %K intervention %K model %K care %K hospital %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. Objective: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. Methods: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (“apps”), (2) mobile app + volunteer support + TAU (“volunteers”), or (3) TAU only as the control group (“TAU”). They were asked to submit a mobile app–based questionnaire during 4 measurement time points at monthly intervals. Results: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. Conclusions: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial Registration: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078 %M 37585260 %R 10.2196/43526 %U https://formative.jmir.org/2023/1/e43526 %U https://doi.org/10.2196/43526 %U http://www.ncbi.nlm.nih.gov/pubmed/37585260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45952 %T Gender Affirmation–Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study %A Boskey,Elizabeth R %A Quint,Meg %A Xu,Rena %A Kremen,Jessica %A Estrada,Carlos %A Tham,Regina %A Kane,Kaiden %A Reisner,Sari L %+ Division of Gynecology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 617 919 6525, Elizabeth.Boskey@childrens.harvard.edu %K web-based health %K information seeking %K transgender youth %K health communication %K survey %K gender diverse %K youth %K United States %K support %K gender identity %K accessibility %K transgender community %K web-based information %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet. Objective: We aim to understand ways TGD young adults look for web-based information about gender and health. Methods: In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled. Results: Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people. Conclusions: There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community. %M 37581925 %R 10.2196/45952 %U https://formative.jmir.org/2023/1/e45952 %U https://doi.org/10.2196/45952 %U http://www.ncbi.nlm.nih.gov/pubmed/37581925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39525 %T Patients’ Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis %A Madujibeya,Ifeanyi %A Lennie,Terry A %A Pelzel,Jamie %A Moser,Debra K %+ Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, United States, 1 8593340561, ima232@uky.edu %K heart failure %K patients’ experiences %K experience %K satisfaction %K facilitator %K mobile health apps %K mobile app %K health app %K app feature %K mobile health %K cardiology %K cardiovascular %K patient care %K self-management %K patient %K heart %K mHealth %K self-care %K medication %K performance %K feedback %K personalized %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)–related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. Objective: The purpose of this study was to explore patients’ experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods: Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results: Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions: Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care. %M 37581912 %R 10.2196/39525 %U https://formative.jmir.org/2023/1/e39525 %U https://doi.org/10.2196/39525 %U http://www.ncbi.nlm.nih.gov/pubmed/37581912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47968 %T An App to Support Fathers’ Mental Health and Well-Being: User-Centered Development Study %A Liverpool,Shaun %A Eisenstadt,Mia %A Mulligan Smith,Aoife %A Kozhevnikova,Sofia %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, 4-8 Rodney Street London, London, N1 9JH, United Kingdom, 44 7960674724, mia.eisenstadt@annafreud.org %K fathers %K parenting %K apps %K mental health %K well-being %D 2023 %7 14.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Numerous studies describe the popularity and usefulness of parenting programs. In particular, parenting programs are generally viewed as effective for supporting parents’ mental well-being during key transition periods. However, the evidence base for fathers is limited owing to their lack of involvement in parenting programs and scarcity of tailored support. Objective: This paper aimed to describe the co-design process for a universal digital intervention for fathers (fatherli) and the outline of a logic model with its expected outcomes. Methods: Following established guidelines for co-designing and developing complex interventions, we conducted a nonsystematic review of the available literature to gather key information, developed market surveys to assess fathers’ needs and interests, consulted with key stakeholders to obtain expert opinions, and engaged in a rapid iterative prototyping process with app developers. Each step was summarized, and the information was collated and integrated to inform a logic model and the features of the resulting intervention. Results: The steps in the co-design process confirmed a need for and interest in a digital intervention for fathers. In response to this finding, fatherli was developed, consisting of 5 key features: a discussion forum for anyone to post information about various topics (the forum), a socializing platform for fathers to create and engage with others in small groups about topics or points of shared interest (dad hub), a tool for fathers to find other fathers with shared interests or within the same geographic location (dad finder), a resource for fathers to access up-to-date information about topics that interest them (dad wiki), and a portal to book sessions with coaches who specialize in different topics (dad coaching space). The evidence-based logic model proposes that if fatherli is successfully implemented, important outcomes such as increased parental efficacy and mental health help-seeking behaviors may be observed. Conclusions: We documented the co-design and development process of fatherli, which confirmed that it is possible to use input from end users and experts, integrated with theory and research evidence, to create suitable digital well-being interventions for fathers. In general, the key findings suggest that an app that facilitates connection, communication, and psychoeducation may appeal to fathers. Further studies will now focus on acceptability, feasibility, and effectiveness. Feedback gathered during pilot-testing will inform any further developments in the app to increase its applicability to fathers and its usability. %M 37578834 %R 10.2196/47968 %U https://formative.jmir.org/2023/1/e47968 %U https://doi.org/10.2196/47968 %U http://www.ncbi.nlm.nih.gov/pubmed/37578834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45749 %T Investigating Relationships Among Self-Efficacy, Mood, and Anxiety Using Digital Technologies: Randomized Controlled Trial %A Rohde,Judith %A Marciniak,Marta Anna %A Henninger,Mirka %A Homan,Stephanie %A Paersch,Christina %A Egger,Stephan T %A Seifritz,Erich %A Brown,Adam D %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatic, Psychiatric University Hospital Zurich, Lenggstrasse 31, Zurich, 8008, Switzerland, 41 058 384 2111, judith.rohde@uzh.ch %K self-efficacy %K digital intervention %K digital assessment %K EMA %K EMI %K mood %K anxiety %K emotional flexibility %D 2023 %7 14.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital tools assessing momentary parameters and offering interventions in people’s daily lives play an increasingly important role in mental health research and treatment. Ecological momentary assessment (EMA) makes it possible to assess transient mental health states and their parameters. Ecological momentary interventions (EMIs) offer mental health interventions that fit well into individuals’ daily lives and routines. Self-efficacy is a transdiagnostic construct that is commonly associated with positive mental health outcomes. Objective: The aim of our study assessing mood, specific self-efficacy, and other parameters using EMA was 2-fold. First, we wanted to determine the effects of daily assessed moods and dissatisfaction with social contacts as well as the effects of baseline variables, such as depression, on specific self-efficacy in the training group (TG). Second, we aimed to explore which variables influenced both groups’ positive and negative moods during the 7-day study period. Methods: In this randomized controlled trial, we applied digital self-efficacy training (EMI) to 93 university students with elevated self-reported stress levels and daily collected different parameters, such as mood, dissatisfaction with social contacts, and specific self-efficacy, using EMA. Participants were randomized to either the TG, where they completed the self-efficacy training combined with EMA, or the control group, where they completed EMA only. Results: In total, 93 university students participated in the trial. Positive momentary mood was associated with higher specific self-efficacy in the evening of the same day (b=0.15, SE 0.05, P=.005). Higher self-efficacy at baseline was associated with reduced negative mood during study participation (b=–0.61, SE 0.30, P=.04), while we could not determine an effect on positive mood. Baseline depression severity was significantly associated with lower specific self-efficacy over the week of the training (b=–0.92, SE 0.35, P=.004). Associations between higher baseline anxiety with higher mean negative mood (state anxiety: b=0.78, SE 0.38, P=.04; trait anxiety: b=0.73, SE 0.33, P=.03) and lower mean positive mood (b=–0.64, SE 0.28, P=.02) during study participation were found. Emotional flexibility was significantly enhanced in the TG. Additionally, dissatisfaction with social contacts was associated with both a decreased positive mood (b=–0.56, SE 0.15, P<.001) and an increased negative mood (b=0.45, SE 0.12, P<.001). Conclusions: This study showed several significant associations between mood and self-efficacy as well as those between mood and anxiety in students with elevated stress levels, for example, suggesting that improving mood in people with low mood could enhance the effects of digital self-efficacy training. In addition, engaging in 1-week self-efficacy training was associated with increased emotional flexibility. Future work is needed to replicate and investigate the training’s effects in other groups and settings. Trial Registration: ClinicalTrials.gov NCT05617248; https://clinicaltrials.gov/study/NCT05617248 %M 37578827 %R 10.2196/45749 %U https://formative.jmir.org/2023/1/e45749 %U https://doi.org/10.2196/45749 %U http://www.ncbi.nlm.nih.gov/pubmed/37578827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46034 %T Exploring the Impact of Dawn Phenomenon on Glucose-Guided Eating Thresholds in Individuals With Type 2 Diabetes Using Continuous Glucose Monitoring: Observational Study %A Jospe,Michelle R %A Marano,Kari M %A Bedoya,Arianna R %A Behrens,Nick L %A Cigan,Lacey %A Villegas,Vanessa %A Magee,Michelle F %A Marrero,David G %A Richardson,Kelli M %A Liao,Yue %A Schembre,Susan M %+ Lombardi Comprehensive Cancer Center, Georgetown University, 800 Reservoir Rd NW, Washington, DC, 20057, United States, 1 202 444 2223, ss4731@georgetown.edu %K glucose-guided eating %K dawn phenomenon %K eating timing %K eating behavior %K type 2 diabetes %K appetite regulation %K blood glucose self-monitoring %K food intake regulation %K glycemic control %K continuous glucose monitoring %K glucose %K appetite %K diabetes %K diabetic %K type 2 %K monitoring %K blood sugar %K mobile phone %D 2023 %7 11.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Glucose-guided eating (GGE) improves metabolic markers of chronic disease risk, including insulin resistance, in adults without diabetes. GGE is a timed eating paradigm that relies on experiencing feelings of hunger and having a preprandial glucose level below a personalized threshold computed from 2 consecutive morning fasting glucose levels. The dawn phenomenon (DP), which results in elevated morning preprandial glucose levels, could cause typically derived GGE thresholds to be unacceptable or ineffective among people with type 2 diabetes (T2DM). Objective: The aim of this study is to quantify the incidence and day-to-day variability in the magnitude of DP and examine its effect on morning preprandial glucose levels as a preliminary test of the feasibility of GGE in adults with T2DM. Methods: Study participants wore a single-blinded Dexcom G6 Pro continuous glucose monitoring (CGM) system for up to 10 days. First and last eating times and any overnight eating were reported using daily surveys over the study duration. DP was expressed as a dichotomous variable at the day level (DP day vs non-DP day) and as a continuous variable reflecting the percent of days DP was experienced on a valid day. A valid day was defined as having no reported overnight eating (between midnight and 6 AM). ∂ Glucose was computed as the difference in nocturnal glucose nadir (between midnight and 6 AM) to morning preprandial glucose levels. ∂ Glucose ≥20 mg/dL constituted a DP day. Using multilevel modeling, we examined the between- and within-person effects of DP on morning preprandial glucose and the effect of evening eating times on DP. Results: In total, 21 adults (59% female; 13/21, 62%) with non–insulin-treated T2DM wore a CGM for an average of 10.5 (SD 1.1) days. Twenty out of 21 participants (95%) experienced DP for at least 1 day, with an average of 51% of days (SD 27.2; range 0%-100%). The mean ∂ glucose was 23.7 (SD 13.2) mg/dL. People who experience DP more frequently had a morning preprandial glucose level that was 54.1 (95% CI 17.0-83.9; P<.001) mg/dL higher than those who experienced DP less frequently. For within-person effect, morning preprandial glucose levels were 12.1 (95% CI 6.3-17.8; P=.008) mg/dL higher on a DP day than on a non-DP day. The association between ∂ glucose and preprandial glucose levels was 0.50 (95% CI 0.37-0.60; P<.001). There was no effect of the last eating time on DP. Conclusions: DP was experienced by most study participants regardless of last eating times. The magnitude of the within-person effect of DP on morning preprandial glucose levels was meaningful in the context of GGE. Alternative approaches for determining acceptable and effective GGE thresholds for people with T2DM should be explored and evaluated. %M 37566445 %R 10.2196/46034 %U https://formative.jmir.org/2023/1/e46034 %U https://doi.org/10.2196/46034 %U http://www.ncbi.nlm.nih.gov/pubmed/37566445 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47380 %T Understanding Mental Health Clinicians’ Perceptions and Concerns Regarding Using Passive Patient-Generated Health Data for Clinical Decision-Making: Qualitative Semistructured Interview Study %A Nghiem,Jodie %A Adler,Daniel A %A Estrin,Deborah %A Livesey,Cecilia %A Choudhury,Tanzeem %+ College of Computing and Information Science, Cornell Tech, 2 W Loop Rd, New York, NY, 10044, United States, 1 2155953769, daa243@cornell.edu %K digital technology %K clinical decision support %K mobile health %K mHealth %K qualitative research %K mental health %K clinician %K perception %K patient-generated health data %K mobile app %K digital app %K wearables %K mobile phone %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health-tracking tools are changing mental health care by giving patients the ability to collect passively measured patient-generated health data (PGHD; ie, data collected from connected devices with little to no patient effort). Although there are existing clinical guidelines for how mental health clinicians should use more traditional, active forms of PGHD for clinical decision-making, there is less clarity on how passive PGHD can be used. Objective: We conducted a qualitative study to understand mental health clinicians’ perceptions and concerns regarding the use of technology-enabled, passively collected PGHD for clinical decision-making. Our interviews sought to understand participants’ current experiences with and visions for using passive PGHD. Methods: Mental health clinicians providing outpatient services were recruited to participate in semistructured interviews. Interview recordings were deidentified, transcribed, and qualitatively coded to identify overarching themes. Results: Overall, 12 mental health clinicians (n=11, 92% psychiatrists and n=1, 8% clinical psychologist) were interviewed. We identified 4 overarching themes. First, passive PGHD are patient driven—we found that current passive PGHD use was patient driven, not clinician driven; participating clinicians only considered passive PGHD for clinical decision-making when patients brought passive data to clinical encounters. The second theme was active versus passive data as subjective versus objective data—participants viewed the contrast between active and passive PGHD as a contrast between interpretive data on patients’ mental health and objective information on behavior. Participants believed that prioritizing passive over self-reported, active PGHD would reduce opportunities for patients to reflect upon their mental health, reducing treatment engagement and raising questions about how passive data can best complement active data for clinical decision-making. Third, passive PGHD must be delivered at appropriate times for action—participants were concerned with the real-time nature of passive PGHD; they believed that it would be infeasible to use passive PGHD for real-time patient monitoring outside clinical encounters and more feasible to use passive PGHD during clinical encounters when clinicians can make treatment decisions. The fourth theme was protecting patient privacy—participating clinicians wanted to protect patient privacy within passive PGHD-sharing programs and discussed opportunities to refine data sharing consent to improve transparency surrounding passive PGHD collection and use. Conclusions: Although passive PGHD has the potential to enable more contextualized measurement, this study highlights the need for building and disseminating an evidence base describing how and when passive measures should be used for clinical decision-making. This evidence base should clarify how to use passive data alongside more traditional forms of active PGHD, when clinicians should view passive PGHD to make treatment decisions, and how to protect patient privacy within passive data–sharing programs. Clear evidence would more effectively support the uptake and effective use of these novel tools for both patients and their clinicians. %M 37561561 %R 10.2196/47380 %U https://formative.jmir.org/2023/1/e47380 %U https://doi.org/10.2196/47380 %U http://www.ncbi.nlm.nih.gov/pubmed/37561561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e28848 %T A Fast and Minimal System to Identify Depression Using Smartphones: Explainable Machine Learning–Based Approach %A Ahmed,Md Sabbir %A Ahmed,Nova %+ Design Inclusion and Access Lab, North South University, Plot #15, Block #B, Bashundhara, Dhaka, 1229, Bangladesh, 880 1781920068, msg2sabbir@gmail.com %K smartphone %K depression %K explainable machine learning %K low-resource settings %K real-time system %K students %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing robust, pervasive device-based systems developed in recent years to detect depression require data collected over a long period and may not be effective in cases where early detection is crucial. Additionally, due to the requirement of running systems in the background for prolonged periods, existing systems can be resource inefficient. As a result, these systems can be infeasible in low-resource settings. Objective: Our main objective was to develop a minimalistic system to identify depression using data retrieved in the fastest possible time. Another objective was to explain the machine learning (ML) models that were best for identifying depression. Methods: We developed a fast tool that retrieves the past 7 days’ app usage data in 1 second (mean 0.31, SD 1.10 seconds). A total of 100 students from Bangladesh participated in our study, and our tool collected their app usage data and responses to the Patient Health Questionnaire-9. To identify depressed and nondepressed students, we developed a diverse set of ML models: linear, tree-based, and neural network–based models. We selected important features using the stable approach, along with 3 main types of feature selection (FS) approaches: filter, wrapper, and embedded methods. We developed and validated the models using the nested cross-validation method. Additionally, we explained the best ML models through the Shapley additive explanations (SHAP) method. Results: Leveraging only the app usage data retrieved in 1 second, our light gradient boosting machine model used the important features selected by the stable FS approach and correctly identified 82.4% (n=42) of depressed students (precision=75%, F1-score=78.5%). Moreover, after comprehensive exploration, we presented a parsimonious stacking model where around 5 features selected by the all-relevant FS approach Boruta were used in each iteration of validation and showed a maximum precision of 77.4% (balanced accuracy=77.9%). Feature importance analysis suggested app usage behavioral markers containing diurnal usage patterns as being more important than aggregated data-based markers. In addition, a SHAP analysis of our best models presented behavioral markers that were related to depression. For instance, students who were not depressed spent more time on education apps on weekdays, whereas those who were depressed used a higher number of photo and video apps and also had a higher deviation in using photo and video apps over the morning, afternoon, evening, and night time periods of the weekend. Conclusions: Due to our system’s fast and minimalistic nature, it may make a worthwhile contribution to identifying depression in underdeveloped and developing regions. In addition, our detailed discussion about the implication of our findings can facilitate the development of less resource-intensive systems to better understand students who are depressed and take steps for intervention. %M 37561568 %R 10.2196/28848 %U https://formative.jmir.org/2023/1/e28848 %U https://doi.org/10.2196/28848 %U http://www.ncbi.nlm.nih.gov/pubmed/37561568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47950 %T Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study %A Sarhaddi,Fatemeh %A Azimi,Iman %A Niela-Vilen,Hannakaisa %A Axelin,Anna %A Liljeberg,Pasi %A Rahmani,Amir M %+ Department of Computer Science, University of California, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 5011, azimii@uci.edu %K health monitoring %K internet of things %K maternal loneliness %K passive sensing %K wearable device %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child. Objective: The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection. Methods: We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants’ smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction. Results: The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness. Conclusions: Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness. %M 37556183 %R 10.2196/47950 %U https://formative.jmir.org/2023/1/e47950 %U https://doi.org/10.2196/47950 %U http://www.ncbi.nlm.nih.gov/pubmed/37556183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46841 %T The Effectiveness of Improving Infectious Disease–Specific Health Literacy Among Residents: WeChat-Based Health Education Intervention Program %A Zhao,Yusui %A Xu,Shuiyang %A Zhang,Xuehai %A Wang,Lei %A Huang,Yu %A Wu,Shuxian %A Wu,Qingqing %+ Zhejiang Provincial Center for Disease Control and Prevention, Department of Health Education, 3399 Binsheng Road, Hanghzhou, 310051, China, 86 0571 87118439, qqwu@cdc.zj.cn %K effectiveness %K health education %K infectious disease-specific health literacy %K intervention %K WeChat %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Infectious disease–specific health literacy (IDSHL) has become an important determinant of infectious disease incidence. It can not only reduce the incidence of re-emerging infectious diseases, but also effectively prevent the emergence of new infectious diseases such as COVID-19. WeChat, as a new media, has been proven to greatly reduce the chance of infectious diseases spreading from person to person, especially in case of respiratory infections. However, there is currently no concrete health education invention program to improve IDSHL using a WeChat public account. Objective: The aims of this study were as follows: (1) to determine the IDSHL of the population in Zhejiang, China; (2) to develop a health education program for the improvement of IDSHL using a WeChat public account; and (3) to evaluate the effectiveness of the health education program that was implemented in the prevention of infectious disease outbreaks. Methods: We used a standardized questionnaire, which consisted of 28 closed-ended questions, to measure the level and score of IDSHL before and after intervention. A multiple-stage stratified random sampling technique was used to select study participants from Zhejiang province in China, who were further divided randomly into 2 groups: the intervention and control groups. From July 2014 to January 2015, a WeChat-based health education intervention program was carried out on the intervention group. Standard descriptive statistics and chi-square and t tests were conducted to analyze the data. Results: A total of 3001 residents participated in the baseline survey of this study. At baseline, participant IDSHL rates were 73.29% and 72.12% for the intervention and control groups, respectively (Χ21=0.5; P=.50). After 7 months of intervention, 9.90% (297/3001) of participants dropped out of the study. Of the lost participants, 119 were from the intervention group and 178 were from the control group. There were significant differences between follow-up and lost participants with respect to age (P=.04), marital status (P=.02) and occupations (P=.002). After intervention, the intervention group scores in the different domains were higher than those in the control group (infectious disease–related knowledge, prevention, management, or treatment, identification of pathogens and infection sources, and cognitive ability). There were significant improvements in the IDSHL of participants in both the intervention and control groups (Χ21=135.9; P<.001 vs Χ21=9.1; P=.003), and there was a greater change in the IDSHL among the intervention group participants than among the control group participants (1230/1359, 90.51% vs 1038/1359, 77.17%). Conclusions: The health education intervention program using a WeChat public account proved to be an effective, feasible, and well-accepted means to improve the IDSHL of the general population. In the future, this health education intervention program can be used as a reference for prevention and treatment of infectious diseases. %M 37556189 %R 10.2196/46841 %U https://formative.jmir.org/2023/1/e46841 %U https://doi.org/10.2196/46841 %U http://www.ncbi.nlm.nih.gov/pubmed/37556189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44888 %T Changes in Learning From Social Feedback After Web-Based Interpretation Bias Modification: Secondary Analysis of a Digital Mental Health Intervention Among Individuals With High Social Anxiety Symptoms %A Beltzer,Miranda L %A Daniel,Katharine E %A Daros,Alexander R %A Teachman,Bethany A %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, United States, 1 9144622962, miranda.beltzer@northwestern.edu %K social anxiety %K reinforcement learning %K cognitive bias modification %K interpretation bias %K reward learning %K probabilistic learning %K Q-learning %K digital intervention %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Biases in social reinforcement learning, or the process of learning to predict and optimize behavior based on rewards and punishments in the social environment, may underlie and maintain some negative cognitive biases that are characteristic of social anxiety. However, little is known about how cognitive and behavioral interventions may change social reinforcement learning in individuals who are anxious. Objective: This study assessed whether a scalable, web-based cognitive bias modification for interpretations (CBM-I) intervention changed social reinforcement learning biases in participants with high social anxiety symptoms. This study focused on 2 types of social reinforcement learning relevant to social anxiety: learning about other people and learning about one’s own social performance. Methods: Participants (N=106) completed 2 laboratory sessions, separated by 5 weeks of ecological momentary assessment tracking emotion regulation strategy use and affect. Approximately half (n=51, 48.1%) of the participants completed up to 6 brief daily sessions of CBM-I in week 3. Participants completed a task that assessed social reinforcement learning about other people in both laboratory sessions and a task that assessed social reinforcement learning about one’s own social performance in the second session. Behavioral data from these tasks were computationally modeled using Q-learning and analyzed using mixed effects models. Results: After the CBM-I intervention, participants updated their beliefs about others more slowly (P=.04; Cohen d=−0.29) but used what they learned to make more accurate decisions (P=.005; Cohen d=0.20), choosing rewarding faces more frequently. These effects were not observed among participants who did not complete the CBM-I intervention. Participants who completed the CBM-I intervention also showed less-biased updating about their social performance than participants who did not complete the CBM-I intervention, learning similarly from positive and negative feedback and from feedback on items related to poor versus good social performance. Regardless of the intervention condition, participants at session 2 versus session 1 updated their expectancies about others more from rewarding (P=.003; Cohen d=0.43) and less from punishing outcomes (P=.001; Cohen d=−0.47), and they became more accurate at learning to avoid punishing faces (P=.001; Cohen d=0.20). Conclusions: Taken together, our results provide initial evidence that there may be some beneficial effects of both the CBM-I intervention and self-tracking of emotion regulation on social reinforcement learning in individuals who are socially anxious, although replication will be important. %M 37556186 %R 10.2196/44888 %U https://formative.jmir.org/2023/1/e44888 %U https://doi.org/10.2196/44888 %U http://www.ncbi.nlm.nih.gov/pubmed/37556186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46839 %T A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study %A Guan,Vivienne %A Zhou,Chenghuai %A Wan,Hengyi %A Zhou,Rengui %A Zhang,Dongfa %A Zhang,Sihan %A Yang,Wangli %A Voutharoja,Bhanu Prakash %A Wang,Lei %A Win,Khin Than %A Wang,Peng %+ School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Bldg 41 Northfields Ave, Wollongong, New South Wales, 2522, Australia, 61 2 4221 3555, vguan@uow.edu.au %K food %K diet %K mobile health %K mHealth %K persuasive technology %K gamification %K computer vision %K cloud computing %K design science research %K mobile phone %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. Objective: This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. Methods: The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). Results: The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was “acceptable,” with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. Conclusions: A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development. %M 37549000 %R 10.2196/46839 %U https://formative.jmir.org/2023/1/e46839 %U https://doi.org/10.2196/46839 %U http://www.ncbi.nlm.nih.gov/pubmed/37549000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35790 %T Clinical and Economic Assessment of MyDiaCare, Digital Tools Combined With Diabetes Nurse Educator Support, for Managing Diabetes in South Africa: Observational Multicenter, Retrospective Study Associated With a Budget Impact Model %A Makan,Hemant %A Makan,Lindie %A Lubbe,Jacqueline %A Alami,Sarah %A Lancman,Guila %A Schaller,Manuella %A Delval,Cécile %A Kok,Adri %+ Centre for Diabetes, 80 Gemsbok Avenue, Lenasia, Johannesburg, 1827, South Africa, 27 011 852 4397, h.makan@megaweb.co.za %K diabetes mellitus %K diabetes nurse educator %K digital tool %K MyDiaCare program %K type 2 %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. In South Africa, diabetes-related complications severely impact not only patient health and quality of life but also the economy. Objective: The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing patients with type 1 and type 2 diabetes in South Africa. An economic study was also performed to estimate the budget impact of adding MyDiaCare to standard of care for patients with type 2 diabetes older than 19 years treated in the South African private health care sector. Methods: The real-world DNE study was designed as an observational, retrospective, multicenter, single-group study. Eligible patients were older than 18 years and had at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines a patient mobile app and a health care professional platform with face-to-face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in glycated hemoglobin (HbA1c) levels, the proportion of patients achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort of the DISCOVERY study to estimate the economic impact of MyDiaCare. Results: Between November 25, 2019, and June 30, 2020, a total of 117 patients (8 with type 1 diabetes and 109 with type 2 diabetes) were enrolled in 2 centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean HbA1c levels of 0.6% from 7.8% to 7.2% was observed. Furthermore, 54% (43/79) of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (53/79, 67% for systolic and 70/79, 89% for diastolic blood pressure) and lipid parameters (49/71, 69% for low-density-lipoprotein [LDL] cholesterol, 41/71, 58% for high-density-lipoprotein [HDL] cholesterol, and 59/71, 83% for total cholesterol), but fewer patients achieved their targets for triglycerides (32/70, 46%), waist circumference (12/68, 18%), and body weight (13/76, 17%). The mean overall adherence to the MyDiaCare care plan was 93%. Most patients (87/117, 74%) were satisfied with the MyDiaCare program. The net budget impact per patient with type 2 diabetes, older than 19 years, treated in the private sector using MyDiaCare was estimated to be approximately South African Rands (ZAR) 71,023 (US $4089) during the first year of introducing MyDiaCare. Conclusions: The results of using MyDiaCare program, which combines digital tools for patients and health care professionals with DNE support, suggest that it may be a clinically effective and cost-saving solution for diabetes management in the South African private health care sector. %M 37548994 %R 10.2196/35790 %U https://formative.jmir.org/2023/1/e35790 %U https://doi.org/10.2196/35790 %U http://www.ncbi.nlm.nih.gov/pubmed/37548994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44323 %T The Influence of Greenspace Exposure on Affect in People With and Those Without Schizophrenia: Exploratory Study %A Kangarloo,Tairmae %A Mote,Jasmine %A Abplanalp,Samuel %A Gold,Alisa %A James,Peter %A Gard,David %A Fulford,Daniel %+ Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States, 1 6035681431, tairmaek@bu.edu %K greenspace %K mental health %K mobile technology %K affect %K smartphone %K sensing %K schizophrenia %K natural vegetation %K mental health %K exposure %K assessment %K mechanism %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure to natural vegetation (ie, “greenspace”) is related to beneficial outcomes, including higher positive and lower negative affect, in individuals with and those without mental health concerns. Researchers have yet to examine dynamic associations between greenspace exposure and affect within individuals over time. Smartphone-based ecological momentary assessment (EMA) and passive sensors (eg, GPS, microphone) allow for frequent sampling of data that may reveal potential moment-to-moment mechanisms through which greenspace exposure impacts mental health. Objective: In this study, we examined associations between greenspace exposure and affect (both self-reported and inferred through speech) in people with and those without schizophrenia spectrum disorder (SSD) at the daily level using smartphones. Methods: Twenty people with SSD and 14 healthy controls reported on their current affect 3 times per day over 7 days using smartphone-based EMA. Affect expressed through speech was labeled from ambient audio data collected via the phone’s microphone using Linguistic Inquiry and Word Count (LIWC). Greenspace exposure, defined as the normalized difference vegetation index (NDVI), was quantified based on continuous geo-location data collected from the phone’s GPS. Results: Overall, people with SSD used significantly more positive affect words (P=.04) and fewer anger words (P=.04) than controls. Groups did not significantly differ in mean EMA-reported positive or negative affect, LIWC total word count, or NDVI exposure. Greater greenspace exposure showed small to moderate associations with lower EMA-reported negative affect across groups. In controls, greenspace exposure on a given day was associated with significantly lower EMA-reported anxiety on that day (b=–0.40, P=.03, 95% CI –0.76 to –0.04) but significantly higher use of negative affect words (b=0.66, P<.001, 95% CI 0.29-1.04). There were no significant associations between greenspace exposure and affect at the daily level among participants with SSD. Conclusions: Our findings speak to the utility of passive and active smartphone assessments for identifying potential mechanisms through which greenspace exposure influences mental health. We identified preliminary evidence that greenspace exposure could be associated with improved mental health by reducing experiences of negative affect. Future directions will focus on furthering our understanding of the relationship between greenspace exposure and affect on individuals with and those without SSD. %M 37535418 %R 10.2196/44323 %U https://formative.jmir.org/2023/1/e44323 %U https://doi.org/10.2196/44323 %U http://www.ncbi.nlm.nih.gov/pubmed/37535418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46606 %T An SMS Text Message–Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process %A Soltero,Erica %A Lopez,Callie %A Mihail,Sandra %A Hernandez,Ayleen %A Musaad,Salma M %A O'Connor,Teresia M %A Thompson,Debbe %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Str, Houston, TX, 77030, United States, 1 713 798 3802, soltero@bcm.edu %K Hispanic health %K adolescents %K digital health %K physical activity %K sleep %K type 2 diabetes %K mobile phone %K smartphone %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text message–based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. Objective: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. Methods: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message–based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. Results: The background phase revealed that few SMS text message–based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Conclusions: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message–based strategies among high-risk adolescents. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2023.107117 %M 37531191 %R 10.2196/46606 %U https://formative.jmir.org/2023/1/e46606 %U https://doi.org/10.2196/46606 %U http://www.ncbi.nlm.nih.gov/pubmed/37531191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43720 %T The Use of Travel as an Appeal to Motivate Millennial Parents on Facebook to Get Vaccinated Against COVID-19: Message Framing Evaluation %A Arshanapally,Suraj %A Starr,Tiearra %A Elsberry,Lauren Blackmun %A Rinker,Robin %+ National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H16-4, Atlanta, GA, 30329, United States, 1 404 498 1007, otv1@cdc.gov %K COVID-19 %K coronavirus %K vaccination %K travel %K parents %K millennial %K appeal %K health communication %K social media %K Facebook %K infectious disease %K message testing %K public health %K messaging %K parenting %K program %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In summer 2021, the Centers for Disease Control and Prevention recommended that people get fully vaccinated against COVID-19 before fall travel to protect themselves and others from getting and spreading COVID-19 and new variants. Only 61% of parents had reported receiving at least 1 dose of the COVID-19 vaccine, according to a Kaiser Family Foundation study. Millennial parents, ages 25 to 40 years, were a particularly important parent population because they were likely to have children aged 12 years or younger (the age cutoff for COVID-19 vaccine eligibility during this time period) and were still planning to travel. Since Facebook has been identified as a popular platform for millennials and parents, the Centers for Disease Control and Prevention’s Travelers’ Health Branch determined an evaluation of public health messages was needed to identify which message appeals would resonate best with this population on Facebook. Objective: The objective was to evaluate which travel-based public health message appeals aimed at addressing parental concerns and sentiments about COVID-19 vaccination would resonate most with Millennial parents (25 to 40 years old) using Facebook Ads Manager and social media metrics. Methods: Six travel-based public health message appeals on parental concerns and sentiments around COVID-19 were developed and disseminated to millennial parents using Facebook Ads Manager. The messages ran from October 23, 2021, to November 8, 2021. Primary outcomes included the number of people reached and the number of impressions delivered. Secondary outcomes included engagements, clicks, click-through rate, and audience sentiments. A thematic analysis was conducted to analyze comments. The advertisement budget was evaluated by cost-per-mille and cost-per-click metrics. Results: All messages reached a total of 6,619,882 people and garnered 7,748,375 impressions. The Family (n=3,572,140 people reached, 53.96%; 4,515,836 impressions, 58.28%) and Return to normalcy (n=1,639,476 people reached, 24.77%; 1,754,227 impressions, 22.64%) message appeals reached the greatest number of people and garnered the most impressions out of all 6 message appeals. The Family message appeal received 3255 engagements (60.46%), and the Return to normalcy message appeal received 1148 engagements (21.28%). The Family appeal also received the highest number of positive post reactions (n=82, 28.37%). Most of the comments portrayed negative opinions about COVID-19 vaccination (n=46, 68.66%). All 6 message appeals were either on par with or outperformed cost-per-mille benchmarks set by other similar public health campaigns. Conclusions: Health communicators can use travel, specifically the Family and Return to normalcy message appeals, to successfully reach parents in their future COVID-19 vaccination campaigns and potentially inform health communication messaging efforts for other vaccine-preventable infectious disease campaigns. Public health programs can also utilize the lessons learned from this evaluation to communicate important COVID-19 information to their parent populations through travel messaging. %M 37437085 %R 10.2196/43720 %U https://formative.jmir.org/2023/1/e43720 %U https://doi.org/10.2196/43720 %U http://www.ncbi.nlm.nih.gov/pubmed/37437085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40277 %T Expressive Interviewing Agents to Support Health-Related Behavior Change: Randomized Controlled Study of COVID-19 Behaviors %A Stewart,Ian %A Welch,Charles %A An,Lawrence %A Resnicow,Ken %A Pennebaker,James %A Mihalcea,Rada %+ School of Computer Science and Engineering, University of Michigan, 2260 Hayward Street, Ann Arbor, MI, 48109, United States, 1 7347648504, ianbstew@umich.edu %K expressive writing %K motivational interviewing %K dialogue systems %K counseling %K behavior change %K text analysis %K COVID-19 %K mental health %K automated writing %K writing system %K stress %K psychological health %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Expressive writing and motivational interviewing are well-known approaches to help patients cope with stressful life events. Although these methods are often applied by human counselors, it is less well understood if an automated artificial intelligence approach can benefit patients. Providing an automated method would help expose a wider range of people to the possible benefits of motivational interviewing, with lower cost and more adaptability to sudden events like the COVID-19 pandemic. Objective: This study presents an automated writing system and evaluates possible outcomes among participants with respect to behavior related to the COVID-19 pandemic. Methods: We developed a rule-based dialogue system for “Expressive Interviewing” to elicit writing from participants on the subject of how COVID-19 has impacted their lives. The system prompts participants to describe their life experiences and emotions and provides topic-specific prompts in response to participants’ use of topical keywords. In May 2021 and June 2021, we recruited participants (N=151) via Prolific to complete either the Expressive Interviewing task or a control task. We surveyed participants immediately before the intervention, immediately after the intervention, and again 2 weeks after the intervention. We measured participants’ self-reported stress, general mental health, COVID-19–related health behavior, and social behavior. Results: Participants generally wrote long responses during the task (53.3 words per response). In aggregate, task participants experienced a significant decrease in stress in the short term (~23% decrease, P<.001) and a slight difference in social activity compared with the control group (P=.03). No significant differences in short-term or long-term outcomes were detected between participant subgroups (eg, male versus female participants) except for some within-condition differences by ethnicity (eg, higher social activity among African American people participating in Expressive Interviewing vs participants of other ethnicities). For short-term effects, participants showed different outcomes based on their writing. Using more anxiety-related words was correlated with a greater short-term decrease in stress (r=–0.264, P<.001), and using more positive emotion words was correlated with a more meaningful experience (r=0.243, P=.001). As for long-term effects, writing with more lexical diversity was correlated with an increase in social activity (r=0.266, P<.001). Conclusions: Expressive Interviewing participants exhibited short-term, but not long-term, positive changes in mental health, and some linguistic metrics of writing style were correlated with positive change in behavior. Although there were no significant long-term effects observed, the positive short-term effects suggest that the Expressive Interviewing intervention could be used in cases in which a patient lacks access to traditional therapy and needs a short-term solution. Trial Registration: Clincaltrials.gov NCT05949840; https://www.clinicaltrials.gov/study/NCT05949840 %M 37074948 %R 10.2196/40277 %U https://formative.jmir.org/2023/1/e40277 %U https://doi.org/10.2196/40277 %U http://www.ncbi.nlm.nih.gov/pubmed/37074948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45294 %T A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing %A Hietbrink,Eclaire A G %A Oude Nijeweme-d’Hollosy,Wendy %A Middelweerd,Anouk %A Konijnendijk,Annemieke A J %A Schrijver,Laura K %A ten Voorde,Anouk S %A Fokkema,Elise M S %A Laverman,Gozewijn D %A Vollenbroek-Hutten,Miriam M R %+ Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, Netherlands, 31 53 4892760, e.a.g.hietbrink@utwente.nl %K eHealth %K type 2 diabetes %K physical activity %K nutrition %K lifestyle change %K acceptability %K limited efficacy %K formative evaluation %K mobile phone %D 2023 %7 28.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D. Objective: This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels. Methods: Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale). Results: In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=−2.040; P=.04) and self-efficacy levels (z=−1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline. Conclusions: On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors. %M 37505804 %R 10.2196/45294 %U https://formative.jmir.org/2023/1/e45294 %U https://doi.org/10.2196/45294 %U http://www.ncbi.nlm.nih.gov/pubmed/37505804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46446 %T Perceived Knowledge, Attitudes, and Barriers Toward the Adoption of Telemedicine Services in the Kingdom of Saudi Arabia: Cross-Sectional Study %A Baradwan,Saeed %A Al-Hanawi,Mohammed %+ Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Prince Saud Al Faisal Road, Jeddah, 23431, Saudi Arabia, 966 504385978, dr.saeed_bardwan@yahoo.com %K telemedicine %K telehealth %K attitude %K knowledge %K barrier %K Saudi Arabia %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of telemedicine has facilitated the opportunity to offer the best health care services. Nevertheless, there is a mismatch between the presence of telemedicine programs in the Kingdom of Saudi Arabia and poor acceptance by the end-user patients. Objective: This study aimed to gain a holistic understanding of the knowledge, attitudes, and barriers of the end-user patients (ie, research participants) toward the utility of telemedicine services in the Kingdom of Saudi Arabia. Methods: A cross-sectional, survey-based study was conducted from June 1 to July 31, 2022, in the Kingdom of Saudi Arabia. The questionnaire was developed based on a literature review and was examined for validity and reliability. Knowledge questions used a yes-or-no format, whereas attitude and barrier questions used a 5-point Likert-scale format. Data were reported descriptively and analyzed using SPSS (IBM Corp) software. To evaluate the differences in mean scores and identify sociodemographic factors associated with knowledge and attitudes toward the adoption of telemedicine, the data were analyzed using univariate and multivariable regression analyses, respectively. Results: Overall, 1024 participants participated in the survey. The percentages of participants who attended a telemedicine service before, during, and after COVID-19 were 49.61% (508/1024), 61.91% (634/1024), and 50.1% (513/1024), respectively. The mean score for knowledge was 3.52 (SD 1.486; range 0-5), reflecting a high level of knowledge. The mean score for attitudes was 37.08 (SD 8.526; range 11-55), reflecting optimistic (positive) attitudes. Regarding barriers, the participants voiced some concerns regarding patient and physician resistance and attributed some cultural and technology-related limitations as potential hindrances to the full adoption of telemedicine services. The place of residence (rural vs nonrural) had a significant impact on the scores of knowledge, attitudes, and barriers, whereas gender had no significant impact. The multivariable regression analysis showed that several sociodemographic factors significantly correlated with knowledge and attitudes toward the adoption of telemedicine services. Conclusions: The participants showed good knowledge and positive attitudes toward telemedicine services. The perceived barriers were in line with the published literature. This research calls for the need to strengthen the positive attitudes and rectify the barriers, so that the utility of telemedicine services can be maximized in the community. %M 37315177 %R 10.2196/46446 %U https://formative.jmir.org/2023/1/e46446 %U https://doi.org/10.2196/46446 %U http://www.ncbi.nlm.nih.gov/pubmed/37315177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45713 %T Building the Business Case for an Inclusive Approach to Digital Health Measurement With a Web App (Market Opportunity Calculator): Instrument Development Study %A Tang,Mitchell %A Sharma,Yashoda %A Goldsack,Jennifer C %A Stern,Ariel Dora %+ Digital Medicine Society, 90 Canal Street, 4th Floor, Boston, MA, 02114, United States, 1 7652343463, yashoda@dimesociety.org %K inclusion %K digital health %K digital product development %K health equity %K public health %K Digital Health Measurement Collaborative Community %K DATAcc %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital health measurement tools has grown substantially in recent years. However, there are concerns that the promised benefits from these products will not be shared equitably. Underserved populations, such as those with lower education and income, racial and ethnic minorities, and those with disabilities, may find such tools poorly suited for their needs. Because underserved populations shoulder a disproportionate share of the US disease burden, they also represent a substantial share of digital health companies’ target markets. Incorporating inclusive principles into the product development process can help ensure that the resulting tools are broadly accessible and effective. In this context, inclusivity not only maximizes societal benefit but also leads to greater commercial success. Objective: A critical element in fostering inclusive product development is building the business case for why it is worthwhile. The Digital Health Measurement Collaborative Community (DATAcc) Market Opportunity Calculator was developed as an open-access resource to enable digital health measurement product developers to build a business case for incorporating inclusive practices into their research and development processes. Methods: The DATAcc Market Opportunity Calculator combines data on population demographics and disease prevalence and health status from the US Census Bureau and the US Centers for Disease Control and Prevention (CDC). Together, these data are used to calculate the share of US adults with specific conditions (eg, diabetes) falling into various population segments along key “inclusion vectors” (eg, race and ethnicity). Results: A free and open resource, the DATAcc Market Opportunity Calculator can be accessed from the DATAcc website. Users first select the target health condition addressed by their product, and then an inclusion vector to segment the patient population. The calculator displays each segment as a share of the overall US adult population and its share specifically among adults with the target condition, quantifying the importance of underserved patient segments to the target market. The calculator also estimates the value of improvements to product inclusivity by modeling the downstream impact on the accessible market size. For example, simplifying prompts on a hypertension-focused product to make it more accessible for adults with lower educational attainment is shown by the calculator to increase the target market by 2 million people and the total addressable market opportunity by US $200 million. Conclusions: Digital health measurement is still in its infancy. Now is the time to establish a precedent for inclusive product development to maximize societal benefit and build sustainable commercial returns. The Market Opportunity Calculator can help build the business case for “why”—showing how inclusivity can translate to financial opportunity. Once the decision has been made to pursue inclusive design, other components of the broader DATAcc toolkit for inclusive product development can support the “how.” %M 37494108 %R 10.2196/45713 %U https://formative.jmir.org/2023/1/e45713 %U https://doi.org/10.2196/45713 %U http://www.ncbi.nlm.nih.gov/pubmed/37494108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45098 %T Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions %A Mey,Jacob T %A Karpinski,Christine A %A Yang,Shengping %A Madere,Joseph D %A Piattoly,Tavis %A Harper,Ronnie %A Kirwan,John P %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632644, jacob.mey@pbrc.edu %K dietitian %K malnutrition %K mHealth %K mobile health %K performance %K RED-S %K relative energy deficiency in sport %K sports nutrition %K technology %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes’ and sport professionals’ perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. “Health” and “sports performance” were the highest scoring motivators, while the highest scoring barriers were “cost of food,” “easy access to unhealthy food,” and “time to cook or prepare food.” Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. %M 37494083 %R 10.2196/45098 %U https://formative.jmir.org/2023/1/e45098 %U https://doi.org/10.2196/45098 %U http://www.ncbi.nlm.nih.gov/pubmed/37494083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43516 %T Identifying Trusted Sources of Lyme Disease Prevention Information Among Internet Users Connected to Academic Public Health Resources: Internet-Based Survey Study %A Kopsco,Heather L %A Krell,Rayda K %A Mather,Thomas N %A Connally,Neeta P %+ Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, 2001 South Lincoln Ave, Urbana, IL, 61802, United States, 1 7325709980, hkopsco@illinois.edu %K communication %K consumer health information %K disease %K internet %K Lyme disease %K online %K pathogen %K prevention %K public health %K resources %K social media %K survey %K tickborne disease %K ticks %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation about Lyme disease and other tick-transmitted pathogens circulates frequently on the internet and can compete with, or even overshadow, science-based guidance on tick-borne disease (TBD) prevention. Objective: We surveyed internet users connected to academic tick-related resources to identify trusted sources of Lyme disease prevention information, explore confidence in tick bite prevention information, and examine associations of these responses with answers to commonly disputed issues. Methods: The survey was conducted through social media and website pages for Western Connecticut State University Tickborne Disease Prevention Laboratory and the University of Rhode Island TickEncounter Resource Center. Results: Respondents (N=1190) were predominantly female (903/1190, 76.3%), middle-aged (574/1182, 48.6%), and resided in New England states (663/1190, 55.7%). In total 984 of 1186 (83%) respondents identified conventional experts (eg, the Centers for Disease Control [CDC] or other government health agencies, physicians who follow Infectious Diseases Society of America guidelines for Lyme disease treatment guidelines, and academics) as trustworthy TBD prevention resources. However, nearly one-fourth of respondents would first consult personal contacts and web-based communities regarding prevention information before consulting conventional expert sources. The opinions of public health experts and physicians were rated among the top motivators underlying personal prevention decisions; yet, more than 50% of participants revealed distrustful attitudes toward, or were uncertain about, CDC-supported statements related to time to transmission of Lyme disease (708/1190, 59.5%), the safety of diethyltoluamide-based repellents for children (604/1183, 51.1%), and recommended use of antibiotic prophylaxis (773/1181, 65.4%). Multimodal regression models revealed that participants from high-Lyme-disease-incidence states were more likely to first seek TBD prevention information from personal networks and nontraditional sources before approaching conventional sources of TBD prevention information. We found that those reporting high rates of social media usage were more than twice as likely to first seek traditional expert sources of prevention information but were overall more likely to reject CDC-promoted Lyme disease information, in particular the established time to transmission of Lyme disease bacteria. Models also predicted that those participants who disagreed with the conventional scientific view on the antibiotic prophylaxis prevention statement were less likely to be confident in their ability to protect themselves from a tick bite. Overall, uncertainty in one’s ability to protect oneself against tick bites was strongly associated with uncertainty about beliefs in CDC-promoted TBD prevention information. Self-reported trust in experts and frequency of social media use suggest that these platforms may provide opportunities to engage directly with the public about TBD prevention practices. Conclusions: Using strategies to improve public trust and provide information where the public engages on social media may improve prevention communication and adoption of best practices. %M 37494089 %R 10.2196/43516 %U https://formative.jmir.org/2023/1/e43516 %U https://doi.org/10.2196/43516 %U http://www.ncbi.nlm.nih.gov/pubmed/37494089 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47851 %T Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study %A Roh,Soonhee %A Lee,Yeon-Shim %A Kenyon,DenYelle B %A Elliott,Amy J %A Petereit,Daniel G %A Gaba,Anu %A Lee,Hee Yun %+ Department of Social Work, University of South Dakota, 4801 N Career Ave, 145C, Sioux Falls, SD, 57107, United States, 1 6053571593, soonhee.roh@usd.edu %K American Indian women %K breast cancer %K mammogram %K mHealth %K mobile web app intervention %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants’ satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=−5.22; P<.001), increase in knowledge (t120=−4.75; P<.001), and satisfaction with the intervention (t120=−3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial Registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603 %M 37471115 %R 10.2196/47851 %U https://formative.jmir.org/2023/1/e47851 %U https://doi.org/10.2196/47851 %U http://www.ncbi.nlm.nih.gov/pubmed/37471115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45086 %T Factors Influencing Preferences of Patients With Rheumatic Diseases Regarding Telehealth Channels for Support With Medication Use: Qualitative Study %A Haegens,Lex L %A Huiskes,Victor J B %A van der Ven,Jeffrey %A van den Bemt,Bart J F %A Bekker,Charlotte L %+ Department of Research and Innovation, Sint Maartenskliniek, Hengstdal 3, Ubbergen, 6574NA, Netherlands, 31 683833157, l.haegens@maartenskliniek.nl %K digital human %K drug-related problems %K frequently asked questions %K interviews %K qualitative %K rheumatology %K support %K telehealth %K telemedicine %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients’ health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient’s preference for telehealth channels can improve the actual use of telehealth channels. Objective: This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use. Methods: A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed. Results: A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history. Conclusions: Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs. %M 37471137 %R 10.2196/45086 %U https://formative.jmir.org/2023/1/e45086 %U https://doi.org/10.2196/45086 %U http://www.ncbi.nlm.nih.gov/pubmed/37471137 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44362 %T A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial %A Nagraj,Shobhana %A Kennedy,Stephen %A Jha,Vivekananda %A Norton,Robyn %A Hinton,Lisa %A Billot,Laurent %A Rajan,Eldho %A Mohammed Abdul,Ameer %A Phalswal,Anita %A Arora,Varun %A Praveen,Devarsetty %A Hirst,Jane %+ Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, United Kingdom, 44 1865 281231, shobhana.nagraj@ndm.ox.ac.uk %K decision support systems %K clinical %K telemedicine %K community health workers %K pregnancy %K high risk %K diabetes %K gestational %K cardiovascular diseases %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 %M 37471135 %R 10.2196/44362 %U https://formative.jmir.org/2023/1/e44362 %U https://doi.org/10.2196/44362 %U http://www.ncbi.nlm.nih.gov/pubmed/37471135 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43504 %T The Building Healthy Eating and Self-Esteem Together for University Students Mobile App to Treat Eating Disorders: User-Centered Research Design and Feasibility Study %A Forbush,Kelsie T %A Christensen Pacella,Kara A %A Thomeczek,Marianna L %A Gould,Sara R %A A N Chapa,Danielle %A Richson,Brianne N %A Perko,Victoria L %A Ayres,Joseph %A Chen,Yiyang %A Negi,Sonakshi %+ Department of Psychology, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66049, United States, 1 7858646525, dr.forbush@ku.edu %K Building Healthy Eating and Self-Esteem Together for University Students %K BEST-U %K eating disorders %K EDs %K college %K university %K students %K cognitive behavioral therapy %K dialectical behavioral therapy %K mobile health %K mHealth %K mental health %K guided self-help %K therapy %K app %K treatment %K design %K usability %K testing %K development %K development %K acceptability %K cognitive %K mobile phone %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: University students are an at-risk group for the development of eating disorders (EDs); however, many college campuses lack sufficient resources to provide ED specialty care. Students report unique reasons for not seeking ED treatment, including the desire to solve the problem on their own (eg, seeking help from friends, self-medicating, or waiting to see if their problems improve), inability to afford treatment, lack of time to participate in the treatment, fear of seeing their primary care physician, and lack of recognition of their issues as an ED. Mobile health (mHealth) apps may be a cost-effective, helpful adjunctive tool to overcome personal and systemic barriers and encourage help seeking. Objective: This paper describes the development, usability, and acceptability of the Building Healthy Eating and Self-Esteem Together for University Students (BEST-U) mHealth smartphone app, which is designed to fill critical gaps in access to ED treatment on college campuses. Methods: We undertook a 4-phase iterative development process that focused on user-centered design. The 4 phases included needs assessment based on literature reviews, prototype development and initial evaluation in a pilot trial, redesign, and further pilot-testing to assess the usability and acceptability of the final version of the mHealth app. Acceptability and user satisfaction were assessed using an ad hoc survey that ranged from 1 (strongly disagree) to 7 (strongly agree). Results: Our needs assessment identified a lack of accessible and affordable treatments for university students. To help meet this need, the BEST-U prototype was designed as an 11-week program that provided interactive, weekly modules that focused on second- and third-wave cognitive behavioral skills. The modules focused on topics such as psychoeducation, reducing thought distortions and body checking, improving body image, interpersonal effectiveness, and behavior chain analysis. The content included interactive quizzes, short answer questions, daily and weekly logs, and surveys completed in the app. BEST-U was paired with brief 25-30 minutes of weekly telehealth coaching sessions provided by a licensed provider or supervised trainee. Pilot-testing revealed minor issues with one module of the app content, which some participants viewed as having low relevance to their experience and therapist concerns about the organization of the app content. These issues were addressed through the removal, addition, and reorganization of BEST-U modules, with the help of therapists-in-training across 2 workshops. The revised version of the BEST-U app had a grand mean acceptability rating of 5.73 out of 7. The participants completed 90.1% (694/770) of the BEST-U modules, indicating high compliance. Conclusions: BEST-U is a new, acceptable, and user-friendly mHealth app to help therapists deliver brief, evidence-based cognitive behavioral interventions. Owing to its acceptability and user-friendly nature, BEST-U has high user compliance and holds promise for future implementation and dissemination in university mental health settings. %M 37436790 %R 10.2196/43504 %U https://formative.jmir.org/2023/1/e43504 %U https://doi.org/10.2196/43504 %U http://www.ncbi.nlm.nih.gov/pubmed/37436790 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48666 %T Feasibility of a Home-Based Cognitive-Physical Exercise Program in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Feasibility and Pilot Randomized Controlled Trial %A Rozenberg,Dmitry %A Shore,Josh %A Camacho Perez,Encarna %A Nourouzpour,Sahar %A Ibrahim Masthan,Megha %A Santa Mina,Daniel %A Campos,Jennifer L %A Huszti,Ella %A Green,Robin %A Khan,Mohammad Hashim %A Lau,Ambrose %A Gold,David %A Stanbrook,Matthew B %A Reid,W Darlene %+ Respirology and Lung Transplantation, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13 EN-229, Toronto, ON, M5G 2C4, Canada, 1 4163404800 ext 7358, Dmitry.Rozenberg@uhn.ca %K pulmonary disease %K chronic obstructive %K telerehabilitation %K physical exercise %K cognitive training %K randomized controlled trial %K pilot study %D 2023 %7 12.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL. Objective: The aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL. Methods: A total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively. Results: Enrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023. Conclusions: A supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL. Trial Registration: ClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226 International Registered Report Identifier (IRRID): DERR1-10.2196/48666 %M 37436794 %R 10.2196/48666 %U https://www.researchprotocols.org/2023/1/e48666 %U https://doi.org/10.2196/48666 %U http://www.ncbi.nlm.nih.gov/pubmed/37436794 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47656 %T Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial %A Bielinski,Laura Luisa %A Wälchli,Gwendolyn %A Nissen,Christoph %A Berger,Thomas %A Moggi,Franz %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 794457768, laura.bielinski@unibe.ch %K blended treatment %K inpatient %K emotion regulation %K internet intervention %K acute psychiatric setting %K randomized controlled pilot trial %K randomized controlled trial %K RCT %K transdiagnostic %K feasibility %K emotion %K mental health %K psychiatric %K psychiatry %K randomized %K internet based %K digital health %D 2023 %7 11.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. Objective: The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. Methods: The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. Results: Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. Conclusions: This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. Trial Registration: ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674 International Registered Report Identifier (IRRID): DERR1-10.2196/47656 %M 37432724 %R 10.2196/47656 %U https://www.researchprotocols.org/2023/1/e47656 %U https://doi.org/10.2196/47656 %U http://www.ncbi.nlm.nih.gov/pubmed/37432724 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34387 %T Architecture Assessment of the Chilean Epidemiological Surveillance System for Notifiable Diseases (EPIVIGILA): Qualitative Study %A Taramasco,Carla %A Rimassa,Carla %+ Universidad Andrés Bello, Facultad de Ingeniería, Quillota 980, Viña del Mar, 2531015, Chile, 56 322507000, carla.taramasco@unab.cl %K eHealth %K surveillance %K mandatory reporting of infectious diseases %K public health %K data mining %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: To fulfill their epidemiological vigilance function, authorities require valid, complete, timely, precise, and reliable information. Advancements in new technologies have facilitated public health control through vigilance systems for notifiable diseases; these systems can gather large numbers of simultaneous notifications, process a wide array of data, and deliver updated information in real time to relevant decision-makers. A large worldwide deployment of new information technologies was seen during the COVID-19 pandemic; these technologies proved to be efficient, resourceful tools . Platform developers should seek self-evaluation strategies to optimize functionality or improve the capacity of national vigilance systems. These tools exist in the Latin American region at various development stages, although publications reporting architectural characteristics of these tools are scarce. International publications are more abundant a nd serve as a basis for comparing the standards that need to be met. Objective: This study aimed to assess the architecture of the Chilean epidemiological surveillance system for notifiable diseases (EPIVIGILA), as compared to that of the international systems reported in scientific publications. Methods: A search for scientific publications was conducted to identify systematic reviews that documented the architectural characteristics of disease notification and vigilance systems. EPIVIGILA was compared to other systems from countries in Africa, the Americas, Asia, Europe, and Oceania. Results: The following aspects of the architecture were identified: (1) notification provenance, (2) minimum data set, (3) database users, and (4) data quality control. The notifying organizations, including hospitals, clinics, laboratories, and medical consultation offices, were similar among the 13 countries analyzed; this contrasted with Chile, where the reporting agent is the physician who can belong to an organization. The minimum data set include patient identification, disease data, and general codifications. EPIVIGILA includes all these elements, in addition to symptomatology, hospitalization data, type of medicine and treatment result, and laboratory test types. The database users or data analyzers include public health organizations, research organizations, epidemiological organizations, health organizations or departments, and the Centers for Disease Control and Prevention. Finally, for data quality control, the criteria most often used were completeness, consistency, validity, timeliness, accuracy, and competencies. Conclusions: An efficient notification and vigilance system must be capable of promptly identifying probable risks as well as incidence and prevalence of the diseases under surveillance. EPIVIGILA has been shown to comply with high quality and functionality standards, at the level of developed countries, by achieving total national coverage and by providing timely, trustworthy, and complete information at high-security levels, thus obtaining positive assessment from national and international authorities. %M 37418297 %R 10.2196/34387 %U https://formative.jmir.org/2023/1/e34387 %U https://doi.org/10.2196/34387 %U http://www.ncbi.nlm.nih.gov/pubmed/37418297 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43304 %T Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study %A Suzuki,Joji %A Loguidice,Frank %A Prostko,Sara %A Szpak,Veronica %A Sharma,Samata %A Vercollone,Lisa %A Garner,Carol %A Ahern,David %+ Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Rd, Room 4168, Boston, MA, 02474, United States, 1 6174557981, jsuzuki2@bwh.harvard.edu %K alcohol use disorder %K inpatient detoxification %K peer recovery coach %K smartphone app %K alcohol %K substance use %K substance abuse %K drinking %K recovery %K peer support %K detox %K coaching %K health app %K mobile health %K mHealth %K mobile app %K care coordination %K digitally %K detoxification %K Lifeguard %K peer recovery %K inpatient alcohol %D 2023 %7 5.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches—individuals with the lived experience of recovery who obtain training to be coaches—are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. Objective: We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. Methods: This study was conducted on an American Society of Addiction Medicine–Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. Results: All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). Conclusions: The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. Trial Registration: ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544 %M 37405844 %R 10.2196/43304 %U https://formative.jmir.org/2023/1/e43304 %U https://doi.org/10.2196/43304 %U http://www.ncbi.nlm.nih.gov/pubmed/37405844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44400 %T mHealth Early Intervention to Reduce Posttraumatic Stress and Alcohol Use After Sexual Assault (THRIVE): Feasibility and Acceptability Results From a Pilot Trial %A Dworkin,Emily R %A Schallert,Macey %A Lee,Christine M %A Kaysen,Debra %+ Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, United States, 1 206 221 6932, edworkin@uw.edu %K mobile health %K mHealth %K mobile apps %K prevention %K alcohol use %K trauma %K sexual violence %K rape %K mobile phone %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is associated with increased risk for both posttraumatic stress (PTS) and alcohol misuse. Mobile health interventions have shown promise in addressing PTS and substance use in trauma survivors and might be a promising strategy in extending the reach of early interventions to individuals who have recently experienced trauma. Objective: This study assesses the feasibility and acceptability of THRIVE, a mobile health early intervention for recent survivors of sexual assault involving a cognitive behavioral app used daily over 21 days with weekly telephone coaching. Methods: Twenty adult female survivors of past–10-week sexual assault with elevated PTS and alcohol use were randomized to receive the THRIVE intervention as part of a pilot randomized controlled trial. We sought to understand feasibility by examining rates of completion of intervention activities and testing changes in participants’ self-reported knowledge of key intervention concepts from baseline to after the intervention. We assessed acceptability by collecting self-report ratings of satisfaction with the intervention and app usability in a follow-up survey. The coach took notes during coaching calls to track call content and record participant feedback; these notes were qualitatively analyzed to elaborate on the aforementioned domains. Results: Feasibility was demonstrated by moderate rates of activity completion: all participants at least opened the app, 19 (95%) of the 20 participants completed at least 1 cognitive behavioral exercise, and 16 (80%) of the 20 participants attended all 4 coaching calls. Participants completed cognitive behavioral exercises on an average of 10.40 (SD 6.52) out of 21 days. The coaching call notes documented participant comments that app-generated reminders increased completion rates. Feasibility was also demonstrated by the finding that knowledge changes occurred from baseline to after the intervention; this indicated that THRIVE was successful in conveying key concepts. Acceptability was demonstrated by high participant ratings of THRIVE’s usability; the ratings corresponded to a B+ usability grade. The coaching call notes documented that usability was increased by the coaching calls, the app exercises’ clarity, and the app exercises’ inclusion of suggestions; however, the coaching call notes also documented that some of the participants found aspects of the app exercises to be difficult or confusing. Acceptability was also demonstrated by participant ratings of satisfaction: most of the participants (15/16, 94%) rated the app as either moderately helpful or very helpful. The coaching call notes documented that the cognitive behavioral activity modules were seen as appealing and that the positive impact of the intervention contributed to participants’ satisfaction. Conclusions: These findings suggest that THRIVE is feasible and acceptable to survivors of recent sexual assault and that further testing of THRIVE is warranted. Trial Registration: ClinicalTrials.gov NCT03703258; https://clinicaltrials.gov/ct2/show/NCT03703258 %M 37402144 %R 10.2196/44400 %U https://formative.jmir.org/2023/1/e44400 %U https://doi.org/10.2196/44400 %U http://www.ncbi.nlm.nih.gov/pubmed/37402144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46179 %T m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study %A Grasa,Eva %A Seppälä,Jussi %A Alonso-Solis,Anna %A Haapea,Marianne %A Isohanni,Matti %A Miettunen,Jouko %A Caro Mendivelso,Johanna %A Almazan,Cari %A Rubinstein,Katya %A Caspi,Asaf %A Unoka,Zsolt %A Farkas,Kinga %A Usall,Judith %A Ochoa,Susana %A van der Graaf,Shenja %A Jewell,Charlotte %A Triantafillou,Anna %A Stevens,Matthias %A Reixach,Elisenda %A Berdun,Jesus %A , %A Corripio,Iluminada %+ Mental Health Division, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Llatjos St, Manresa, 08243, Spain, 34 93 8742112, aalonso@althaia.cat %K schizophrenia %K treatment-resistant %K digital mental health %K mHealth %K mobile health %K mental health %K mental illness %K mental disorder %K psychosis %K symptom management %K adherence %K acceptability %K usability %K feasibility %K digital intervention %K mobile intervention %K mobile phone %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. Objective: The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. Methods: A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. Results: This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients’ acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients’ satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. Conclusions: The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS. Trial Registration: ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-021346 %M 37389933 %R 10.2196/46179 %U https://formative.jmir.org/2023/1/e46179 %U https://doi.org/10.2196/46179 %U http://www.ncbi.nlm.nih.gov/pubmed/37389933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45298 %T Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge %A Sae-lee,Kittiya %A Surangsrirat,Decho %A Parlawong,Chanatip %A Anawilkul,T-touch %A Assawachamrun,Narinuch %A Boonbandan,Pawanya %A Ladapongpuwat,Paweerata %A Chupetch,Bhawat %A Thongchai,Supatcha %A Pruphetkaew,Nannapat %A Thongseiratch,Therdpong %A Vichitkunakorn,Polathep %A Ngamchaliew,Pitchayanont %+ Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnchanawanich Road, Hat Yai, Songkhla, 90110, Thailand, 66 74451330, pitchayanont@hotmail.com %K generations %K logging frequency %K mobile health app %K weight status %K weight reduction %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. Objective: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. Methods: A secondary data analysis was performed using data collected from the “MED PSU×ThaiSook Healthier Challenge,” a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). Results: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was −3.85% (IQR −3.40% to −4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of −1.08% (IQR −2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). Conclusions: More than half of the “MED PSU×ThaiSook Healthier Challenge” participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction. %M 37389918 %R 10.2196/45298 %U https://formative.jmir.org/2023/1/e45298 %U https://doi.org/10.2196/45298 %U http://www.ncbi.nlm.nih.gov/pubmed/37389918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44126 %T Barriers to and Facilitators of Using Remote Measurement Technology in the Long-Term Monitoring of Individuals With ADHD: Interview Study %A Denyer,Hayley %A Deng,Qigang %A Adanijo,Abimbola %A Asherson,Philip %A Bilbow,Andrea %A Folarin,Amos %A Groom,Madeleine J %A Hollis,Chris %A Wykes,Til %A Dobson,Richard JB %A Kuntsi,Jonna %A Simblett,Sara %+ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 5308, hayley.denyer@kcl.ac.uk %K attention-deficit/hyperactivity disorder %K ADHD %K remote measurement technology %K engagement %K barriers and facilitators %K qualitative analysis %K mobile phone %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. Objective: We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants’ views on using RMT for 1 or 2 years in future studies. Methods: In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. Results: Barriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. Conclusions: Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. %M 37389932 %R 10.2196/44126 %U https://formative.jmir.org/2023/1/e44126 %U https://doi.org/10.2196/44126 %U http://www.ncbi.nlm.nih.gov/pubmed/37389932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41738 %T Economic Impact of a Hospital Cyberattack in a National Health System: Descriptive Case Study %A Portela,Diana %A Nogueira-Leite,Diogo %A Almeida,Rafael %A Cruz-Correia,Ricardo %+ Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, Porto, 4200-450, Portugal, 351 225 513 622, di.portelasilva@gmail.com %K cybersecurity %K medical informatics %K economic impact %K economic %K cost %K security %K privacy %K cyberattack %K data breach %K health system %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, the frequency and size of cyberattacks in the health care industry have increased, ranging from breaches of processes or networks to encryption of files that restrict access to data. These attacks may have multiple consequences for patient safety, as they can, for example, target electronic health records, access to critical information, and support for critical systems, thereby causing delays in hospital activities. The effects of cybersecurity breaches are not only a threat to patients’ lives but also have financial consequences due to causing inactivity in health care systems. However, publicly available information on these incidents quantifying their impact is scarce. Objective: We aim, while using public domain data from Portugal, to (1) identify data breaches in the public national health system since 2017 and (2) measure the economic impact using a hypothesized scenario as a case study. Methods: We retrieved data from multiple national and local media sources on cybersecurity from 2017 until 2022 and built a timeline of attacks. In the absence of public information on cyberattacks, reported drops in activity were estimated using a hypothesized scenario for affected resources and percentages and duration of inactivity. Only direct costs were considered for estimates. Data for estimates were produced based on planned activity through the hospital contract program. We use sensitivity analysis to illustrate how a midlevel ransomware attack might impact health institutions’ daily costs (inferring a potential range of values based on assumptions). Given the heterogeneity of our included parameters, we also provide a tool for users to distinguish such impacts of different attacks on institutions according to different contract programs, served population size, and proportion of inactivity. Results: From 2017 to 2022, we were able to identify 6 incidents in Portuguese public hospitals using public domain data (there was 1 incident each year and 2 in 2018). Financial impacts were obtained from a cost point of view, where estimated values have a minimum-to-maximum range of €115,882.96 to €2,317,659.11 (a currency exchange rate of €1=US $1.0233 is applicable). Costs of this range and magnitude were inferred assuming different percentages of affected resources and with different numbers of working days while considering the costs of external consultation, hospitalization, and use of in- and outpatient clinics and emergency rooms, for a maximum of 5 working days. Conclusions: To enhance cybersecurity capabilities at hospitals, it is important to provide robust information to support decision-making. Our study provides valuable information and preliminary insights that can help health care organizations better understand the costs and risks associated with cyber threats and improve their cybersecurity strategies. Additionally, it demonstrates the importance of adopting effective preventive and reactive strategies, such as contingency plans, as well as enhanced investment in improving cybersecurity capabilities in this critical area while aiming to achieve cyber-resilience. %M 37389934 %R 10.2196/41738 %U https://formative.jmir.org/2023/1/e41738 %U https://doi.org/10.2196/41738 %U http://www.ncbi.nlm.nih.gov/pubmed/37389934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39576 %T Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study %A Wynn,Chelsea S %A Fiks,Alexander G %A Localio,Russell %A Shults,Justine %A Nekrasova,Ekaterina %A Shone,Laura P %A Torres,Alessandra %A Griffith,Miranda %A Unger,Rebecca %A Ware,Leigh Ann %A Kelly,Mary Kate %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 617 West 168th Street, New York, NY, 10032, United States, 1 2123425732, mss2112@columbia.edu %K influenza vaccine %K mHealth %K mobile phone %K pediatric %K primary care %K PROS %K reminders %K text message %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. Objective: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. Methods: As part of a National Institutes of Health (NIH)–funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics’ (AAP) Pediatric Research in Office Settings (PROS) research network, the Children’s Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Results: Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population’s SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference –7.2%, 95% CI –27.1 to –1.8). There were no significant differences in having an unlimited plan associated with child’s race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor’s office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. Conclusions: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings. %M 37389945 %R 10.2196/39576 %U https://formative.jmir.org/2023/1/e39576 %U https://doi.org/10.2196/39576 %U http://www.ncbi.nlm.nih.gov/pubmed/37389945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44331 %T Optimizing Patient Record Linkage in a Master Patient Index Using Machine Learning: Algorithm Development and Validation %A Nelson,Walter %A Khanna,Nityan %A Ibrahim,Mohamed %A Fyfe,Justin %A Geiger,Maxwell %A Edwards,Keith %A Petch,Jeremy %+ Centre for Data Science and Digital Health, Hamilton Health Sciences, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada, 1 9055212100, walterj.nelson@mail.utoronto.ca %K medical record linkage %K electronic health records %K medical record systems %K computerized %K machine learning %K quality of care %K health care system %K open-source software %K Bayesian optimization %K pilot %K data linkage %K master patient index %K master index %K record link %K matching algorithm %K FEBRL %D 2023 %7 29.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: To provide quality care, modern health care systems must match and link data about the same patient from multiple sources, a function often served by master patient index (MPI) software. Record linkage in the MPI is typically performed manually by health care providers, guided by automated matching algorithms. These matching algorithms must be configured in advance, such as by setting the weights of patient attributes, usually by someone with knowledge of both the matching algorithm and the patient population being served. Objective: We aimed to develop and evaluate a machine learning–based software tool, which automatically configures a patient matching algorithm by learning from pairs of patient records previously linked by humans already present in the database. Methods: We built a free and open-source software tool to optimize record linkage algorithm parameters based on historical record linkages. The tool uses Bayesian optimization to identify the set of configuration parameters that lead to optimal matching performance in a given patient population, by learning from prior record linkages by humans. The tool is written assuming only the existence of a minimal HTTP application programming interface (API), and so is agnostic to the choice of MPI software, record linkage algorithm, and patient population. As a proof of concept, we integrated our tool with SantéMPI, an open-source MPI. We validated the tool using several synthetic patient populations in SantéMPI by comparing the performance of the optimized configuration in held-out data to SantéMPI’s default matching configuration using sensitivity and specificity. Results: The machine learning–optimized configurations correctly detect over 90% of true record linkages as definite matches in all data sets, with 100% specificity and positive predictive value in all data sets, whereas the baseline detects none. In the largest data set examined, the baseline matching configuration detects possible record linkages with a sensitivity of 90.2% (95% CI 88.4%-92.0%) and specificity of 100%. By comparison, the machine learning–optimized matching configuration attains a sensitivity of 100%, with a decreased specificity of 95.9% (95% CI 95.9%-96.0%). We report significant gains in sensitivity in all data sets examined, at the cost of only marginally decreased specificity. The configuration optimization tool, data, and data set generator have been made freely available. Conclusions: Our machine learning software tool can be used to significantly improve the performance of existing record linkage algorithms, without knowledge of the algorithm being used or specific details of the patient population being served. %M 37384382 %R 10.2196/44331 %U https://formative.jmir.org/2023/1/e44331 %U https://doi.org/10.2196/44331 %U http://www.ncbi.nlm.nih.gov/pubmed/37384382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44549 %T Evaluation of the EsteR Toolkit for COVID-19 Decision Support: Sensitivity Analysis and Usability Study %A Alpers,Rieke %A Kühne,Lisa %A Truong,Hong-Phuc %A Zeeb,Hajo %A Westphal,Max %A Jäckle,Sonja %+ Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Str. 2, Bremen, 28209, Germany, 49 421 218 ext 59228, rieke.alpers@mevis.fraunhofer.de %K COVID-19 %K public health %K decision support tool %K sensitivity analysis %K web application %K usability study %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. Objective: The main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. Methods: For model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. Results: The simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. Conclusions: This evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness. %M 37368487 %R 10.2196/44549 %U https://formative.jmir.org/2023/1/e44549 %U https://doi.org/10.2196/44549 %U http://www.ncbi.nlm.nih.gov/pubmed/37368487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44877 %T Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study %A Kadirvelu,Balasundaram %A Bellido Bel,Teresa %A Wu,Xiaofei %A Burmester,Victoria %A Ananth,Shayma %A Cabral C C Branco,Bianca %A Girela-Serrano,Braulio %A Gledhill,Julia %A Di Simplicio,Martina %A Nicholls,Dasha %A Faisal,A Aldo %+ Brain & Behaviour Lab, Department of Computing and Department of Bioengineering, Imperial College London, Royal School of Mines, London, SW7 2AZ, United Kingdom, 44 20 7594 6373, a.faisal@imperial.ac.uk %K mobile mental health %K passive sensing %K smartphone apps for mental health %K children and young people %K adolescents %K digital tools %K mobile apps %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being. Objective: This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being. Methods: A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period. Results: Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention. Conclusions: The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people. %M 37358901 %R 10.2196/44877 %U https://formative.jmir.org/2023/1/e44877 %U https://doi.org/10.2196/44877 %U http://www.ncbi.nlm.nih.gov/pubmed/37358901 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46431 %T User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Shalaby,Reham %A Agyapong,Belinda %A Phung,Natalie %A Eyben,Scarlett %A Wells,Kristopher %A Dias,Raquel da Luz %A Hilario,Carla %A Jones,Chelsea %A Brémault-Phillips,Suzette %A Zhang,Yanbo %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K public safety personnel %K Text4PTSI %K text messaging %K satisfaction %K occupational health %K work safety %K public safety %K digital health intervention %K mental health service %K user satisfaction %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users’ satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)–based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral–based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents’ perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users. %M 37351940 %R 10.2196/46431 %U https://formative.jmir.org/2023/1/e46431 %U https://doi.org/10.2196/46431 %U http://www.ncbi.nlm.nih.gov/pubmed/37351940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45254 %T Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study %A Lauvsnes,Anders Dahlen Forsmo %A Hansen,Tor Ivar %A Ankill,Sebastian Øiungen %A Bae,Sang Won %A Gråwe,Rolf W %A Braund,Taylor A %A Larsen,Mark %A Langaas,Mette %+ Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 99592222, anders.d.f.lauvsnes@ntnu.no %K executive functioning %K substance use disorder %K ecological momentary assessment %K clinical inference %K substance use %K pilot study %K mood %K mental health %K neurocognitive functioning %K smartphone use %K mobile sensor %K sensor %K decision support %K mobile phone %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. Objective: This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. Methods: In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone’s battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. Results: A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. Conclusions: This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes. %M 37351934 %R 10.2196/45254 %U https://formative.jmir.org/2023/1/e45254 %U https://doi.org/10.2196/45254 %U http://www.ncbi.nlm.nih.gov/pubmed/37351934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44876 %T Identifying Patient Populations in Texts Describing Drug Approvals Through Deep Learning–Based Information Extraction: Development of a Natural Language Processing Algorithm %A Gendrin,Aline %A Souliotis,Leonidas %A Loudon-Griffiths,James %A Aggarwal,Ravisha %A Amoako,Daniel %A Desouza,Gregory %A Dimitrievska,Sashka %A Metcalfe,Paul %A Louvet,Emilie %A Sahni,Harpreet %+ AstraZeneca, City house, 126-130 Hills Rd, Cambridge, CB2 1RY, United Kingdom, 44 7814585004, aline.gendrinbrokmann@astrazeneca.com %K algorithm %K artificial intelligence %K BERT %K cancer %K classification %K data extraction %K data mining %K deep-learning %K development %K drug approval %K free text %K information retrieval %K line of therapy %K machine learning %K natural language processing %K NLP %K oncology %K pharmaceutic %K pharmacology %K pharmacy %K stage of cancer %K text extraction %K text mining %K unstructured data %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: New drug treatments are regularly approved, and it is challenging to remain up-to-date in this rapidly changing environment. Fast and accurate visualization is important to allow a global understanding of the drug market. Automation of this information extraction provides a helpful starting point for the subject matter expert, helps to mitigate human errors, and saves time. Objective: We aimed to semiautomate disease population extraction from the free text of oncology drug approval descriptions from the BioMedTracker database for 6 selected drug targets. More specifically, we intended to extract (1) line of therapy, (2) stage of cancer of the patient population described in the approval, and (3) the clinical trials that provide evidence for the approval. We aimed to use these results in downstream applications, aiding the searchability of relevant content against related drug project sources. Methods: We fine-tuned a state-of-the-art deep learning model, Bidirectional Encoder Representations from Transformers, for each of the 3 desired outputs. We independently applied rule-based text mining approaches. We compared the performances of deep learning and rule-based approaches and selected the best method, which was then applied to new entries. The results were manually curated by a subject matter expert and then used to train new models. Results: The training data set is currently small (433 entries) and will enlarge over time when new approval descriptions become available or if a choice is made to take another drug target into account. The deep learning models achieved 61% and 56% 5-fold cross-validated accuracies for line of therapy and stage of cancer, respectively, which were treated as classification tasks. Trial identification is treated as a named entity recognition task, and the 5-fold cross-validated F1-score is currently 87%. Although the scores of the classification tasks could seem low, the models comprise 5 classes each, and such scores are a marked improvement when compared to random classification. Moreover, we expect improved performance as the input data set grows, since deep learning models need to be trained on a large enough amount of data to be able to learn the task they are taught. The rule-based approach achieved 60% and 74% 5-fold cross-validated accuracies for line of therapy and stage of cancer, respectively. No attempt was made to define a rule-based approach for trial identification. Conclusions: We developed a natural language processing algorithm that is currently assisting subject matter experts in disease population extraction, which supports health authority approvals. This algorithm achieves semiautomation, enabling subject matter experts to leverage the results for deeper analysis and to accelerate information retrieval in a crowded clinical environment such as oncology. %M 37347514 %R 10.2196/44876 %U https://formative.jmir.org/2023/1/e44876 %U https://doi.org/10.2196/44876 %U http://www.ncbi.nlm.nih.gov/pubmed/37347514 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44226 %T Evaluation of a Knowledge Mobilization Campaign to Promote Support for Working Caregivers in Canada: Quantitative Evaluation %A Neil-Sztramko,Sarah E %A Dobbins,Maureen %A Williams,Allison %+ National Collaborating Centre for Methods and Tools, McMaster University, 175 Longwood Road, S, Suite 210a, Hamilton, ON, L8P0A1, Canada, 1 9055259140 ext 20459, neilszts@mcmaster.ca %K informal caregiver %K knowledge mobilization %K social media %K workplace standard %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As population demographics continue to shift, many employees will also be tasked with providing informal care to a friend or family member. The balance between working and caregiving can greatly strain carer-employees. Caregiver-friendly work environments can help reduce this burden. However, there is little awareness of the benefits of these workplace practices, and they have not been widely adopted in Canada. An awareness-generating campaign with the core message “supporting caregivers at work makes good business sense” was created leading up to Canada’s National Caregivers Day on April 5, 2022. Objective: Our primary objective is to describe the campaign's reach and engagement, including social media, email, and website activity, and our secondary objective is to compare engagement metrics across social media platforms. Methods: An awareness-generating campaign was launched on September 22, 2021, with goals to (1) build awareness about the need for caregiver-friendly workplaces and (2) direct employees and employers to relevant resources on a campaign website. Content was primarily delivered through 4 social media platforms (Twitter, LinkedIn, Facebook, and Instagram), and supplemented by direct emails through a campaign partner, and through webinars. Total reach, defined as the number of impressions, and quality of engagement, defined per social media platform as the engagement rate per post, average site duration, and page depth, were captured and compared through site-specific analytics on Facebook, Instagram, Twitter, and LinkedIn throughout the awareness-generating campaign. The number of views, downloads, bounce rate, and time on the page for the website were counted using Google Analytics. Open and click-through rates were measured using email analytics, and webinar registrants and attendees were also tracked. Results: Data were collected from September 22, 2021, to April 12, 2022. During this time, 30 key messages were developed and disseminated through 74 social media tiles. While Facebook posts generated the most extensive reach (137,098 impressions), the quality of the engagement was low (0.561 engagement per post). Twitter resulted in the highest percentage of impressions that resulted in engagement (24%), and those who viewed resources through Twitter spent a substantial amount of time on the page (3 minute 5 second). Website users who visited the website through Instagram spent the most time on the website (5 minute 44 second) and had the greatest page depth (2.20 pages), and the overall reach was low (3783). Recipients’ engagement with email content met industry standards. Webinar participation ranged from 57 to 78 attendees. Conclusions: This knowledge mobilization campaign reached a large audience and generated engagement in content. Twitter is most helpful for this type of knowledge mobilization. Further work is needed to evaluate the characteristics of individuals engaging in this content and to work more closely with employers and employees to move from engagement and awareness to adopt caregiver-friendly workplace practices. %M 37347525 %R 10.2196/44226 %U https://formative.jmir.org/2023/1/e44226 %U https://doi.org/10.2196/44226 %U http://www.ncbi.nlm.nih.gov/pubmed/37347525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43855 %T Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data %A Noholoza,Sandisiwe %A Phillips,Tamsin K %A Madwayi,Sindiswa %A Mrubata,Megan %A Camlin,Carol S %A Myer,Landon %A Clouse,Kate %+ Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, 9 Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 732901598, sandisiwe.noholoza@uct.ac.za %K HIV %K mHealth %K mobile phone %K ownership %K smartphone %K South Africa %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. Objective: In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. Methods: We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ≥28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results: Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Conclusions: Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms—particularly WhatsApp—are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625 %M 37347521 %R 10.2196/43855 %U https://formative.jmir.org/2023/1/e43855 %U https://doi.org/10.2196/43855 %U http://www.ncbi.nlm.nih.gov/pubmed/37347521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43527 %T A Mobile Medication Support App and Its Impact on People Living With HIV: 12-Week User Experience and Medication Compliance Pilot Study %A Suzuki,Mai %A Yamanaka,Kou %A Fukushima,Shinichi %A Ogawa,Mayu %A Nagaiwa,Yuki %A Naito,Toshio %+ Department of General Medicine, Juntendo University Faculty of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 3813 3111, naito@juntendo.ac.jp %K human immunodeficiency virus %K HIV %K acquired immunodeficiency syndrome %K mobile health %K mHealth %K medication compliance %K satisfaction survey %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The continuity of care between hospital visits conducted through mobile apps creates new opportunities for people living with HIV in situations where face-to-face interventions are difficult. Objective: This study investigated the user experience of a mobile medication support app and its impact on improving antiretroviral therapy compliance and facilitating teleconsultations between people living with HIV and medical staff. Methods: Two clinics in Japan were invited to participate in a 12-week trial of the medication support app between July 27, 2018, and March 31, 2021. Medication compliance was assessed based on responses to scheduled medication reminders; users, including people living with HIV and medical staff, were asked to complete an in-app satisfaction survey to rate their level of satisfaction with the app and its specific features on a 5-point Likert scale. Results: A total of 10 people living with HIV and 11 medical staff were included in this study. During the trial, the medication compliance rate was 90%, and the mean response rates to symptom and medication alerts were 73% and 76%, respectively. Overall, people living with HIV and medical staff were satisfied with the medication support app (agreement rate: mean 81% and 65%, respectively). Over 80% of medical staff and people living with HIV were satisfied with the ability to record medications taken (9/11 and 8/10 medical staff and people living with HIV, respectively), record symptoms of concern (10/11 and 8/10),and inquire about drug combinations (8/10, 10/10). And further, 90% of people living with HIV were satisfied with the function for communication with medical staff (9/10). Conclusions: Our preliminary results demonstrate the feasibility of the medication support app in improving medication compliance and enhancing communication between people living with HIV and medical staff. %M 37021843 %R 10.2196/43527 %U https://formative.jmir.org/2023/1/e43527 %U https://doi.org/10.2196/43527 %U http://www.ncbi.nlm.nih.gov/pubmed/37021843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41876 %T Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study %A Diefenbach,Michael A %A Marziliano,Allison %A Siembida,Elizabeth J %A Mistretta,Thomas %A Pfister,Halie %A Yacoub,Andrea %A Aibel,Kelli %A Patel,Priya %A Lapitan,Emmanuel %A Tagai,Erin K %A Smaldone,Marc %A Miller,Suzanne M %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 600 Community Drive, Suite 403 Manhasset, New York, NY, 11030, United States, 1 516 600 1440, mdiefenbach@northwell.edu %K muscle invasive bladder cancer %K behavioral intervention development %K ORBIT model %K usability testing %K web-based intervention %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Bladder cancer survivors and their caregivers face profound practical (eg, use of stoma appliances and care for urinary diversion methods) and psychosocial (eg, depression and anxiety) challenges after surgical treatment with cystectomy. Objective: To improve the health-related quality of life and postsurgical outcomes of both bladder cancer survivors and their caregivers, the team, in collaboration with Sourcetop, Inc (software design) and Dappersmith (graphic design), developed the Cancer Resource and Information Support (CRIS) software. The purpose of this manuscript is to report on the development and usability testing of the CRIS software. Methods: The development of the CRIS software was guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for developing behavioral treatments for chronic diseases. The ORBIT model is unique in that it proposes a flexible and progressive process with prespecific clinically significant milestones for forward movement and returns to earlier stages for refinement, and it facilitates communication among diverse groups by using terminology from the drug development model. This paper focuses on 2 phases of the ORBIT model: phase IA: define and IB: refine. During phase IA, the study team developed solutions for the stated clinical problem—adjustment to life post cystectomy—by reviewing the literature and collecting feedback from clinicians, professional organizations, bladder cancer survivors, and their caregivers. During Phase IB, the study team focused on tailoring content in the CRIS software to the user as well as usability testing with 7 participants. Results: The finished product is CRIS, a web-based software for survivors of bladder cancer and their caregivers to serve as a health management and lifestyle resource after surgery. Overarching themes from phase IA (participant feedback) included how to use new medical equipment, tips and tricks for easier living with new medical equipment, questions about health maintenance, and questions about lifestyle modifications. To accommodate our target population, we also incorporated recommendations from the Americans with Disabilities Act for website design, such as large text size, large paragraph spacing, highly contrasting text and background colors, use of headings and labels to describe the purpose of the content, portrait orientation without the need for horizontal scrolling, multiple ways to access a web page within a set of pages, ability to navigate web pages in sequential order, and in-text links that are descriptive. Usability participants evaluated CRIS very positively, indicating that it was easy to use, the functions were well-integrated, and if available, they would use CRIS frequently. Conclusions: CRIS, developed over the course of 18 months by integrating feedback from experts, literature reviews, and usability testing, is the first web-based software developed for bladder cancer survivors and their caregivers to help them adjust to life following cystectomy. The efficacy of CRIS in improving patients’ and caregivers’ quality of life is currently being evaluated in a randomized controlled trial. %M 37347533 %R 10.2196/41876 %U https://formative.jmir.org/2023/1/e41876 %U https://doi.org/10.2196/41876 %U http://www.ncbi.nlm.nih.gov/pubmed/37347533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39487 %T The Effects of Scheduled Smoking Reduction and Precessation Nicotine Replacement Therapy on Smoking Cessation: Randomized Controlled Trial With Compliance %A Cinciripini,Paul M %A Minnix,Jennifer A %A Robinson,Jason D %A Kypriotakis,George %A Cui,Yong %A Blalock,Janice A %A Lam,Cho Y %A Wetter,David W %+ Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler St., Houston, TX, 77030, United States, 1 281 908 6782, gkypriotakis@mdanderson.org %K gradual reduction %K scheduled smoking %K nicotine replacement therapy %K smoking cessation %K compliance %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health problem, and it is important to provide a variety of efficacious and appealing options to encourage smokers to quit smoking. Scheduled smoking is a method of gradual reduction, preparing smokers to quit by systematically reducing cigarette consumption according to a predetermined schedule that increases the time between cigarette consumption. Gradual reduction may be preferred to abrupt quitting, but the efficacy of this cessation approach is unclear. Objective: This study aims, first, to evaluate the overall effectiveness of scheduled smoking alone, or in combination with precessation nicotine replacement therapy (NRT), versus standard NRT starting on the quit date with no prior smoking reduction and, second, to evaluate the impact of schedule compliance on the effectiveness of the intervention. Methods: A total of 916 participants recruited from the Houston metropolitan area were randomly assigned to 1 of the following 3 groups: scheduled smoking plus a precessation nicotine patch (n=306, 33.4%), scheduled smoking only with no precessation patch (n=309, 33.7%), and enhanced usual care (n=301, 32.9%) control. The primary abstinence outcomes were carbon monoxide–verified, self-reported, 7-day point prevalence abstinence at 2 and 4 weeks after the quit date. Unadjusted and adjusted logistic regression analyses were performed to evaluate the intervention effect. Scheduled smoking was implemented using a handheld device for 3 weeks before quitting. This trial was not registered because data collection began before July 1, 2005. Results: Results for the first aim showed no overall differences in abstinence among the 3 groups in both the unadjusted and adjusted models. However, the results for the second aim showed a clear effect on abstinence by schedule compliance at 2 and 4 weeks and 6 months after quitting (odds ratio [OR] 2.01, 95% CI 1.31-3.07), 4 weeks (OR 1.58, 95% CI 1.05-2.38), and 6 months (OR 1.68, 95% CI 1.04-2.64), with the differences at 2 and 4 weeks after quitting being the most robust. We also found that scheduled smoking was related to a reduction in nicotine withdrawal, negative affect, and craving when compared with the controls. Conclusions: Scheduled smoking, when combined with precessation use of NRT, can result in significantly higher abstinence rates than usual care (abrupt quitting with NRT), particularly in the early postquit phase (2 and 4 weeks after cessation) when smokers are compliant with the procedure. Scheduled smoking also produced a better overall quitting experience by reducing symptoms of nicotine withdrawal and craving, in comparison with usual care, which could encourage future quit attempts. Studies in this area should focus on the use of counseling or other methods to improve adherence. %M 37338956 %R 10.2196/39487 %U https://formative.jmir.org/2023/1/e39487 %U https://doi.org/10.2196/39487 %U http://www.ncbi.nlm.nih.gov/pubmed/37338956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40274 %T Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study %A Fountaine,Alex R %A Iyar,Megumi M %A Lutes,Lesley D %+ The Center for Obesity and Well-Being Research Excellence, Department of Psychology, University of British Columbia - Okanagan Campus, 1238 Discovery Ave, Kelowna, BC, Canada, 1 2503075045, lesley.lutes@ubc.ca %K integrated primary care %K integrated care %K patient-centered medical home %K warm handoff %K treatment engagement %K collaborative care %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A warm handoff from a physician to a mental health provider is often patients’ first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. Objective: In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. Methods: A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. Results: Logistic associations between referral type and the likelihood of referral acceptance (χ21=10.9, P=.004) and the likelihood of continued engagement (χ21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician’s office. Conclusions: A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings. %M 37338963 %R 10.2196/40274 %U https://formative.jmir.org/2023/1/e40274 %U https://doi.org/10.2196/40274 %U http://www.ncbi.nlm.nih.gov/pubmed/37338963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38388 %T Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study %A Lee,Hee Yun %A Xiong,Serena %A Sur,Aparajita %A Khang,Tounhia %A Vue,Bai %A Culhane-Pera,Kathleen A %A Pergament,Shannon %A Torres,M Beatriz %A Koopmeiners,Joseph S %A Desai,Jay %+ School of Social Work, The University of Alabama, 2024 Little Hall Box 870314, Tuscaloosa, AL, 35487, United States, 1 205 348 6553, hlee94@ua.edu %K human papillomavirus %K HPV %K HPV vaccine %K community-based participatory action research %K CBPAR %K eHealth %K website %K social cognitive theory %K Hmong %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website’s effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants’ HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents’ average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers’ self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website’s content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research–designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents’ and adolescents’ knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website’s impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). %M 37338961 %R 10.2196/38388 %U https://formative.jmir.org/2023/1/e38388 %U https://doi.org/10.2196/38388 %U http://www.ncbi.nlm.nih.gov/pubmed/37338961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45321 %T A Continuous Aerobic Resistance Exercise Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study %A Hutchison,Michael G %A Di Battista,Alex P %A Loenhart,Matthew M %+ Goldring Centre for High Performance Sport, University of Toronto, 100 Devonshire Pl, Toronto, ON, M5S 2C9, Canada, 1 416 946 5630, michael.hutchison@utoronto.ca %K Bayesian modeling %K concussion %K exercise rehabilitation %K mobile health %K mild traumatic brain injury %K persisting symptoms %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, several studies have consistently reported the beneficial effects of aerobic exercise in alleviating symptoms following concussion. However, exercise modality recommendations by practitioners are often limited to traditional exercise equipment (eg, treadmills and stationary bikes). Advances in digital technologies may help to overcome this limitation, as mobile apps can now provide users with high-quality instructional videos, programs, and monitoring capabilities using alternative modalities such as resistance exercises. Mobile technologies are also rapidly expanding to deliver and complement in-person clinical care. Thus, it is imperative to evaluate this emerging technology on its feasibility, safety, and clinical utility for concussion care. Objective: The objective of the study was to determine the feasibility of a mobile app to deliver a resistance exercise protocol with minimal equipment to individuals following concussion. Feasibility was defined by retention, adverse events, and achievement of a target heart rate (HR) of 60%±5% (age-adjusted percentage of max: 220 – age). HR data were collected using an Apple Watch, Series 6. Symptoms were evaluated before and after 3 exercise sessions. Methods: A 2-week, prospective, single-arm pilot study was conducted on 21 adults diagnosed with a concussion. Users were provided a continuous aerobic resistance exercise (CARE) protocol through a mobile app. Results: A total of 18 participants (14 female and 4 male) completed a 3-session exercise plan. The median age-adjusted percent of HR max for session 1 was 55.5% (IQR 49%-63%), 58.1% (IQR 50.8%-65.2%) for session 2, and 57.4% (IQR 49.5%-64.7%) for session 3. Individual median HR% across all sessions ranged from 46.9% to 67.4%; furthermore, 10 participants (55.5%) had a total mean HR% within the target HR%, 7 participants had a mean HR% below 55%, and 1 participant had a mean HR% above 65%. In addition, adherence to the plan resulted in a decrease in reported symptom burden with 94% posterior probability. Conclusions: Following concussion, a CARE protocol delivered through a mobile app resulted in no adverse effects with 14% (n=3/21) attrition over 3 sessions. CARE was successful in achieving an aerobic exercise intensity of 55%-65% of age-adjusted maximum HR in the majority of participants and resulted in a decrease in reported symptom burden. The potential for this platform in concussion rehabilitation warrants further investigation. Future studies are needed to assess the use of this technology throughout concussion recovery in both individuals with acute concussion, and those with persistent symptoms. %M 37335605 %R 10.2196/45321 %U https://formative.jmir.org/2023/1/e45321 %U https://doi.org/10.2196/45321 %U http://www.ncbi.nlm.nih.gov/pubmed/37335605 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42573 %T Computerized Cognitive Behavioral Therapy for Anxiety and Depression in Farming Communities: Mixed Methods Feasibility Study of Participant Use and Acceptability %A Bowyer,Harriet L %A Pegler,Ruth %A Williams,Christopher %+ Department of Psychology, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, United Kingdom, 44 1413318630, harriet.bowyer@gcu.ac.uk %K computerized cognitive behavioral therapy %K cCBT %K cognitive behavioral therapy %K CBT %K farmer %K depression %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community. Objective: This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach. Methods: Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire–9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder–7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis. Results: Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention. Conclusions: cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention. %M 37335597 %R 10.2196/42573 %U https://formative.jmir.org/2023/1/e42573 %U https://doi.org/10.2196/42573 %U http://www.ncbi.nlm.nih.gov/pubmed/37335597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47256 %T Models of Gender Dysphoria Using Social Media Data for Use in Technology-Delivered Interventions: Machine Learning and Natural Language Processing Validation Study %A Cascalheira,Cory J %A Flinn,Ryan E %A Zhao,Yuxuan %A Klooster,Dannie %A Laprade,Danica %A Hamdi,Shah Muhammad %A Scheer,Jillian R %A Gonzalez,Alejandra %A Lund,Emily M %A Gomez,Ivan N %A Saha,Koustuv %A De Choudhury,Munmun %+ Department of Counseling & Educational Psychology, New Mexico State University, 1220 Stewart Street, Las Cruces, NM, 88003, United States, 1 575 323 1272, cjcascalheira@gmail.com %K gender diverse %K gender dysphoria %K social media %K social computing %K digital health %K mobile phone %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The optimal treatment for gender dysphoria is medical intervention, but many transgender and nonbinary people face significant treatment barriers when seeking help for gender dysphoria. When untreated, gender dysphoria is associated with depression, anxiety, suicidality, and substance misuse. Technology-delivered interventions for transgender and nonbinary people can be used discretely, safely, and flexibly, thereby reducing treatment barriers and increasing access to psychological interventions to manage distress that accompanies gender dysphoria. Technology-delivered interventions are beginning to incorporate machine learning (ML) and natural language processing (NLP) to automate intervention components and tailor intervention content. A critical step in using ML and NLP in technology-delivered interventions is demonstrating how accurately these methods model clinical constructs. Objective: This study aimed to determine the preliminary effectiveness of modeling gender dysphoria with ML and NLP, using transgender and nonbinary people’s social media data. Methods: Overall, 6 ML models and 949 NLP-generated independent variables were used to model gender dysphoria from the text data of 1573 Reddit (Reddit Inc) posts created on transgender- and nonbinary-specific web-based forums. After developing a codebook grounded in clinical science, a research team of clinicians and students experienced in working with transgender and nonbinary clients used qualitative content analysis to determine whether gender dysphoria was present in each Reddit post (ie, the dependent variable). NLP (eg, n-grams, Linguistic Inquiry and Word Count, word embedding, sentiment, and transfer learning) was used to transform the linguistic content of each post into predictors for ML algorithms. A k-fold cross-validation was performed. Hyperparameters were tuned with random search. Feature selection was performed to demonstrate the relative importance of each NLP-generated independent variable in predicting gender dysphoria. Misclassified posts were analyzed to improve future modeling of gender dysphoria. Results: Results indicated that a supervised ML algorithm (ie, optimized extreme gradient boosting [XGBoost]) modeled gender dysphoria with a high degree of accuracy (0.84), precision (0.83), and speed (1.23 seconds). Of the NLP-generated independent variables, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) clinical keywords (eg, dysphoria and disorder) were most predictive of gender dysphoria. Misclassifications of gender dysphoria were common in posts that expressed uncertainty, featured a stressful experience unrelated to gender dysphoria, were incorrectly coded, expressed insufficient linguistic markers of gender dysphoria, described past experiences of gender dysphoria, showed evidence of identity exploration, expressed aspects of human sexuality unrelated to gender dysphoria, described socially based gender dysphoria, expressed strong affective or cognitive reactions unrelated to gender dysphoria, or discussed body image. Conclusions: Findings suggest that ML- and NLP-based models of gender dysphoria have significant potential to be integrated into technology-delivered interventions. The results contribute to the growing evidence on the importance of incorporating ML and NLP designs in clinical science, especially when studying marginalized populations. %M 37327053 %R 10.2196/47256 %U https://formative.jmir.org/2023/1/e47256 %U https://doi.org/10.2196/47256 %U http://www.ncbi.nlm.nih.gov/pubmed/37327053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45061 %T mHealth Intervention for Promoting Hypertension Self-management Among African American Patients Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App %A Brewer,LaPrincess C %A Jones,Clarence %A Slusser,Joshua P %A Pasha,Maarya %A Lalika,Mathias %A Chacon,Megan %A Takawira,Patricia %A Shanedling,Stanton %A Erickson,Paul %A Woods,Cynthia %A Krogman,Ashton %A Ferdinand,Daphne %A Underwood,Paul %A Cooper,Lisa A %A Patten,Christi A %A Hayes,Sharonne N %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 1st St S.W., Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K hypertension %K telemedicine %K health promotion %K community health workers %K community-based participatory research %K mobile phone %K mobile health %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. Objective: This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients. Methods: A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health–related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment. Results: In phase 1, thirteen African American patients (n=9, 69% aged ≥50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ≥50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ≥50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment. Conclusions: A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted. Trial Registration: ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147 %M 37115658 %R 10.2196/45061 %U https://formative.jmir.org/2023/1/e45061 %U https://doi.org/10.2196/45061 %U http://www.ncbi.nlm.nih.gov/pubmed/37115658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44429 %T A Gamified Mobile App That Helps People Develop the Metacognitive Skills to Cope With Stressful Situations and Difficult Emotions: Formative Assessment of the InsightApp %A Amo,Victoria %A Prentice,Mike %A Lieder,Falk %+ Max Planck Institute for Intelligent Systems, Max Planck Ring 4, Tübingen, 72076, Germany, 49 15730645508, victoria.amo@tuebingen.mpg.de %K ecological momentary interventions %K serious games %K mindfulness-based interventions %K acceptance and commitment therapy %K cognitive behavioral therapy %K mobile phone %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary interventions open up new and exciting possibilities for delivering mental health interventions and conducting research in real-life environments via smartphones. This makes designing psychotherapeutic ecological momentary interventions a promising step toward cost-effective and scalable digital solutions for improving mental health and understanding the effects and mechanisms of psychotherapy. Objective: The first objective of this study was to formatively assess and improve the usability and efficacy of a gamified mobile app, the InsightApp, for helping people learn some of the metacognitive skills taught in cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions. The app aims to help people constructively cope with stressful situations and difficult emotions in everyday life. The second objective of this study was to test the feasibility of using the InsightApp as a research tool for investigating the efficacy of psychological interventions and their underlying mechanisms. Methods: We conducted 2 experiments. In experiment 1 (n=65; completion rate: 63/65, 97%), participants (mean age 27, SD 14.9; range 19-55 years; 41/60, 68% female) completed a single session with the InsightApp. The intervention effects on affect, belief endorsement, and propensity for action were measured immediately before and after the intervention. Experiment 2 (n=200; completion rate: 142/200, 71%) assessed the feasibility of conducting a randomized controlled trial using the InsightApp. We randomly assigned participants to an experimental or a control condition, and they interacted with the InsightApp for 2 weeks (mean age 37, SD 12.16; range 20-78 years; 78/142, 55% female). Experiment 2 included all the outcome measures of experiment 1 except for the self-reported propensity to engage in predefined adaptive and maladaptive behaviors. Both experiments included user experience surveys. Results: In experiment 1, a single session with the app seemed to decrease participants’ emotional struggle, the intensity of their negative emotions, their endorsement of negative beliefs, and their self-reported propensity to engage in maladaptive coping behaviors (P<.001 in all cases; average effect size=−0.82). Conversely, participants’ endorsement of adaptive beliefs and their self-reported propensity to act in accordance with their values significantly increased (P<.001 in all cases; average effect size=0.48). Experiment 2 replicated the findings of experiment 1 (P<.001 in all cases; average effect size=0.55). Moreover, experiment 2 identified a critical obstacle to conducting a randomized controlled trial (ie, asymmetric attrition) and how it might be overcome. User experience surveys suggested that the app’s design is suitable for helping people apply psychotherapeutic techniques to cope with everyday stress and anxiety. User feedback provided valuable information on how to further improve app usability. Conclusions: In this study, we tested the first prototype of the InsightApp. Our encouraging preliminary results show that it is worthwhile to continue developing the InsightApp and further evaluate it in a randomized controlled trial. %M 37327040 %R 10.2196/44429 %U https://formative.jmir.org/2023/1/e44429 %U https://doi.org/10.2196/44429 %U http://www.ncbi.nlm.nih.gov/pubmed/37327040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43903 %T Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing %A Trivedi,Ranak %A Hirayama,Sierra Kawena %A Risbud,Rashmi %A Suresh,Madhuvanthi %A Humber,Marika Blair %A Butler,Kevin %A Razze,Alex %A Timko,Christine %A Nelson,Karin %A Zulman,Donna M %A Asch,Steven M %A Humphreys,Keith %A Piette,John D %+ Center for Innovation to Implementation, Veteran Affairs Palo Alto Health Care System, 795 Willow Rd Bldg 324, 152-MPD Ci2i, Menlo Park, CA, 94025, United States, 1 4157872805, ranakt@stanford.edu %K dyadic %K eHealth %K behavioral interventions %K self-management %K caregiver %K web-based %K interventions %K stress management %K self-care %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient outcomes. Dyadic technology–enabled interventions that simultaneously improve outcomes for patients and caregivers are needed. Objective: This study aimed to describe the methodology used to adapt a telephone-based, facilitated, and dyadic self-management program called Self-care Using Collaborative Coping Enhancement in Diseases (SUCCEED) into a self-guided, web-based version (web-SUCCEED) and to conduct usability testing for web-SUCCEED. Methods: We developed web-SUCCEED in 6 steps: ideation—determine the intervention content areas; prototyping—develop the wireframes, illustrating the look and feel of the website; prototype refinement via feedback from focus groups; finalizing the module content; programming web-SUCCEED; and usability testing. A diverse team of stakeholders including content experts, web designers, patients, and caregivers provided input at various stages of development. Costs, including full-time equivalent employee, were summarized. Results: At the ideation stage, we determined the content of web-SUCCEED based on feedback from the program’s original pilot study. At the prototyping stage, the principal investigator and web designers iteratively developed prototypes that included inclusive design elements (eg, large font size). Feedback about these prototypes was elicited through 2 focus groups of veterans with chronic conditions (n=13). Rapid thematic analysis identified two themes: (1) web-based interventions can be useful for many but should include ways to connect with other users and (2) prototypes were sufficient to elicit feedback about the esthetics, but a live website allowing for continual feedback and updating would be better. Focus group feedback was incorporated into building a functional website. In parallel, the content experts worked in small groups to adapt SUCCEED’s content, so that it could be delivered in a didactic, self-guided format. Usability testing was completed by veterans (8/16, 50%) and caregivers (8/16, 50%). Veterans and caregivers gave web-SUCCEED high usability scores, noting that it was easy to understand, easy to use, and not overly burdensome. Notable negative feedback included “slightly agreeing” that the site was confusing and awkward. All veterans (8/8, 100%) agreed that they would choose this type of program in the future to access an intervention that aims to improve their health. Developing and maintaining the software and hosting together cost approximately US $100,000, excluding salary and fringe benefits for project personnel (steps 1-3: US $25,000; steps 4-6: US $75,000). Conclusions: Adapting an existing, facilitated self-management support program for delivery via the web is feasible, and such programs can remotely deliver content. Input from a multidisciplinary team of experts and stakeholders can ensure the program’s success. Those interested in adapting programs should have a realistic estimate of the budget and staffing requirements. %M 37327057 %R 10.2196/43903 %U https://formative.jmir.org/2023/1/e43903 %U https://doi.org/10.2196/43903 %U http://www.ncbi.nlm.nih.gov/pubmed/37327057 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43037 %T Exploring the Impact of Social Media on Anxiety Among University Students in the United Kingdom: Qualitative Study %A Anto,Ailin %A Asif,Rafey Omar %A Basu,Arunima %A Kanapathipillai,Dylan %A Salam,Haadi %A Selim,Rania %A Zaman,Jahed %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, rania.selim18@imperial.ac.uk %K social media %K anxiety %K university student %K university %K college %K student %K qualitative %K mental health %K mental well-being %K thematic analysis %K stress %K health care professional %K humanistic %K social science %K undergraduate %K narrative inquiry %K narrative inquiry %K social network %K United Kingdom %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid surge in social media platforms has significant implications for users’ mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern. However, there has been limited research into how the association between social media and anxiety arises, specifically among university students—the generation that has seen the introduction and evolution of social media, and currently lives through the medium. Extant systematic literature reviews within this area of research have not yet focused on university students or anxiety, rather predominantly investigating adolescents or generalized mental health symptoms and disorders. Furthermore, there is little to no qualitative data exploring the association between social media and anxiety among university students. Objective: The purpose of this study is to conduct a systematic literature review of the existing literature and a qualitative study that aims to develop foundational knowledge around the association of social media and anxiety among university students and enhance extant knowledge and theory. Methods: A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and university faculties. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media. Results: Thematic analysis resulted in 8 second-order themes: 3 mediating factors that decrease anxiety levels and 5 factors that increase anxiety levels. Social media decreased anxiety through positive experiences, social connectivity, and escapism. Social media increased anxiety through stress, comparison, fear of missing out, negative experiences, and procrastination. Conclusions: This qualitative study sheds critical light on how university students perceive how social media affects their anxiety levels. Students revealed that social media did impact their anxiety levels and considered it an important factor in their mental health. Thus, it is essential to educate stakeholders, including students, university counselors, and health care professionals, about the potential impact of social media on students’ anxiety levels. Since anxiety is a multifactorial condition, pinpointing the main stressors in a person’s life, such as social media use, may help manage these patients more effectively. The current research highlights that there are also many benefits to social media, and uncovering these may help in producing more holistic management plans for anxiety, reflective of the students’ social media usage. %M 37327030 %R 10.2196/43037 %U https://formative.jmir.org/2023/1/e43037 %U https://doi.org/10.2196/43037 %U http://www.ncbi.nlm.nih.gov/pubmed/37327030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41590 %T Feasibility and Preliminary Efficacy of Digital Interventions for Depressive Symptoms in Working Adults: Multiarm Randomized Controlled Trial %A Taylor,Rachael Wallis %A Male,Rhian %A Economides,Marcos %A Bolton,Heather %A Cavanagh,Kate %+ Unmind Ltd, 180 Borough High Street, London, SE1 1LB, United Kingdom, 44 7814522979, rachaelwtaylor@gmail.com %K depression %K digital intervention %K randomized controlled trial %K RCT %K cognitive behavioral therapy %K CBT %K acceptance and commitment therapy %K ACT %K behavioral activation %K BA %K mobile phone %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depressive symptoms are highly prevalent and have broad-ranging negative implications. Digital interventions are increasingly available in the workplace context, but supporting evidence is limited. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of 3 digital interventions for depressive symptoms in a sample of UK-based working adults experiencing mild to moderate symptoms. Methods: This was a parallel, multiarm, pilot randomized controlled trial. Participants were allocated to 1 of 3 digital interventions or a waitlist control group and had 3 weeks to complete 6 to 8 short self-guided sessions. The 3 interventions are available on the Unmind mental health app for working adults and draw on behavioral activation, cognitive behavioral therapy, and acceptance and commitment therapy. Web-based assessments were conducted at baseline, postintervention (week 3), and at 1-month follow-up (week 7). Participants were recruited via Prolific, a web-based recruitment platform, and the study was conducted entirely on the web. Feasibility and acceptability were assessed using objective engagement data and self-reported feedback. Efficacy outcomes were assessed using validated self-report measures of mental health and functioning and linear mixed models with intention-to-treat principles. Results: In total, 2003 individuals were screened for participation, of which 20.22% (405/2003) were randomized. A total of 92% (373/405) of the participants were retained in the study, 97.4% (295/303) initiated their allocated intervention, and 66.3% (201/303) completed all sessions. Moreover, 80.6% (229/284) of the participants rated the quality of their allocated intervention as excellent or good, and 79.6% (226/284) of the participants were satisfied or very satisfied with their intervention. All active groups showed improvements in well-being, functioning, and depressive and anxiety symptoms compared with the control group, which were maintained at 4 weeks. Hedges g effect sizes for depressive symptoms ranged from −0.53 (95% CI −0.25 to −0.81) to −0.74 (95% CI −0.45 to −1.03). Conclusions: All interventions were feasible and acceptable, and the preliminary efficacy findings indicated that their use may improve depressive symptoms, well-being, and functioning. The predefined criteria for a definitive trial were met. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN13067492; https://www.isrctn.com/ISRCTN13067492 %M 37327027 %R 10.2196/41590 %U https://formative.jmir.org/2023/1/e41590 %U https://doi.org/10.2196/41590 %U http://www.ncbi.nlm.nih.gov/pubmed/37327027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35858 %T Mobile Apps for Dietary and Food Timing Assessment: Evaluation for Use in Clinical Research %A Gioia,Siena %A Vlasac,Irma M %A Babazadeh,Demsina %A Fryou,Noah L %A Do,Elizabeth %A Love,Jessica %A Robbins,Rebecca %A Dashti,Hassan S %A Lane,Jacqueline M %+ Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA, EBRC104, United States, 1 617 525 7829, jlane@broadinstitute.org %K dietary assessment %K mobile phone %K smartphone %K nutrition apps %K dietary record %K circadian rhythms %K food diary %K food timing %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, health mobile apps have become an increasingly popular tool used by clinicians and researchers to track food consumption and exercise. However, many consumer apps lack the technological features for facilitating the capture of critical food timing details. Objective: This study aimed to introduce users to 11 apps from US app stores that recorded both dietary intake and food timing to establish which one would be the most appropriate for clinical research. Methods: To determine a viable app that recorded both dietary intake and food timing for use in a food timing–related clinical study, we evaluated the time stamp data, usability, privacy policies, the accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment that were available on US app stores. The following apps were selected using a keyword search of related terms and reviewed: text entry apps—Cronometer, DiaryNutrition, DietDiary, FoodDiary, Macros, and MyPlate; image entry apps—FoodView and MealLogger; and text plus image entry apps—Bitesnap, myCircadianClock, and MyFitnessPal. Results: Our primary goal was to identify apps that recorded food time stamps, which 8 (73%) of the 11 reviewed apps did. Of the 11 apps, only 4 (36%) allowed users to edit the time stamps. Next, we sought to evaluate the usability of the apps using the System Usability Scale across 2 days, and 82% (9/11) of the apps received favorable scores for usability. To enable use in research and clinical settings, the privacy policies of each app were systematically reviewed using common criteria, with 1 (9%) Health Insurance Portability and Accountability Act–compliant app (Cronometer). Furthermore, protected health information was collected by 9 (82%) of the 11 apps. Finally, to assess the accuracy of the nutrient estimates generated by these apps, we selected 4 sample food items and a 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared with the nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research database. In terms of the 3-day food record, the apps were found to consistently underestimate daily calories and macronutrients compared with the Nutrition Data System for Research output. Conclusions: Overall, we found that the Bitesnap app provided flexible dietary and food timing functionality capable of being used in research and clinical settings, whereas most other apps lacked in the necessary food timing functionality or user privacy. %M 37327038 %R 10.2196/35858 %U https://formative.jmir.org/2023/1/e35858 %U https://doi.org/10.2196/35858 %U http://www.ncbi.nlm.nih.gov/pubmed/37327038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42382 %T A Transgender Health Information Resource: Participatory Design Study %A Morse,Brad %A Soares,Andrey %A Kwan,Bethany M %A Allen,Marvyn %A Lee,Rita S %A Desanto,Kristen %A Holliman,Brooke Dorsey %A Ytell,Kate %A Schilling,Lisa M %+ Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 8th Floor, Academic Office 1-Office 8219, 12631 E 17th Ave, Aurora, CO, 80045, United States, 1 303 724 2254, lisa.schilling@cuanschutz.edu %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K transgender %K mobile app %K health information %K participatory design %K agile development %K mobile phone %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users’ needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app’s objective and subjective quality. Results: A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features—the ability to filter to narrow TGHIR resources—was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions: Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners. %M 37318836 %R 10.2196/42382 %U https://humanfactors.jmir.org/2023/1/e42382 %U https://doi.org/10.2196/42382 %U http://www.ncbi.nlm.nih.gov/pubmed/37318836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45626 %T Obstacles to Evidence-Based Procurement, Implementation, and Evaluation of Health and Welfare Technologies in Swedish Municipalities: Mixed Methods Study %A Norgren,Therese %A Richardson,Matt X %A Wamala-Andersson,Sarah %+ Department of Health and Welfare Technology, School of Health, Care and Social Welfare, Mälardalen University, Hamngatan 15, Eskilstuna, 632 20, Sweden, 46 16153280, matt.richardson@mdu.se %K evaluation %K evidence %K health and welfare technology %K implementation %K mixed methods %K municipalities %K procurement %K social care %K effectiveness %K Sweden %K support %K design %K survey %K interview %K welfare %K technology %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health and welfare technologies (HWTs) are interventions that aim at maintaining or promoting health, well-being, quality of life, and increasing efficiency in the service delivery system of welfare, social, and health care services, while improving the working conditions of the staff. Health and social care must be evidence-based according to national policy, but there are indications that evidence for HWT effectiveness is lacking in related Swedish municipal work processes. Objective: This study aimed to investigate whether the evidence is used when Swedish municipalities procure, implement, and evaluate HWT, and if so, the kinds of evidence and the manner of their use. The study also aimed to identify if municipalities currently receive adequate support in using evidence for HWT, and if not, what support is desired. Methods: An explanatory sequential mixed methods design was used with quantitative surveys and subsequent semistructured interviews with officials in 5 nationally designated “model” municipalities regarding HWT implementation and use. Results: In the past 12 months, 4 of 5 municipalities had required some form of evidence during procurement processes, but the frequency of this varied and often consisted of references from other municipalities instead of other objective sources. Formulating requirements or requests for evidence during procurement was viewed as difficult, and gathered evidence was often only assessed by procurement administration personnel. In total, 2 of 5 municipalities used an established process for the implementation of HWT, and 3 of 5 had a plan for structured follow-up, but the use and dissemination of evidence within these were varying and often weakly integrated. Standardized processes for follow-up and evaluation across municipalities did not exist, and those processes used by individual municipalities were described as inadequate and difficult to follow. Most municipalities desired support for using evidence when procuring, establishing evaluation frameworks for, and following up effectiveness of HWT, while all municipalities suggested tools or methods for this kind of support. Conclusions: Structured use of evidence in procurement, implementation, and evaluation of HWT is inconsistent among municipalities, and internal and external dissemination of evidence for effectiveness is rare. This may establish a legacy of ineffective HWT in municipal settings. The results suggest that existing national agency guidance is not sufficient to meet current needs. New, more effective types of support to increase the use of evidence in critical phases of municipal procurement and implementation of HWT are recommended. %M 37318831 %R 10.2196/45626 %U https://formative.jmir.org/2023/1/e45626 %U https://doi.org/10.2196/45626 %U http://www.ncbi.nlm.nih.gov/pubmed/37318831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45696 %T Developing a Culturally and Linguistically Congruent Digital Storytelling Intervention in Vietnamese and Korean American Mothers of Human Papillomavirus–Vaccinated Children: Feasibility and Acceptability Study %A Kim,Sunny Wonsun %A Chen,Angela Chia-Chen %A Ou,Lihong %A Larkey,Linda %A Todd,Michael %A Han,Yooro %+ Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St. MC. 3020, Phoenix, AZ, 85004, United States, 1 602 496 6789, Sunny.Kim@asu.edu %K Vietnamese %K Korean %K Asia %K cultural %K digital storytelling %K storytelling %K story %K stories %K HPV %K vaccine %K vaccination %K feasibility %K digital intervention %K mortality rate %K ratio %K odd %K rate %K deep analysis %K social media %K child %K immigrant %K mother %K immunization %K inoculation %K inoculate %K communication %K culture %K language %K human papillomavirus %K photo %K video %K digital %K microphone %K conversation %K dialogue %K Research Electronic Data Capture %K voiceover %K soundtrack %K writing %K write %K script %K health status %K health insurance %K survey %K questionnaire %K qualitative %K constructivist %K constructivism %D 2023 %7 14.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) call for researchers to address this public health concern through HPV vaccination. Disparities of HPV-associated cancers in Vietnamese and Korean Americans exist, yet their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve their HPV vaccination rates. We adopted digital storytelling (DST) that combines oral storytelling with computer-based technology (digital images, audio recording, and music) as a promising approach for facilitating the communication of culturally relevant health messages. Objective: This study aimed to (1) assess the feasibility and acceptability of intervention development through DST workshops, (2) conduct an in-depth analysis of the cultural experience that shapes HPV attitudes, and (3) explore aspects of the DST workshop experience that could inform future formative and intervention work. Methods: Through community partners, social media, and snowball sampling, we recruited 2 Vietnamese American and 6 Korean American mothers (mean age 41.4, SD 5.8 years) who had children vaccinated against HPV. Three virtual DST workshops were conducted between July 2021 and January 2022. Our team supported mothers to develop their own stories. Mothers completed web-based surveys before and after the workshop and provided feedback on each other’s story ideas and the workshop experience. We used descriptive statistics to summarize quantitative data and constant comparative analysis to analyze qualitative data collected in the workshop and field notes. Results: Eight digital stories were developed in the DST workshops. They were well accepted, and the mothers showed overall satisfaction and relevant indicators (eg, would recommend it to others, would attend a similar workshop, it was worth their time; mean 4.2-5, range 1-5). Mothers found the process rewarding and appreciated the opportunity to share their stories in group settings and learn from each other. The 6 major themes that emerged from the data reflect the mothers’ rich personal experiences, attitudes, and perceptions about their child’s HPV vaccination, which included (1) showing parents’ love and responsibility; (2) HPV and related knowledge, awareness, and attitudes; (3) factors influencing vaccine decision-making; (4) source of information and information sharing; (5) response to children's being vaccinated; and (6) cultural perspectives on health care and HPV vaccination. Conclusions: Our findings suggest that a virtual DST workshop is a highly feasible and acceptable approach to engaging Vietnamese American and Korean American immigrant mothers in developing culturally and linguistically congruent DST interventions. Further research is needed to test the efficacy and effectiveness of digital stories as an intervention for Vietnamese American and Korean American mothers of unvaccinated children. This process of developing an easy-to-deliver, culturally and linguistically aligned, and holistic web-based DST intervention can be implemented with other populations in other languages. %M 37314851 %R 10.2196/45696 %U https://formative.jmir.org/2023/1/e45696 %U https://doi.org/10.2196/45696 %U http://www.ncbi.nlm.nih.gov/pubmed/37314851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41227 %T Engagement, Retention, and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study %A Gudmundsdóttir,Sigrídur Lára %A Ballarini,Tommaso %A Ámundadóttir,María L %A Mészáros,Judit %A Eysteinsdottir,Jenna Huld %A Thorleifsdottir,Ragna H %A Hrafnkelsdóttir,Sigrídur K %A Helgadottir,Halla %A Oddsson,Saemundur %A Silverberg,Jonathan I %+ Sidekick Health Digital Therapeutics, Vallakor 4, Kopavogur, 203, Iceland, 354 6992254, halla@sidekickhealth.com %K digital therapeutics %K DTX %K eHealth %K engagement %K retention %K atopic dermatitis %K eczema %K medication reminder %K symptom tracking %K patient-reported outcomes %K quality of life %K dermatology %K feasibility %K mobile phone %D 2023 %7 14.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with atopic dermatitis can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of atopic dermatitis. Digital therapeutics can help with these and support patients toward a healthier lifestyle to improve their overall QoL. Objective: The aim of the study is to test the feasibility of a digital health program tailored for atopic dermatitis through program engagement, retention, and acceptability. Methods: Adults with atopic dermatitis were recruited in Iceland for a 6-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education; medication reminders; patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs); atopic dermatitis symptom PROs; guided meditation; and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth (ie, mobile health) App Usability Questionnaire (MAUQ). Results: A total of 21 patients were recruited (17 female, mean age 31 years), 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users were continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants, respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed atopic dermatitis symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of atopic dermatitis symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program, respectively, and all reported improvements over time. User satisfaction was high with a total score of 6.2/7. Conclusions: We found high overall engagement and retention in a targeted digital health program among patients with atopic dermatitis, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity were reduced, and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with atopic dermatitis, including the tracking and improvement of atopic dermatitis symptoms. %M 36975050 %R 10.2196/41227 %U https://formative.jmir.org/2023/1/e41227 %U https://doi.org/10.2196/41227 %U http://www.ncbi.nlm.nih.gov/pubmed/36975050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41919 %T Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study %A Zhu,Jieting %A Weng,Huiting %A Ou,Peng %A Li,Lezhi %+ Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, China, 86 0731 85295888, lilezhi@csu.edu.cn %K smart elderly care app %K mobile health %K smartphone %D 2023 %7 13.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the advent of China’s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected “Have used a smart elderly care app” in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care–related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. %M 37310777 %R 10.2196/41919 %U https://formative.jmir.org/2023/1/e41919 %U https://doi.org/10.2196/41919 %U http://www.ncbi.nlm.nih.gov/pubmed/37310777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43896 %T Expectations of Anesthesiology and Intensive Care Professionals Toward Artificial Intelligence: Observational Study %A Kloka,Jan Andreas %A Holtmann,Sophie C %A Nürenberg-Goloub,Elina %A Piekarski,Florian %A Zacharowski,Kai %A Friedrichson,Benjamin %+ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Theodor-Stern Kai 7, Frankfurt, 60590, Germany, 49 630183876, JanAndreas.Kloka@kgu.de %K anesthesiology %K artificial intelligence %K health care %K intensive care %K medical informatics %K technology acceptance %K Europe-wide survey %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) applications offer numerous opportunities to improve health care. To be used in the intensive care unit, AI must meet the needs of staff, and potential barriers must be addressed through joint action by all stakeholders. It is thus critical to assess the needs and concerns of anesthesiologists and intensive care physicians related to AI in health care throughout Europe. Objective: This Europe-wide, cross-sectional observational study investigates how potential users of AI systems in anesthesiology and intensive care assess the opportunities and risks of the new technology. The web-based questionnaire was based on the established analytic model of acceptance of innovations by Rogers to record 5 stages of innovation acceptance. Methods: The questionnaire was sent twice in 2 months (March 11, 2021, and November 5, 2021) through the European Society of Anaesthesiology and Intensive Care (ESAIC) member email distribution list. A total of 9294 ESAIC members were reached, of whom 728 filled out the questionnaire (response rate 728/9294, 8%). Due to missing data, 27 questionnaires were excluded. The analyses were conducted with 701 participants. Results: A total of 701 questionnaires (female: n=299, 42%) were analyzed. Overall, 265 (37.8%) of the participants have been in contact with AI and evaluated the benefits of this technology higher (mean 3.22, SD 0.39) than participants who stated no previous contact (mean 3.01, SD 0.48). Physicians see the most benefits of AI application in early warning systems (335/701, 48% strongly agreed, and 358/701, 51% agreed). Major potential disadvantages were technical problems (236/701, 34% strongly agreed, and 410/701, 58% agreed) and handling difficulties (126/701, 18% strongly agreed, and 462/701, 66% agreed), both of which could be addressed by Europe-wide digitalization and education. In addition, the lack of a secure legal basis for the research and use of medical AI in the European Union leads doctors to expect problems with legal liability (186/701, 27% strongly agreed, and 374/701, 53% agreed) and data protection (148/701, 21% strongly agreed, and 343/701, 49% agreed). Conclusions: Anesthesiologists and intensive care personnel are open to AI applications in their professional field and expect numerous benefits for staff and patients. Regional differences in the digitalization of the private sector are not reflected in the acceptance of AI among health care professionals. Physicians anticipate technical difficulties and lack a stable legal basis for the use of AI. Training for medical staff could increase the benefits of AI in professional medicine. Therefore, we suggest that the development and implementation of AI in health care require a solid technical, legal, and ethical basis, as well as adequate education and training of users. %M 37307038 %R 10.2196/43896 %U https://formative.jmir.org/2023/1/e43896 %U https://doi.org/10.2196/43896 %U http://www.ncbi.nlm.nih.gov/pubmed/37307038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37553 %T Gender Effects on the Impact of Colorectal Cancer Risk Calculators on Screening Intentions: Experimental Study %A Lee,Jungmin %A Keil,Mark %A Lee,Jong Seok %A Baird,Aaron %A Choi,Hyoung-Yong %+ J Mack Robinson College of Business, Georgia State University, 55 Park Place NE, suite 1704, Atlanta, GA, 30303, United States, 1 404 413 7360, jlee469@gsu.edu %K colorectal %K cancer %K oncology %K risk calculator %K risk %K perceived susceptibility %K susceptibility %K gender %K intention %K randomized %K randomization %K screening %K perception %K prevention %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: According to a 2020 study by the American Cancer Society, colorectal cancer (CRC) represents the third leading cause of cancer both in incidence and death in the United States. Nonetheless, CRC screening remains lower than that for other high-risk cancers such as breast and cervical cancer. Risk calculators are increasingly being used to promote cancer awareness and improve compliance with CRC screening tests. However, research concerning the effects of CRC risk calculators on the intention to undergo CRC screening has been limited. Moreover, some studies have found the impacts of CRC risk calculators to be inconsistent, reporting that receiving personalized assessments from such calculators lowers people’s risk perception. Objective: The objective of this study is to examine the effect of using CRC risk calculators on individuals’ intentions to undergo CRC screening. In addition, this study aims to examine the mechanisms through which using CRC risk calculators might influence individuals’ intentions to undergo CRC screening. Specifically, this study focuses on the role of perceived susceptibility to CRC as a potential mechanism mediating the effect of using CRC risk calculators. Finally, this study examines how the effect of using CRC risk calculators on individuals’ intentions to undergo CRC screening may vary by gender. Methods: We recruited a total of 128 participants through Amazon Mechanical Turk who live in the United States, have health insurance, and are in the age group of 45 to 85 years. All participants answered questions needed as input for the CRC risk calculator but were randomly assigned to treatment (CRC risk calculator results immediately received) and control (CRC risk calculator results made available after the experiment ended) groups. The participants in both groups answered a series of questions regarding demographics, perceived susceptibility to CRC, and their intention to get screened. Results: We found that using CRC risk calculators (ie, answering questions needed as input and receiving calculator results) has a positive effect on intentions to undergo CRC screening, but only for men. For women, using CRC risk calculators has a negative effect on their perceived susceptibility to CRC, which in turn reduces the intention to sign up for CRC screening. Additional simple slope and subgroup analyses confirm that the effect of perceived susceptibility on CRC screening intention is moderated by gender. Conclusions: This study shows that using CRC risk calculators can increase individuals’ intentions to undergo CRC screening, but only for men. For women, using CRC risk calculators can reduce their intentions to undergo CRC screening, as it reduces their perceived susceptibility to CRC. Given these mixed results, although CRC risk calculators can be a useful source of information on one’s CRC risk, patients should be discouraged from relying solely on them to inform decisions regarding CRC screening. %M 37307035 %R 10.2196/37553 %U https://formative.jmir.org/2023/1/e37553 %U https://doi.org/10.2196/37553 %U http://www.ncbi.nlm.nih.gov/pubmed/37307035 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40113 %T Therapist Feedback and Implications on Adoption of an Artificial Intelligence–Based Co-Facilitator for Online Cancer Support Groups: Mixed Methods Single-Arm Usability Study %A Leung,Yvonne W %A Ng,Steve %A Duan,Lauren %A Lam,Claire %A Chan,Kenith %A Gancarz,Mathew %A Rennie,Heather %A Trachtenberg,Lianne %A Chan,Kai P %A Adikari,Achini %A Fang,Lin %A Gratzer,David %A Hirst,Graeme %A Wong,Jiahui %A Esplen,Mary Jane %+ de Souza Institute, University Health Network, 222 St Patrick Street, Suite 503, Toronto, ON, M5T 1V4, Canada, 1 844 758 6891, yw.leung@utoronto.ca %K cancer %K recommender system %K natural language processing %K LIWC %K natural language processing %K emotion analysis %K therapist adoption %K therapist attitudes %K legal implications of AI %K therapist liability %D 2023 %7 9.6.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The recent onset of the COVID-19 pandemic and the social distancing requirement have created an increased demand for virtual support programs. Advances in artificial intelligence (AI) may offer novel solutions to management challenges such as the lack of emotional connections within virtual group interventions. Using typed text from online support groups, AI can help identify the potential risk of mental health concerns, alert group facilitator(s), and automatically recommend tailored resources while monitoring patient outcomes. Objective: The aim of this mixed methods, single-arm study was to evaluate the feasibility, acceptability, validity, and reliability of an AI-based co-facilitator (AICF) among CancerChatCanada therapists and participants to monitor online support group participants’ distress through a real-time analysis of texts posted during the support group sessions. Specifically, AICF (1) generated participant profiles with discussion topic summaries and emotion trajectories for each session, (2) identified participant(s) at risk for increased emotional distress and alerted the therapist for follow-up, and (3) automatically suggested tailored recommendations based on participant needs. Online support group participants consisted of patients with various types of cancer, and the therapists were clinically trained social workers. Methods: Our study reports on the mixed methods evaluation of AICF, including therapists’ opinions as well as quantitative measures. AICF’s ability to detect distress was evaluated by the patient's real-time emoji check-in, the Linguistic Inquiry and Word Count software, and the Impact of Event Scale-Revised. Results: Although quantitative results showed only some validity of AICF’s ability in detecting distress, the qualitative results showed that AICF was able to detect real-time issues that are amenable to treatment, thus allowing therapists to be more proactive in supporting every group member on an individual basis. However, therapists are concerned about the ethical liability of AICF’s distress detection function. Conclusions: Future works will look into wearable sensors and facial cues by using videoconferencing to overcome the barriers associated with text-based online support groups. International Registered Report Identifier (IRRID): RR2-10.2196/21453 %M 37294610 %R 10.2196/40113 %U https://cancer.jmir.org/2023/1/e40113 %U https://doi.org/10.2196/40113 %U http://www.ncbi.nlm.nih.gov/pubmed/37294610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42214 %T Web-Based, Interactive, Interest-Based Negotiation Training for Managing Conflict in Isolated Environments: Opportunistic Study With an e-Survey %A Fleischer,Jennifer %A Ayton,Jeff %A Riley,Maree %A Binsted,Kim %A Cowan,Devin R %A Fellows,Abigail M %A Weiss,Jeff A %A Buckey,Jay C %+ Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, United States, 1 603 650 6012, jennfleischer@gmail.com %K conflict management %K bargaining %K confined environments %K COVID-19 %K pandemic %K development %K environment %K skill %K training %K users %K essential %K Australia %K management %D 2023 %7 9.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective negotiation in relationships is critical for successful long-duration space missions; inadequate conflict resolution has shown serious consequences. Less desirable forms of negotiation, including positional bargaining (eg, negotiating prices), can exacerbate conflicts. Traditional positional bargaining may work for simple, low-stakes transactions but does not prioritize ongoing relationships. High-stakes situations warrant interest-based negotiation, where parties with competing interests or goals collaborate in a mutually beneficial agreement. This is learnable but must be practiced. Refresher training during conflicts is important to prevent out-of-practice crew members from using less effective negotiation techniques. Training should be self-directed and not involve others because, on a space mission, the only other people available may be part of the conflict. Objective: We aimed to develop and test an interactive module teaching principles and skills of interest-based negotiation in a way that users find acceptable, valuable for learning, and enjoyable. Methods: Using a web-based, interactive-media approach, we scripted, filmed, and programmed an interest-based negotiation interactive training module. In the module, the program mentor introduces users to “The Circle of Value” approach to negotiation and highlights its key concepts through interactive scenarios requiring users to make selections at specific decision points. Each selection prompts feedback designed to reinforce a teaching point or highlight a particular negotiation technique. To evaluate the module, we sought populations experiencing isolation and confinement (an opportunistic design). This included 9 participants in isolated, confined environments in the Australian Antarctic Program and the Hawai'i Space Exploration Analog and Simulation Mars simulation, as well as a subset of people who self-identified as being isolated and confined during the COVID-19 pandemic. Feedback was collected from participants (n=54) through free-response answers and questionnaires with numerical scaling (0=strongly disagree to 4=strongly agree) at the end of the module. Results: In total, 51 of 54 (94%) participants found the activity valuable for learning about conflict management (identified by those who selected either “somewhat agree” or “strongly agree”), including 100% of participants in the isolated and confined environment subset (mode=3). In total, 79% (128/162) of participant responses indicated that the module was realistic (mode=3), including 85% (23/27) of responses from participants in isolated and confined environments (mode=3). Most participants felt that this would be particularly valuable for new team members in an isolated, confined environment (46/54, 85% of all participants, mode 4; 7/9, 78% of the isolated and confined environment subset, mode 3) as well as veterans. Conclusions: This module offers a self-directed, consistent approach to interest-based negotiation training, which is well received by users. Although the data are limited due to the opportunistic study design, the module could be useful for individuals in isolated and confined environments and for anyone involved in high-stakes negotiations where sustaining relationships is essential. %M 37075233 %R 10.2196/42214 %U https://formative.jmir.org/2023/1/e42214 %U https://doi.org/10.2196/42214 %U http://www.ncbi.nlm.nih.gov/pubmed/37075233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38696 %T Consumer Expectations and Attitudes About Psychotherapy: Survey Study %A O'Callaghan,Erin %A Belanger,Heather %A Lucero,Steven %A Boston,Shannon %A Winsberg,Mirene %+ Brightside Health, 2471 Peralta St, Oakland, CA, 94607, United States, 1 415 360 3348, Erin@brightside.com %K internet %K survey %K psychotherapy %K telehealth, psychiatry, mental health %D 2023 %7 8.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although mental illness is common among adults in the United States, access to, and public perception of, mental health care continue to present as key barriers to care. Objective: Given the importance of attitudes toward, and perceptions of, mental health treatment in the successful access to mental health care and treatment of mental health issues, the primary goal of this survey study was to further investigate consumer perspectives of psychotherapy among adults in the United States; specifically, adding to the literature by investigating perceptions of both the general public and patients receiving telehealth. More specifically, the aims were to better understand openness to, and satisfaction with, therapy; perceptions, preferences, and expectations around therapy; and perceptions of psychotropic medication. Methods: An electronic survey was administered to current and former patients (those receiving psychotherapy) of Brightside, a nationwide telehealth company, as well as to the general public; both were convenience samples. Using the same survey questions, Brightside surveyed its own members (using Qualtrics; Qualtrics International Inc) and the general population (using SurveyMonkey’s Audience tool; Momentive). This survey included questions about basic participant demographics, as well as questions about current mental health treatment, perceptions about therapy, and therapists’ qualities. Results: A total of 714 people completed the survey. The data were fairly evenly split between those collected from Brightside patients (368/714, 51.5%) and those collected from the general public (346/714, 48.5%). Combining both samples, overall participation was 67.1% (479/714) women; 73.1% (522/714) White, 7.3% (52/714) Asian, 6.7% (48/714) African American, and 7.4% (53/714) Hispanic or Latinx; largely aged 25 to 34 years (255/714, 35.7%) or 35 to 44 years (187/714, 26.2%); from either the Mid-Atlantic (131/714, 18.3%) or South Atlantic (129/714, 18.1%) regions of the country; and most (402/714, 56.3%) earning annual salaries of US $30,000 to US $100,000. There were generally favorable perceptions of both psychotherapy and psychiatric medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. The most commonly held perception of psychotherapy duration was indefinite (250/714, 35%). Very few (58/714, 8.1%) thought that therapy typically lasts 1 to 3 months. Most of the participants (414/714, 58%) thought that evidence-based practice was important. Conclusions: Public education is needed to increase awareness of the typical duration and cost of psychotherapy. There seem to be generally favorable perceptions of both psychotherapy and psychotropic medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. Practitioners and those marketing their services might consider using their marketing campaigns to counter some of the more common falsely held beliefs. %M 37289494 %R 10.2196/38696 %U https://formative.jmir.org/2023/1/e38696 %U https://doi.org/10.2196/38696 %U http://www.ncbi.nlm.nih.gov/pubmed/37289494 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44500 %T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers %A Varma,Deepthi S %A Mualem,Maya %A Goodin,Amie %A Gurka,Kelly K %A Wen,Tony Soo-Tung %A Gurka,Matthew J %A Roussos-Ross,Kay %+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K perinatal mental health %K mobile health %K mHealth %K mobile apps %K ecological momentary assessment %K EMA %K mobile phone %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. %M 37285185 %R 10.2196/44500 %U https://formative.jmir.org/2023/1/e44500 %U https://doi.org/10.2196/44500 %U http://www.ncbi.nlm.nih.gov/pubmed/37285185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43036 %T An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study %A Liu,Shuyan %A Wegner,Luisa %A Haucke,Matthias %A Gates,Jennifer %A Adam,Maya %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156534, till.baernighausen@uni-heidelberg.de %K entertainment media %K perceived social isolation %K health communication %K digital knowledge %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested. Objective: In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness. Methods: We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on “what really matters” in one’s life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform “Unipark,” on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS). Results: We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (β=4.14; t248=1.74; 1-tailed P=.04). Conclusions: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. Trial Registration: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116 %M 37285206 %R 10.2196/43036 %U https://formative.jmir.org/2023/1/e43036 %U https://doi.org/10.2196/43036 %U http://www.ncbi.nlm.nih.gov/pubmed/37285206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45234 %T Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach %A Gan,Daniel Z Q %A McGillivray,Lauren %A Larsen,Mark Erik %A Bloomfield,Taylor %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, NSW 2031, Australia, 61 423828945, danielzqgan@gmail.com %K eHealth %K digital mental health %K smartphone app %K engagement %K youth suicide prevention %K qualitative methods %K suicide %K development %K youth %K mental health %K support %K user-centered %K design %K survey %K interview %K prototype %K prevention %K participatory design %K mobile phone %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. Objective: This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy—a smartphone app that helps young people manage suicidal thoughts. Methods: Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings—from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population—with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Results: Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. Conclusions: This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health. %M 37279058 %R 10.2196/45234 %U https://formative.jmir.org/2023/1/e45234 %U https://doi.org/10.2196/45234 %U http://www.ncbi.nlm.nih.gov/pubmed/37279058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37863 %T ePrescribing-Based Antimicrobial Stewardship Practices in an English National Health Service Hospital: Qualitative Interview Study Among Medical Prescribers and Pharmacists %A Cresswell,Kathrin %A Hinder,Susan %A Sheikh,Aziz %A Pontefract,Sarah %A Watson,Neil W %A Price,David %A Heed,Andrew %A Coleman,Jamie %A Ennis,Holly %A Beggs,Jillian %A Chuter,Antony %A Williams,Robin %+ Usher Institute, The University of Edinburgh, Usher Institute, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 07502154328, kathrin.cresswell@ed.ac.uk %K antimicrobial resistance %K antimicrobial stewardship %K electronic prescribing %K hospitals %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Antimicrobial resistance, the ability of microorganisms to survive antimicrobial drugs, is a public health emergency. Although electronic prescribing (ePrescribing)–based interventions designed to reduce unnecessary antimicrobial usage exist, these often do not integrate effectively with existing workflows. As a result, ePrescribing-based interventions may have limited impact in addressing antimicrobial resistance. Objective: We sought to understand the existing ePrescribing-based antimicrobial stewardship (AMS) practices in an English hospital preceding the implementation of functionality designed to improve AMS. Methods: We conducted 18 semistructured interviews with medical prescribers and pharmacists with varying levels of seniority exploring current AMS practices and investigating potential areas for improvement. Participants were recruited with the help of local gatekeepers. Topic guides sought to explore both formal and informal practices surrounding AMS, and challenges and opportunities for ePrescribing-based intervention. We coded audio-recorded and transcribed data with the help of the Technology, People, Organizations, and Macroenvironmental factors framework, allowing emerging themes to be added inductively. We used NVivo 12 (QSR International) to facilitate coding. Results: Antimicrobial prescribing and review processes were characterized by competing priorities and uncertainty of prescribers and reviewers around prescribing decisions. For example, medical prescribers often had to face trade-offs between individual patient benefit and more diffuse population health benefits, and the rationale for prescribing decisions was not always clear. Prescribing involved a complex set of activities carried out by various health care practitioners who each only had a partial and temporary view of the whole process, and whose relationships were characterized by deeply engrained hierarchies that shaped interactions and varied across specialties. For example, newly qualified doctors and pharmacists were hesitant to change a consultant’s prescribing decision when reviewing prescriptions. Multidisciplinary communication, collaboration, and coordination promoted good AMS practices by reducing uncertainty. Conclusions: Design of ePrescribing-based interventions to improve AMS needs to take into account the multitude of actors and organizational complexities involved in the prescribing and review processes. Interventions that help reduce prescriber or reviewer uncertainty and improve multidisciplinary collaboration surrounding initial antimicrobial prescribing and subsequent prescription review are most likely to be effective. Without such attention, interventions are unlikely to fulfill their goal of improving patient outcomes and combatting antimicrobial resistance. %M 37279044 %R 10.2196/37863 %U https://formative.jmir.org/2023/1/e37863 %U https://doi.org/10.2196/37863 %U http://www.ncbi.nlm.nih.gov/pubmed/37279044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43067 %T Acceptability and Usability of a Wearable Device for Sleep Health Among English- and Spanish-Speaking Patients in a Safety Net Clinic: Qualitative Analysis %A Purnell,Larissa %A Sierra,Maribel %A Lisker,Sarah %A Lim,Melissa S %A Bailey,Emma %A Sarkar,Urmimala %A Lyles,Courtney R %A Nguyen,Kim H %+ Division of General Internal Medicine, School of Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, United States, 1 6282066483, Courtney.Lyles@ucsf.edu %K health equity %K medical informatics %K sleep disorders %K user-centered design %K wearable electronic devices %D 2023 %7 5.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disorders are common and disproportionately affect marginalized populations. Technology, such as wearable devices, holds the potential to improve sleep quality and reduce sleep disparities, but most devices have not been designed or tested with racially, ethnically, and socioeconomically diverse patients. Inclusion and engagement of diverse patients throughout digital health development and implementation are critical to achieving health equity. Objective: This study aims to evaluate the usability and acceptability of a wearable sleep monitoring device—SomnoRing—and its accompanying mobile app among patients treated in a safety net clinic. Methods: The study team recruited English- and Spanish-speaking patients from a mid-sized pulmonary and sleep medicine practice serving publicly insured patients. Eligibility criteria included initial evaluation of obstructed sleep apnea, which is most appropriate for limited cardiopulmonary testing. Patients with primary insomnia or other suspected sleep disorders were not included. Patients tested the SomnoRing over a 7-night period and participated in a 1-hour semistructured web-based qualitative interview covering perceptions of the device, motivators and barriers to use, and general experiences with digital health tools. The study team used inductive or deductive processes to code interview transcripts, guided by the Technology Acceptance Model. Results: A total of 21 individuals participated in the study. All participants owned a smartphone, almost all (19/21) felt comfortable using their phone, and few already owned a wearable (6/21). Almost all participants wore the SomnoRing for 7 nights and found it comfortable. The following four themes emerged from qualitative data: (1) the SomnoRing was easy to use compared to other wearable devices or traditional home sleep testing alternatives, such as the standard polysomnogram technology for sleep studies; (2) the patient’s context and environment, such as family and peer influence, housing status, access to insurance, and device cost affected the overall acceptance of the SomnoRing; (3) clinical champions motivated use in supporting effective onboarding, interpretation of data, and, ongoing technical support; and (4) participants desired more assistance and information to best interpret their own sleep data summarized in the companion app. Conclusions: Racially, ethnically, and socioeconomically diverse patients with sleep disorders perceived a wearable as useful and acceptable for sleep health. Participants also uncovered external barriers related to the perceived usefulness of the technology, such as housing status, insurance coverage, and clinical support. Future studies should further examine how to best address these barriers so that wearables, such as the SomnoRing, can be successfully implemented in the safety net health setting. %M 37098152 %R 10.2196/43067 %U https://formative.jmir.org/2023/1/e43067 %U https://doi.org/10.2196/43067 %U http://www.ncbi.nlm.nih.gov/pubmed/37098152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47575 %T Supporting Adolescents With HIV in South Africa Through an Adherence-Supporting App: Mixed Methods Beta-Testing Study %A Mulawa,Marta I %A Mtukushe,Bulelwa %A Knippler,Elizabeth T %A Matiwane,Mluleki %A Al-Mujtaba,Maryam %A Muessig,Kathryn E %A Hoare,Jacqueline %A Hightow-Weidman,Lisa B %+ School of Nursing, Duke University, DUMC 3322, Durham, NC, 27710, United States, 1 919 684 9555, marta.mulawa@duke.edu %K adolescents %K HIV %K adherence %K mHealth %K mobile health %K technology %K smartphone app %K health app %K beta testing %K implementation %K digital health intervention %K usability %K HIV treatment %D 2023 %7 1.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel smartphone app–delivered interventions have the potential to improve HIV treatment adherence among adolescents with HIV, although such interventions are limited. Our team has developed Masakhane Siphucule Impilo Yethu (MASI; Xhosa for “Let's empower each other and improve our health”), a smartphone app–delivered intervention to improve treatment adherence among adolescents with HIV in South Africa. MASI was adapted to the South African cultural context using the HealthMpowerment platform, an evidence-based digital health intervention developed for and with youth in the United States. Objective: We conducted this beta-testing study to (1) explore the initial usability of MASI, (2) examine engagement and experiences using MASI features, and (3) inform refinements to the app and intervention implementation plan prior to a subsequent pilot randomized controlled trial (RCT). Methods: This study was conducted from August 2021 to December 2021 in Cape Town, South Africa. Beta-testing participants received access to MASI for 3 weeks. A mixed methods approach was used, with brief questionnaires and semistructured in-depth interviews conducted prior to app installation and after 1 week to 2 weeks of app testing. Engagement with MASI was measured through analysis of back-end app paradata, and follow-up in-depth interview guides were tailored to each participant based on their app use. Results: Participants in the beta-testing study (6 male participants, 6 female participants; ages 16-19 years) collectively spent 4.3 hours in MASI, averaging 21.4 minutes per participant over the 3-week period (range 1-51.8 minutes). Participants logged into MASI an average of 24.1 (range 10-75) times during the study period. The mean System Usability Scale score was 69.5 (SD 18), which is considered slightly above average for digital health apps. Thematic analysis of qualitative results revealed generally positive experiences across MASI features, although opportunities to refine the app and intervention delivery were identified. Conclusions: Initial usability of MASI was high, and participants described having a generally positive experience across MASI features. Systematically analyzing paradata and using the interview findings to explore participant experiences allowed us to gain richer insights into patterns of participant engagement, enabling our team to further enhance MASI. The results from this study led to a few technological refinements to improve the user experience. Enhancements were also made to the intervention implementation plan in preparation for a pilot RCT. Lessons learned from the conduct of this beta-testing study may inform the development, implementation, and evaluation of similar app-delivered interventions in the future. %M 37261883 %R 10.2196/47575 %U https://formative.jmir.org/2023/1/e47575 %U https://doi.org/10.2196/47575 %U http://www.ncbi.nlm.nih.gov/pubmed/37261883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45654 %T A Smart System for Remote Monitoring of Patients in Palliative Care (HumanITcare Platform): Mixed Methods Study %A Castillo Padrós,Manuel Ramón %A Pastor,Nuria %A Altarriba Paracolls,Júlia %A Mosquera Peña,Marcelino %A Pergolizzi,Denise %A Salvador Vergès,Àngels %+ Innohealth Academy, C/Magi Casanovas 11, Barcelona, 08870, Spain, 34 630887995, angels.salvador@innohealth.academy %K palliative care %K advanced illness %K remote monitoring %K eHealth %K telemedicine %K mHealth %D 2023 %7 31.5.2023 %9 Viewpoint %J JMIR Form Res %G English %X Background: Due to the complexities of advanced illnesses and their treatments, it can be difficult for patients in palliative care to maintain their quality of life. Telemedicine interventions in chronic disease management engage patients in their care, provide continuous follow-up by their health care providers, identify symptoms earlier, and allow a quick response to illness-related decline. Objective: We aimed to detail and reflect on the design of an app and evaluate its feasibility to monitor the clinical situation of patients with advanced illnesses. Methods: This study used a mixed methods design using qualitative methods to inform app development and design and quantitative methods for data collection and analysis of patient evaluations. Palliative care units in 2 Spanish university hospitals (Nuestra Señora de la Candelaria in Santa Cruz de Tenerife and University Hospital Complex of Ferrol in A Coruña) carried out a literature review, designed the study protocol, and obtained approval from the Ethics Committee from June to December 2020. In addition, focus group meetings were held, and the design and technical development of the app were elaborated on and subsequently presented in the participating palliative care units. From January to March 2021, the app was made public on the App Store and Play Store, and a pilot study with patients was carried out in April to September 2021. Results: Six focus group meetings were held that included doctors, nurses, app developers, technology consultants, and sponsors. In addition, the technology consultants presented their results 3 times in the participating palliative care units to obtain feedback. After the app’s final design, it was possible to publish it on the usual servers and begin its evaluation in patients (n=60, median age 72 years). Sixty percent (n=36) of the participants were women and 40% (n=24) were men. The most prevalent advanced pathology was cancer (n=46, 76%), followed by other diseases (n=7, 12%) and amyotrophic lateral sclerosis (n=5, 8%). Seventy percent (n=42) of the patients were already in follow-up prior to the start of the study, while 30% (n=18) were included at the start of their follow-up. The information in the app was collected and entered by relatives or caregivers in 60% (n=36) of the cases. The median follow-up was 52 (IQR 14-104) days. In all, 69% (n=41) had a follow-up >30 days (10 were deceased and 9 were missing data). The use of the different sections of the app ranged from 37% (n=22) for the glycemic record to 90% (n=54) for the constipation scale). Patients and caregivers were delighted with its ease of use and usefulness. Conclusions: Incorporating an intelligent remote patient monitoring system in clinical practice for patients in palliative care can improve access to health services and provide more information to professionals. %M 37256664 %R 10.2196/45654 %U https://formative.jmir.org/2023/1/e45654 %U https://doi.org/10.2196/45654 %U http://www.ncbi.nlm.nih.gov/pubmed/37256664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40327 %T Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study %A Naranjo-Saucedo,Ana Belen %A Escobar-Rodriguez,German Antonio %A Tabernero,Carmen %A Cuadrado,Esther %A Parra-Calderon,Carlos Luis %A Arenas,Alicia %+ Institute of Biomedicine of Seville/Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas/University of Seville, Hospital Universitario Virgen del Rocío - Servicio Andaluz de Salud, Avda. Manuel Siurot S/N, Sevilla, 41013, Spain, 34 955013616, german.antonio.er@gmail.com %K occupational health assessment %K psychosocial risks %K health care professionals %K mobile health %K mHealth %K Delphi method %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. Objective: We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. Methods: A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. Results: Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees’ well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. Conclusions: For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements. %M 37256659 %R 10.2196/40327 %U https://formative.jmir.org/2023/1/e40327 %U https://doi.org/10.2196/40327 %U http://www.ncbi.nlm.nih.gov/pubmed/37256659 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43981 %T Building Compassionate Experience Through Compassionate Action: Qualitative Behavioral Analysis %A Desveaux,Laura %A Wu,Kelly %A Rouleau,Geneviève %A Srinivasan,Diya %A Azavedo,Rhea %A Dang Nguyen,Marlena %A Martin,Danielle %A Steele Gray,Carolyn %+ Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada, 1 4377726836, laura.desveaux@thp.ca %K technology-based care %K compassion %K primary care %K behavior change %K communication competency %K continuing professional development %K qualitative %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The acceleration of technology-based primary care during the COVID-19 pandemic outpaced the ability to understand whether and how it impacts care delivery and outcomes. As technology-based care continues to evolve, focusing on the core construct of compassion in a primary care context will help ensure high-quality patient care and increased patient autonomy and satisfaction. The ability to successfully operationalize the use of technology in patient-clinician interactions hinges on understanding not only how compassionate care is experienced in this context but also how clinicians can create it. Objective: The objectives of this study were to understand whether and how compassionate behaviors are experienced in technology-based primary care interactions and identify the individual and contextual drivers that influence whether and how these behaviors occur. Methods: We conducted a series of qualitative one-on-one interviews with primary care physicians, nurses, and patients. Qualitative data were initially analyzed using an inductive thematic analysis approach to identify preliminary themes for each participant group independently. We then looked across participant groups to identify areas of alignment and distinction. Descriptions of key behaviors that participants identified as elements of a compassionate interaction and descriptions of key drivers of these behaviors were inductively coded and defined at this stage. Results: A total of 74 interviews were conducted with 40 patients, 20 nurses, and 14 primary care physicians. Key behaviors that amplified the experience of compassion included asking the patient’s modality preference, using video to establish technology-based presence, sharing the screen, and practicing effective communication. Participants’ knowledge or skills as well as their beliefs and emotions influenced whether or not these behaviors occurred. Contextual elements beyond participants’ control influenced technology-based interactions, including resource access, funding structures, culture, regulatory standards, work structure, societal influence, and patient characteristics and needs. A high-yield, evidence-based approach to address the identified drivers of compassion-focused clinician behavior includes a combination of education, training, and enablement. Conclusions: Much of the patient experience is influenced by clinician behavior; however, clinicians need a supportive system and adequate supports to evolve new ways of working to create the experience of compassionate care. The current state of technology-based care operationalization has led to widespread burnout, societal pressure, and shifting expectations of both clinicians and the health system more broadly, threatening the ability to deliver compassionate care. For clinicians to exhibit compassionate behaviors, they need more than just adequate supports; they also need to receive compassion from and experience the humanity of their patients. %M 37256678 %R 10.2196/43981 %U https://formative.jmir.org/2023/1/e43981 %U https://doi.org/10.2196/43981 %U http://www.ncbi.nlm.nih.gov/pubmed/37256678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38828 %T Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study %A Leddy,Anna %A Ggita,Joseph %A Berger,Christopher A %A Kityamuwesi,Alex %A Sanyu,Agnes Nakate %A Tinka,Lynn Kunihira %A Crowder,Rebecca %A Turyahabwe,Stavia %A Katamba,Achilles %A Cattamanchi,Adithya %+ Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, 550 16th St 3rd floor, San Francisco, CA, 94158, United States, 1 5102385100, Adithya.Cattamanchi@ucsf.edu %K digital adherence technology %K gender norms %K tuberculosis %K adherence %K sub-Saharan Africa %D 2023 %7 30.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone–based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone–access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women’s narratives centered on the ways the platform facilitated and improved their adherence, whereas the men’s narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. %M 37252774 %R 10.2196/38828 %U https://www.jmir.org/2023/1/e38828 %U https://doi.org/10.2196/38828 %U http://www.ncbi.nlm.nih.gov/pubmed/37252774 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45434 %T An Artificial Intelligence–Based Smartphone App for Assessing the Risk of Opioid Misuse in Working Populations Using Synthetic Data: Pilot Development Study %A Islam,A B M Rezbaul %A Khan,Khalid M %A Scarbrough,Amanda %A Zimpfer,Mariah Jade %A Makkena,Navya %A Omogunwa,Adebola %A Ahamed,Sheikh Iqbal %+ Department of Computer Science, Sam Houston State University, 1803 Avenue I AB1, Room 214, Huntsville, TX, 77341, United States, 1 936294 ext 4198, ari014@shsu.edu %K opioid overused disorder %K OUD %K mobile health %K mHealth %K artificial intelligence %K smartphone app %K opioids %K application %K caregivers %K mobile app %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorder (OUD) is an addiction crisis in the United States. As recent as 2019, more than 10 million people have misused or abused prescription opioids, making OUD one of the leading causes of accidental death in the United States. Workforces that are physically demanding and laborious in the transportation, construction and extraction, and health care industries are prime targets for OUD due to high-risk occupational activities. Because of this high prevalence of OUD among working populations in the United States, elevated workers’ compensation and health insurance costs, absenteeism, and declined productivity in workplaces have been reported. Objective: With the emergence of new smartphone technologies, health interventions can be widely used outside clinical settings via mobile health tools. The major objective of our pilot study was to develop a smartphone app that can track work-related risk factors leading to OUD with a specific focus on high-risk occupational groups. We used synthetic data analyzed by applying a machine learning algorithm to accomplish our objective. Methods: To make the OUD assessment process more convenient and to motivate potential patients with OUD, we developed a smartphone-based app through a step-by-step process. First, an extensive literature survey was conducted to list a set of critical risk assessment questions that can capture high-risk behaviors leading to OUD. Next, a review panel short-listed 15 questions after careful evaluation with specific emphasis on physically demanding workforces—9 questions had two, 5 questions had five, and 1 question had three response options. Instead of human participant data, synthetic data were used as user responses. Finally, an artificial intelligence algorithm, naive Bayes, was used to predict the OUD risk, trained with the synthetic data collected. Results: The smartphone app we have developed is functional as tested with synthetic data. Using the naive Bayes algorithm on collected synthetic data, we successfully predicted the risk of OUD. This would eventually create a platform to test the functionality of the app further using human participant data. Conclusions: The use of mobile health techniques, such as our mobile app, is highly promising in predicting and offering mitigation plans for disease detection and prevention. Using a naive Bayes algorithm model along with a representational state transfer (REST) application programming interface and cloud-based data encryption storage, respondents can guarantee their privacy and accuracy in estimating their risk. Our app offers a tailored mitigation strategy for specific workforces (eg, transportation and health care workers) that are most impacted by OUD. Despite the limitations of the study, we have developed a robust methodology and believe that our app has the potential to help reduce the opioid crisis. %M 37252763 %R 10.2196/45434 %U https://formative.jmir.org/2023/1/e45434 %U https://doi.org/10.2196/45434 %U http://www.ncbi.nlm.nih.gov/pubmed/37252763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45106 %T Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study %A Darnell,Doyanne %A Ranna-Stewart,Minu %A Psaros,Christina %A Filipowicz,Teresa R %A Grimes,LaKendra %A Henderson,Savannah %A Parman,Mariel %A Gaddis,Kathy %A Gaynes,Bradley Neil %A Mugavero,Michael J %A Dorsey,Shannon %A Pence,Brian W %+ University of Washington, 325 9th Ave, Box 359911, Seattle, WA, 98104, United States, 1 206 744 9108, darnelld@uw.edu %K adaptation %K transdiagnostic psychotherapy %K people with HIV %K trauma %K comorbidity %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV treatment engagement is critical for people with HIV; however, behavioral health comorbidities and HIV-related stigma are key barriers to engagement. Treatments that address these barriers and can be readily implemented in HIV care settings are needed. Objective: We presented the process for adapting transdiagnostic cognitive behavioral psychotherapy, the Common Elements Treatment Approach (CETA), for people with HIV receiving HIV treatment at a Southern US HIV clinic. Behavioral health targets included posttraumatic stress, depression, anxiety, substance use, and safety concerns (eg, suicidality). The adaptation also included ways to address HIV-related stigma and a component based on Life-Steps, a brief cognitive behavioral intervention to support patient HIV treatment engagement. Methods: We applied principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing model, a framework for adapting evidence-based HIV interventions, and described our adaptation process, which included adapting the CETA manual based on expert input; conducting 3 focus groups, one with clinic social workers (n=3) and 2 with male (n=3) and female (n=4) patients to obtain stakeholder input for the adapted therapy; revising the manual according to this input; and training 2 counselors on the adapted protocol, including a workshop held over the internet followed by implementing the therapy with 3 clinic patients and receiving case-based consultation for them. For the focus groups, all clinic social workers were invited to participate, and patients were referred by clinic social workers if they were adults receiving services at the clinic and willing to provide written informed consent. Social worker focus group questions elicited reactions to the adapted therapy manual and content. Patient focus group questions elicited experiences with behavioral health conditions and HIV-related stigma and their impacts on HIV treatment engagement. Transcripts were reviewed by 3 team members to catalog participant commentary according to themes relevant to adapting CETA for people with HIV. Coauthors independently identified themes and met to discuss and reach a consensus on them. Results: We successfully used principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing framework to adapt CETA for people with HIV. The focus group with social workers indicated that the adapted therapy made conceptual sense and addressed common behavioral health concerns and practical and cognitive behavioral barriers to HIV treatment engagement. Key considerations for CETA for people with HIV obtained from social worker and patient focus groups were related to stigma, socioeconomic stress, and instability experienced by the clinic population and some patients’ substance use, which can thwart the stability needed to engage in care. Conclusions: The resulting brief, manualized therapy is designed to help patients build skills that promote HIV treatment engagement and reduce symptoms of common behavioral health conditions that are known to thwart HIV treatment engagement. %M 37252786 %R 10.2196/45106 %U https://formative.jmir.org/2023/1/e45106 %U https://doi.org/10.2196/45106 %U http://www.ncbi.nlm.nih.gov/pubmed/37252786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43603 %T Black Smokers’ Preferences for Features of a Smoking Cessation App: Qualitative Study %A Enyioha,Chineme %A Loufman,Larissa M %A Grewe,Mary E %A Cené,Crystal W %A Khairat,Saif %A Goldstein,Adam O %A Kistler,Christine E %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27599, United States, 1 9842155048, chineme_enyioha@med.unc.edu %K mobile health apps %K smoking cessation %K Black smokers %K smoking %K mobile health %K intervention %K application %K development %K online research %K interview %K functionality %K social network %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for smoking cessation have grown extensively over the last few years. Although these interventions improve cessation rates, studies of these interventions consistently lack sufficient Black smokers; hence knowledge of features that make mHealth interventions attractive to Black smokers is limited. Identifying features of mHealth interventions for smoking cessation preferred by Black smokers is critical to developing an intervention that they are likely to use. This may in turn address smoking cessation challenges and barriers to care, which may reduce smoking-related disparities that currently exist. Objective: This study aims to identify features of mHealth interventions that appeal to Black smokers using an evidence-based app developed by the National Cancer Institute, QuitGuide, as a reference. Methods: We recruited Black adult smokers from national web-based research panels with a focus on the Southeastern United States. Participants were asked to download and use QuitGuide for at least a week before participation in remote individual interviews. Participants gave their opinions about features of the QuitGuide app and other mHealth apps they may have used in the past and suggestions for future apps. Results: Of the 18 participants, 78% (n=14) were women, with age ranging from 32 to 65 years. Themes within five major areas relevant for developing a future mHealth smoking cessation app emerged from the individual interviews: (1) content needs including health and financial benefits of quitting, testimonials from individuals who were successful in quitting, and strategies for quitting; (2) format needs such as images, ability to interact with and respond to elements within the app, and links to other helpful resources; (3) functionality including tracking of smoking behavior and symptoms, provision of tailored feedback and reminders to users, and an app that allows for personalization of functions; (4) social network, such as connecting with friends and family through the app, connecting with other users on social media, and connecting with a smoking cessation coach or therapist; and (5) the need for inclusivity for Black individuals, which may be accomplished through the inclusion of smoking-related information and health statistics specific for Black individuals, the inclusion of testimonials from Black celebrities who successfully quit, and the inclusion of cultural relevance in messages contained in the app. Conclusions: Certain features of mHealth interventions for smoking cessation were highly preferred by Black smokers based on their use of a preexisting mHealth app, QuitGuide. Some of these preferences are similar to those already identified by the general population, whereas preferences for increasing the inclusivity of the app are more specific to Black smokers. These findings can serve as the groundwork for a large-scale experiment to evaluate preferences with a larger sample size and can be applied in developing mHealth apps that Black smokers may be more likely to use. %M 37252777 %R 10.2196/43603 %U https://formative.jmir.org/2023/1/e43603 %U https://doi.org/10.2196/43603 %U http://www.ncbi.nlm.nih.gov/pubmed/37252777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43385 %T A Fully Automated Self-help Biopsychosocial Transdiagnostic Digital Intervention to Reduce Anxiety and/or Depression and Improve Emotional Regulation and Well-being: Pre–Follow-up Single-Arm Feasibility Trial %A Klein,Britt %A Nguyen,Huy %A McLaren,Suzanne %A Andrews,Brooke %A Shandley,Kerrie %+ Health Innovation & Transformation Centre, Federation University Australia, PO Box 663, Ballarat, 3353, Australia, 61 353276717, b.klein@federation.edu.au %K anxiety %K depression %K fully automated %K self-help %K digital intervention %K transdiagnostic %K biopsychosocial %K emotion regulation %K allostatic load %K brain plasticity %K positive affect %K comorbidity %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. Objective: The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. Methods: This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). Results: The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum—Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR]<.001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=−0.50 to −0.63) and optimism (range Cohen d=−0.72 to −0.79) and small-to-medium treatment effect size change for EQ-5D-3L Health Rating (range Cohen d=−0.34 to −0.58). Changes across all outcome variables were generally strongest for participants with preintervention clinical comorbid anxiety and depression presentations (range |d|=0.58 to 2.01) and weakest for participants presenting with nonclinical anxiety and/or depressive symptoms (|d|=0.05 to 0.84). Life Flex was rated as acceptable at the postintervention time point, and participants indicated that they enjoyed the transdiagnostic program and biological, wellness, and lifestyle-focused content and strategies. Conclusions: Given the paucity of evidence on fully automated self-help transdiagnostic digital interventions for anxiety and/or depressive symptomatology and general treatment accessibility issues, this study provides preliminary support for biopsychosocial transdiagnostic interventions, such as Life Flex, as a promising future mental health service delivery gap filler. Following large-scale, randomized controlled trials, the potential benefits of fully automated self-help digital health programs, such as Life Flex, could be considerable. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000480583; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368007 %M 37252790 %R 10.2196/43385 %U https://formative.jmir.org/2023/1/e43385 %U https://doi.org/10.2196/43385 %U http://www.ncbi.nlm.nih.gov/pubmed/37252790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46513 %T Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study %A Cyranka,Katarzyna %A Juza,Anna %A Kwiendacz,Hanna %A Nabrdalik,Katarzyna %A Gumprecht,Janusz %A Małecki,Maciej %A Klupa,Tomasz %A Matejko,Bartłomiej %+ Department of Metabolic Diseases, Jagiellonian University Medical College, 2 Jakubowskiego Street, Kraków, 30-688, Poland, 48 48 12 400 29 50, b.matejko@yahoo.com %K young adults %K type 1 diabetes %K transitioning care %K psychological %K diabetes %K cross-sectional study %K anxiety %K socioeconomic %K validation %K anger %K depression %K outpatient %K chronic disease %K pediatric %K adulthood %K coping mechanism %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient’s reluctance to transition. Objective: This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. Methods: We examined 50 consecutive patients (n=28, 56% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. Results: During the first adult outpatient visit, patients’ mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36% (n=18) live in villages, 26% (n=13) live in towns with ≤100,000 inhabitants, and 38% (n=19) live in bigger cities. Regarding therapy type, 68% (n=34) were treated with insulin pump therapy, whereas 32% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5% (SD 1.2%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62%) believe that control over their health depends on themselves, whereas 52% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions—anger, depression, and anxiety—than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64% (n=32) had a high level of self-efficacy and 26% (n=13) had a high level of life satisfaction. Conclusions: This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood. %M 37247225 %R 10.2196/46513 %U https://formative.jmir.org/2023/1/e46513 %U https://doi.org/10.2196/46513 %U http://www.ncbi.nlm.nih.gov/pubmed/37247225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45894 %T Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts %A Han,Hee Jeong %A Mendu,Sanjana %A Jaworski,Beth K %A Owen,Jason E %A Abdullah,Saeed %+ College of Information Sciences and Technology, Pennsylvania State University, Westgate Building, University Park, PA, 16802, United States, 1 (814) 865 8947, heejeonghan@psu.edu %K conversational agent %K PTSD %K self-management %K clinical experts %K evaluation %K support system %K mental health %K trauma %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a serious public health concern. However, individuals with PTSD often do not have access to adequate treatment. A conversational agent (CA) can help to bridge the treatment gap by providing interactive and timely interventions at scale. Toward this goal, we have developed PTSDialogue—a CA to support the self-management of individuals living with PTSD. PTSDialogue is designed to be highly interactive (eg, brief questions, ability to specify preferences, and quick turn-taking) and supports social presence to promote user engagement and sustain adherence. It includes a range of support features, including psychoeducation, assessment tools, and several symptom management tools. Objective: This paper focuses on the preliminary evaluation of PTSDialogue from clinical experts. Given that PTSDialogue focuses on a vulnerable population, it is critical to establish its usability and acceptance with clinical experts before deployment. Expert feedback is also important to ensure user safety and effective risk management in CAs aiming to support individuals living with PTSD. Methods: We conducted remote, one-on-one, semistructured interviews with clinical experts (N=10) to gather insight into the use of CAs. All participants have completed their doctoral degrees and have prior experience in PTSD care. The web-based PTSDialogue prototype was then shared with the participant so that they could interact with different functionalities and features. We encouraged them to “think aloud” as they interacted with the prototype. Participants also shared their screens throughout the interaction session. A semistructured interview script was also used to gather insights and feedback from the participants. The sample size is consistent with that of prior works. We analyzed interview data using a qualitative interpretivist approach resulting in a bottom-up thematic analysis. Results: Our data establish the feasibility and acceptance of PTSDialogue, a supportive tool for individuals with PTSD. Most participants agreed that PTSDialogue could be useful for supporting self-management of individuals with PTSD. We have also assessed how features, functionalities, and interactions in PTSDialogue can support different self-management needs and strategies for this population. These data were then used to identify design requirements and guidelines for a CA aiming to support individuals with PTSD. Experts specifically noted the importance of empathetic and tailored CA interactions for effective PTSD self-management. They also suggested steps to ensure safe and engaging interactions with PTSDialogue. Conclusions: Based on interviews with experts, we have provided design recommendations for future CAs aiming to support vulnerable populations. The study suggests that well-designed CAs have the potential to reshape effective intervention delivery and help address the treatment gap in mental health. %M 37247220 %R 10.2196/45894 %U https://formative.jmir.org/2023/1/e45894 %U https://doi.org/10.2196/45894 %U http://www.ncbi.nlm.nih.gov/pubmed/37247220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44979 %T A Financial Incentives Program to Promote Smoking Cessation Among Recently Hospitalized Individuals: Feasibility and Acceptability Study %A Shusterman,Sara %A Villarreal-Calderon,Rodolfo %A Gunawan,Adrian %A Gallardo Foreman,Alexis %A O'Donnell,Charles %A Wakeman,Cornelia %A Javeed,Hadi %A Keteyian,Jacob %A Howard,Jinesa %A Bulekova,Katia %A de Silva,Shalen %A Campbell,Trevor %A Lasser,Karen %A Kathuria,Hasmeena %+ Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA, 02118, United States, 1 6176583564, sara.shusterman@bmc.org %K financial incentives %K mobile application %K smoking cessation %K tobacco treatment intervention %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge tobacco treatment services. Financial incentives for smoking cessation are an intervention in which participants receive incentives, such as cash payments or vouchers for goods, to encourage individuals to stop smoking or to reward individuals for maintaining abstinence. Objective: We sought to determine the feasibility and acceptability of a novel postdischarge financial incentive intervention that uses a smartphone application paired to measurements of exhaled carbon monoxide (CO) concentration levels to promote smoking cessation in individuals who smoke cigarettes. Methods: We collaborated with Vincere Health, Inc. to tailor their mobile application that uses facial recognition features, a portable breath test CO monitor, and smartphone technology to deliver financial incentives to a participant’s digital wallet after the completion of each CO test. The program includes 3 racks. Track 1: Noncontingent incentives for conducting CO tests. Track 2: Combination of noncontingent and contingent incentives for CO levels <10 parts per million (ppm). Track 3: Contingent incentives only for CO levels <10 ppm. After obtaining informed consent, we pilot-tested the program from September to November 2020 with a convenience sample of 33 hospitalized individuals at Boston Medical Center, a large safety-net hospital in New England. Participants received text reminders to conduct CO tests twice daily for 30 days postdischarge. We collected data on engagement, CO levels, and incentives earned. We measured feasibility and acceptability quantitatively and qualitatively at 2 and 4 weeks. Results: Seventy-six percent (25/33) completed the program and 61% (20/33) conducted at least 1 breath test each week. Seven patients had consecutive CO levels <10 ppm during the last 7 days of the program. Engagement with the financial incentive intervention as well as in-treatment abstinence was highest in Track 3 that delivered financial incentives contingent on CO levels <10 ppm. Participants reported high program satisfaction and that the intervention helped motivate smoking cessation. Participants suggested increasing program duration to at least 3 months and adding supplemental text messaging to increase motivation to stop smoking. Conclusions: Financial incentives paired to measurements of exhaled CO concentration levels is a novel smartphone-based tobacco cessation approach that is feasible and acceptable. Future studies should examine the efficacy of the intervention after it is refined to add a counseling or text-messaging component. %M 37247216 %R 10.2196/44979 %U https://formative.jmir.org/2023/1/e44979 %U https://doi.org/10.2196/44979 %U http://www.ncbi.nlm.nih.gov/pubmed/37247216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47008 %T Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications %A Officer,Tara N %A Tait,Marika %A McBride-Henry,Karen %A Burnet,Laura %A Werkmeister,Benjamin J %+ School of Nursing, Midwifery, and Health Practice, Te Herenga Waka - Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand, 64 463 6575, tara.officer@vuw.ac.nz %K telehealth %K mental health service delivery %K COVID-19 %K Aotearoa New Zealand %K clients %K patient-centered care %K telemedicine %K mental health %K experience %K satisfaction %K perception %K perspective %K attitude %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. %M 37234041 %R 10.2196/47008 %U https://formative.jmir.org/2023/1/e47008 %U https://doi.org/10.2196/47008 %U http://www.ncbi.nlm.nih.gov/pubmed/37234041 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44082 %T Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study %A Rhodes,Alexandra %A Pimprikar,Arya %A Baum,Alison %A Smith,Andrea D %A Llewellyn,Clare H %+ Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076791720, alexandra.rhodes.15@ucl.ac.uk %K digital %K app %K dietary %K physical activity %K lifestyle %K pregnancy %K prenatal %K person-based approach %K behavior change habit formation %K intervention %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective: The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods: The intervention’s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings’ objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results: Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions: This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy. %M 37234026 %R 10.2196/44082 %U https://formative.jmir.org/2023/1/e44082 %U https://doi.org/10.2196/44082 %U http://www.ncbi.nlm.nih.gov/pubmed/37234026 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43015 %T A Virtual Reality App Intervention to Improve Concussion Recognition and Reporting in Athletes Aged 9 to 12 Years: Development and Pilot Testing %A Sullivan,Lindsay %A McKenzie,Lara B %A Roberts,Kristin %A Recker,Robyn %A Schwebel,David C %A Pommering,Thomas %A Yang,Jingzhen %+ Center for Injury Research and Policy, Abigail Wexner Research Institute, Nationwide Children's Hospital, RBIII-WB5403, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 355 5852, ginger.yang@nationwidechildrens.org %K concussion %K education %K sports %K athlete %K athletic %K virtual reality %K youth %K child %K pediatric %K head injury %K symptom reporting %K symptom recognition %K patient education %K brain injury %K user experience %K user centered design %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing concussion education programs for preteen athletes typically do not result in sustained improvements in concussion symptom recognition or reporting behaviors. Virtual reality (VR) technology offers an innovative tool that may improve concussion symptom recognition and reporting behaviors among preteen athletes. Objective: We aimed to describe the design and development of a VR concussion education app, Make Play Safe (MPS), and present findings on the usability and preliminary efficacy of MPS in improving concussion recognition and reporting intentions among soccer athletes aged 9-12 years. Methods: A collaborative user-centered design process was implemented to develop and evaluate MPS, a semi-immersive VR concussion education app designed to address two behavioral outcomes in preteen athletes aged 9-12 years: (1) recognizing concussion and (2) reporting concussion. The development of MPS occurred in three phases: (1) design and development, (2) usability testing, and (3) preliminary efficacy testing. During phase 1, consultations were completed with 6 experts. Additionally, 5 interviews with children who had a history of concussion were conducted to collect feedback about the proof of concept of MPS. During phase 2, a participatory workshop with 11 preteen athletes and a small group discussion with 6 parents and 2 coaches were conducted to explore the usefulness and acceptability of MPS from the perspective of end users. Finally, phase 3 included preliminary efficacy testing with 33 soccer athletes aged 9-12 years to examine changes in concussion-related knowledge, attitudes, and reporting intentions from pre- to postintervention. The data generated from each phase of this study informed the development of the final version of the proof of concept of the VR concussion education app, MPS. Results: Experts positively rated the features of MPS and noted that the design and content were innovative and age-appropriate. Preteens with a history of concussion indicated the scenarios and symptoms portrayed in the app represented well what they experienced while concussed. Further, they stated that the app would be an engaging way for children to learn about concussions. The 11 healthy children in the workshop perceived the app positively, noting that the scenarios were informative and engaging. Results from preliminary efficacy testing revealed increases in many athletes’ knowledge and reporting intentions from pre- to postintervention. Others demonstrated no significant changes or a decrease in knowledge, attitudes, or reporting intentions from pre- to postintervention. Group-level changes in concussion knowledge and intention to report concussions were statistically significant (P<.05), while changes in attitudes toward reporting concussions were not (P=.08). Conclusions: Results suggest VR technology may be an effective and efficient tool to equip preteen athletes with the requisite knowledge and skills to recognize and report future concussions. Further research is recommended to examine the use of VR as an effective strategy to improve concussion-reporting behaviors in preteen athletes. %M 37234027 %R 10.2196/43015 %U https://formative.jmir.org/2023/1/e43015 %U https://doi.org/10.2196/43015 %U http://www.ncbi.nlm.nih.gov/pubmed/37234027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41725 %T Machine Learning and Causal Approaches to Predict Readmissions and Its Economic Consequences Among Canadian Patients With Heart Disease: Retrospective Study %A Rajkumar,Ethan %A Nguyen,Kevin %A Radic,Sandra %A Paa,Jubelle %A Geng,Qiyang %+ Department of Chemistry, Faculty of Science, The University of British Columbia, 2036 Main Mall, Vancouver, BC, Canada, 1 (604) 822 3266, er12da@student.ubc.ca %K patient readmission %K health care economics %K ensemble %K prediction model %K classification %K linear regression resource intensity value %K hospital %K health care %K principal component analysis %K PCA %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unplanned patient readmissions within 30 days of discharge pose a substantial challenge in Canadian health care economics. To address this issue, risk stratification, machine learning, and linear regression paradigms have been proposed as potential predictive solutions. Ensemble machine learning methods, such as stacked ensemble models with boosted tree algorithms, have shown promise for early risk identification in specific patient groups. Objective: This study aims to implement an ensemble model with submodels for structured data, compare metrics, evaluate the impact of optimized data manipulation with principal component analysis on shorter readmissions, and quantitatively verify the causal relationship between expected length of stay (ELOS) and resource intensity weight (RIW) value for a comprehensive economic perspective. Methods: This retrospective study used Python 3.9 and streamlined libraries to analyze data obtained from the Discharge Abstract Database covering 2016 to 2021. The study used 2 sub–data sets, clinical and geographical data sets, to predict patient readmission and analyze its economic implications, respectively. A stacking classifier ensemble model was used after principal component analysis to predict patient readmission. Linear regression was performed to determine the relationship between RIW and ELOS. Results: The ensemble model achieved precision and slightly higher recall (0.49 and 0.68), indicating a higher instance of false positives. The model was able to predict cases better than other models in the literature. Per the ensemble model, readmitted women and men aged 40 to 44 and 35 to 39 years, respectively, were more likely to use resources. The regression tables verified the causality of the model and confirmed the trend that patient readmission is much more costly than continued hospital stay without discharge for both the patient and health care system. Conclusions: This study validates the use of hybrid ensemble models for predicting economic cost models in health care with the goal of reducing the bureaucratic and utility costs associated with hospital readmissions. The availability of robust and efficient predictive models, as demonstrated in this study, can help hospitals focus more on patient care while maintaining low economic costs. This study predicts the relationship between ELOS and RIW, which can indirectly impact patient outcomes by reducing administrative tasks and physicians’ burden, thereby reducing the cost burdens placed on patients. It is recommended that changes to the general ensemble model and linear regressions be made to analyze new numerical data for predicting hospital costs. Ultimately, the proposed work hopes to emphasize the advantages of implementing hybrid ensemble models in forecasting health care economic cost models, empowering hospitals to prioritize patient care while simultaneously decreasing administrative and bureaucratic expenses. %M 37234042 %R 10.2196/41725 %U https://formative.jmir.org/2023/1/e41725 %U https://doi.org/10.2196/41725 %U http://www.ncbi.nlm.nih.gov/pubmed/37234042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45276 %T Web-Based Knowledge Translation Tool About Pediatric Acute Gastroenteritis for Parents: Pilot Randomized Controlled Trial %A Hartling,Lisa %A Elliott,Sarah A %A Munan,Matthew %A Scott,Shannon D %+ Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy 4-472, 11405-87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K knowledge translation %K pediatric acute gastroenteritis %K emergency department %K health care decision-making %K multiple methods %K randomized controlled trial %K qualitative interviews %K web-based tool %D 2023 %7 25.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). Objective: The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. Methods: A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged <16 years presenting to the ED with an acute episode of diarrhea or vomiting, ability to communicate in English, and agreeable to follow-up via email. Parents were randomized to receive the web-based KT tool (intervention) about AGE or a sham video (control) during their ED visit. The primary outcome was knowledge assessed before the intervention (baseline), immediately after the intervention, and at follow-up 4 to 14 days after ED discharge. Other outcomes included decision regret, health care use, and KT tool usability and satisfaction. The intervention group participants were invited to participate in a semistructured interview to gather additional feedback about the KT tool. Results: A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P<.001) and at follow-up (mean 9.1, SD 2.7 vs mean 6.8, SD 1.6; P<.001) were significantly higher in the intervention group. After the intervention, parents in the intervention group reported greater confidence in knowledge than those in the control group. No significant difference in decision regret was found at any time point. Parents rated the KT tool higher than the sham video across 5 items assessing usability and satisfaction. Conclusions: The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents’ decision-making regarding their child’s health. Trial Registration: ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-018-0318-0 %M 37227758 %R 10.2196/45276 %U https://formative.jmir.org/2023/1/e45276 %U https://doi.org/10.2196/45276 %U http://www.ncbi.nlm.nih.gov/pubmed/37227758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41944 %T Effects of WAKE.TAIWAN Healthy Lifestyle Web-Based Promotion Programs on Adults’ Awareness of Self-perceived Weight Status and Their Healthy Lifestyle Stages: Retrospective Analysis %A Lord,Asta Y Z %A Pan,Wen-Harn %+ Institute of Population Health Sciences, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County, 350, Taiwan, 886 37 206166 ext 36309, 850501@nhri.edu.tw %K healthy eating %K active living %K obese %K weight %K social media %K website %K web based %K health behavior %K online health promotion %K obesity %K chronic disease %K healthy lifestyle %K lifestyle %K health promotion %K health education %K online health information %K quasi-experimental %K questionnaire %K survey research %K applied method %K nutrition %K food %K eat %K confidence interval %K generalized linear model %D 2023 %7 25.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a major risk factor of many chronic diseases. However, current obesity control policies and actions are not sufficient to halt the pandemic. It has been documented that more than half of all adults are not able to interpret their own weight status, not to mention to practice healthy lifestyles. Social media and interactive websites can reach people on a long-term basis, which may be used as intervention vehicles to build up cognition for weight control and to promote healthy behavior practices. Objective: WAKE.TAIWAN is an ongoing web-based multifaceted healthy lifestyle promotion program with social media and interactive websites as the intervention vehicle. This study aimed to examine whether adults reached by our program would have increased awareness to their own anthropometric measures, correctly judge their body weight status, and practice healthy behaviors over time. Methods: This study adopted a quasi-experimental design with web-based questionnaire surveys. The experimental group consisted of WAKE.TAIWAN Facebook group members aged 20-65 years who have used the interactive website health education resources (n=177). The group was further stratified into 2 subgroups based on their duration of participation (E1 group: duration <1 year; E2 group: duration ≥1 year). The control group consisted of other Facebook users (n=545) in the same age range who had not been exposed to the health education materials of this project. A total of 722 people (male: n=267, 37%; and female: n=455, 63%) participated in our survey in 2019. Data were analyzed to evaluate program effectiveness using a generalized linear model. Results: The proportion of people correctly interpreting their own weight status in the experimental group was greater than that of the control group (control group: 320/545, 58.7%; group E1: 53/88, 60%; and group E2: 64/89, 72%). The E2 experimental group was significantly better than the control group in paying attention to weight-related measures and in correctly interpreting their own weight status (odds ratio 1.73, 95% CI 1.04-2.89; P=.04). With respect to the behavioral stages of practicing healthy eating and active living, both experimental groups, E1 and E2, performed significantly better than the control group (group E1: P=.003 and P=.02; and group E2: P=.004 and P<.001, respectively). Conclusions: This study demonstrates that the longer the participants were exposed to our social media–based programs, the higher the proportion of them that would have the correct judgement on their weight status and fall in the higher stages of healthy lifestyle behaviors. A longitudinal follow-up survey is in place to verify these findings. %M 37227770 %R 10.2196/41944 %U https://formative.jmir.org/2023/1/e41944 %U https://doi.org/10.2196/41944 %U http://www.ncbi.nlm.nih.gov/pubmed/37227770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45991 %T Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study %A Kim,Jae Sung %A Wang,Bohyun %A Kim,Meelim %A Lee,Jung %A Kim,Hyungjun %A Roh,Danyeul %A Lee,Kyung Hwa %A Hong,Soon-Beom %A Lim,Joon Shik %A Kim,Jae-Won %A Ryan,Neal %+ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 3648, kimjw412@snu.ac.kr %K major depressive disorder %K adolescent %K deep learning %K smart health care %K suicide %K risk factor %K antidepressant treatment %K depression %K machine learning %K smartphone %K mobile health %K mHealth %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem. Objective: We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app. Methods: We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week’s baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children’s Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection. Results: We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD. Conclusions: Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches. %M 37223978 %R 10.2196/45991 %U https://formative.jmir.org/2023/1/e45991 %U https://doi.org/10.2196/45991 %U http://www.ncbi.nlm.nih.gov/pubmed/37223978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43592 %T Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study %A Blazey,Meghan %A Marinac,Catherine %A Whiteley,Jessica %A Peterson,Sarah %A Burns White,Karen %A Jacques,Cathyanah %A Lam,Helen %A Halpenny,Barbara %A Patel,Shree %A Lamothe,Raymond %A Wright,Julie %+ School of Nursing, University of Rochester, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, United States, 1 585 276 6123, meghan_blazey@urmc.rochester.edu %K sedentary behavior %K digital health %K dyad-based intervention %K breast cancer risk %K breast cancer survivor %K social support %K mobile phone %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. Objective: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). Methods: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. Results: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days—SUS score of 72 (range 55-95)—and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. Conclusions: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. Trial Registration: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279 %M 37223968 %R 10.2196/43592 %U https://formative.jmir.org/2023/1/e43592 %U https://doi.org/10.2196/43592 %U http://www.ncbi.nlm.nih.gov/pubmed/37223968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40709 %T Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey %A Fridman,Ilona %A Smalls,Ahmaya %A Fleming,Patrice %A Elston Lafata,Jennifer %+ Cancer Care Quality Program, Lineberger Cancer Center, University of North Carolina, 450 West Dr, Chapel Hill, NC, 27599, United States, 1 6469028137, ilona_fridman@med.unc.edu %K electronic communication %K patient preferences %K digital health %K patient portals %K physician-patient communication %K communication %K text %K phone %K test %K treatment %K clinical %K vaccination %K survey %K intervention %K screening %K social media %K information %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors’ offices. Objective: We explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions. Methods: A cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors’ offices. Respondents indicated their willingness to receive messages from their doctors’ offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from “unwilling” to “willing.” We present the percentage of respondents who indicated that they were “willing” to receive information via specific electronic mode. Chi-square tests were used to compare participants’ willingness by social characteristics. Results: In total, 133 people completed the survey (response rate 27%). The average respondent age was 64 years, 82 (63%) respondents were female, 106 (83%) were White, 20 (16%) were Black, and 1 (1%) was Asian. In total, 75 (58%) respondents had a bachelor’s degree or higher; 26 (20%) resided in rural areas, 37 (29%) in suburban areas, 50 (39%) in a town, and 15 (12%) in a city. The majority, 73 (57%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75%) respondents were willing to receive information from their doctor’s office via their patient portal, 98 (74%) via email, 75 (56%) via text, 60 (45%) via the hospital website, 50 (38%) via telephone, and 14 (11%) via social media. About 6 (5%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes. Conclusions: To optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services. %M 37223979 %R 10.2196/40709 %U https://formative.jmir.org/2023/1/e40709 %U https://doi.org/10.2196/40709 %U http://www.ncbi.nlm.nih.gov/pubmed/37223979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40103 %T The Relationship Between Insufficient Vision and Technology Access and Use Among Hospitalized Adults at an Urban Academic Hospital: Observational Study %A Gupta,Juhi C %A Arora,Vineet M %A Vollbrecht,Hanna %A Kappel,Nicole %A Meltzer,David O %A Press,Valerie G %+ Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 773 702 5170, vpress@bsd.uchicago.edu %K vision %K health technology %K chronic disease %K ownership %K internet %K eHealth %K digital health %K eye %K optometry %K myopia %K ophthalmology %K myopic %K digital device %K observational study %K use %K visual impairment %K visually impaired %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The role of sufficient vision in self-management is salient with respect to the growing prevalence of eHealth-based interventions for chronic diseases. However, the relationship between insufficient vision and self-management has been understudied. Objective: We aimed to assess differences in access to and use of technology among adults with and without insufficient vision at an academic urban hospital. Methods: This is an observational study of hospitalized adult general medicine patients that is part of a larger quality improvement study called the hospitalist study. The hospitalist study provided demographic and health literacy data (Brief Health Literacy Screen). Our substudy included several measures. Validated surveys assessed technology access and use, and included benchmarked questions from the National Pew Survey to determine access to, willingness to use, and self-described ability to use technology at home, particularly for self-management, and eHealth-specific questions assessing future willingness to access eHealth post discharge. The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy. Visual acuity was assessed using the Snellen pocket eye chart with low vision defined as visual acuity ≤20/50 in at least one eye. Descriptive statistics, bivariate chi-square analyses, and multivariate logistic regressions (adjusted for age, race, gender, education level, and eHealth literacy) were performed using Stata. Results: A total of 59 participants completed our substudy. The mean age was 54 (SD 16.4) years. Demographic data from the hospitalist study was missing for several participants. Among those who responded, most identified as Black (n=34, 79%) and female (n=26, 57%), and most reported at least some college education (n=30, 67%). Most participants owned technology devices (n=57, 97%) and had previously used the internet (n=52, 86%), with no significant differences between those with insufficient and sufficient vision (n=34 vs n=25). Though there was a 2x effect size for laptop ownership, with those with sufficient vision more likely to own a laptop, those with insufficient vision versus sufficient vision were less likely to report an ability to perform online tasks without assistance, including using a search engine (n=22, 65% vs n=23, 92%; P=.02), opening an attachment (n=17, 50% vs n=22, 88%; P=.002), and using an online video (n=20, 59% vs n=22, 88%; P=.01). In multivariate analysis, the ability to independently open an online attachment did not remain statistically significant (P=.01). Conclusions: Technology device ownership and internet use rates are high in this population, yet participants with insufficient vision (vs sufficient vision) reported a reduced ability to independently perform online tasks. To ensure the effective use of eHealth technologies by at-risk populations, the relationship between vision and technology use needs to be further studied. %M 37223969 %R 10.2196/40103 %U https://formative.jmir.org/2023/1/e40103 %U https://doi.org/10.2196/40103 %U http://www.ncbi.nlm.nih.gov/pubmed/37223969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39158 %T Acceptability of Online Yoga Among Individuals With Chronic Conditions and Their Caregivers: Qualitative Study %A Portz,Jennifer Dickman %A Schmid,Arlene %A Fruhauf,Christine %A Fox,Aimee %A Van Puymbroeck,Marieke %A Sharp,Julia %A Leach,Heather %+ University of Colorado, Mailstop B119, 13001 East 17th Place, Aurora, CO, 80045, United States, 1 303 724 8856, jennifer.portz@CUAnschutz.edu %K yoga %K meditative movement %K online %K chronic conditions %K self-management %K caregiver %K dyads %K meditation %K participation %K perspective %K intervention %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The online delivery of yoga interventions rapidly expanded during the COVID-19 pandemic, and preliminary studies indicate that online yoga is feasible across multiple chronic conditions. However, few yoga studies provide synchronous online yoga sessions and rarely target the caregiving dyad. Online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples. However, the perceived acceptability of online yoga, including self-reported satisfaction and online delivery preferences, is underexplored among individuals with chronic conditions and their caregivers. Understanding user preferences is essential for successful and safe online yoga implementation. Objective: We aimed to qualitatively examine the perceived acceptability of online yoga among individuals with chronic conditions and their caregivers who participated in an online dyadic intervention that merged yoga and self-management education to develop skills (MY-Skills) to manage persistent pain. Methods: We conducted a qualitative study among 9 dyads (>18 years of age; individuals experiencing persistent moderate pain) who participated in MY-Skills online during the COVID-19 pandemic. The intervention consisted of 16 online, synchronous yoga sessions over 8 weeks for both dyad members. After the completion of the intervention, participants (N=18) participated in semistructured telephone interviews for around 20 minutes, discussing their preferences, challenges, and recommendations for improved online delivery. Interviews were analyzed by using a rapid analytic approach. Results: MY-Skills participants were, on average, aged 62.7 (SD 19) years; were primarily women; were primarily White; and had a mean of 5.5 (SD 3) chronic conditions. Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory. The following three themes were identified related to online delivery: (1) participants indicated a preference for the intervention to be in person rather than online because they were distracted in the home setting, because they felt that in-person yoga would be more engaging, because the yoga therapist could physically correct positions, and because of safety concerns (eg, fear of falling); (2) participants indicated good acceptability of online MY-Skills delivery due to convenience, access, and comfort with being in their home; and (3) recommendations for improving online delivery highlighted a need for additional and accessible technical support. Conclusions: Both individuals with chronic conditions and their caregivers find online yoga to be an acceptable intervention. Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Some participants preferred in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Convenience and access were the primary reasons for preferring online delivery. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support. Trial Registration: ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320 %M 37223971 %R 10.2196/39158 %U https://formative.jmir.org/2023/1/e39158 %U https://doi.org/10.2196/39158 %U http://www.ncbi.nlm.nih.gov/pubmed/37223971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41114 %T Development of a Mobile Health Snacktivity App to Promote Physical Activity in Inactive Adults (SnackApp): Intervention Mapping and User Testing Study %A Sanders,James P %A Gokal,Kajal %A Thomas,Jonah J C %A Rawstorn,Jonathan C %A Sherar,Lauren B %A Maddison,Ralph %A Greaves,Colin J %A Esliger,Dale %A Daley,Amanda J %A , %+ Centre for Lifestyle Medicine and Behaviour, Loughborough University, Sir John Beckwith Building, Epinal way, Loughborough, LE11 3TU, United Kingdom, 44 01509 ext 225454, J.Sanders2@lboro.ac.uk %K intervention development %K physical activity %K mobile health %K mHealth %K health app %K user testing %K intervention %K behavior %K smartphone %K app %K social %K user %K engagement %K development %K testing %K mobile phone %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the unequivocal evidence demonstrating the benefits of being physically active, many people do not meet the recommended guidelines of at least 150 minutes of moderate- to vigorous-intensity physical activity per week. This can be changed with the development and implementation of innovative interventions. The use of mobile health (mHealth) technologies has been suggested as a mechanism to offer people innovative health behavior change interventions. Objective: This study aims to outline the systematic, theory-driven processes and user testing applied to the development of a smartphone-based physical activity app (SnackApp) to promote participation in a novel physical activity intervention called Snacktivity. The acceptability of the app was explored and reported. Methods: Intervention mapping involves a 6-step process, the first 4 of which were presented in this study. These steps were used to develop the SnackApp for use within the Snacktivity intervention. The first step involved a needs assessment, which included composing an expert planning group, patient and public involvement group, and gathering the views of the public on Snacktivity and the public perception of the use of wearable technology to support Snacktivity. This first step aimed to determine the overall purpose of the Snacktivity intervention. Steps 2 to 4 involved determining the intervention objectives, the behavior change theory and techniques on which the intervention is based, and the development of the intervention resources (ie, SnackApp). After the completion of steps 1 to 3 of the intervention mapping process, the SnackApp was developed and linked to a commercial physical activity tracker (Fitbit Versa Lite) for the automated capture of physical activity. SnackApp includes provisions for goal setting, activity planning, and social support. Stage 4 involved users (inactive adults, N=15) testing the SnackApp for 28 days. App engagement (mobile app use analytics) was analyzed to determine app use and to inform the further development of SnackApp. Results: Over the study period (step 4), participants engaged with SnackApp an average of 77 (SD 80) times. On average, participants used the SnackApp for 12.6 (SD 47) minutes per week, with most of the time spent on the SnackApp dashboard and engaging, on average, 14 (SD 12.1) times, lasting 7 to 8 minutes per week. Overall, male participants used the SnackApp more than female participants did. The app rating score was 3.5 (SD 0.6) out of 5, suggesting that SnackApp was rated as fair to good. Conclusions: This study outlines and reports data regarding the development of an innovative mHealth app using a systematic, theory-driven framework. This approach can guide the development of future mHealth programs. User testing of the SnackApp suggested that physically inactive adults will engage with the SnackApp, indicating its applicability of use in the Snacktivity physical activity intervention. %M 37213198 %R 10.2196/41114 %U https://formative.jmir.org/2023/1/e41114 %U https://doi.org/10.2196/41114 %U http://www.ncbi.nlm.nih.gov/pubmed/37213198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44592 %T Views and Needs of Students, Parents, and Teachers on Closed-Circuit Television, Proximity Trackers, and Access Cards to Facilitate COVID-19 Contact Tracing in Schools: Thematic Analysis of Focus Groups and Interviews %A Chantziara,Sofia %A Craddock,Ian J %A Mccallum,Claire H %A Brigden,Amberly L C %+ Faculty of Engineering, University of Bristol, Merchant Venturers Building, Bristol, BS8 1UB, United Kingdom, 44 44 0117 928 ext 900, amberly.brigden@bristol.ac.uk %K digital contact tracing %K school %K student %K teacher %K focus group %K proximity tracking %K Unified Theory of Technology and Acceptance %K UTAUT %K acceptance %K adoption %K CCTV %K COVID-19 %K contact tracing %K public health intervention %K digital health intervention %K implementation %K digital tool %K technology acceptance %K privacy %K surveillance technology %K surveillance %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact tracing is considered a key measure in preventing the spread of infectious diseases. Governments around the world adopted contact tracing to limit the spread of COVID-19 in schools. Contact tracing tools utilizing digital technology (eg, GPS chips, Bluetooth radios) can increase efficiency compared to manual methods. However, these technologies can introduce certain privacy challenges in relation to retention, tracking, and the using and sharing of personal data, and little is known about their applicability in schools. Objective: This is the second of two studies exploring the potential of digital tools and systems to help schools deal with the practical challenges of preventing and coping with an outbreak of COVID-19. The aim was to explore the views, needs, and concerns among secondary school stakeholders (parents, teachers, pupils) regarding the implementation of three digital tools for contact tracing: access cards, proximity tracking, and closed-circuit television (CCTV). Methods: Focus groups and interviews were conducted with secondary school students, parents, and teachers. The topic guide was informed by the Unified Theory of Technology and Acceptance. Data-driven and theory-driven approaches were combined to identify themes and subthemes. Results: We recruited 22 participants. Findings showed that there is no single solution that is suitable for all schools, with each technology option having advantages and limitations. Existing school infrastructure (eg, CCTV and smart/access cards technology) and the geography of each school would determine which tools would be optimal for a particular school. Concerns regarding the cost of installing and maintaining equipment were prominent among all groups. Parents and teachers worried about how the application of these solutions will affect students’ right to privacy. Parents also appeared not to have adequate knowledge of the surveillance technologies already available in schools (eg, CCTV). Students, who were mostly aware of the presence of surveillance technologies, were less concerned about any potential threats to their privacy, while they wanted reassurances that any solutions would be used for their intended purposes. Conclusions: Findings revealed that there is not one tool that would be suitable for every school and the context will determine which tool would be appropriate. This study highlights important ethical issues such as privacy concerns, balancing invasions of privacy against potential benefits, transparency of communication around surveillance technology and data use, and processes of consent. These issues need to be carefully considered when implementing contact tracing technologies in school settings. Communication, transparency, and consent within the school community could lead to acceptance and engagement with the new tools. %M 36939667 %R 10.2196/44592 %U https://formative.jmir.org/2023/1/e44592 %U https://doi.org/10.2196/44592 %U http://www.ncbi.nlm.nih.gov/pubmed/36939667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42590 %T Impact of Multimedia Messaging Service Education and Exercise Social Support on Physical Activity Among Patients With Type 2 Diabetes: Quasi-Experimental Study %A Alyahya,Mohammad S %A Al-Sheyab,Nihaya A %A Khader,Yousef S %A Alqudah,Jumana A %+ Health Management and Policy, Faulty of Medicine, Jordan University of Science and Technology (JUST), 22110, Irbid, 3030, Jordan, 962 775582824, msalyahya@just.edu.jo %K diabetes mellitus %K educational interventions %K multimedia messaging service %K physical activity %K social support %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social support is one of the interpersonal stimuli that define an individual’s predisposition to engage in health-promoting behaviors and is considered a facilitator in improving health habits. Patients with type 2 diabetes mellitus (T2DM) can benefit from educating supportive families and friends on self-care management including exercise behavior. Multimedia messaging service (MMS) could also be an effective method for delivering targeted educational interventions that focus on physical activity (PA). Objective: This study aimed to assess the effectiveness of MMS educational interventions and perceived social support for exercise on level of PA of patients with T2DM. Methods: A quasi-experimental pretest-posttest design was conducted to recruit 98 patients with T2DM. The intervention group received MMS education aiming to improve exercise social support and PA level for 2 months, and their counterparts in the control group received the usual routine care. We sent 2 to 3 messages daily for 2 weeks from Saturday to Thursday (12 days total). These messages were a combination of videos and texts, and the evidence-based content of these messages was reviewed and approved by the advisory committee. We randomly assigned eligible patients in a 1:1 ratio into the intervention or the control groups. Participants completed a survey in 3 periods. Results: There were no significant differences in friends’ support, family verbal, practical, or emotional support over time in the intervention group (P>.05). Yet, there was a small effect size (Cohen d) in friends’ social support (0.389), family practical support (0.271), and moderate activities (0.386). A medium effect size was found in family verbal (0.463) and emotional (0.468) support. Being married increased the likelihood of friends’ support by 2.3 times after intervention (P=.04), whereas rarely doing exercise decreased the likelihood of friends’ support by 28% (P=.03) and family practical support by 28% (P=.01). Being female and married increased the likelihood of doing moderate activities by 1.6 times (P=.002) and 1.5 times (P=.049) in the intervention group. Being a housewife decreased the likelihood of doing moderate activities by 20% (P=.001). Finally, being a female with a higher educational level decreased the likelihood of doing hard activities by 20% (P=.04) and 15% (P=.002), respectively. Conclusions: A theoretically based MMS health education targeting PA levels and social support of family and friends to perform PA seems promising in promoting family and friends’ social support and improving PA levels among patients with T2DM. Actively involving family and friends in educational interventions that target PA can have an impact on health-promoting behaviors in patients with diabetes. %M 37213171 %R 10.2196/42590 %U https://formative.jmir.org/2023/1/e42590 %U https://doi.org/10.2196/42590 %U http://www.ncbi.nlm.nih.gov/pubmed/37213171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43008 %T Gait Device Treatment Using Telehealth for Individuals With Stroke During the COVID-19 Pandemic: Nonrandomized Pilot Feasibility Study %A Darcy,Brianne %A Rashford,Lauren %A Shultz,Stephen Tyler %A Tsai,Nancey T %A Huizenga,David %A Reed,Kyle B %A Bamberg,Stacy J M %+ Moterum Technologies, 26 S Rio Grande St #2072, Salt Lake City, UT, 84101, United States, 1 3853788333, brie@moterum.com %K gait device %K telerehabilitation %K iStride %K stroke rehabilitation %K walking speed %K gait %K gait treatment %K telehealth %K COVID-19 %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, rehabilitation providers and consumers adopted telehealth practices at unprecedented rates. Multiple prepandemic studies demonstrate the feasibility and comparable efficacy between in-clinic and remote treatment for certain impairments caused by stroke, such as upper extremity weakness and impaired motor function. However, less guidance has been available regarding gait assessment and treatment. Despite this limitation, safe and effective gait treatment is fundamental to optimizing health and well-being after stroke and should be considered a treatment priority, including during the COVID-19 pandemic. Objective: This study explores the feasibility of using telehealth to deliver gait treatment using a wearable gait device, the iStride device, to stroke survivors during the 2020 pandemic. The gait device is used to treat hemiparetic gait impairments caused by stroke. The device alters the user’s gait mechanics and creates a subtle destabilization of the nonparetic limb; therefore, supervision is required during its usage. Before the pandemic, treatment with the gait device had been provided in person to appropriate candidates using a combination of physical therapists and trained personnel. However, upon the emergence of the COVID-19 pandemic, in-person treatment was halted in adherence to pandemic guidelines. This study investigates the feasibility of 2 remote delivery treatment models with the gait device for stroke survivors. Methods: Participants were recruited during the first half of 2020 after the onset of the pandemic and included 5 individuals with chronic stroke (mean age 72 years; 84 months post stroke). Four participants were previous gait device users who transitioned to the telehealth delivery model to continue their gait treatment remotely. The fifth participant performed all study-related activities, from recruitment through follow-up, remotely. The protocol included virtual training for the at-home care partner, followed by 3 months of remote treatment with the gait device. Participants were instructed to wear gait sensors during all treatment activities. To assess feasibility, we monitored the safety of the remote treatment, compliance with protocol activities, acceptability of the telehealth treatment delivery, and preliminary efficacy of the gait treatment. Functional improvement was measured using the 10-Meter Walk Test, the Timed Up and Go Test, and the 6-Minute Walk Test, and quality of life was assessed using the Stroke-Specific Quality of Life Scale. Results: No serious adverse events occurred, and participants rated high acceptance of the telehealth delivery. Protocol compliance averaged 95% of treatment sessions, 100% of assessments, and 85% of sensor usage during treatment. After 3 months of treatment, the average improvement in each functional outcome exceeded the minimal clinically important difference or minimal detectable change value. Conclusions: Remote treatment delivery with the gait device appeared feasible with care partner support. Gait treatment using telehealth may be useful to offset negative immobility impacts for those requiring or preferring remote care during the pandemic or otherwise. Trial Registration: ClinicalTrials.gov NCT04434313; https://clinicaltrials.gov/ct2/show/NCT04434313 %M 37204830 %R 10.2196/43008 %U https://formative.jmir.org/2023/1/e43008 %U https://doi.org/10.2196/43008 %U http://www.ncbi.nlm.nih.gov/pubmed/37204830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45554 %T TikTok and #OccupationalTherapy: Cross-sectional Study %A Chasca,Whitney %A Nerada,Samantha %A Zenone,Marco %A Barbic,Skye %+ Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, T325 - 2211 Wesbrook Mall, Musqueam Territory, Vancouver, BC, V6T 2A1, Canada, 1 778 846 6134, skye.barbic@ubc.ca %K TikTok %K occupational therapy %K health professional %K knowledge translation %K social media %K education %K treatment %K community %K quality control %K information %K platform %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical providers use the short-form video social media platform TikTok to share information related to their scope of practice and insights about their professions. Videos under the hashtag #occupationaltherapy on TikTok have over 100 million views, but there is no evidence investigating how occupational therapy information and knowledge are shared on the platform. Objective: The purpose of this cross-sectional study is to describe TikTok content with the hashtag #occupationaltherapy and investigate how occupational therapy is portrayed. Methods: We performed a content analysis on the top 500 TikTok videos under the hashtag #occupationaltherapy. We analyzed occupational therapy content themes (occupational therapy intervention, education, student training, universal design, and humor), practice settings (pediatrics, generalists, dementia, hand therapy, neurology, occupational therapy students, older adults, mental health, and unknown), and sentiments (positive, negative, and neutral). Results: The videos in our sample (n=500) received 175,862,994 views. The 2 most prevalent content areas were education (n=210) and occupational therapy interventions (n=146). The overall sentiment of the videos was positive (n=302). The most frequently observed practice settings in the videos were pediatrics (n=131) and generalists (n=129). Most videos did not state that it was occupational therapy (n=222) or misused the hashtag (n=131). Conclusions: TikTok has the potential for occupational therapists to share innovations, build communities of practice, and engage in collaborative efforts to share information about occupational therapists’ unique roles with diverse populations. Future research is needed to monitor the quality of information and debunk inaccuracies. %M 37204836 %R 10.2196/45554 %U https://formative.jmir.org/2023/1/e45554 %U https://doi.org/10.2196/45554 %U http://www.ncbi.nlm.nih.gov/pubmed/37204836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40818 %T A Systematic Analysis of Biological, Sociodemographic, Psychosocial, and Lifestyle Factors Contributing to Work Ability Across the Working Life Span: Cross-sectional Study %A Gajewski,Patrick D %A Rieker,Jennifer A %A Athanassiou,Georgios %A Bröde,Peter %A Claus,Maren %A Golka,Klaus %A Hengstler,Jan G %A Kleinsorge,Thomas %A Nitsche,Michael A %A Reinders,Jörg %A Tisch,Anita %A Watzl,Carsten %A Wascher,Edmund %A Getzmann,Stephan %+ Leibniz Research Centre for Working Environment and Human Factors (IfADo) at the Technical University of Dortmund, Ardeystr. 67, Dortmund, 44139, Germany, 49 231 1084 383, gajewski@ifado.de %K aging %K cognitive aging %K cardiovascular system %K immunology %K lifestyle %K metabolism %K occupational safety and health %K public health %K psychosocial stress %K work ability %K mobile phone %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As employees age, their physical and mental abilities decline and work ability decreases, enhancing the risk for long-term sick leave or even premature retirement. However, the relative impact of biological and environmental determinants on work ability with increasing age is poorly understood in terms of their complexity. Objective: Previous research has shown relationships between work ability and job and individual resources, as well as specific demographic and lifestyle-related variables. However, other potentially important predictors of work ability remain unexplored, such as personality traits and biological determinants, including cardiovascular, metabolic, immunological, and cognitive abilities or psychosocial factors. Our aim was to systematically evaluate a wide range of factors to extract the most crucial predictors of low and high work ability across the working life span. Methods: As part of the Dortmund Vital Study, 494 participants from different occupational sectors, aged between 20 and 69 years, completed the Work Ability Index (WAI) assessing employee’s mental and physical resources. A total of 30 sociodemographic variables were grouped into 4 categories (social relationships, nutrition and stimulants, education and lifestyle, and work related), and 80 biological and environmental variables were grouped into 8 domains (anthropometric, cardiovascular, metabolic, immunologic, personality, cognitive, stress related, and quality of life) and have been related to the WAI. Results: Using the analyses, we extracted important sociodemographic factors influencing work ability, such as education, social activities, or sleep quality, and identified age-dependent and age-independent determinants of work ability. Regression models explained up to 52% of the WAI variance. Negative predictors of work ability were chronological and immunological age, immunological inefficiency, BMI, neuroticism, psychosocial stress, emotional exhaustion, demands from work, daily cognitive failures, subclinical depression, and burnout symptoms. Positive predictors were maximum heart rate during ergometry, normal blood pressure, hemoglobin and monocyte concentration, weekly physical activity, commitment to the company, pressure to succeed, and good quality of life. Conclusions: The identified biological and environmental risk factors allowed us to evaluate work ability in its complexity. Policy makers, employers, and occupational safety and health personnel should consider the modifiable risk factors we identified to promote healthy aging at work through focused physical, dietary, cognitive, and stress-reduced preventive programs, in addition to well-balanced working conditions. This may also increase the quality of life, commitment to the job, and motivation to succeed, which are important factors to maintain or even enhance work ability in the aging workforce and to prevent early retirement. Trial Registration: ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397 International Registered Report Identifier (IRRID): RR2-10.2196/32352 %M 37204831 %R 10.2196/40818 %U https://formative.jmir.org/2023/1/e40818 %U https://doi.org/10.2196/40818 %U http://www.ncbi.nlm.nih.gov/pubmed/37204831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46020 %T Roles and Competencies of Doctors in Artificial Intelligence Implementation: Qualitative Analysis Through Physician Interviews %A Tanaka,Masashi %A Matsumura,Shinji %A Bito,Seiji %+ Department of Clinical Epidemiology, Tokyo Medical Center, National Hospital Organization, 2-5-1,higashigaoka,meguroku, Tokyo, 1520021, Japan, 81 334110111, tanakamasashino@gmail.com %K artificial intelligence %K shared decision-making %K competency %K decision-making, qualitative research %K patient-physician %K medical field %K AI services %K AI technology %D 2023 %7 18.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) is a term used to describe the use of computers and technology to emulate human intelligence mechanisms. Although AI is known to affect health services, the impact of information provided by AI on the patient-physician relationship in actual practice is unclear. Objective: The purpose of this study is to investigate the effect of introducing AI functions into the medical field on the role of the physician or physician-patient relationship, as well as potential concerns in the AI era. Methods: We conducted focus group interviews in Tokyo’s suburbs with physicians recruited through snowball sampling. The interviews were conducted in accordance with the questions listed in the interview guide. A verbatim transcript recording of all interviews was qualitatively analyzed using content analysis by all authors. Similarly, extracted code was grouped into subcategories, categories, and then core categories. We continued interviewing, analyzing, and discussing until we reached data saturation. In addition, we shared the results with all interviewees and confirmed the content to ensure the credibility of the analysis results. Results: A total of 9 participants who belonged to various clinical departments in the 3 groups were interviewed. The same interviewers conducted the interview as the moderator each time. The average group interview time for the 3 groups was 102 minutes. Content saturation and theme development were achieved with the 3 groups. We identified three core categories: (1) functions expected to be replaced by AI, (2) functions still expected of human physicians, and (3) concerns about the medical field in the AI era. We also summarized the roles of physicians and patients, as well as the changes in the clinical environment in the age of AI. Some of the current functions of the physician were primarily replaced by AI functions, while others were inherited as the functions of the physician. In addition, “functions extended by AI” obtained by processing massive amounts of data will emerge, and a new role for physicians will be created to deal with them. Accordingly, the importance of physician functions, such as responsibility and commitment based on values, will increase, which will simultaneously increase the expectations of the patients that physicians will perform these functions. Conclusions: We presented our findings on how the medical processes of physicians and patients will change as AI technology is fully implemented. Promoting interdisciplinary discussions on how to overcome the challenges is essential, referring to the discussions being conducted in other fields. %M 37200074 %R 10.2196/46020 %U https://formative.jmir.org/2023/1/e46020 %U https://doi.org/10.2196/46020 %U http://www.ncbi.nlm.nih.gov/pubmed/37200074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46659 %T Automated Diet Capture Using Voice Alerts and Speech Recognition on Smartphones: Pilot Usability and Acceptability Study %A Chikwetu,Lucy %A Daily,Shaundra %A Mortazavi,Bobak J %A Dunn,Jessilyn %+ Department of Biomedical Engineering, Duke University, 1427 FCIEMAS, Durham, NC, 27708, United States, 1 9196605131, jessilyn.dunn@duke.edu %K automatic dietary monitoring %K ADM %K food logging %K diet logging %K voice technologies %K voice alert %K speech recognition %K natural language processing %K NLP %D 2023 %7 16.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective monitoring of dietary habits is critical for promoting healthy lifestyles and preventing or delaying the onset and progression of diet-related diseases, such as type 2 diabetes. Recent advances in speech recognition technologies and natural language processing present new possibilities for automated diet capture; however, further exploration is necessary to assess the usability and acceptability of such technologies for diet logging. Objective: This study explores the usability and acceptability of speech recognition technologies and natural language processing for automated diet logging. Methods: We designed and developed base2Diet—an iOS smartphone application that prompts users to log their food intake using voice or text. To compare the effectiveness of the 2 diet logging modes, we conducted a 28-day pilot study with 2 arms and 2 phases. A total of 18 participants were included in the study, with 9 participants in each arm (text: n=9, voice: n=9). During phase I of the study, all 18 participants received reminders for breakfast, lunch, and dinner at preselected times. At the beginning of phase II, all participants were given the option to choose 3 times during the day to receive 3 times daily reminders to log their food intake for the remainder of the phase, with the ability to modify the selected times at any point before the end of the study. Results: The total number of distinct diet logging events per participant was 1.7 times higher in the voice arm than in the text arm (P=.03, unpaired t test). Similarly, the total number of active days per participant was 1.5 times higher in the voice arm than in the text arm (P=.04, unpaired t test). Furthermore, the text arm had a higher attrition rate than the voice arm, with only 1 participant dropping out of the study in the voice arm, while 5 participants dropped out in the text arm. Conclusions: The results of this pilot study demonstrate the potential of voice technologies in automated diet capturing using smartphones. Our findings suggest that voice-based diet logging is more effective and better received by users compared to traditional text-based methods, underscoring the need for further research in this area. These insights carry significant implications for the development of more effective and accessible tools for monitoring dietary habits and promoting healthy lifestyle choices. %M 37191989 %R 10.2196/46659 %U https://formative.jmir.org/2023/1/e46659 %U https://doi.org/10.2196/46659 %U http://www.ncbi.nlm.nih.gov/pubmed/37191989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45718 %T Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses %A Zhao,Xin %A Stadnick,Nicole A %A Ceballos-Corro,Eduardo %A Castro Jr,Jorge %A Mallard-Swanson,Kera %A Palomares,Kristina J %A Eikey,Elizabeth %A Schneider,Margaret %A Zheng,Kai %A Mukamel,Dana B %A Schueller,Stephen M %A Sorkin,Dara H %+ Department of Medicine, University of California, Irvine, Department of Medicine, 1001 Health Sciences Rd, Irvine, CA, Irvine, CA, 92617, United States, 1 (949) 824 6119, zhaox44@hs.uci.edu %K digital mental health %K mobile health %K mHealth %K implementation readiness %K implementation science %K qualitative analyses %K mobile phone %D 2023 %7 16.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts. Objective: This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors. Methods: This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework. Results: On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate. Conclusions: The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor). %M 37191975 %R 10.2196/45718 %U https://formative.jmir.org/2023/1/e45718 %U https://doi.org/10.2196/45718 %U http://www.ncbi.nlm.nih.gov/pubmed/37191975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44385 %T Exploring Access as a Process of Adaptation in a Self-Monitoring Perinatal eHealth System: Mixed Methods Study From a Sociomaterial Perspective %A Auxier,Jennifer %A Savolainen,Kaisu T %A Bender,Miriam %A Rahmani,Amir M %A Sarhaddi,Fatemeh %A Azimi,Iman %A Axelin,Anna M %+ Donald Bren School of Information and Computer Sciences, University of California, Irvine, 123 street, Irvine, CA, 123 431, United States, 1 4516819876, a.rahmani@uci.edu %K patient engagement %K eHealth %K pregnancy %K motivation %K pregnant %K maternal %K cocreation %K participatory %K codesign %K use pattern %K usage %K self-monitor %K sociomaterial %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The development and quality assurance of perinatal eHealth self-monitoring systems is an upcoming area of inquiry in health science. Building patient engagement into eHealth development as a core component has potential to guide process evaluation. Access, 1 attribute of patient engagement, is the focus of study here. Access to eHealth self-monitoring programs has the potential to influence pregnancy health and wellness outcomes. Little is known about how pregnant users’ ability to obtain resources is influenced by their own adaptive activities and the mediating activities of eHealth systems during the process of real-world testing of these systems. Objective: Here, we examine the patient engagement process of access occurring during the adaptation of eHealth self-monitoring use from a sociomaterial perspective. Methods: In this mixed methods convergent evaluation design, we interviewed women about perceptions of the adaptation process of using an eHealth self-monitoring system. Deductive analysis was conducted guided by the definition of access as an attribute of patient engagement. After initial qualitative and quantitative data collection and analysis, participants were spilt based on their level of use of the eHealth system (physical wear time of self-monitoring device). Content analysis was then conducted according to user group, using a conceptual matrix developed from ontological perspectives of sociomateriality. Results: Pregnant users’ adaptive activities and the mediation activities of the eHealth system represent a cocreation process that resulted in user group–specific characteristics of accessing and using the system. The high- and low-use groups experienced different personal adaptation and eHealth mediation during this process of cocreation. Differences were noted between high- and low-use groups, with the high-use group giving attention to developing skills in recording and interpreting data and the low-use group discussing the manual adding of activities to the system and how the system worked best for them when they used it in their mother tongue. Conclusions: A cocreation process between pregnant users and the eHealth system was identified, illustrating access as a useful core component of perinatal eHealth self-monitoring systems. Researchers and clinicians can observe reasons for why pregnant users access eHealth systems in unique ways based on their personal preferences, habits, and values. Mediation activities of the eHealth system and the different user adaptive activities represent a cocreation process between the users and the eHealth system that is necessary for the personalization of perinatal eHealth systems. %M 37184929 %R 10.2196/44385 %U https://formative.jmir.org/2023/1/e44385 %U https://doi.org/10.2196/44385 %U http://www.ncbi.nlm.nih.gov/pubmed/37184929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42986 %T Screening for Media Use in the Emergency Department Among Young Australians: Cross-sectional Study %A Dullur,Pravin %A Joseph,Joanne %A Diaz,Antonio Mendoza %A Lin,Ping-I %A Jairam,Rajeev %A Davies,Rhian %A Masi,Anne %A Shulruf,Boaz %A Eapen,Valsamma %+ Discipline of Psychiatry and Mental Health, University of New South Wales, High St Kensington, NSW 2052, Sydney, Australia, 61 9385 1000, z5173736@ad.unsw.edu.au %K internet %K mental illness %K overuse %K problematic internet behaviors %K emergency department %K screening %K adolescent %K youth %K internet use %K mental health %K technology use %K young people %K internet behavior %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). Objective: The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. Methods: This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person’s mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. Results: Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). Conclusions: Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use–related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties. %M 37184914 %R 10.2196/42986 %U https://formative.jmir.org/2023/1/e42986 %U https://doi.org/10.2196/42986 %U http://www.ncbi.nlm.nih.gov/pubmed/37184914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44501 %T Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study %A Cheng,Jessica %A Arora,Vineet M %A Kappel,Nicole %A Vollbrecht,Hanna %A Meltzer,David O %A Press,Valerie %+ General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 773 702 5170, vpress@bsd.uchicago.edu %K health literacy %K eHealth literacy %K telehealth %K transitions of care, digital divide %K telemedicine %K technology use %K video consultation %K urban population %K digital health literacy %K patient care %D 2023 %7 12.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients. Objective: The aim of this study is to evaluate video capabilities, eHealth literacy, and engagement with video telehealth among hospitalized patients. Methods: The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed self-reported rates of audio versus video telehealth usage as well as the participants’ self-reported willingness to use video telehealth for future health care visits. We used a multivariable binary logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race or ethnicity, educational level, eHL literacy scale (eHEALS), health literacy (brief health literacy screen), technology access, internet access, and video capability. Results: Of the 297 enrolled participants, median age was 58 years, most (n=185, 62%) identified as Black, half (n=149, 50%) were female, one-quarter (n=66, 22%) lacked home internet access, and one-third (n=102, 34%) had inadequate eHL. Conclusions: Patients with low eHL reported greater participation in audio-only telehealth over video telehealth, of which the former may lose its flexible pandemic reimbursement policy. This may widen the existing health disparities as older adults and patients with low eHL face challenges in accessing video telehealth services. Low eHL is associated with lack of web-based skills, lower rates of video telehealth usage, and lower willingness to use video technology. The study results raise the question of how to improve video capability among patients who, despite having access to smartphones and laptops, face challenges in using telehealth optimally. %M 37171854 %R 10.2196/44501 %U https://formative.jmir.org/2023/1/e44501 %U https://doi.org/10.2196/44501 %U http://www.ncbi.nlm.nih.gov/pubmed/37171854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41487 %T Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study %A Mamuye,Adane %A Nigatu,Araya Mesfin %A Chanyalew,Moges Asressie %A Amor,Lamia Ben %A Loukil,Sihem %A Moyo,Chris %A Quarshie,Samuel %A Antypas,Konstantinos %A Tilahun,Binyam %+ College of Medicine and Health Sciences, University of Gondar, Azezo, Gondar, 6260, Ethiopia, 251 918713813, hitdt2005@gmail.com %K attributes %K Africa %K eHealth %K low- and middle-income countries %K sustainability %D 2023 %7 12.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. Objective: The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. Methods: A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. Results: A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5% (36/49) of them were male participants; and 71.4% (35/49) of them had a master’s degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. Conclusions: This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries. %M 37171865 %R 10.2196/41487 %U https://formative.jmir.org/2023/1/e41487 %U https://doi.org/10.2196/41487 %U http://www.ncbi.nlm.nih.gov/pubmed/37171865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36815 %T An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach %A Weil,Marie-Theres %A Spinler,Kristin %A Lieske,Berit %A Dingoyan,Demet %A Walther,Carolin %A Heydecke,Guido %A Kofahl,Christopher %A Aarabi,Ghazal %+ Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Bldg O58, Martinistrasse 52, Hamburg, 20246, Germany, 49 40 7410 55332, g.aarabi@uke.de %K oral health %K health behavior %K oral health knowledge %K migration %K mobile health %K mHealth %K preventive dentistry %K intervention mapping %K mobile phone %D 2023 %7 11.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. Objective: This study aims to describe the development process of the MuMi app. Methods: For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. Results: On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. Conclusions: The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background. %M 37166956 %R 10.2196/36815 %U https://formative.jmir.org/2023/1/e36815 %U https://doi.org/10.2196/36815 %U http://www.ncbi.nlm.nih.gov/pubmed/37166956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45281 %T Perceptions on Oral Ulcers From Facebook Page Categories: Observational Study %A Simhadri,Suguna %A Yalamanchi,Sriha %A Stone,Sean %A Srinivasan,Mythily %+ Indiana University School of Dentistry, Indiana University Purdue University at Indianapolis, 1121 West Michigan Street, Indianapolis, IN, 46202, United States, 1 3172789686, mysriniv@iu.edu %K oral ulcer %K internet %K Facebook %K information %K apthous stomatitis %K cold sore %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Oral ulcers are a common condition affecting a considerable proportion of the population, and they are often associated with trauma and stress. They are very painful, and interfere with eating. As they are usually considered an annoyance, people may turn to social media for potential management options. Facebook is one of the most commonly accessed social media platforms and is the primary source of news information, including health information, for a significant percentage of American adults. Given the increasing importance of social media as a source of health information, potential remedies, and prevention strategies, it is essential to understand the type and quality of information available on Facebook regarding oral ulcers. Objective: The goal of our study was to evaluate information on recurrent oral ulcers that can be accessed via the most popular social media network—Facebook. Methods: We performed a keyword search of Facebook pages on 2 consecutive days in March 2022, using duplicate, newly created accounts, and then anonymized all posts. The collected pages were filtered, using predefined criteria to include only English-language pages wherein oral ulcer information was posted by the general public and to exclude pages created by professional dentists, associated professionals, organizations, and academic researchers. The selected pages were then screened for page origin and Facebook categories. Results: Our initial keyword search yielded 517 pages; interestingly however, only 112 (22%) of pages had information relevant to oral ulcers, and 405 (78%) had irrelevant information, with ulcers being mentioned in relation to other parts of the human body. Excluding professional pages and pages without relevant posts resulted in 30 pages, of which 9 (30%) were categorized as “health/beauty” pages or as “product/service” pages, 3 (10%) were categorized as “medical & health” pages, and 5 (17%) were categorized as “community” pages. Majority of the pages (22/30, 73%) originated from 6 countries; most originated from the United States (7 pages), followed by India (6 pages). There was little information on oral ulcer prevention, long-term treatment, and complications. Conclusions: Facebook, in oral ulcer information dissemination, appears to be primarily used as an adjunct to business enterprises for marketing or for enhancing access to a product. Consequently, it was unsurprising that there was little information on oral ulcer prevention, long-term treatment, and complications. Although we made efforts to identify and select Facebook pages related to oral ulcers, we did not manually verify the authenticity or accuracy of the pages included in our analysis, potentially limiting the reliability of our findings or resulting in bias toward specific products or services. Although this work forms something of a pilot project, we plan to expand the project to encompass text mining for content analysis and include multiple social media platforms in the future. %M 37155234 %R 10.2196/45281 %U https://formative.jmir.org/2023/1/e45281 %U https://doi.org/10.2196/45281 %U http://www.ncbi.nlm.nih.gov/pubmed/37155234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44412 %T A New Podcast for Reducing Stigma Against People Living With Complex Mental Health Issues: Co-design Study %A Carrotte,Elise %A Hopgood,Fincina %A Blanchard,Michelle %A Groot,Christopher %A Phillips,Lisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville, 3010, Australia, 61 0383446377, elise.carrotte@student.unimelb.edu.au %K mental illness stigma %K co-design %K podcasting %K participatory methods %K attitude change %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public’s stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma; however, it is unclear what features could make a podcast effective or engaging. Objective: The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners’ stigmatizing attitudes toward people living with complex mental health issues. Methods: This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities. Results: Most survey respondents (537/629, 85.3%) indicated a willingness to listen to a podcast about experiences of mental illness stigma; participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners’ attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings; the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination; and overarching content principles, including a sincere, empathetic, and hopeful tone; using plain language; having clear calls to action; and providing listener resources. Conclusions: The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change. %M 37145860 %R 10.2196/44412 %U https://formative.jmir.org/2023/1/e44412 %U https://doi.org/10.2196/44412 %U http://www.ncbi.nlm.nih.gov/pubmed/37145860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45136 %T Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan %A Yoshinaga,Naoki %A Thew,Graham R %A Hayashi,Yuta %A Matsuoka,Jun %A Tanoue,Hiroki %A Takanashi,Rieko %A Araki,Mutsumi %A Kanai,Yoshihiro %A Smith,Alisha %A Grant,Sophie H L %A Clark,David M %+ School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan, 81 985 85 9784, naoki-y@med.miyazaki-u.ac.jp %K benchmarking %K anxiety %K social anxiety %K social phobia %K cognitive behavioral therapy %K cognitive therapy %K cross-cultural comparison %K Japan %K mental disorders %K internet-based intervention %K mobile phone %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly. %M 37145850 %R 10.2196/45136 %U https://formative.jmir.org/2023/1/e45136 %U https://doi.org/10.2196/45136 %U http://www.ncbi.nlm.nih.gov/pubmed/37145850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39862 %T Leveraging Mobile Phone Sensors, Machine Learning, and Explainable Artificial Intelligence to Predict Imminent Same-Day Binge-drinking Events to Support Just-in-time Adaptive Interventions: Algorithm Development and Validation Study %A Bae,Sang Won %A Suffoletto,Brian %A Zhang,Tongze %A Chung,Tammy %A Ozolcer,Melik %A Islam,Mohammad Rahul %A Dey,Anind K %+ Human-Computer Interaction and Human-Centered AI Systems Lab, AI for Healthcare Lab, School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4122658616, sbae4@stevens.edu %K alcohol consumption %K binge-drinking event %K BDE %K behavioral prediction model %K machine learning %K smartphone sensors %K passive sensing %K explainable artificial intelligence %K XAI %K just-in-time adaptive interventions %K JITAIs %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital just-in-time adaptive interventions can reduce binge-drinking events (BDEs; consuming ≥4 drinks for women and ≥5 drinks for men per occasion) in young adults but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact. Objective: We aimed to determine the feasibility of developing a machine learning (ML) model to accurately predict future, that is, same-day BDEs 1 to 6 hours prior BDEs, using smartphone sensor data and to identify the most informative phone sensor features associated with BDEs on weekends and weekdays to determine the key features that explain prediction model performance. Methods: We collected phone sensor data from 75 young adults (aged 21 to 25 years; mean 22.4, SD 1.9 years) with risky drinking behavior who reported their drinking behavior over 14 weeks. The participants in this secondary analysis were enrolled in a clinical trial. We developed ML models testing different algorithms (eg, extreme gradient boosting [XGBoost] and decision tree) to predict same-day BDEs (vs low-risk drinking events and non-drinking periods) using smartphone sensor data (eg, accelerometer and GPS). We tested various “prediction distance” time windows (more proximal: 1 hour; distant: 6 hours) from drinking onset. We also tested various analysis time windows (ie, the amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable artificial intelligence was used to explore interactions among the most informative phone sensor features contributing to the prediction of BDEs. Results: The XGBoost model performed the best in predicting imminent same-day BDEs, with 95% accuracy on weekends and 94.3% accuracy on weekdays (F1-score=0.95 and 0.94, respectively). This XGBoost model needed 12 and 9 hours of phone sensor data at 3- and 6-hour prediction distance from the onset of drinking on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (eg, time of day) and GPS-derived features, such as the radius of gyration (an indicator of travel). Interactions among key features (eg, time of day and GPS-derived features) contributed to the prediction of same-day BDEs. Conclusions: We demonstrated the feasibility and potential use of smartphone sensor data and ML for accurately predicting imminent (same-day) BDEs in young adults. The prediction model provides “windows of opportunity,” and with the adoption of explainable artificial intelligence, we identified “key contributing features” to trigger just-in-time adaptive intervention prior to the onset of BDEs, which has the potential to reduce the likelihood of BDEs in young adults. Trial Registration: ClinicalTrials.gov NCT02918565; https://clinicaltrials.gov/ct2/show/NCT02918565 %M 36809294 %R 10.2196/39862 %U https://formative.jmir.org/2023/1/e39862 %U https://doi.org/10.2196/39862 %U http://www.ncbi.nlm.nih.gov/pubmed/36809294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39857 %T The Use of Web-Based Patient Reviews to Assess Medical Oncologists’ Competency: Mixed Methods Sequential Explanatory Study %A Morena,Nina %A Zelt,Nicholas %A Nguyen,Diana %A Dionne,Emilie %A Rentschler,Carrie A %A Greyson,Devon %A Meguerditchian,Ari N %+ Art History and Communication Studies, McGill University, 853 Sherbrooke St W, Montreal, QC, H3A 2A7, Canada, 1 514 345 3511 ext 5060, nina.morena@mail.mcgill.ca %K web-based patient reviews %K medical oncology %K cancer care %K CanMEDS %K RateMDs %K web-based physician rating %K physician rating websites %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients increasingly use web-based evaluation tools to assess their physicians, health care teams, and overall medical experience. Objective: This study aimed to evaluate the extent to which the standardized physician competencies of the CanMEDS Framework are present in web-based patient reviews (WPRs) and to identify patients’ perception of important physician qualities in the context of quality cancer care. Methods: The WPRs of all university-affiliated medical oncologists in midsized cities with medical schools in the province of Ontario (Canada) were collected. Two reviewers (1 communication studies researcher and 1 health care professional) independently assessed the WPRs according to the CanMEDS Framework and identified common themes. Comment scores were then evaluated to identify κ agreement rates between the reviewers, and a descriptive quantitative analysis of the cohort was completed. Following the quantitative analysis, an inductive thematic analysis was performed. Results: This study identified 49 actively practicing university-affiliated medical oncologists in midsized urban areas in Ontario. A total of 473 WPRs reviewing these 49 physicians were identified. Among the CanMEDS competencies, those defining the roles of medical experts, communicators, and professionals were the most prevalent (303/473, 64%; 182/473, 38%; and 129/473, 27%, respectively). Common themes in WPRs include medical skill and knowledge, interpersonal skills, and answering questions (from the patient to the physician). Detailed WPRs tend to include the following elements: experience and connection; discussion and evaluation of the physician’s knowledge, professionalism, interpersonal skills, and punctuality; in positive reviews, the expression of feelings of gratitude and a recommendation; and in negative reviews, discouragement from seeking the physician’s care. Patients’ perception of medical skills is less specific than their perception of interpersonal qualities, although medical skills are the most commented-on element of care in WPRs. Patients’ perception of interpersonal skills (listening, compassion, and overall caring demeanor) and other experiential phenomena, such as feeling rushed during appointments, is often specific and detailed. Details about a physician’s interpersonal skills or “bedside manner” are highly perceived, valued, and shareable in an WPR context. A small number of WPRs reflected a distinction between the value of medical skills and that of interpersonal skills. The authors of these WPRs claimed that for them, a physician’s medical skills and competence are more important than their interpersonal skills. Conclusions: CanMEDS roles and competencies that are explicitly patient facing (ie, those directly experienced by patients in their interactions with physicians and through the care that physicians provide) are the most likely to be present and reported on in WPRs. The findings demonstrate the opportunity to learn from WPRs, not simply to discern physicians’ popularity but to grasp what patients may expect from their physicians. In this context, WPRs can represent a method for the measurement and assessment of patient-facing physician competency. %M 37140959 %R 10.2196/39857 %U https://formative.jmir.org/2023/1/e39857 %U https://doi.org/10.2196/39857 %U http://www.ncbi.nlm.nih.gov/pubmed/37140959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45509 %T Understanding Treatment Needs of Youth in a Remote Intensive Outpatient Program Through Solicited Journals: Quality Improvement Analysis %A Evans-Chase,Michelle %A Kornmann,Rachel %A Peralta,Bethany %A Gliske,Kate %A Berry,Katie %A Solomon,Phyllis %A Fenkel,Caroline %+ School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, United States, 1 609 602 3792, meva@upenn.edu %K youth %K young adults %K recovery %K intensive outpatient programming %K telehealth %K qualitative methods %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. Objective: The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. Methods: Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. Results: Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. Conclusions: These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods. %M 37133910 %R 10.2196/45509 %U https://formative.jmir.org/2023/1/e45509 %U https://doi.org/10.2196/45509 %U http://www.ncbi.nlm.nih.gov/pubmed/37133910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44373 %T Physician Compliance With a Computerized Clinical Decision Support System for Anemia Management of Patients With End-stage Kidney Disease on Hemodialysis: Retrospective Electronic Health Record Observational Study %A Yang,Ju-Yeh %A Shu,Kai-Hsiang %A Peng,Yu-Sen %A Hsu,Shih-Ping %A Chiu,Yen-Ling %A Pai,Mei-Fen %A Wu,Hon-Yen %A Tsai,Wan-Chuan %A Tung,Kuei-Ting %A Kuo,Raymond N %+ Institute of Health Policy and Management, College of Public Health, National Taiwan University, 632R, No 17, Syujhou Rd, Taipei, 100, Taiwan, 886 2 3366 8716, nckuo@ntu.edu.tw %K clinical decision support system %K erythropoietin-stimulating agent %K end-stage kidney disease %K hemodialysis %K physician compliance %K kidney disease %K clinical decision support %K electronic health records %K decision support %K anemia management %K patient outcome %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies on clinical decision support systems (CDSSs) for the management of renal anemia in patients with end-stage kidney disease undergoing hemodialysis have previously focused solely on the effects of the CDSS. However, the role of physician compliance in the efficacy of the CDSS remains ill-defined. Objective: We aimed to investigate whether physician compliance was an intermediate variable between the CDSS and the management outcomes of renal anemia. Methods: We extracted the electronic health records of patients with end-stage kidney disease on hemodialysis at the Far Eastern Memorial Hospital Hemodialysis Center (FEMHHC) from 2016 to 2020. FEMHHC implemented a rule-based CDSS for the management of renal anemia in 2019. We compared the clinical outcomes of renal anemia between the pre- and post-CDSS periods using random intercept models. Hemoglobin levels of 10 to 12 g/dL were defined as the on-target range. Physician compliance was defined as the concordance of adjustments of the erythropoietin-stimulating agent (ESA) between the CDSS recommendations and the actual physician prescriptions. Results: We included 717 eligible patients on hemodialysis (mean age 62.9, SD 11.6 years; male n=430, 59.9%) with a total of 36,091 hemoglobin measurements (average hemoglobin and on-target rate were 11.1, SD 1.4, g/dL and 59.9%, respectively). The on-target rate decreased from 61.3% (pre-CDSS) to 56.2% (post-CDSS) owing to a high hemoglobin percentage of >12 g/dL (pre: 21.5%; post: 29%). The failure rate (hemoglobin <10 g/dL) decreased from 17.2% (pre-CDSS) to 14.8% (post-CDSS). The average weekly ESA use of 5848 (SD 4211) units per week did not differ between phases. The overall concordance between CDSS recommendations and physician prescriptions was 62.3%. The CDSS concordance increased from 56.2% to 78.6%. In the adjusted random intercept model, the post-CDSS phase showed increased hemoglobin by 0.17 (95% CI 0.14-0.21) g/dL, weekly ESA by 264 (95% CI 158-371) units per week, and 3.4-fold (95% CI 3.1-3.6) increased concordance rate. However, the on-target rate (29%; odds ratio 0.71, 95% CI 0.66-0.75) and failure rate (16%; odds ratio 0.84, 95% CI 0.76-0.92) were reduced. After additional adjustments for concordance in the full models, increased hemoglobin and decreased on-target rate tended toward attenuation (from 0.17 to 0.13 g/dL and 0.71 to 0.73 g/dL, respectively). Increased ESA and decreased failure rate were completely mediated by physician compliance (from 264 to 50 units and 0.84 to 0.97, respectively). Conclusions: Our results confirmed that physician compliance was a complete intermediate factor accounting for the efficacy of the CDSS. The CDSS reduced failure rates of anemia management through physician compliance. Our study highlights the importance of optimizing physician compliance in the design and implementation of CDSSs to improve patient outcomes. %M 37133912 %R 10.2196/44373 %U https://formative.jmir.org/2023/1/e44373 %U https://doi.org/10.2196/44373 %U http://www.ncbi.nlm.nih.gov/pubmed/37133912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42930 %T Impact of the COVID-19 Pandemic on Clinical Findings in Medical Imaging Exams in a Nationwide Israeli Health Organization: Observational Study %A Ozery-Flato,Michal %A Ein-Dor,Liat %A Pinchasov,Ora %A Dabush Kasa,Miel %A Hexter,Efrat %A Chodick,Gabriel %A Rosen-Zvi,Michal %A Guindy,Michal %+ IBM Research - Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825, Israel, 972 508997422, ozery@il.ibm.com %K COVID-19 %K COVID %K coronavirus %K postacute COVID-19 syndrome %K PCS %K long COVID %K pandemic %K vaccination %K vaccine %K health services %K utilization %K medical imaging %K radiology %K MRI %K CT %K Mammography %K observational study %K electronic health records %K EHRs %K causal inference %K causal effect %K inverse probability weighting %K IPW %K balancing weights %K adversarial balancing %K machine learning %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The outbreak of the COVID-19 pandemic had a major effect on the consumption of health care services. Changes in the use of routine diagnostic exams, increased incidences of postacute COVID-19 syndrome (PCS), and other pandemic-related factors may have influenced detected clinical conditions. Objective: This study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination. Methods: Our data set included 572,480 ambulatory medical imaging patients in a national health organization from January 1, 2019, to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein before and after the surge of the pandemic to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between SARS-CoV-2 infection, COVID-19–related hospitalization (indicative of COVID-19 complications), and COVID-19 vaccination and future risk for abnormal findings. To adjust for a multitude of confounding factors, we used causal inference methodologies. Results: After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included the following: SARS-CoV-2 infection increasing the risk for an abnormal finding in a CT-brain exam (odds ratio [OR] 1.4, 95% CI 1.1-1.7) and COVID-19–related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9-5.3). Conclusions: COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and nonvaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams. %M 36989460 %R 10.2196/42930 %U https://formative.jmir.org/2023/1/e42930 %U https://doi.org/10.2196/42930 %U http://www.ncbi.nlm.nih.gov/pubmed/36989460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41498 %T Participant Preferences for the Development of a Digitally Delivered Gardening Intervention to Improve Diet, Physical Activity, and Cardiovascular Health: Cross-sectional Study %A Veldheer,Susan %A Whitehead-Zimmers,Maxfield %A Bordner,Candace %A Watt,Benjamin %A Conroy,David E %A Schmitz,Kathryn H %A Sciamanna,Christopher %+ Department of Family and Community Medicine, Penn State College of Medicine, 90 Hope Dr., room 2120H, Hershey, PA, 17033, United States, 1 717 531 5625, sveldheer@psu.edu %K intervention development %K cardiovascular health %K gardening %K diet %K physical activity %K behavior change wheel %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Low dietary intake of fruits and vegetables and physical inactivity are 2 modifiable risk factors for cardiovascular disease. Fruit and vegetable gardening can provide access to fresh produce, and many gardening activities are considered moderate physical activity. This makes gardening interventions a potential strategy for cardiovascular disease risk reduction. Previously developed gardening interventions have relied on in-person delivery models, which limit scalability and reach. Objective: The purpose of this study was to ascertain participant insight on intervention components and topics of interest to inform a digitally delivered, gardening-focused, multiple health behavior change intervention. Methods: A web-based survey was delivered via Amazon Mechanical Turk (MTurk), including quantitative and open-ended questions. Eligible participants were aged ≥20 years, could read and write in English, were US residents, and had at least a 98% MTurk task approval rating. A multilevel screening process was used to identify and exclude respondents with response inattention, poor language fluency, or suspected automated web robots (bots). Participants were asked about their interest in gardening programming, their preferences for intervention delivery modalities (1-hour expert lectures, a series of brief <5-minute videos, or in-person meetings), and what information is needed to teach new gardeners. Comparisons were made between never gardeners (NG) and ever gardeners (EG) in order to examine differences in perceptions based on prior experience. Quantitative data were summarized, and differences between groups were tested using chi-square tests. Qualitative data were coded and organized into intervention functions based on the Behavior Change Wheel. Results: A total of 465 participants were included (n=212, 45.6% NG and n=253, 54.4% EG). There was a high level of program interest overall (n=355, 76.3%), though interest was higher in EG (142/212, 67% NG; 213/253, 84.2% EG; P<.001). The majority of participants (n=282, 60.7%) preferred a series of brief <5-minute videos (136/212, 64.2% NG; 146/253, 57.7% EG; P=.16) over 1-hour lectures (29/212, 13.7% NG; 50/253, 19.8% EG; P=.08) or in-person delivery modes (47/212, 22.2% NG; 57/253, 22.5% EG; P=.93). Intervention functions identified were education and training (performing fundamental gardening and cooking activities), environmental restructuring (eg, social support), enablement (provision of tools or seeds), persuasion (offering encouragement and highlighting the benefits of gardening), and modeling (using content experts and participant testimonials). Content areas identified included the full lifecycle of gardening activities, from the fundamentals of preparing a garden site, planting and maintenance to harvesting and cooking. Conclusions: In a sample of potential web-based learners, participants were interested in a digitally delivered gardening program. They preferred brief videos for content delivery and suggested content topics that encompassed how to garden from planting to harvesting and cooking. The next step in this line of work is to identify target behavior change techniques and pilot test the intervention to assess participant acceptability and preliminary efficacy. %M 37129952 %R 10.2196/41498 %U https://formative.jmir.org/2023/1/e41498 %U https://doi.org/10.2196/41498 %U http://www.ncbi.nlm.nih.gov/pubmed/37129952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41225 %T Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study %A Ndlovu,Kagiso %A Mars,Maurice %A Scott,Richard E %+ Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa, 27 0312601075, ndlovuk@ub.ac.bw %K mobile health %K mHealth %K electronic record systems %K eRecord systems %K mHealth-eRecord Interoperability Framework %K mHeRIF %K interoperability architecture %K validation %K Botswana %K mobile phone %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts’ suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts’ reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. %M 37129939 %R 10.2196/41225 %U https://formative.jmir.org/2023/1/e41225 %U https://doi.org/10.2196/41225 %U http://www.ncbi.nlm.nih.gov/pubmed/37129939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36590 %T Revealing the Roles of Part-of-Speech Taggers in Alzheimer Disease Detection: Scientific Discovery Using One-Intervention Causal Explanation %A Wen,Bingyang %A Wang,Ning %A Subbalakshmi,Koduvayur %A Chandramouli,Rajarathnam %+ Department of Electrical and Computer Engineering, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07002, United States, 1 2012165000, bwen4@stevens.edu %K explainable machine learning %K Alzheimer disease %K natural language processing %K causal inference %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Recently, rich computational methods that use deep learning or machine learning have been developed using linguistic biomarkers for the diagnosis of early-stage Alzheimer disease (AD). Moreover, some qualitative and quantitative studies have indicated that certain part-of-speech (PoS) features or tags could be good indicators of AD. However, there has not been a systematic attempt to discover the underlying relationships between PoS features and AD. Moreover, there has not been any attempt to quantify the relative importance of PoS features in detecting AD. Objective: Our goal was to disclose the underlying relationship between PoS features and AD, understand whether PoS features are useful in AD diagnosis, and explore which PoS features play a vital role in the diagnosis. Methods: The DementiaBank, containing 1049 transcripts from 208 patients with AD and 243 transcripts from 104 older control individuals, was used. A total of 27 PoS features were extracted from each record. Then, the relationship between AD and each of the PoS features was explored. A transformer-based deep learning model for AD prediction using PoS features was trained. Then, a global explainable artificial intelligence method was proposed and used to discover which PoS features were the most important in AD diagnosis using the transformer-based predictor. A global (model-level) feature importance measure was derived as a summary from the local (example-level) feature importance metric, which was obtained using the proposed causally aware counterfactual explanation method. The unique feature of this method is that it considers causal relations among PoS features and can, hence, preclude counterfactuals that are improbable and result in more reliable explanations. Results: The deep learning–based AD predictor achieved an accuracy of 92.2% and an F1-score of 0.955 when distinguishing patients with AD from healthy controls. The proposed explanation method identified 12 PoS features as being important for distinguishing patients with AD from healthy controls. Of these 12 features, 3 (25%) have been identified by other researchers in previous works in psychology and natural language processing. The remaining 75% (9/12) of PoS features have not been previously identified. We believe that this is an interesting finding that can be used in creating tests that might aid in the diagnosis of AD. Note that although our method is focused on PoS features, it should be possible to extend it to more types of features, perhaps even those derived from other biomarkers, such as syntactic features. Conclusions: The high classification accuracy of the proposed deep learner indicates that PoS features are strong clues in AD diagnosis. There are 12 PoS features that are strongly tied to AD, and because language is a noninvasive and potentially cheap method for detecting AD, this work shows some promising directions in this field. %M 37129944 %R 10.2196/36590 %U https://formative.jmir.org/2023/1/e36590 %U https://doi.org/10.2196/36590 %U http://www.ncbi.nlm.nih.gov/pubmed/37129944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43348 %T Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis %A Dong,Zhaogang %A Ji,Meng %A Shan,Yi %A Xu,Xiaofei %A Xing,Zhaoquan %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K functional health literacy %K associated factors %K Chinese populations %K latent class analysis %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one’s health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China. Objective: This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making. Methods: We hypothesized that the participants’ functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy. Results: All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5%), moderate-to-adequate (n=286, 35.7%), and low-to-moderate (n=222, 27.8%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck. Conclusions: We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making. %M 37115594 %R 10.2196/43348 %U https://formative.jmir.org/2023/1/e43348 %U https://doi.org/10.2196/43348 %U http://www.ncbi.nlm.nih.gov/pubmed/37115594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39331 %T A New Digital Health Program for Patients With Inflammatory Bowel Disease: Preliminary Program Evaluation %A Oddsson,Saemundur Jon %A Gunnarsdottir,Thrudur %A Johannsdottir,Lilja Gudrun %A Amundadottir,Maria Lovisa %A Frimannsdottir,Arna %A Molander,Pauliina %A Ylanne,Anna Karoliina %A Islind,Anna Sigridur %A Oskarsdottir,Maria %A Thorgeirsson,Tryggvi %+ Sidekick Health Digital Therapeutics, Vallakór 4, Kópavogur, Reykjavik, 203, Iceland, 354 78 20 401, thrudur@sidekickhealth.com %K inflammatory bowel disease %K self-management %K stress %K fatigue %K sleep %K digital platform %K digital therapeutics %K real-world evidence %K mobile phone %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Inflammatory bowel disease (IBD) causes chronic inflammation of the gastrointestinal tract. IBD is characterized by an unpredictable disease course that varies greatly between individuals and alternates between the periods of relapse and remission. A low energy level (fatigue) is a common symptom, whereas stress and reduced sleep quality may be the triggering factors. Therapeutic guidelines call for effective disease assessment, early intervention, and personalized care using a treat-to-target approach, which may be difficult to achieve through typical time- and resource-constrained standard care. Providing patients with a digital health program that incorporates helpful self-management features and patient support to complement standard care may be optimal for improving the disease course. Objective: This study aimed to perform a preliminary program evaluation, analyzing engagement and preliminary effectiveness and the effect on participants’ energy levels (fatigue), stress, and sleep quality, of a newly developed 16-week digital health program (SK-311 and SK-321) for patients with IBD. Methods: Adults with IBD were recruited to participate in a real-world, live, digital health program via Finnish IBD patient association websites and social media. No inclusion or exclusion criteria were applied for this study. Baseline characteristics were entered by the participants upon sign-up. Platform engagement was measured by tracking the participants’ event logs. The outcome measures of stress, energy levels (fatigue), and quality of sleep were reported by participants through the platform. Results: Of the 444 adults who registered for the digital health program, 205 (46.2%) were included in the intention-to-treat sample. The intention-to-treat participants logged events on average 41 times per week (5.9 times per day) during the weeks in which they were active on the digital platform. More women than men participated in the intervention (126/205, 88.7%). The mean age of the participants was 40.3 (SD 11.5) years, and their mean BMI was 27.9 (SD 6.0) kg/m2. In total, 80 people provided the required outcome measures during weeks 12 to 16 (completers). Treatment completion was strongly predicted by the number of active days in week 1. Analysis of the completers (80/205, 39%) showed significant improvements for stress (t79=4.57; P<.001; percentage change=−23.26%) and energy levels (t79=−2.44; P=.017; percentage change=9.48%); however, no significant improvements were observed for quality of sleep (t79=−1.32; P=.19). Conclusions: These results support the feasibility of a digital health program for patients with IBD (SK-311 and SK-321) and suggest that treatment completion might have a substantial positive effect on patient-reported stress and energy levels in a real-world setting. These findings are promising and provide initial support for using the Sidekick Health digital health program to supplement standard care for patients with IBD. %M 37115598 %R 10.2196/39331 %U https://formative.jmir.org/2023/1/e39331 %U https://doi.org/10.2196/39331 %U http://www.ncbi.nlm.nih.gov/pubmed/37115598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35064 %T A Telemedicine System Intervention for Patients With Type 1 Diabetes: Pilot Feasibility Crossover Intervention Study %A Vlasakova,Martina %A Muzik,Jan %A Holubová,Anna %A Fiala,Dominik %A Arsand,Eirik %A Urbanová,Jana %A Janíčková Žďárská,Denisa %A Brabec,Marek %A Brož,Jan %+ First Faculty of Medicine, Charles University, Kateřinská 32, Prague, 12800, Czech Republic, 420 777858717, m.oulicka@gmail.com %K diabetes mellitus %K diabetes %K telemedicine %K telemedicine system %K mobile health %K mHealth %K telemonitoring %K quality of life %K telehealth %K compensation %K evaluation %K intervention %K feasibility %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Today’s diabetes-oriented telemedicine systems can gather and analyze many parameters like blood glucose levels, carbohydrate intake, insulin doses, and physical activity levels (steps). Information collected can be presented to patients in a variety of graphical outputs. Despite the availability of several technical means, a large percentage of patients do not reach the goals established in their diabetes treatment. Objective: The objective of the study was to evaluate the benefits of the Diani telemedicine system for the treatment of patients with type 1 diabetes mellitus. Methods: Data were collected during a 24-week feasibility study. Patients responded to the World Health Organization Quality of Life – BREF (WHOQOL-BREF) questionnaire and a system evaluation questionnaire. The level of glycated hemoglobin (HbA1c) and the patient’s body weight were measured, and the patient’s use of the telemedicine system and their daily physical activity level were monitored. All data were sent from the patient’s device to the Diani server using a real-time diabetes diary app. Wilcoxon and Friedman tests and the linear mixed effects method were used for data analysis. Results: This study involved 10 patients (men: n=5; women: n=5), with a mean age of 47.7 (SD 19.3) years, a mean duration of diabetes of 10.5 (SD 8.6) years, and a mean HbA1c value of 59.5 (SD 6.7) mmol/mol. The median number of days the patients used the system was 84. After the intervention, the mean HbA1c decreased by 4.35 mmol/mol (P=.01). The patients spent 18.6 (SD 6.8) minutes on average using the app daily. After the intervention, the number of patients who measured their blood glucose level at least 3 times a day increased by 30%. The graphical visualization of the monitored parameters, automatic transmission of measured data from the glucometer, compatibility, and interconnection of individual devices when entering data were positively evaluated by patients. Conclusions: The Diani system was found to be beneficial for patients with type 1 diabetes mellitus in terms of managing their disease. Patients perceived it positively; it strengthened their knowledge of diabetes and their understanding of the influences of the measured values on the management of their disease. Its use had a positive effect on the HbA1c level. %M 37115601 %R 10.2196/35064 %U https://formative.jmir.org/2023/1/e35064 %U https://doi.org/10.2196/35064 %U http://www.ncbi.nlm.nih.gov/pubmed/37115601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46136 %T Promoting Social Participation and Recovery Using Virtual Reality–Based Interventions Among People With Mental Health and Substance Use Disorders: Qualitative Study %A Aasen,Jan %A Galaaen,Kari %A Nilsson,Fredrik %A Sørensen,Torgeir %A Lien,Lars %A Leonhardt,Marja %+ Norwegian National Advisory Unit on Concurrent Substance Use and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, Brummundal, 2381, Norway, 47 99428096, jan.aasen@sykehuset-innlandet.no %K mental health disorders and substance use disorders %K MHD %K SUD %K recovery %K social participation %K social functioning impairments %K virtual reality–based interventions %K VRI %K reflexive thematic analysis %K qualitative study %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mental health disorders (MHDs) and substance use disorders (SUDs) are a highly vulnerable group, particularly affected by social exclusion, marginalization, and disconnectedness. Virtual reality technology holds a potential for simulating social environments and interactions to mitigate the social barriers and marginalization faced by people recovering from MHDs and SUDs. However, it is still unclear how we can harness the greater ecological validity of virtual reality–based interventions targeting social and functional impairments in individuals with MHDs and SUDs. Objective: The aim of this paper was to explore how service providers in community-based MHD and SUD health care services perceive the barriers to social participation among adults recovering from MHDs and SUDs to provide a broader understanding of how learning experiences can be modeled to promote social participation in virtual reality environments. Methods: Two semistructured, open-ended, and dual-moderator focus group interviews were conducted with participants representing different community-based MHD and SUD health care services. Service providers were recruited from their MHD and SUD services in our collaborating municipality in Eastern Norway. We recruited the first participant group at a municipal MHD and SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community-based follow-up care service aimed at clients with a broad range of MHDs and SUDs and various levels of social functioning. The qualitative data extracted in the interviews were analyzed, using reflexive thematic analysis. Results: The analysis of the service providers’ perceptions of the barriers to social participation among clients with MHDs and SUDs revealed the following five main themes: challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and insufficient social security. The barriers identified are interrelated in a cluster of cognitive, socioemotional, and functional impairments, leading to a severe and diverse complex of barriers to social participation. Conclusions: Social participation relies on people’s capability to use their present social opportunities. Promoting basic human functioning is key to promoting social participation among people with MHDs and SUDs. The findings in this study indicate a need to address cognitive functioning, socioemotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. Virtual reality–based interventions for promoting social participation should be sequenced into distinct scenarios dedicated to specific learning goals to build complex learning in a step-by-step process based on successively more complex levels of human and social functioning. %M 37104000 %R 10.2196/46136 %U https://formative.jmir.org/2023/1/e46136 %U https://doi.org/10.2196/46136 %U http://www.ncbi.nlm.nih.gov/pubmed/37104000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44857 %T The Validation of Automated Social Skills Training in Members of the General Population Over 4 Weeks: Comparative Study %A Tanaka,Hiroki %A Saga,Takeshi %A Iwauchi,Kota %A Honda,Masato %A Morimoto,Tsubasa %A Matsuda,Yasuhiro %A Uratani,Mitsuhiro %A Okazaki,Kosuke %A Nakamura,Satoshi %+ Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, 630-0192, Japan, 81 90 7649 3408, hiroki-tan@is.naist.jp %K social skills training %K conversational agents %K role-play %K feedback %K multimodal %K long-term training effects %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social skills training by human trainers is a well-established method of teaching appropriate social and communication skills and strengthening social self-efficacy. Specifically, human social skills training is a fundamental approach to teaching and learning the rules of social interaction. However, it is cost-ineffective and offers low accessibility, since the number of professional trainers is limited. A conversational agent is a system that can communicate with a human being in a natural language. We proposed to overcome the limitations of current social skills training with conversational agents. Our system is capable of speech recognition, response selection, and speech synthesis and can also generate nonverbal behaviors. We developed a system that incorporated automated social skills training that completely adheres to the training model of Bellack et al through a conversational agent. Objective: This study aimed to validate the training effect of a conversational agent–based social skills training system in members of the general population during a 4-week training session. We compare 2 groups (with and without training) and hypothesize that the trained group’s social skills will improve. Furthermore, this study sought to clarify the effect size for future larger-scale evaluations, including a much larger group of different social pathological phenomena. Methods: For the experiment, 26 healthy Japanese participants were separated into 2 groups, where we hypothesized that group 1 (system trained) will make greater improvement than group 2 (nontrained). System training was done as a 4-week intervention where the participants visit the examination room every week. Each training session included social skills training with a conversational agent for 3 basic skills. We evaluated the training effect using questionnaires in pre- and posttraining evaluations. In addition to the questionnaires, we conducted a performance test that required the social cognition and expression of participants in new role-play scenarios. Blind ratings by third-party trainers were made by watching recorded role-play videos. A nonparametric Wilcoxson Rank Sum test was performed for each variable. Improvement between pre- and posttraining evaluations was used to compare the 2 groups. Moreover, we compared the statistical significance from the questionnaires and ratings between the 2 groups. Results: Of the 26 recruited participants, 18 completed this experiment: 9 in group 1 and 9 in group 2. Those in group 1 achieved significant improvement in generalized self-efficacy (P=.02; effect size r=0.53). We also found a significant decrease in state anxiety presence (P=.04; r=0.49), measured by the State-Trait Anxiety Inventory (STAI). For ratings by third-party trainers, speech clarity was significantly strengthened in group 1 (P=.03; r=0.30). Conclusions: Our findings reveal the usefulness of the automated social skills training after a 4-week training period. This study confirms a large effect size between groups on generalized self-efficacy, state anxiety presence, and speech clarity. %M 37103996 %R 10.2196/44857 %U https://formative.jmir.org/2023/1/e44857 %U https://doi.org/10.2196/44857 %U http://www.ncbi.nlm.nih.gov/pubmed/37103996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37329 %T Evaluating Mobile Apps Targeting Older Adults: Descriptive Study %A Sweeney,Megan %A Barton,William %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 858 534 7786, nebeker@ucsd.edu %K older adults %K mobile apps %K privacy %K data management, research ethics %K app %K aging %K environment %K safety %K smartphone %K personal information %K user knowledge %K user %K data %K data collection %K storage %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing “apps for older adults.” The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best “apps for older adults.” Of these 133 mobile apps, 83% (n=110) included a privacy policy. Fewer apps designated in the “medical” category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. %M 37103995 %R 10.2196/37329 %U https://formative.jmir.org/2023/1/e37329 %U https://doi.org/10.2196/37329 %U http://www.ncbi.nlm.nih.gov/pubmed/37103995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45003 %T Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study %A Zigo,Liliana %A Wilkinson,Alyson %A Landry,Megan %A Castel,Amanda D %A Vyas,Amita %A McDonnell,Karen %A Nagaraj,Nitasha Chaudhary %A Goldman,Lynn R %+ Office of the Dean, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Fl, Washington, DC, 20037, United States, 1 2029940883, mmlandry@gwu.edu %K COVID-19 %K college %K university %K students %K rapid antigen test %K isolation %K antigen test %K testing %K tool %K utility %K symptoms %K policy %K productivity %K age %K university students %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the US Centers for Disease Control and Prevention required 10 days of isolation after a positive test result. In December 2021, this was reduced to a minimum of 5 days with symptom improvement, followed by 5 days of mask wearing. As a result, several institutions of higher education, including the George Washington University, required persons testing positive for COVID-19 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after 5 days or to maintain a 10-day isolation period in the absence of a negative RAT and the presence of continued symptoms. RATs are tools that can be used both to shorten isolation periods and to ensure that persons testing positive for COVID-19 remain in isolation if infectious. Objective: The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation. Methods: In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC, uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analyses examined the odds of uploading a RAT by campus residential living status (ie, on or off campus), student or employee designation, age, and days in isolation. Results: A total of 76% (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5; 45.4% (55/121) on day 6; 47.1% (99/210) on day 7; and 11.1% (7/63) on day 10 or beyond. Adjusted logistic regression modeling indicated cases living on campus had increased odds of uploading a RAT (odds ratio [OR] 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69) and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to lack of symptoms and timely submission, resulting in a total of 1547 days of lost productivity saved compared to all being in isolation for 10 days. Conclusions: RATs are beneficial, as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals’ lives. %M 37040562 %R 10.2196/45003 %U https://formative.jmir.org/2023/1/e45003 %U https://doi.org/10.2196/45003 %U http://www.ncbi.nlm.nih.gov/pubmed/37040562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44354 %T Development and Usability Testing of a Web-Based Workplace Disability Disclosure Decision Aid Tool for Autistic Youth and Young Adults: Qualitative Co-design Study %A Tomas,Vanessa %A Hsu,Shaelynn %A Kingsnorth,Shauna %A Anagnostou,Evdokia %A Kirsh,Bonnie %A Lindsay,Sally %+ Rehabilitation Sciences Institute, University of Toronto, Suite 160, 500 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 416 978 0300, vanessa.tomas@mail.utoronto.ca %K autism %K decision aids %K co-design %K disability disclosure %K employment %K knowledge translation %K patient-oriented research %K qualitative %K usability testing %K youth and young adults %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Deciding whether and how to disclose one’s autism at work is complex, especially for autistic youth and young adults who are newly entering the labor market and still learning important decision-making and self-determination skills. Autistic youth and young adults may benefit from tools to support disclosure processes at work; however, to our knowledge, no evidence-based, theoretically grounded tool exists specifically for this population. There is also limited guidance on how to pursue the development of such a tool in collaboration with knowledge users. Objective: This study aimed to co-design a prototype of a disclosure decision aid tool with and for Canadian autistic youth and young adults, explore the perceived usability of the prototype (usefulness, satisfaction, and ease of use) and make necessary revisions, and outline the process used to achieve the aforementioned objectives. Methods: Taking a patient-oriented research approach, we engaged 4 autistic youths and young adults as collaborators on this project. Prototype development was guided by co-design principles and strategies, and tool content was informed by a previous needs assessment led by our team, the autistic collaborators’ lived experiences, considering intersectionality, research on knowledge translation (KT) tool development, and recommendations from the International Patient Decision Aid Standards. We co-designed a web-based PDF prototype. To assess perceived usability and experiences with the prototype, we conducted 4 participatory design and focus group Zoom (Zoom Video Communications) sessions with 19 Canadian autistic youths and young adults aged 16 to 29 (mean 22.8, SD 4.1) years. We analyzed the data using a combined conventional (inductive) and modified framework method (deductive) analysis to map the data onto usability indicators (usefulness, satisfaction, and ease of use). Grounded in participants’ feedback, considering factors of feasibility and availability of resources, and ensuring tool fidelity, we revised the prototype. Results: We developed 4 categories pertaining to the perceived usability of and participant experiences with the prototype: past disclosure experiences, prototype information and activities, prototype design and structure, and overall usability. Participant feedback was favorable and indicative of the tool’s potential impact and usability. The usability indicator requiring the most attention was ease of use, which was prioritized when revising the prototype. Our findings highlight the importance of engaging knowledge users throughout the entire prototype co-design and testing processes; incorporating co-design strategies and principles; and having content informed by relevant theories, evidence, and knowledge users’ experiences. Conclusions: We outline an innovative co-design process that other researchers, clinicians, and KT practitioners may consider when developing KT tools. We also developed a novel, evidence-based, and theoretically informed web-based disclosure decision aid tool that may help autistic youth and young adults navigate disclosure processes and improve their transitional outcomes as they enter the workforce. %M 37104002 %R 10.2196/44354 %U https://formative.jmir.org/2023/1/e44354 %U https://doi.org/10.2196/44354 %U http://www.ncbi.nlm.nih.gov/pubmed/37104002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37269 %T An Emerging Screening Method for Interrogating Human Brain Function: Tutorial %A Sudre,Gustavo %A Bagić,Anto I %A Becker,James T %A Ford,John P %+ Brain FIT Imaging, LLC, 141 Main Street, Unadilla, NY, 13849, United States, 1 607 435 0930, gsudre@brainfitimaging.com %K screening %K brain function %K cognition %K magnetoencephalography %K MEG %K neuroimaging %K tutorial %K tool %K cognitive test %K neuroimaging %K signal %K cognitive function %D 2023 %7 27.4.2023 %9 Tutorial %J JMIR Form Res %G English %X Cognitive decline can be observed due to a myriad of causes. Clinicians would benefit from a noninvasive quantitative tool to screen and monitor brain function based on direct measures of neural features. In this study, we used neuroimaging data from magnetoencephalography (with a whole-head Elekta Neuromag 306 sensor system) to derive a set of features that strongly correlate with brain function. We propose that simple signal characteristics related to peak variability, timing, and abundance can be used by clinicians as a screening tool to investigate cognitive function in at-risk individuals. Using a minimalistic set of features, we were able to perfectly distinguish between participants with normative and nonnormative brain function, and we were also able to successfully predict participants’ Mini-Mental Test score (r=0.99; P<.001; mean absolute error=0.413). This set of features can be easily visualized in an analog fashion, providing clinicians with several graded measurements (in comparison to a single binary diagnostic tool) that can be used for screening and monitoring cognitive decline. %M 37103988 %R 10.2196/37269 %U https://formative.jmir.org/2023/1/e37269 %U https://doi.org/10.2196/37269 %U http://www.ncbi.nlm.nih.gov/pubmed/37103988 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37839 %T Exploring the Acceptability, Feasibility, and Effectiveness of a Digital Parenting Program to Improve Parental Well-being After the Christchurch Earthquakes: Cluster-Randomized Trial %A Donkin,Liesje %A Merry,Sally %A Moor,Stephanie %A Mowat,Anna %A Hetrick,Sarah %A Hopkins,Sarah %A Seers,Kara %A Frampton,Chris %A D'Aeth,Lucy %+ Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K psychology %K eHealth %K app %K parenting %K digital health %K children %K parent %K well-being %K earthquake %K cluster-randomized trial %K distress %K child %K mental health %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true %M 37103986 %R 10.2196/37839 %U https://formative.jmir.org/2023/1/e37839 %U https://doi.org/10.2196/37839 %U http://www.ncbi.nlm.nih.gov/pubmed/37103986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46578 %T Using Digital Measurement–Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Huberty,Jennifer %A Beatty,Clare %A Roots,Monika %A Roots,Kurt %A Parikh,Amit %A Guerra,Rachael %A Weiser,Jaclyn %+ Bend Health, Inc., 2801 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K digital mental health intervention %K attention-deficit/hyperactivity disorder %K opposition defiance disorder %K attention deficit %K collaborative care %K behavioral care %K mental health %K adolescent %K child %K hyperactivity %K hyperactive %K inattention %K ADHD %K use %K caregiver %K behavioral problem %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. Objective: The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. Methods: Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children’s symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). Results: Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. Conclusions: This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings. %M 37099379 %R 10.2196/46578 %U https://formative.jmir.org/2023/1/e46578 %U https://doi.org/10.2196/46578 %U http://www.ncbi.nlm.nih.gov/pubmed/37099379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43300 %T A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study %A Zlamal,Jaroslav %A Roth Gjevjon,Edith %A Fossum,Mariann %A Steindal,Simen A %A Nes,Andréa Aparecida Gonçalves %+ Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K technology %K guidance model %K critical thinking %K feasibility %K nursing %K nursing education %K medical education %K nursing student %K digital intervention %K mobile app %K clinical practice %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 %M 37099377 %R 10.2196/43300 %U https://formative.jmir.org/2023/1/e43300 %U https://doi.org/10.2196/43300 %U http://www.ncbi.nlm.nih.gov/pubmed/37099377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42523 %T Development of an Alcohol Refusal Training in Immersive Virtual Reality for Patients With Mild to Borderline Intellectual Disability and Alcohol Use Disorder: Cocreation With Experts in Addiction Care %A Langener,Simon %A Kolkmeier,Jan %A VanDerNagel,Joanne %A Klaassen,Randy %A van Manen,Jeannette %A Heylen,Dirk %+ Department of Human Media Interaction, University of Twente, Hallenweg 15, Enschede, 7522NH, Netherlands, 31 534898771, s.langener@utwente.nl %K virtual reality %K conversational agent %K embodied agent %K persuasion %K peer pressure %K addiction %K alcohol %K intellectual disability %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mild to borderline intellectual disability (MBID; IQ=50-85) are at risk for developing an alcohol use disorder (AUD). One factor contributing to this risk is sensitivity to peer pressure. Hence, tailored trainings are needed to practice alcohol refusal in impacted patients. Immersive virtual reality (IVR) appears promising to engage patients in dialogs with virtual humans, allowing to practice alcohol refusal realistically. However, requirements for such an IVR have not been studied for MBID/AUD. Objective: This study aims to develop an IVR alcohol refusal training for patients with MBID and AUD. In this work, we cocreated our peer pressure simulation with experienced experts in addiction care. Methods: We followed the Persuasive System Design (PSD) model to develop our IVR alcohol refusal training. With 5 experts from a Dutch addiction clinic for patients with MBID, we held 3 focus groups to design the virtual environment, persuasive virtual human(s), and persuasive dialog. Subsequently, we developed our initial IVR prototype and conducted another focus group to evaluate IVR and procedures for clinical usage, resulting in our final peer pressure simulation. Results: Our experts described visiting a friend at home with multiple friends as the most relevant peer pressure situation in the clinical setting. Based on the identified requirements, we developed a social-housing apartment with multiple virtual friends present. Moreover, we embedded a virtual man with generic appearance to exert peer pressure using a persuasive dialog. Patients can respond to persuasive attempts by selecting (refusal) responses with varying degrees of risk for relapse in alcohol use. Our evaluation showed that experts value a realistic and interactable IVR. However, experts identified lacking persuasive design elements, such as paralanguage, for our virtual human. For clinical usage, a user-centered customization is needed to prevent adverse effects. Further, interventions should be therapist delivered to avoid try-and-error in patients with MBID. Lastly, we identified factors for immersion, as well as facilitators and barriers for IVR accessibility. Conclusions: Our work establishes an initial PSD for IVR for alcohol refusal trainings in patients with MBID and AUD. With this, scholars can create comparable simulations by performing an analogous cocreation, replicate findings, and identify active PSD elements. For peer pressure, conveying emotional information in a virtual human’s voice (eg, paralanguage) seems vital. However, previous rapport building may be needed to ensure that virtual humans are perceived as cognitively capable entities. Future work should validate our PSD with patients and start developing IVR treatment protocols using interdisciplinary teams. %M 37099362 %R 10.2196/42523 %U https://formative.jmir.org/2023/1/e42523 %U https://doi.org/10.2196/42523 %U http://www.ncbi.nlm.nih.gov/pubmed/37099362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41428 %T An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings %A Zech,James M %A Johnson,Morgan %A Pullmann,Michael D %A Hull,Thomas D %A Althoff,Tim %A Munson,Sean A %A Fridling,Nicole %A Litvin,Boris %A Wu,Jerilyn %A Areán,Patricia A %+ Talkspace, 33 West 60th Street, New York, NY, 32304, United States, 1 2035177111, zech@psy.fsu.edu %K Health Action Process Approach %K lived informatics %K digital engagement %K messaging therapy %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. User engagement, or client behaviors and therapeutic relationships that facilitate positive treatment outcomes, is a necessary condition for the effectiveness of any digital treatment. Developing a better understanding of the factors that impact user engagement can impact the overall effectiveness of digital psychotherapy. Mapping the user experience in digital therapy may be facilitated by integrating theories from several fields. Specifically, health science’s Health Action Process Approach and human-computer interaction’s Lived Informatics Model may be usefully synthesized with relational constructs from psychotherapy process–outcome research to identify the determinants of engagement in digital messaging therapy. Objective: This study aims to capture insights into digital therapy users’ engagement patterns through a qualitative analysis of focus group sessions. We aimed to synthesize emergent intrapersonal and relational determinants of engagement into an integrative framework of engagement in digital therapy. Methods: A total of 24 focus group participants were recruited to participate in 1 of 5 synchronous focus group sessions held between October and November 2021. Participant responses were coded by 2 researchers using thematic analysis. Results: Coders identified 10 relevant constructs and 24 subconstructs that can collectively account for users’ engagement and experience trajectories in the context of digital therapy. Although users’ engagement trajectories in digital therapy varied widely, they were principally informed by intrapsychic factors (eg, self-efficacy and outcome expectancy), interpersonal factors (eg, the therapeutic alliance and its rupture), and external factors (eg, treatment costs and social support). These constructs were organized into a proposed Integrative Engagement Model of Digital Psychotherapy. Notably, every participant in the focus groups indicated that their ability to connect with their therapist was among the most important factors that were considered in continuing or terminating treatment. Conclusions: Engagement in messaging therapy may be usefully approached through an interdisciplinary lens, linking constructs from health science, human-computer interaction studies, and clinical science in an integrative engagement framework. Taken together, our results suggest that users may not view the digital psychotherapy platform itself as a treatment so much as a means of gaining access to a helping provider, that is, users did not see themselves as engaging with a platform but instead viewed their experience as a healing relationship. The findings of this study suggest that a better understanding of user engagement is crucial for enhancing the effectiveness of digital mental health interventions, and future research should continue to explore the underlying factors that contribute to engagement in digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT04507360; https://clinicaltrials.gov/ct2/show/NCT04507360 %M 37099363 %R 10.2196/41428 %U https://formative.jmir.org/2023/1/e41428 %U https://doi.org/10.2196/41428 %U http://www.ncbi.nlm.nih.gov/pubmed/37099363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46299 %T The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study %A Watland,Solbjørg %A Solberg Nes,Lise %A Hanson,Elizabeth %A Ekstedt,Mirjam %A Stenberg,Una %A Børøsund,Elin %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, 47 92667161, Elin.Borosund@rr-research.no %K caregivers %K next of kin %K relatives %K family-centered care %K digital assessment tool %K nurse intervention %K intensive care unit %K ICU %K post–intensive care syndrome-Family %K PICS-F %K empower %K support %K follow-up %K health promotion %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one’s admission to an intensive care unit (ICU) are also known as post–intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. Objective: This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients’ ICU admission to after their discharge or death. Methods: The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). Results: The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient’s ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. Conclusions: This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up. %M 37097744 %R 10.2196/46299 %U https://formative.jmir.org/2023/1/e46299 %U https://doi.org/10.2196/46299 %U http://www.ncbi.nlm.nih.gov/pubmed/37097744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40722 %T Direct Support Professionals’ Perspectives on Using Technology to Help Support Adults With Autism Spectrum Disorder: Mixed Methods Study %A Simmons,Christina A %A Moretti,Abigail E %A Lobo,Andrea F %A Tremoulet,Patrice D %+ Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53777, tremoulet@rowan.edu %K technology %K data collection %K documentation %K direct support professionals %K autism %K mobile phone %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. Objective: This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. Methods: In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. Results: In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. Conclusions: Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs’ effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD. %M 37097738 %R 10.2196/40722 %U https://formative.jmir.org/2023/1/e40722 %U https://doi.org/10.2196/40722 %U http://www.ncbi.nlm.nih.gov/pubmed/37097738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42206 %T Predictors of Cyberchondria During the COVID-19 Pandemic: Cross-sectional Study Using Supervised Machine Learning %A Infanti,Alexandre %A Starcevic,Vladan %A Schimmenti,Adriano %A Khazaal,Yasser %A Karila,Laurent %A Giardina,Alessandro %A Flayelle,Maèva %A Hedayatzadeh Razavi,Seyedeh Boshra %A Baggio,Stéphanie %A Vögele,Claus %A Billieux,Joël %+ Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 6862, alexandre.infanti@uni.lu %K cyberchondria %K COVID-19 %K online health information %K fear of COVID-19 %K health anxiety %K machine learning %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Cyberchondria is characterized by repeated and compulsive online searches for health information, resulting in increased health anxiety and distress. It has been conceptualized as a multidimensional construct fueled by both anxiety and compulsivity-related factors and described as a “transdiagnostic compulsive behavioral syndrome,” which is associated with health anxiety, problematic internet use, and obsessive-compulsive symptoms. Cyberchondria is not included in the International Classification of Diseases 11th Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and its defining features, etiological mechanisms, and assessment continue to be debated. Objective: This study aims to investigate changes in the severity of cyberchondria during the COVID-19 pandemic and identify the predictors of cyberchondria at this time. Methods: Data collection started on May 4, 2020, and ended on June 10, 2020, which corresponds to the first wave of the COVID-19 pandemic in Europe. At the time the study took place, French-speaking countries in Europe (France, Switzerland, Belgium, and Luxembourg) all implemented lockdown or semilockdown measures. The survey consisted of a questionnaire collecting demographic information (sex, age, education level, and country of residence) and information about socioeconomic circumstances during the first lockdown (eg, economic situation, housing, and employment status) and was followed by several instruments assessing various psychological and health-related constructs. Inclusion criteria for the study were being at least 18 years of age and having a good understanding of French. Self-report data were collected from 725 participants aged 18-77 (mean 33.29, SD 12.88) years, with females constituting the majority (416/725, 57.4%). Results: The results showed that the COVID-19 pandemic affected various facets of cyberchondria: cyberchondria-related distress and compulsion increased (distress z=–3.651, P<.001; compulsion z=–5.697, P<.001), whereas the reassurance facet of cyberchondria decreased (z=–6.680, P<.001). In addition, COVID-19–related fears and health anxiety emerged as the strongest predictors of cyberchondria-related distress and interference with functioning during the pandemic. Conclusions: These findings provide evidence of the impact of the COVID-19 pandemic on cyberchondria and identify factors that should be considered in efforts to prevent and manage cyberchondria at times of public health crises. In addition, they are consistent with a theoretical model of cyberchondria during the COVID-19 pandemic proposed in 2020. These findings have implications for the conceptualization and future assessment of cyberchondria. %M 36947575 %R 10.2196/42206 %U https://formative.jmir.org/2023/1/e42206 %U https://doi.org/10.2196/42206 %U http://www.ncbi.nlm.nih.gov/pubmed/36947575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38430 %T A Personalized Avatar-Based Web Application to Help People Understand How Social Distancing Can Reduce the Spread of COVID-19: Cross-sectional, Observational, Pre-Post Study %A Etienne,Doriane %A Archambault,Patrick %A Aziaka,Donovan %A Chipenda-Dansokho,Selma %A Dubé,Eve %A Fallon,Catherine S %A Hakim,Hina %A Kindrachuk,Jason %A Krecoum,Dan %A MacDonald,Shannon E %A Ndjaboue,Ruth %A Noubi,Magniol %A Paquette,Jean-Sébastien %A Parent,Elizabeth %A Witteman,Holly O %+ VITAM – Centre de recherche en santé durable, Université Laval, 2480, Chemin de la Canardière, Québec, QC, G1J 2G1, Canada, 1 418 663 5313 ext 12286, doriane.etienne.1@ulaval.ca %K social distancing %K COVID-19 %K SARS-CoV-2 %K pandemic %K personalized risk communication %K public health %K digital health intervention %K web application %K visualization %K personalized avatar %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: To reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. Objective: This study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the health care system, and society. Methods: Using Scrum, which is an agile framework; JavaScript (Vue.js framework); and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces the transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8, 2020, and April 9, 2020. Results: After 26 days, the application received 3588 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly (170/177, 96%) already practicing distancing and indicated that they intended to practice distancing in the coming week (172/177, 97.2%). Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. Conclusions: We developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The nonrandomized design of this rapid study prevents us from concluding the application’s effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission. %M 36961787 %R 10.2196/38430 %U https://formative.jmir.org/2023/1/e38430 %U https://doi.org/10.2196/38430 %U http://www.ncbi.nlm.nih.gov/pubmed/36961787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45189 %T A Team-Based Training for Continuous Glucose Monitoring in Diabetes Care: Mixed Methods Pilot Implementation Study in Primary Care Practices %A Filippi,Melissa K %A Lanigan,Angela M %A Oser,Sean M %A Alai,Jillian %A Brooks-Greisen,Alicia %A Oser,Tamara K %+ American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy, Leawood, KS, 66211, United States, 1 9139066382, alanigan@aafp.org %K continuous glucose monitoring %K CGM %K continuing medical education %K CME %K diabetes %K evaluation %K family physician %K implementation %K primary care %K primary care practice %K glucose %K glucose monitoring %K pilot study %K workflow %K medical education %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The American Academy of Family Physicians (AAFP) develops and maintains continuing medical education that is relevant to modern primary care practices. One continuing medical education modality is AAFP TIPS, which are comprised of resources designed for family medicine physicians and their care teams that aid in quick and accessible practice improvement strategies, with actionable steps. Evaluating physicians’ use of and satisfaction with this modality’s content and implementation strategies has not been prioritized previously. Continuous glucose monitoring (CGM) plays an increasing role in the treatment of diabetes; uptake occurs more rapidly in endocrinology settings than in primary care settings. To help address such differences in CGM uptake and diabetes care, AAFP TIPS on Continuous Glucose Monitoring (AAFP TIPS CGM) was developed, using published evidence and input from content experts (family medicine faculty; AAFP staff; and an advisory group comprised of other primary care physicians, patients, a pharmacist, and a primary care practice facilitator). A pilot implementation project was conducted in 3 primary care practices. Objective: To evaluate AAFP TIPS CGM in primary care practices, the research team assessed use of and satisfaction with the content and assessed barriers to and facilitators for strategy and workflow implementation. Methods: In total, 3 primary care practices participated in a mixed methods pilot implementation of AAFP TIPS CGM between June and October 2021. Practice champions at each site completed AAFP TIPS CGM and baseline practice surveys to evaluate practice characteristics and CGM prescribing. They conducted team trainings (via webinars or in person), with the goals of implementing CGM into practice and establishing or improving CGM workflows. Practice champions and team training participants completed posttraining surveys to evaluate the training, AAFP TIPS materials, and likelihood of implementing CGM. Interviews were conducted with 6 physicians, including practice champions, 2 months after team training. Satisfaction surveys were also distributed to those who completed the AAFP TIPS CGM course via the internet during the study period. Results: Of the 3 practices, 2 conducted team trainings. The team training evaluation survey showed that practice staff understood their role in implementing CGM in practice (19/20, 95%), and most (11/20, 55%) did not have questions after the training. Insurance coverage for CGM was a remaining knowledge gap and potential barrier to implementing CGM in practice. Physicians and interdisciplinary care team members who took the AAFP TIPS CGM course via the internet, as well as those who attended in-person team training, expressed a high degree of satisfaction with the education, content, and applicability of the course. Conclusions: This pilot implementation of AAFP TIPS CGM offers pertinent and timely information for primary care practices that desire to initiate or expand CGM use to best meet the needs of their patients with diabetes. %M 37093632 %R 10.2196/45189 %U https://formative.jmir.org/2023/1/e45189 %U https://doi.org/10.2196/45189 %U http://www.ncbi.nlm.nih.gov/pubmed/37093632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36837 %T An App-Based Intervention for Pediatric Weight Management: Pre-Post Acceptability and Feasibility Trial %A Cox,Jennifer S %A Hinton,Elanor C %A Hamilton Shield,Julian %A Lawrence,Natalia S %+ NIHR Bristol Biomedical Research Centre Nutrition Theme, 3rd Floor, Education & Research Centre, Upper Maudlin Street, Bristol, BS2 8AE, United Kingdom, 44 07718905807, jennifer.cox@bristol.ac.uk %K obesity %K pediatric %K intervention %K eHealth %K weight management %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidisciplinary approach to weight management is offered at tier 3 pediatric weight management services in the United Kingdom. Encouraging dietary change is a major aim, with patients meeting with dieticians, endocrinologists, psychologists, nurse specialists, and social workers on average every other month. Objective: This research sought to trial an inhibitory control training smartphone app—FoodT—with the clinic population of a pediatric weight management service. FoodT has shown positive impacts on food choice in adult users, with resulting weight loss. It was hoped that when delivered as an adjunctive treatment alongside the extensive social, medical, psychological, and dietetic interventions already offered at the clinic, the introduction of inhibitory control training may offer patients another tool that supports eating choice. In this feasibility trial, recruitment, retention, and app use were the primary outcomes. An extensive battery of measures was included to test the feasibility and acceptability of these measures for future powered trials. Methods: FoodT was offered to pediatric patients and their parents during a routine clinic appointment, and patients were asked to use the app at home every day for the first week and once per week for the rest of the month. Feasibility and acceptability were measured in terms of recruitment, engagement with the app, and retention to the trial. A battery of psychometric tests was given before and after app use to assess the acceptability of collecting data on changes to food choices and experiences that would inform future trial work. Results: A total of 12 children and 10 parents consented (22/62, 35% of those approached). Further, 1 child and no parents achieved the recommended training schedule. No participants completed the posttrial measures. The reasons for not wanting to be recruited to the trial included participants not considering their weight to be connected to eating choices and not feeling that the app suited their needs. No reasons are known for noncompletion. Conclusions: It is unclear whether the intervention itself or the research processes, including the battery of measures, prevented completion. It is therefore difficult to make any decisions as to the value that the app has within this setting. Important lessons have been learned from this research that have potential broad relevance, including the importance of co-designing interventions with service users and avoiding deterring people from early-stage participation in extensive data collection. %M 37093633 %R 10.2196/36837 %U https://formative.jmir.org/2023/1/e36837 %U https://doi.org/10.2196/36837 %U http://www.ncbi.nlm.nih.gov/pubmed/37093633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45796 %T Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment %A Berry,Katie R %A Gliske,Kate %A Schmidt,Clare %A Cray,Ley David Elliette %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St, Ste. 401, Bozeman, MT, 59715, United States, 1 9545527671, krberry@fsu.edu %K lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities %K LGBTQIA+ %K youth %K mental health %K affirming health care %K suicidal ideation %K depression %K nonsuicidal self-harm %K NSSI %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. Objective: This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Methods: Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. Results: LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. Conclusions: This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically. %M 37083637 %R 10.2196/45796 %U https://formative.jmir.org/2023/1/e45796 %U https://doi.org/10.2196/45796 %U http://www.ncbi.nlm.nih.gov/pubmed/37083637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41414 %T Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis %A Lee,Alexandra M %A Hojjatinia,Sahar %A Courtney,Jimikaye B %A Brunke-Reese,Deborah %A Hojjatinia,Sarah %A Lagoa,Constantino M %A Conroy,David E %+ The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, United States, 1 814 863 3451, conroy@psu.edu %K physical activity %K exercise %K fitness %K Fitbit %K tracking %K patient-specific modeling %K dynamical model %K patient specific %K fitness tracker %K psychological theory %K messaging %K motivation %K behavior change %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions. Objective: The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques. Methods: We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively. Results: Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages. Conclusions: No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type. %M 37083710 %R 10.2196/41414 %U https://formative.jmir.org/2023/1/e41414 %U https://doi.org/10.2196/41414 %U http://www.ncbi.nlm.nih.gov/pubmed/37083710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41179 %T Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW) %A Speiser,Dorothee %A Heibges,Maren %A Besch,Laura %A Hilger,Caren %A Keinert,Marie %A Klein,Katharina %A Rauwolf,Gudrun %A Schmid,Christine %A Schulz-Niethammer,Sven %A Stegen,Steffi %A Westfal,Viola %A Witzel,Isabell %A Zang,Benedikt %A Kendel,Friederike %A Feufel,Markus A %+ Department of Gynecology with Breast Center, Hereditary Breast and Ovarian Cancer Center, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 664 ext 263, dorothee.speiser@charite.de %K hereditary breast and ovarian cancer %K BRCA %K genetic counseling %K digital health %K online counseling tool %K user-centered design principles %K risk communication %K cancer risk %K hereditary cancer %K breast cancer %K ovarian cancer %D 2023 %7 21.4.2023 %9 Viewpoint %J JMIR Form Res %G English %X iKNOW is the first evidence-based digital tool to support personalized counseling for women in Germany with a hereditary cancer risk. The counseling tool is designed for carriers of pathogenic gBRCA (germline breast cancer gene) variants that increase the lifetime risk of breast and ovarian cancer. Carriers of pathogenic variants are confronted with complex, individualized risk information, and physicians must be able to convey this information in a comprehensible way to enable preference-sensitive health decisions. In this paper, we elaborate on the clinical, regulatory, and practical premises of personalized counseling in Germany. By operationalizing these premises, we formulate 5 design principles that, we suggest, are specific enough to develop a digital tool (eg, iKNOW), yet wide-ranging enough to inform the development of counseling tools for personalized medicine more generally: (1) digital counseling tools should implement the current standard of care (eg, based on guidelines); (2) digital counseling tools should help to both standardize and personalize the counseling process (eg, by enabling the preference-sensitive selection of counseling contents from a common information base); (3) digital counseling tools should make complex information easy to access both cognitively (eg, by using evidenced-based risk communication formats) and technically (eg, by means of responsive design for various devices); (4) digital counseling tools should respect the counselee’s data privacy rights (eg, through strict pseudonymization and opt-in consent); and (5) digital counseling tools should be systematically and iteratively evaluated with the users in mind (eg, using formative prototype testing to ensure a user-centric design and a summative multicenter, randomized controlled trial). On the basis of these paradigmatic design principles, we hope that iKNOW can serve as a blueprint for the development of more digital innovations to support personalized counseling approaches in cancer medicine. %M 37083496 %R 10.2196/41179 %U https://formative.jmir.org/2023/1/e41179 %U https://doi.org/10.2196/41179 %U http://www.ncbi.nlm.nih.gov/pubmed/37083496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40805 %T Visualization of Traditional Chinese Medicine Formulas: Development and Usability Study %A Wu,Zhiyue %A Peng,Suyuan %A Zhou,Liang %+ National Institute of Health Data Science, Peking University, No. 38 Xueyuan Rd., Beijing, 100191, China, 86 10 82806532, zhoul@bjmu.edu.cn %K visualization %K Chinese medicine formulas %K interactive data analysis %K traditional Chinese medicine %K multifaceted data visualization %K five elements %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional Chinese medicine (TCM) formulas are combinations of Chinese herbal medicines. Knowledge of classic medicine formulas is the basis of TCM diagnosis and treatment and is the core of TCM inheritance. The large number and flexibility of medicine formulas make memorization difficult, and understanding their composition rules is even more difficult. The multifaceted and multidimensional properties of herbal medicines are important for understanding the formula; however, these are usually separated from the formula information. Furthermore, these data are presented as text and cannot be analyzed jointly and interactively. Objective: We aimed to devise a visualization method for TCM formulas that shows the composition of medicine formulas and the multidimensional properties of herbal medicines involved and supports the comparison of medicine formulas. Methods: A TCM formula visualization method with multiple linked views is proposed and implemented as a web-based tool after close collaboration between visualization and TCM experts. The composition of medicine formulas is visualized in a formula view with a similarity-based layout supporting the comparison of compositing herbs; a shared herb view complements the formula view by showing all overlaps of pair-wise formulas; and a dimensionality-reduction plot of herbs enables the visualization of multidimensional herb properties. The usefulness of the tool was evaluated through a usability study with TCM experts. Results: Our method was applied to 2 typical categories of medicine formulas, namely tonic formulas and heat-clearing formulas, which contain 20 and 26 formulas composed of 58 and 73 herbal medicines, respectively. Each herbal medicine has a 23-dimensional characterizing attribute. In the usability study, TCM experts explored the 2 data sets with our web-based tool and quickly gained insight into formulas and herbs of interest, as well as the overall features of the formula groups that are difficult to identify with the traditional text-based method. Moreover, feedback from the experts indicated the usefulness of the proposed method. Conclusions: Our TCM formula visualization method is able to visualize and compare complex medicine formulas and the multidimensional attributes of herbal medicines using a web-based tool. TCM experts gained insights into 2 typical medicine formula categories using our method. Overall, the new method is a promising first step toward new TCM formula education and analysis methodologies. %M 37083631 %R 10.2196/40805 %U https://formative.jmir.org/2023/1/e40805 %U https://doi.org/10.2196/40805 %U http://www.ncbi.nlm.nih.gov/pubmed/37083631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39409 %T Application of Phylodynamic Tools to Inform the Public Health Response to COVID-19: Qualitative Analysis of Expert Opinions %A Rich,Shannan N %A Richards,Veronica %A Mavian,Carla %A Rife Magalis,Brittany %A Grubaugh,Nathan %A Rasmussen,Sonja A %A Dellicour,Simon %A Vrancken,Bram %A Carrington,Christine %A Fisk-Hoffman,Rebecca %A Danso-Odei,Demi %A Chacreton,Daniel %A Shapiro,Jerne %A Seraphin,Marie Nancy %A Hepp,Crystal %A Black,Allison %A Dennis,Ann %A Trovão,Nídia Sequeira %A Vandamme,Anne-Mieke %A Rasmussen,Angela %A Lauzardo,Michael %A Dean,Natalie %A Salemi,Marco %A Prosperi,Mattia %+ Department of Epidemiology, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 3522735468, shannanrich@ufl.edu %K COVID-19 %K SARS-CoV-2 %K molecular epidemiology %K genomic surveillance %K variants %K pandemic %K phylogenetic %K genomic %K epidemiology %K data %K virology %K bioinformatics %K response %K phylodynamic %K monitoring %K surveillance %K transmission %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the wake of the SARS-CoV-2 pandemic, scientists have scrambled to collect and analyze SARS-CoV-2 genomic data to inform public health responses to COVID-19 in real time. Open source phylogenetic and data visualization platforms for monitoring SARS-CoV-2 genomic epidemiology have rapidly gained popularity for their ability to illuminate spatial-temporal transmission patterns worldwide. However, the utility of such tools to inform public health decision-making for COVID-19 in real time remains to be explored. Objective: The aim of this study is to convene experts in public health, infectious diseases, virology, and bioinformatics—many of whom were actively engaged in the COVID-19 response—to discuss and report on the application of phylodynamic tools to inform pandemic responses. Methods: In total, 4 focus groups (FGs) occurred between June 2020 and June 2021, covering both the pre- and postvariant strain emergence and vaccination eras of the ongoing COVID-19 crisis. Participants included national and international academic and government researchers, clinicians, public health practitioners, and other stakeholders recruited through purposive and convenience sampling by the study team. Open-ended questions were developed to prompt discussion. FGs I and II concentrated on phylodynamics for the public health practitioner, while FGs III and IV discussed the methodological nuances of phylodynamic inference. Two FGs per topic area to increase data saturation. An iterative, thematic qualitative framework was used for data analysis. Results: We invited 41 experts to the FGs, and 23 (56%) agreed to participate. Across all the FG sessions, 15 (65%) of the participants were female, 17 (74%) were White, and 5 (22%) were Black. Participants were described as molecular epidemiologists (MEs; n=9, 39%), clinician-researchers (n=3, 13%), infectious disease experts (IDs; n=4, 17%), and public health professionals at the local (PHs; n=4, 17%), state (n=2, 9%), and federal (n=1, 4%) levels. They represented multiple countries in Europe, the United States, and the Caribbean. Nine major themes arose from the discussions: (1) translational/implementation science, (2) precision public health, (3) fundamental unknowns, (4) proper scientific communication, (5) methods of epidemiological investigation, (6) sampling bias, (7) interoperability standards, (8) academic/public health partnerships, and (9) resources. Collectively, participants felt that successful uptake of phylodynamic tools to inform the public health response relies on the strength of academic and public health partnerships. They called for interoperability standards in sequence data sharing, urged careful reporting to prevent misinterpretations, imagined that public health responses could be tailored to specific variants, and cited resource issues that would need to be addressed by policy makers in future outbreaks. Conclusions: This study is the first to detail the viewpoints of public health practitioners and molecular epidemiology experts on the use of viral genomic data to inform the response to the COVID-19 pandemic. The data gathered during this study provide important information from experts to help streamline the functionality and use of phylodynamic tools for pandemic responses. %M 36848460 %R 10.2196/39409 %U https://formative.jmir.org/2023/1/e39409 %U https://doi.org/10.2196/39409 %U http://www.ncbi.nlm.nih.gov/pubmed/36848460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37515 %T Integrating Human-Centered Design Methods Into a Health Promotion Project: Supplemental Nutrition Assistance Program Education Case Study for Intervention Design %A Chen,Elizabeth %A Bishop,Jared %A Guge Cozon,Lindsay %A Hernandez,Eduardo %A Sadeghzadeh,Claire %A Bradley,Megan %A Dearth-Wesley,Tracy %A De Marco,Molly %+ Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, United States, 1 9199669207, lizcchen@unc.edu %K human-centered design %K design thinking %K program development %K stakeholder engagement %K nutrition %K parenting %K children %K pediatrics %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human-centered design, or design thinking, offers an extensive toolkit of methods and strategies for user-centered engagement that lends itself well to intervention development and implementation. These methods can be applied to the fields of public health and medicine to design interventions that may be more feasible and viable in real-world contexts than those developed with different methods. Objective: The design team aimed to develop approaches to building food skills among caregivers of children aged 0-5 years who are eligible for a federal food assistance program while they were in the grocery store. Methods: They applied 3 specific human-centered design methods—Extremes and Mainstreams, Journey Mapping, and Co-Creation Sessions—to collaboratively develop intervention approaches to enhance Supplemental Nutrition Assistance Program Education (SNAP-Ed) reach and impact across food retail settings. Extremes and Mainstreams is a specific kind of purposive sampling that selects individuals based on characteristics beyond demographics. Journey Mapping is a visual tool that asks individuals to identify key moments and decision points during an experience. Co-Creation Sessions are choreographed opportunities for individuals to explicitly contribute to the design of a solution alongside research or design team members. Results: Ten caregivers with diverse lived experiences were selected to participate in remote design thinking workshops and create individual journey maps to depict their grocery store experiences. Common happy points and pain points were identified. Nine stakeholders, including caregivers, SNAP-Ed staff, and grocery store dieticians, cocreated 2 potential intervention approaches informed by caregivers’ experiences and needs: a rewards program and a meal box option. Conclusions: These 3 human-centered design methods led to a meaningful co-design process where proposed interventions aligned with caregivers’ wants and needs. This case study provides other public health practitioners with specific examples of how to use these methods in program development and stakeholder engagement as well as lessons learned when adapting these methods to remote settings. %M 37083485 %R 10.2196/37515 %U https://formative.jmir.org/2023/1/e37515 %U https://doi.org/10.2196/37515 %U http://www.ncbi.nlm.nih.gov/pubmed/37083485 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45305 %T The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis %A Berry,Katie R %A Gliske,Kate %A Schmidt,Clare %A Ballard,Jaime %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St Suite 401, Bozeman, MT, 59715, United States, 1 9545527671, krberry@fsu.edu %K adolescents %K family therapy %K intensive outpatient %K mental health %K treatment engagement %K young adults %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background:  Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. Objective:  We aimed to examine whether family members’ participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient’s treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Methods:  Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample’s baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Results:  Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Conclusions:  Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families. %M 37079372 %R 10.2196/45305 %U https://formative.jmir.org/2023/1/e45305 %U https://doi.org/10.2196/45305 %U http://www.ncbi.nlm.nih.gov/pubmed/37079372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42297 %T Multilevel Classification of Users’ Needs in Chinese Online Medical and Health Communities: Model Development and Evaluation Based on Graph Convolutional Network %A Cheng,Quan %A Lin,Yingru %+ School of Economics and Management, Fuzhou University, 2 Xue Yuan Road, University Town, Fuzhou, 350108, China, 86 13675047598, chengquan@fzu.edu.cn %K online medical health community %K multilevel classification %K graph convolutional network %K cardiovascular disease %K cardiovascular %K China %K online %K medical %K community %K behavior %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Online medical and health communities provide a platform for internet users to share experiences and ask questions about medical and health issues. However, there are problems in these communities, such as the low accuracy of the classification of users’ questions and the uneven health literacy of users, which affect the accuracy of user retrieval and the professionalism of the medical personnel answering the question. In this context, it is essential to study more effective classification methods of users’ information needs. Objective: Most online medical and health communities tend to provide only disease-type labels, which do not give a comprehensive summary of users’ needs. The study aims to construct a multilevel classification framework based on the graph convolutional network (GCN) model for users’ needs in online medical and health communities so that users can perform more targeted information retrieval. Methods: Using the Chinese online medical and health community “Qiuyi” as an example, we crawled questions posted by users in the “Cardiovascular Disease” section as the data source. First, the disease types involved in the problem data were segmented by manual coding to generate the first-level label. Second, the needs were identified by K-means clustering to generate the users’ information needs label as the second-level label. Finally, by constructing a GCN model, users’ questions were automatically classified, thus realizing the multilevel classification of users’ needs. Results: Based on the empirical research of questions posted by users in the “Cardiovascular Disease” section of Qiuyi, the hierarchical classification of users’ questions (data) was realized. The classification models designed in the study achieved accuracy, precision, recall, and F1-score of 0.6265, 0.6328, 0.5788, and 0.5912, respectively. Compared with the traditional machine learning method naïve Bayes and the deep learning method hierarchical text classification convolutional neural network, our classification model showed better performance. At the same time, we also performed a single-level classification experiment on users’ needs, which in comparison with the multilevel classification model exhibited a great improvement. Conclusions: A multilevel classification framework has been designed based on the GCN model. The results demonstrated that the method is effective in classifying users’ information needs in online medical and health communities. At the same time, users with different diseases have different directions for information needs, which plays an important role in providing diversified and targeted services to the online medical and health community. Our method is also applicable to other similar disease classifications. %M 37079346 %R 10.2196/42297 %U https://formative.jmir.org/2023/1/e42297 %U https://doi.org/10.2196/42297 %U http://www.ncbi.nlm.nih.gov/pubmed/37079346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40359 %T Learning in a Virtual Environment to Improve Type 2 Diabetes Outcomes: Randomized Controlled Trial %A Johnson,Constance M %A D'Eramo Melkus,Gail %A Reagan,Louise %A Pan,Wei %A Amarasekara,Sathya %A Pereira,Katherine %A Hassell,Nancy %A Nowlin,Sarah %A Vorderstrasse,Allison %+ Cizik School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Ave, SON 539, Houston, TX, 77030, United States, 1 7135009936, constance.m.johnson@uth.tmc.edu %K eHealth %K randomized controlled trial %K self-management %K type 2 diabetes mellitus %K computer-mediated environments %K virtual environment %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the importance of self-management in type 2 diabetes mellitus (T2DM), a major aspect of health is providing diabetes self-management education and support. Known barriers include access, availability, and the lack of follow through on referral to education programs. Virtual education and support have increased in use over the last few years. Objective: The purpose of the Diabetes Learning in a Virtual Environment (LIVE) study was to compare the effects of the LIVE intervention (educational 3D world) to a diabetes self-management education and support control website on diet and physical activity behaviors and behavioral and metabolic outcomes in adults with T2DM over 12 months. Methods: The LIVE study was a 52-week multisite randomized controlled trial with longitudinal repeated measures. Participants were randomized to LIVE (n=102) or a control website (n=109). Both contained the same educational materials, but the virtual environment was synchronous and interactive, whereas the control was a flat website. Data were collected at baseline and 3, 6, and 12 months using surveys and clinical, laboratory, and Fitbit measures. Descriptive statistics included baseline characteristics and demographics. The effects of the intervention were initially examined by comparing the means and SDs of the outcomes across the 4 time points between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months. Results: This trial included 211 participants who consented. The mean age was 58.85 (SD 10.1) years, and a majority were White (127/211, 60.2%), non-Hispanic (198/211, 93.8%), married (107/190, 56.3%), and female (125/211, 59.2%). Mean hemoglobin A1c (HbA1c) level at baseline was 7.64% (SD 1.79%) and mean BMI was 33.51 (SD 7.25). We examined weight loss status versus randomized group, where data with no weight change were eliminated, and the LIVE group experienced significantly more weight loss than the control group (P=.04). There were no significant differences between groups in changes in physical activity and dietary outcomes (all P>.05), but each group showed an increase in physical activity. Both groups experienced a decrease in mean HbA1c level, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline HbA1c level was 8.6% or higher. Conclusions: This study confirmed that there were minor positive changes on glycemic targets in both groups over the 12-month study period; however, the majority of the participants began with optimal HbA1c levels. We did find clinically relevant metabolic changes in those who began with an HbA1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM. Trial Registration: ClinicalTrials.gov NCT02040038; https://clinicaltrials.gov/ct2/show/NCT02040038 %M 36962700 %R 10.2196/40359 %U https://formative.jmir.org/2023/1/e40359 %U https://doi.org/10.2196/40359 %U http://www.ncbi.nlm.nih.gov/pubmed/36962700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38774 %T Effect of the Data Collection Method on Mobile Phone Survey Participation in Bangladesh and Tanzania: Secondary Analyses of a Randomized Crossover Trial %A Pariyo,George %A Meghani,Ankita %A Gibson,Dustin %A Ali,Joseph %A Labrique,Alain %A Khan,Iqbal Ansary %A Kibria,Gulam Muhammed Al %A Masanja,Honorati %A Hyder,Adnan Ali %A Ahmed,Saifuddin %+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8141, Baltimore, MD, 21205, United States, 1 4434779403, gkibria1@jhu.edu %K mobile phone survey %K interactive voice response survey %K non-communicable disease surveillance %K response rate %K cooperation rate %K phone %K risk %K survey %K public health %K interview %K voice %K response %K cooperation %K female %K women %K rural %K school %K countries %K non-communicable disease %K surveillance %K interactive survey %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile phone surveys provide a novel opportunity to collect population-based estimates of public health risk factors; however, nonresponse and low participation challenge the goal of collecting unbiased survey estimates. Objective: This study compares the performance of computer-assisted telephone interview (CATI) and interactive voice response (IVR) survey modalities for noncommunicable disease risk factors in Bangladesh and Tanzania. Methods: This study used secondary data from a randomized crossover trial. Between June 2017 and August 2017, study participants were identified using the random digit dialing method. Mobile phone numbers were randomly allocated to either a CATI or IVR survey. The analysis examined survey completion, contact, response, refusal, and cooperation rates of those who received the CATI and IVR surveys. Differences in survey outcomes between modes were assessed using multilevel, multivariable logistic regression models to adjust for confounding covariates. These analyses were adjusted for clustering effects by mobile network providers. Results: For the CATI surveys, 7044 and 4399 phone numbers were contacted in Bangladesh and Tanzania, respectively, and 60,863 and 51,685 phone numbers, respectively, were contacted for the IVR survey. The total numbers of completed interviews in Bangladesh were 949 for CATI and 1026 for IVR and in Tanzania were 447 for CATI and 801 for IVR. Response rates for CATI were 5.4% (377/7044) in Bangladesh and 8.6% (376/4391) in Tanzania; response rates for IVR were 0.8% (498/60,377) in Bangladesh and 1.1% (586/51,483) in Tanzania. The distribution of the survey population was significantly different from the census distribution. In both countries, IVR respondents were younger, were predominantly male, and had higher education levels than CATI respondents. IVR respondents had a lower response rate than CATI respondents in Bangladesh (adjusted odds ratio [AOR]=0.73, 95% CI 0.54-0.99) and Tanzania (AOR=0.32, 95% CI 0.16-0.60). The cooperation rate was also lower with IVR than with CATI in Bangladesh (AOR=0.12, 95% CI 0.07-0.20) and Tanzania (AOR=0.28, 95% CI 0.14-0.56). Both in Bangladesh (AOR=0.33, 95% CI 0.25-0.43) and Tanzania (AOR=0.09, 95% CI 0.06-0.14), there were fewer completed interviews with IVR than with CATI; however, there were more partial interviews with IVR than with CATI in both countries. Conclusions: There were lower completion, response, and cooperation rates with IVR than with CATI in both countries. This finding suggests that, to increase representativeness in certain settings, a selective approach may be needed to design and deploy mobile phone surveys to increase population representativeness. Overall, CATI surveys may offer a promising approach for surveying potentially under-represented groups like women, rural residents, and participants with lower levels of education in some countries. %M 37079373 %R 10.2196/38774 %U https://formative.jmir.org/2023/1/e38774 %U https://doi.org/10.2196/38774 %U http://www.ncbi.nlm.nih.gov/pubmed/37079373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43002 %T The Chinese Version of the Breast Cancer Literacy Assessment Tool: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K breast cancer literacy assessment tool %K translation %K adaptation %K psychometric evaluation %K validity %K reliability %K breast cancer %K cancer %K tool %K women %K prevention %K detection %K intervention %K assessment %K education %K breast cancer literacy %K assessment tool %K cancer awareness %K health literacy %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer among Chinese women, with an age-standardized prevalence of 21.6 cases per 100,000 women. Limited cancer health literacy reduces females’ ability to engage in cancer prevention and detection. It is necessary to assess Chinese women’s breast cancer literacy to deliver targeted interventions and effective education. However, there is no Breast Cancer Literacy Assessment Tool (B-CLAT) available in China currently. Objective: This study aimed to translate and linguistically and culturally adapt the B-CLAT into a simplified-Chinese version (C-B-CLAT), and then validate its psychometric properties by administering it to Chinese college students. Methods: First, we translated the B-CLAT into a simplified-Chinese version and verified its validity and reliability using rigorous translation and validation guidelines proposed in previous studies. We then evaluated the psychometric properties among 50 female participants with a mean age of 19.62 (SD 1.31) years recruited from Nantong University, China. Results: Items 1, 6, 8, 9, 10, 16, 17, 20, 21, 22, 23, 24, 25, 26, 29, and 30 were deleted to increase the relevant subscale internal consistency. Items 3, 12, 13, 14, 18, 20, 27, and 31 were deleted due to their Cronbach α being lower than .5 in the test-retest analysis. After deletion, the internal consistency of the entire scale was fair with α=.607. The prevention and control subscale had the highest internal consistency with α=.730, followed by the screening and knowledge subscale with α=.509, while the awareness subscale had the lowest internal consistency with α=.224. The intraclass correlation coefficient for the C-B-CLAT (items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34) was fair to excellent (odds ratio [OR] 0.88, 95% CI 0.503-0.808). The values of Cronbach α for items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34 ranged from .499 to .806, and the α value for the C-B-CLAT was .607. This indicates fair test-retest reliability. The mean difference in the C-B-CLAT scores between stage 1 and stage 2 was 0.47 (OR 0.67, 95% CI −0.53 to 1.47), which was not significantly different from zero (t48=0.945; P=.35). This result implies that the C-B-CLAT produced the same scores at stage 1 and stage 2 on average, thus showing good agreement in the C-B-CLAT scores between stage 1 and stage 2. The SD of the difference was 3.48. The 95% limits of agreement were −6.34 to 7.28. Conclusions: We developed a simplified-Chinese version of the B-CLAT through translation and adaptation. Psychometric properties testing has proven this version valid and reliable for assessing breast cancer literacy among Chinese college students. %M 37074784 %R 10.2196/43002 %U https://formative.jmir.org/2023/1/e43002 %U https://doi.org/10.2196/43002 %U http://www.ncbi.nlm.nih.gov/pubmed/37074784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42868 %T Factors Associated With Limited Digital Health Literacy Among Chinese Male Populations: Cross-sectional Study %A Xing,Zhaoquan %A Ji,Meng %A Dong,Zhaogang %A Xu,Xiaofei %A Shan,Yi %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K factor %K older age %K lower education attainment %K lower functional, communicative, and critical health literacy %K weaker belief and self-confidence %K limited eHealth literacy %K Chinese population %K logistic regression %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth resources and interventions promise to promote favorable behavior change, self-efficacy, and knowledge acquisition, thereby improving health literacy. However, individuals with limited eHealth literacy may find it difficult to identify, understand, and benefit from eHealth use. It is necessary to identify the self-assessed eHealth literacy of those who use eHealth resources to classify their eHealth literacy levels and to determine the demographic characteristics associated with higher and lower eHealth literacy skills. Objective: This study aimed to identify notable factors closely associated with limited eHealth literacy among Chinese male populations to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We hypothesized that participants’ eHealth literacy status was associated with various demographic characteristics. Therefore, we elicited the following information in the questionnaire: age and education, self-assessed disease knowledge, 3 well-developed health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, eHealth Literacy Scale, and General Health Numeracy Test), and the 6 Internal items on health beliefs and self-confidence in the Multidimensional Health Locus of Control Scales. Using randomized sampling, we recruited survey participants from Qilu Hospital of Shandong University, China. After validating the data collected through a web-based questionnaire survey via wenjuanxing, we coded all valid data according to predefined coding schemes of Likert scales with different point (score) ranges. We then calculated the total scores of the subsections of the scales or the entire scale. Finally, we used logistic regression modeling to associate the scores of the eHealth Literacy Scale with the scores of the All Aspects of Health Literacy Scale, the General Health Numeracy Test-6, and age and education to ascertain factors considerably associated with limited eHealth literacy among Chinese male populations. Results: All data from the 543 returned questionnaires were valid according to the validation criteria. By interpreting these descriptive statistics, we found that 4 factors were significantly correlated with participants’ limited eHealth literacy: older age, lower education attainment, lower levels of all aspects of health literacy (functional, communicative, and critical), and weaker beliefs and self-confidence in internal drivers and strengths to stay healthy. Conclusions: By applying logistic regression modeling, we ascertained 4 factors that were significantly correlated with limited eHealth literacy among Chinese male populations. These relevant factors identified can inform stakeholders engaging in clinical practice, health education, medical research, and health policy making. %M 37074760 %R 10.2196/42868 %U https://formative.jmir.org/2023/1/e42868 %U https://doi.org/10.2196/42868 %U http://www.ncbi.nlm.nih.gov/pubmed/37074760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41321 %T Children’s and Caregivers’ Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design %A Hollier,John M %A Strickland,Tiantá A %A Fordis,C Michael %A van Tilburg,Miranda AL %A Shulman,Robert J %A Thompson,Debbe %+ Texas Children's Hospital, 6701 Fannin St., Suite 1010.00, Houston, TX, 77030, United States, 1 832 824 3814, jmhollie@bcm.edu %K guided imagery therapy %K guided imagery %K psychotherapy %K disorders of gut-brain interaction %K functional abdominal pain disorders %K pediatric %K pain %K mobile app %K mobile health %K mHealth %K mixed methods research %K usability %K gamification %K user-centered design %K guided image therapy %K app prototype %K prototype %K feedback %K children %K child %K youths %K caregiver %K mobile phone %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. Objective: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. Methods: Children aged 7 to 12 years with Rome IV–defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. Results: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75% (12/16) of children and 69% (11/16) of caregivers had difficulty setting the reminder notification. The children’s interviews confirmed the app’s usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app’s usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app’s ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children’s motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. Conclusions: Children and caregivers rated our GIT app’s usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements. %M 37074773 %R 10.2196/41321 %U https://formative.jmir.org/2023/1/e41321 %U https://doi.org/10.2196/41321 %U http://www.ncbi.nlm.nih.gov/pubmed/37074773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40437 %T Patient Feedback on a Mobile Medication Adherence App for Buprenorphine and Naloxone: Closed and Open-Ended Survey on Feasibility and Acceptability %A Smith,Crystal L %A Keever,Abigail %A Bowden,Theresa %A Olson,Katie %A Rodin,Nicole %A McDonell,Michael G %A Roll,John M %A Smoody,Gillian %A LeBrun,Jeff %A Miguel,Andre QC %A McPherson,Sterling M %+ Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202-2131, United States, 1 509 368 6876, crystal.lederhos@wsu.edu %K opioids %K mobile technology %K medication adherence %K buprenorphine %K naloxone %K opioid use disorder %K opioid agonist therapy %K medication-assisted treatment %K medications for opioid use disorder %K opioid %K opioid use %K well-being %K quality of life %K clinic %K technology %K medication %K remote %K coaching %K tracking %K stress %K incentive %K tool %K mobile phone %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorders impact the health and well-being of millions of Americans. Buprenorphine and naloxone (BUP and NAL) can reduce opioid overdose deaths, decrease misuse, and improve quality of life. Unfortunately, poor medication adherence is a primary barrier to the long-term efficacy of BUP and NAL. Objective: We aimed to examine patient feedback on current and potential features of a Bluetooth-enabled pill bottle cap and associated mobile app for patients prescribed BUP and NAL for an opioid use disorder, and to solicit recommendations for improvement to effectively and appropriately tailor the technology for people in treatment for opioid use disorder. Methods: A convenience sample of patients at an opioid use disorder outpatient clinic were asked about medication adherence, opioid cravings, experience with technology, motivation for treatment, and their existent support system through a brief e-survey. Patients also provided detailed feedback on current features and features being considered for inclusion in a technology designed to increase medication adherence (eg, inclusion of a personal motivational factor, craving and stress tracking, incentives, and web-based coaching). Participants were asked to provide suggestions for improvement and considerations specifically applicable to people in treatment for opioid use disorder with BUP and NAL. Results: Twenty people with an opioid use disorder who were prescribed BUP and NAL participated (mean age 34, SD 8.67 years; 65% female; 80% White). Participants selected the most useful, second-most useful, and least useful features presented; 42.1% of them indicated that motivational reminders would be most useful, followed by craving and stress tracking (26.3%) and web-based support forums (21.1%). Every participant indicated that they had at least 1 strong motivating factor for staying in treatment, and half (n=10) indicated children as that factor. All participants indicated that they had, at some point in their lives, the most extreme craving a person could have; however, 42.1% indicated that they had no cravings in the last month. Most respondents (73.7%) stated that tracking cravings would be helpful. Most respondents (84.2%) also indicated that they believed reinforcers or prizes would help them achieve their treatment goals. Additionally, 94.7% of respondents approved of adherence tracking to accommodate this feature using smart packaging, and 78.9% of them approved of selfie videos of them taking their medication. Conclusions: Engaging patients taking treatment for opioid use disorder with BUP and NAL allowed us to identify preferences and considerations that are unique to this treatment area. As the technology developer of the pill cap and associated mobile app is able to take into consideration or integrate these preferences and suggestions, the smart cap and associated mobile app will become tailored to this population and more useful for them, which may encourage patient use of the smart cap and associated mobile app. %M 37074780 %R 10.2196/40437 %U https://formative.jmir.org/2023/1/e40437 %U https://doi.org/10.2196/40437 %U http://www.ncbi.nlm.nih.gov/pubmed/37074780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45309 %T Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data %A Ilyas,Yousaf %A Hassanbeigi Daryani,Shahrzad %A Kiriella,Dona %A Pachwicewicz,Paul %A Boley,Randy A %A Reyes,Karen M %A Smith,Dale L %A Zalta,Alyson K %A Schueller,Stephen M %A Karnik,Niranjan S %A Stiles-Shields,Colleen %+ Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, ecss@uic.edu %K mHealth %K mobile health %K smartphones %K geolocation %K Wi-Fi %K youth experiencing homelessness %K mobile phone %K homelessness %K youth %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. Objective: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. Results: Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. Conclusions: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions. %M 37071457 %R 10.2196/45309 %U https://formative.jmir.org/2023/1/e45309 %U https://doi.org/10.2196/45309 %U http://www.ncbi.nlm.nih.gov/pubmed/37071457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44661 %T Expectant Parents’ Preferences for Teaching by Texting: Development and Usability Study of SmartMom %A Murray,Jennifer B %A Sharp,Alexander %A Munro,Sarah %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, jennifer.murray@ubc.ca %K pregnancy %K pregnant %K prenatal %K patient education %K text message %K SMS text messaging %K prenatal education %K mHealth %K evidence-based health care %K mobile app %K Canada %K mobile health %K preference %K focus group %K information need %K user need %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. %M 37071451 %R 10.2196/44661 %U https://formative.jmir.org/2023/1/e44661 %U https://doi.org/10.2196/44661 %U http://www.ncbi.nlm.nih.gov/pubmed/37071451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43958 %T Exploring Stakeholder Requirements to Enable Research and Development of Artificial Intelligence Algorithms in a Hospital-Based Generic Infrastructure: Results of a Multistep Mixed Methods Study %A Weinert,Lina %A Klass,Maximilian %A Schneider,Gerd %A Heinze,Oliver %+ Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34367, lina.weinert@med.uni-heidelberg.de %K artificial intelligence %K requirements analysis %K mixed-methods %K data availability %K qualitative research %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Legal, controlled, and regulated access to high-quality data from academic hospitals currently poses a barrier to the development and testing of new artificial intelligence (AI) algorithms. To overcome this barrier, the German Federal Ministry of Health supports the “pAItient” (Protected Artificial Intelligence Innovation Environment for Patient Oriented Digital Health Solutions for developing, testing and evidence-based evaluation of clinical value) project, with the goal to establish an AI Innovation Environment at the Heidelberg University Hospital, Germany. It is designed as a proof-of-concept extension to the preexisting Medical Data Integration Center. Objective: The first part of the pAItient project aims to explore stakeholders’ requirements for developing AI in partnership with an academic hospital and granting AI experts access to anonymized personal health data. Methods: We designed a multistep mixed methods approach. First, researchers and employees from stakeholder organizations were invited to participate in semistructured interviews. In the following step, questionnaires were developed based on the participants’ answers and distributed among the stakeholders’ organizations. In addition, patients and physicians were interviewed. Results: The identified requirements covered a wide range and were conflicting sometimes. Relevant patient requirements included adequate provision of necessary information for data use, clear medical objective of the research and development activities, trustworthiness of the organization collecting the patient data, and data should not be reidentifiable. Requirements of AI researchers and developers encompassed contact with clinical users, an acceptable user interface (UI) for shared data platforms, stable connection to the planned infrastructure, relevant use cases, and assistance in dealing with data privacy regulations. In a next step, a requirements model was developed, which depicts the identified requirements in different layers. This developed model will be used to communicate stakeholder requirements within the pAItient project consortium. Conclusions: The study led to the identification of necessary requirements for the development, testing, and validation of AI applications within a hospital-based generic infrastructure. A requirements model was developed, which will inform the next steps in the development of an AI innovation environment at our institution. Results from our study replicate previous findings from other contexts and will add to the emerging discussion on the use of routine medical data for the development of AI applications. International Registered Report Identifier (IRRID): RR2-10.2196/42208 %M 37071450 %R 10.2196/43958 %U https://formative.jmir.org/2023/1/e43958 %U https://doi.org/10.2196/43958 %U http://www.ncbi.nlm.nih.gov/pubmed/37071450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43085 %T A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study %A Shankar,Lalita %A Dixit,Anvita %A Howard,Susan %+ Howard Delafield International LLP, 1101 30th St NW, Suite 500, Washington, DC, 20007, United States, 1 202 625 4364, lalita@howard-delafield.com %K Theory of Change %K social behavior change %K mobile game app %K digital innovation %K adolescent girls %K sexual and reproductive health %K India %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: India has one of the largest adolescent populations in the world. Yet adolescents, particularly adolescent girls, have limited access to correct sexual and reproductive health information and services. The context in which adolescent girls live is one of gender inequity where they contend with early marriage and early pregnancy and have few opportunities for quality education and labor force participation. The digital revolution has expanded the penetration of mobile phones across India, increasingly being used by adolescent girls. Health interventions are also moving onto digital platforms. Evidence has shown that applications of game elements and game-based learning can be powerful tools in behavior change and health interventions. This provides a unique opportunity, particularly for the private sector, to reach and empower adolescent girls directly with information, products, and services in a private and fun manner. Objective: The objective of this paper is to describe how a design-led Theory of Change (ToC) was formulated for a mobile game app that is not only underpinned by theories of various behavior change models but also identifies variables and triggers for in-game behavioral intentions that can be tracked and measured within the game and validated through a rigorous post-gameplay outcome evaluation. Methods: We describe the use of a multimix methodology to formulate a ToC informing behavioral frameworks and co-design approaches in our proof-of-concept product development journey. This process created a statement of hypothesis and “pathways to impact” with a continuous, cumulative, and iterative design process that included key stakeholders in the production of a smartphone app. With theoretical underpinnings of social behavior and modeling frameworks, systematic research, and other creative methods, we developed a design-led ToC pathway that can delineate complex and multidisciplinary outputs for measuring impact. Results: The statement of hypothesis that emerged posits that “If girls virtually experience the outcomes of choices that they make for their avatar in the mobile game, then they can make informed decisions that direct the course of their own life.” Four learning pathways (DISCOVER, PLAY, DECIDE, and ACT) are scaffolded on 3 pillars of evidence, engagement, and evaluation to support the ToC-led framework. It informs decision-making and life outcomes through game-based objectives and in-game triggers that offer direct access to information, products, and services. Conclusions: This approach of using a multimix methodology for identifying varied and multidisciplinary pathways to change is of particular interest to measuring the impact of innovations, especially digital products, that do not necessarily conform with traditional behavioral change models or standard co-design approaches. We also explain the benefits of using iterative and cumulative inputs to integrate ongoing user feedback, while identifying pathways to various impacts, and not limiting it to only the design and development phase. %M 37071463 %R 10.2196/43085 %U https://formative.jmir.org/2023/1/e43085 %U https://doi.org/10.2196/43085 %U http://www.ncbi.nlm.nih.gov/pubmed/37071463 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46001 %T Patient and Provider Perspectives on Symptom Monitoring During Outpatient Chemotherapy: Interview Study %A Chen,Leeann %A Bartel,Christianna %A Cai,Xinlu %A Cheng,Yanghuidi %A Perer,Adam %A McClaine,Sean %A Kairis,Elizabeth %A Durica,Krina %A Huang,Weiyu %A Low,Carissa A %+ Department of Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, 15213, United States, 1 4123451603, lec171@pitt.edu %K symptom management %K remote patient monitoring %K doctor-patient communication %K mobile technology %K cancer %K ambulatory %K chemotherapy %K oncology %K remote monitoring %K outpatient %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Fluctuating symptoms and side effects are common during outpatient cancer treatment, and approaches to monitoring symptoms vary widely across providers, patients, and clinical settings. To design a remote symptom monitoring system that patients and providers find to be useful, it may be helpful to understand current clinical approaches to monitoring and managing chemotherapy-related symptoms among patients and providers and assess how more frequent and systematic assessment and sharing of data could improve patient and provider experiences. Objective: The goals of this study were to learn about patient and provider perspectives on monitoring symptoms during chemotherapy, understand barriers and challenges to effective symptom monitoring at one institution, and explore the potential value of remote symptom monitoring between provider visits. Methods: A total of 15 patients who were currently undergoing or had recently completed chemotherapy and 7 oncology providers participated in semistructured interviews. Interviews were transcribed and coded using an iterative thematic analysis approach. The study was conducted at a National Cancer Institute–Designated Comprehensive Cancer Center. Results: Four main themes were discussed by patients and providers: (1) asynchronous nature of current methods for tracking and managing symptoms, (2) variability in reported symptoms due to patient factors, (3) limitations of existing communication channels, and (4) potential value of real-time remote symptom monitoring during chemotherapy. Current asynchronous methods and existing communication channels resulted in a disconnect between when symptoms are most severe and when conversations about symptoms happen, a situation further complicated by memory impairments during chemotherapy. Patients and providers both highlighted improvements in patient-provider communication as a potential benefit of remote real-time symptom monitoring. Providers also emphasized the value of temporal data regarding when symptoms first emerge and how they progress over time, as well as the potential value of concurrent activity or other data about daily activities and functioning. Patients noted that symptom monitoring could result in better preparation for subsequent treatment cycles. Conclusions: Both patients and providers highlighted significant challenges of asynchronous, patient-initiated, phone-dependent symptom monitoring and management. Oncology patients and providers reported that more routine remote monitoring of symptoms between visits could improve patient-provider communication, prepare patients for subsequent chemotherapy cycles, and facilitate provider insight and clinical decision-making with regard to symptom management. %M 37067857 %R 10.2196/46001 %U https://formative.jmir.org/2023/1/e46001 %U https://doi.org/10.2196/46001 %U http://www.ncbi.nlm.nih.gov/pubmed/37067857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41775 %T Comparison of Machine Learning Algorithms for Predicting Hospital Readmissions and Worsening Heart Failure Events in Patients With Heart Failure With Reduced Ejection Fraction: Modeling Study %A Ru,Boshu %A Tan,Xi %A Liu,Yu %A Kannapur,Kartik %A Ramanan,Dheepan %A Kessler,Garin %A Lautsch,Dominik %A Fonarow,Gregg %+ Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, 90095, United States, 1 310 206 9112, GFonarow@mednet.ucla.edu %K deep learning %K machine learning %K hospital readmission %K heart failure %K heart failure with reduced ejection fraction %K worsening heart failure event %K Bidirectional Encoder Representations From Transformers %K BERT %K clinical registry %K medical claims %K real-world data %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is highly prevalent in the United States. Approximately one-third to one-half of HF cases are categorized as HF with reduced ejection fraction (HFrEF). Patients with HFrEF are at risk of worsening HF, have a high risk of adverse outcomes, and experience higher health care use and costs. Therefore, it is crucial to identify patients with HFrEF who are at high risk of subsequent events after HF hospitalization. Objective: Machine learning (ML) has been used to predict HF-related outcomes. The objective of this study was to compare different ML prediction models and feature construction methods to predict 30-, 90-, and 365-day hospital readmissions and worsening HF events (WHFEs). Methods: We used the Veradigm PINNACLE outpatient registry linked to Symphony Health’s Integrated Dataverse data from July 1, 2013, to September 30, 2017. Adults with a confirmed diagnosis of HFrEF and HF-related hospitalization were included. WHFEs were defined as HF-related hospitalizations or outpatient intravenous diuretic use within 1 year of the first HF hospitalization. We used different approaches to construct ML features from clinical codes, including frequencies of clinical classification software (CCS) categories, Bidirectional Encoder Representations From Transformers (BERT) trained with CCS sequences (BERT + CCS), BERT trained on raw clinical codes (BERT + raw), and prespecified features based on clinical knowledge. A multilayer perceptron neural network, extreme gradient boosting (XGBoost), random forest, and logistic regression prediction models were applied and compared. Results: A total of 30,687 adult patients with HFrEF were included in the analysis; 11.41% (3184/27,917) of adults experienced a hospital readmission within 30 days of their first HF hospitalization, and nearly half (9231/21,562, 42.81%) of the patients experienced at least 1 WHFE within 1 year after HF hospitalization. The prediction models and feature combinations with the best area under the receiver operating characteristic curve (AUC) for each outcome were XGBoost with CCS frequency (AUC=0.595) for 30-day readmission, random forest with CCS frequency (AUC=0.630) for 90-day readmission, XGBoost with CCS frequency (AUC=0.649) for 365-day readmission, and XGBoost with CCS frequency (AUC=0.640) for WHFEs. Our ML models could discriminate between readmission and WHFE among patients with HFrEF. Our model performance was mediocre, especially for the 30-day readmission events, most likely owing to limitations of the data, including an imbalance between positive and negative cases and high missing rates of many clinical variables and outcome definitions. Conclusions: We predicted readmissions and WHFEs after HF hospitalizations in patients with HFrEF. Features identified by data-driven approaches may be comparable with those identified by clinical domain knowledge. Future work may be warranted to validate and improve the models using more longitudinal electronic health records that are complete, are comprehensive, and have a longer follow-up time. %M 37067873 %R 10.2196/41775 %U https://formative.jmir.org/2023/1/e41775 %U https://doi.org/10.2196/41775 %U http://www.ncbi.nlm.nih.gov/pubmed/37067873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40851 %T SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study %A Vos,Anne L %A de Bruijn,Gert-Jan %A Klein,Michel C A %A Lakerveld,Jeroen %A Boerman,Sophie C %A Smit,Edith G %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 0205253, a.l.vos@uva.nl %K cardiovascular disease %K physical activity %K walking %K smartphone %K mobile health %K mHealth %K mobile app %K behavior change techniques %K tailoring %K intervention development %K socioeconomic position %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools. Objective: To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp’s stepwise development and pilot evaluation process. Methods: We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants). Results: SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users’ behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp’s coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates. Conclusions: SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial. %M 37067890 %R 10.2196/40851 %U https://formative.jmir.org/2023/1/e40851 %U https://doi.org/10.2196/40851 %U http://www.ncbi.nlm.nih.gov/pubmed/37067890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41726 %T Co-design Tensions Between Parents, Children, and Researchers Regarding Mobile Health Technology Design Needs and Decisions: Case Study %A Yip,Jason %A Wong,Kelly %A Oh,Isabella %A Sultan,Farisha %A Roldan,Wendy %A Lee,Kung Jin %A Huh,Jimi %+ Ewha Womans University, Ewha-POSCO Building (Social Sciences) #509, Seoul, 120-750, Republic of Korea, 82 02 3277 2227, kungjinlee@ewha.ac.kr %K just-in-time adaptive intervention %K JITAI %K mobile health %K mHealth %K participatory design %K co-design %K children and families %K Black, Indigenous, and people of color %K BIPOC %K child-computer interaction %K design %K children %K mobile intervention %K intervention %K development %K mobile phone %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Just-in-time adaptive interventions (JITAIs) in mobile health are an intervention design that provides behavior change support based on an individual’s changing and dynamic contextual state. However, few studies have documented how end users of JITAI technologies are involved in their development, particularly from historically marginalized families and children. Less is known for public health researchers and designers of the tensions that occur as families negotiate their needs. Objective: We aimed to broaden our understanding of how historically marginalized families are included in co-design from a public health perspective. We sought to address research questions surrounding JITAIs; co-design; and working with historically marginalized families, including Black, Indigenous, and people of color (BIPOC) children and adults, regarding improving sun protection behaviors. We sought to better understand value tensions in parents’ and children’s needs regarding mobile health technologies and how design decisions are made. Methods: We examined 2 sets of co-design data (local and web-based) pertaining to a larger study on mobile SunSmart JITAI technologies with families in Los Angeles, California, United States, who were predominantly of Latinx and multiracial backgrounds. In these co-design sessions, we conducted stakeholder analysis through perceptions of harms and benefits and an assessment of stakeholder views and values. We open coded the data and compared the developed themes using a value-sensitive design framework by examining value tensions to help organize our qualitative data. Our study is formatted through a narrative case study that captures the essential meanings and qualities that are difficult to present, such as quotes in isolation. Results: We presented 3 major themes from our co-design data: different experiences with the sun and protection, misconceptions about the sun and sun protection, and technological design and expectations. We also provided value flow (opportunities for design), value dam (challenges to design), or value flow or dam (a hybrid problem) subthemes. For each subtheme, we provided a design decision and a response we ended up making based on what was presented and the kinds of value tensions we observed. Conclusions: We provide empirical data to show what it is like to work with multiple BIPOC stakeholders in the roles of families and children. We demonstrate the use of the value tension framework to explain the different needs of multiple stakeholders and technology development. Specifically, we demonstrate that the value tension framework helps sort our participants’ co-design responses into clear and easy-to-understand design guidelines. Using the value tension framework, we were able to sort the tensions between children and adults, family socioeconomic and health wellness needs, and researchers and participants while being able to make specific design decisions from this organized view. Finally, we provide design implications and guidance for the development of JITAI mobile interventions for BIPOC families. %M 37058350 %R 10.2196/41726 %U https://formative.jmir.org/2023/1/e41726 %U https://doi.org/10.2196/41726 %U http://www.ncbi.nlm.nih.gov/pubmed/37058350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44503 %T An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial %A Heffner,Jaimee L %A Kelly,Megan M %A Reilly,Erin D %A Reece,Scott G %A Claudio,Tracy %A Serfozo,Edit %A Baker,Kelsey %A Watson,Noreen L %A Karekla,Maria %+ Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232 PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K embodied agent %K tobacco cessation %K nicotine dependence %K mobile health %K mHealth %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Consequently, there is a great need for accessible, effective smoking cessation interventions for veterans at all levels of readiness to quit smoking. Objective: To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy program for veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial. Methods: Participants (N=49) were randomized 1:1 to receive either the Vet Flexiquit (n=25) or SmokefreeVET (n=24) web program. Both groups received SMS text messages as part of the intervention for 6 weeks. Both interventions are fully automated and self-guided. Primary outcome data were collected at 3 months after the randomization. Self-reported smoking abstinence was biochemically verified using saliva cotinine. Multivariable logistic regression, negative binomial regression, and linear regression models were used to evaluate the association between the treatment arm and outcomes of interest. Results: Acceptability, as measured by overall treatment satisfaction, was high and similar across treatment arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET. Acceptability, as measured by utilization, was more modest (log-ins: M=3.7 for Vet Flexiquit and M=3.2 for SmokefreeVET). There were no statistically significant differences between treatment arms for any acceptability measures. Similarly, there were no statistically significant differences between treatment arms in the secondary outcomes of smoking cessation or change in Acceptance and Commitment Therapy’s theory-based processes. In open-ended survey responses, some veterans in both treatment arms expressed interest in having support from a professional or peer to enhance their experience, as well as an expanded SMS text messaging program. Conclusions: Both programs had high ratings of acceptability, limited utilization, and a similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that the programs may have similar outcomes among veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the SMS text messaging program holds promise as a means of boosting engagement and outcomes for both programs. Trial Registration: ClinicalTrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524 %M 37058346 %R 10.2196/44503 %U https://formative.jmir.org/2023/1/e44503 %U https://doi.org/10.2196/44503 %U http://www.ncbi.nlm.nih.gov/pubmed/37058346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41211 %T Interest in Digital Peer-Delivered Interventions and Preferences to Improve Pain Self-efficacy and Reduce Loneliness Among Patients With Chronic Pain: Mixed Methods Co-design Study %A Yates,Eloise %A Buckley,Lisa %A Sterling,Michele %A Cruwys,Tegan %A Ashton-James,Claire E %A Rankin,Renee %A Elphinston,Rachel A %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, Surgical Treatment and Rehabilitation Service, 296 Herston Road, Herston, Brisbane, 4006, Australia, 61 412662084, rachelel@uq.edu.au %K chronic noncancer pain %K pain %K self-efficacy %K peer support %K peer-led intervention %K peer-led %K peer delivered %K peer intervention %K pain self-efficacy %K social connectedness %K social support %K loneliness %K lonely %K social isolation %K co-design %K participatory design %K qualitative research %K digital health %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Two important factors that prolong and exacerbate chronic noncancer pain (CNCP) and disability are low pain self-efficacy and loneliness. Yet, few interventions have shown long-term sustained improvements in pain self-efficacy, and there are no evidence-based treatments that target social connectedness in people living with CNCP. More effective and accessible interventions designed to target self-efficacy and social connectedness could ease the burden of CNCP. Objective: To co-design accessible interventions to increase pain self-efficacy, social connection, pain-related outcomes, and quality of life, this study explored patients’ interest and preferences for digital peer-delivered interventions for CNCP as well as implementation barriers and enablers. Methods: This cross-sectional mixed methods study was part of a larger longitudinal cohort study. Adult Australian residents (N=186) with CNCP diagnosed by a medical professional or pain specialist were included. Participants were initially recruited through advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions and their preferences for specific features (eg, Newsfeed). Pain self-efficacy and loneliness were assessed using validated questionnaires, and the association between these factors and interest in digital peer-delivered support was explored. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. Results: There was interest in accessing digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated an interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education, links to health services and resources, and delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: shared experience, social connection, and shared pain management solutions. Five potential barriers were identified: negative focus on pain, judgment, lack of engagement, negative impact on mental health, privacy and security concerns, and unmet personal preferences. Finally, there were 8 suggestions from participants: moderation of the group, interest subgroups, professional-led activities, psychological strategies, links to professional pain resources, newsletter, motivational content, live streaming, and online meetups. Conclusions: Digital peer-delivered interventions were of particular interest to those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study could guide further co-design and the development of such interventions. %M 37058351 %R 10.2196/41211 %U https://formative.jmir.org/2023/1/e41211 %U https://doi.org/10.2196/41211 %U http://www.ncbi.nlm.nih.gov/pubmed/37058351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38688 %T Improving Bystander Self-efficacy to Prevent Violence Against Women Through Interpersonal Communication Using Mobile Phone Entertainment Education: Randomized Controlled Trial %A Pant,Ichhya %A Kang,Bee-Ah %A Rimal,Rajiv %+ Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 404 461 9851, ipant@gwu.edu %K mHealth %K voice-response %K entertainment education %K rural %K bystander %K self-efficacy %K violence against women %K interpersonal communication %K violence %K women %K society %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Violence against women is a major challenge worldwide and in India. Patriarchal social and gender norms suppress disclosure of violence experienced by women. Stimulating interpersonal communication about a normatively stigmatized but prevalent topic could offer an avenue toward boosting bystander self-efficacy to intervene and prevent violence against women. Objective: In this study, to reduce violence against women as the distal goal, we adopted a two-pronged strategy grounded in Carey’s model of communication, approaching the issue in an incremental way. First, we aimed to explore whether the intervention promoted interpersonal communication about violence against women as an initial step. Second, we examined whether the intervention improved women’s self-efficacy to intervene when they witness violence in their community through interpersonal communication. Our model is based on the social cognitive theory that posits observational learning (ie, hearing about other women interfering to stop violence) fosters self-efficacy, a proxy for behavior change. Methods: We conducted a randomized controlled trial of women of reproductive age using a 2-arm study design embedded within a parent trial implemented in Odisha, India. In total, 411 participants were randomly assigned to the violence against women intervention arm or a control arm if they were active mobile phone owners and assigned to the treatment arm of the parent trial. Participants received 13 entertainment education episodes daily as phone calls. The intervention included program-driven, audience-driven, and responsive interaction strategies to facilitate the active engagement of participants. Audience-driven interactions were incorporated throughout the episodes using an interactive voice response system, which allowed participants to like or replay individual episodes through voice-recognition or touch-tone keypad. Our primary analysis involved a structural equation model with interpersonal communication as a potential mediator on the pathway between intervention exposure and bystander self-efficacy to prevent violence against women. Results: The findings from structural equation modeling demonstrated the significant mediating effect of interpersonal communication on the relationship between program exposure and bystander self-efficacy. Exposure was positively related to interpersonal communication (β=.21, SE=.05; z=4.31; P<.001) and bystander self-efficacy (β=.19, SE=.05; z=3.82; P<.001). Conclusions: Our results demonstrate participant engagement in interpersonal communication following exposure to a “light” entertainment education program with audio-only format via feature phones in rural settings can result in improved self-efficacy to prevent violence against women. This elevates the role of interpersonal communication as a mechanism of behavior change in mobile phone–based interventions, given that most entertainment education interventions tend to be mass media based. Our findings also show the potential of changing the environment where witnesses of violence deem it worthy of intervention and perceive higher efficacy to stop violence in the community, rather than putting the onus on the perpetrator, to prevent any counterproductive effects. Trial Registration: Clinical Trials Registry-India CTRI/2018/10/016186; https://tinyurl.com/bddp4txc %M 37058330 %R 10.2196/38688 %U https://formative.jmir.org/2023/1/e38688 %U https://doi.org/10.2196/38688 %U http://www.ncbi.nlm.nih.gov/pubmed/37058330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37358 %T A Web-Based Audio Computer-Assisted Self-interview Application With Illustrated Pictures to Administer a Hepatitis B Survey Among a Myanmar-Born Community in Perth, Australia: Development and User Acceptance Study %A Phoo,Nang Nge Nge %A Reid,Alison %A Lobo,Roanna %A Davies,Murray %A Vujcich,Daniel %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au %K audio computer-assisted self-interview %K ACASI %K audio computer %K survey mode %K application %K picture %K digital health %D 2023 %7 14.4.2023 %9 Early Reports %J JMIR Form Res %G English %X Background: Self-administered paper or electronic surveys can create accessibility issues for people with language barriers and limited literacy, whereas face-to-face interviews can create privacy issues and give rise to reporting biases, particularly in the context of sensitive subject matters. An audio computer-assisted self-interview (ACASI) offers an alternative mode of survey administration, and its use has been tested against other survey modes to determine whether the presence of a background narration helps overcome literacy and privacy issues. There are still gaps with the ACASI survey administration because audio narration alone does not assist respondents with limited literacy in choosing response options. To overcome literacy issues, a few studies have used illustrated pictures for a limited number of response options. Objective: This study aimed to illustrate all the questions and response options in an ACASI application. This research is part of a larger study comparing different modes of survey administration (ACASI, face-to-face interviews, and self-administered paper surveys) to collect data on hepatitis B knowledge, attitudes, and practices among the Myanmar-born community in Perth, Australia. This study describes the 2-phase process of developing a web-based ACASI application using illustrated pictures. Methods: The first phase was the preparation of the ACASI elements, such as questionnaire, pictures, brief descriptions of response options, and audio files. Each element was pretested on 20 participants from the target population. The second phase involved synchronizing all the elements into the web-based ACASI application and adapting the application features, in particular, autoplay audio and illustrated pictures. The preprototype survey application was tested for user acceptance on 5 participants from the target population, resulting in minor adjustments to the display and arrangement of response options. Results: After a 12-month development process, the prototype ACASI application with illustrated pictures was fully functional for electronic survey administration and secure data storage and export. Conclusions: Pretesting each element separately was a useful approach because it saved time to reprogram the application at a later stage. Future studies should also consider the participatory development of pictures and visual design of user interfaces. This picture-assisted ACASI survey administration mode can be further developed and used to collect sensitive information from populations that are usually marginalized because of literacy and language barriers. %M 37058345 %R 10.2196/37358 %U https://formative.jmir.org/2023/1/e37358 %U https://doi.org/10.2196/37358 %U http://www.ncbi.nlm.nih.gov/pubmed/37058345 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45913 %T Obstacles to Health Big Data Utilization Based on the Perceptions and Demands of Health Care Workers in South Korea: Web-Based Survey Study %A Lee,Yoon Heui %A Jang,Yu-Jin %A Lee,Soo-Kyoung %+ College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-Gu, Daegu, 42601, Republic of Korea, 82 53 258 7665, soo1005s@gmail.com %K demand %K health big data %K health care worker %K obstacles %K perception %K utilization %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: This study focuses on the potential of health big data in the South Korean context. Despite huge data reserves and pan-government efforts to increase data use, the utilization is limited to public interest research centered in public institutions that have data. To increase the use of health big data, it is necessary to identify and develop measures to meet the various demands for such data from individuals, private companies, and research institutes. Objective: The aim of this study was to identify the perceptions of and demands for health big data analysis and use among workers in health care–related occupations and to clarify the obstacles to the use of health big data. Methods: From May 8 to May 18, 2022, we conducted a web-based survey among 390 health care–related workers in South Korea. We used Fisher exact test and analysis of variance to estimate the differences among occupations. We expressed the analysis results by item in frequency and percentage and expressed the difficulties in analyzing health big data by mean and standard deviation. Results: The respondents who revealed the need to use health big data in health care work–related fields accounted for 86.4% (337/390); 65.6% (256/390) of the respondents had never used health big data. The lack of awareness about the source of the desired data was the most cited reason for nonuse by 39.6% (153/386) of the respondents. The most cited obstacle to using health big data by the respondents was the difficulty in data integration and expression unit matching, followed by missing value processing and noise removal. Thus, the respondents experienced the greatest difficulty in the data preprocessing stage during the health big data analysis process, regardless of occupation. Approximately 91.8% (358/390) of the participants responded that they were willing to use the system if a system supporting big data analysis was developed. As suggestions for the specific necessary support system, the reporting and provision of appropriate data and expert advice on questions arising during the overall process of big data analysis were mentioned. Conclusions: Our findings indicate respondents’ high awareness of and demand for health big data. Our findings also reveal the low utilization of health big data and the need to support health care workers in their analysis and use of such data. Hence, we recommend the development of a customized support system that meets the specific requirements of big data analysis by users such as individuals, nongovernmental agencies, and academia. Our study is significant because it identified important but overlooked failure factors. Thus, it is necessary to prepare practical measures to increase the utilization of health big data in the future. %M 37052992 %R 10.2196/45913 %U https://formative.jmir.org/2023/1/e45913 %U https://doi.org/10.2196/45913 %U http://www.ncbi.nlm.nih.gov/pubmed/37052992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42710 %T Online Health Information Seeking for Mpox in Endemic and Nonendemic Countries: Google Trends Study %A Shepherd,Thomas %A Robinson,Michelle %A Mallen,Christian %+ School of Medicine, Keele University, University Road, Staffordshire, ST5 5BG, United Kingdom, 44 1782 734758, t.a.shepherd1@keele.ac.uk %K monkeypox %K mpox %K infodemiology: surveillance %K public health %K health information seeking %K Google Trends %K joinpoint regression %K epidemic %K outbreak %K infectious disease %K disease %K online %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The recent global outbreak of mpox (monkeypox) has already been declared a public health emergency of international concern by the World Health Organization. Given the health, social, and economic impacts of the COVID-19 pandemic, there is understandable concern and anxiety around the emergence of another infectious disease—especially one about which little is known. Objective: We used Google Trends to explore online health information seeking patterns for mpox in endemic and nonendemic countries and investigated the impact of the publication of the first in-country case on internet search volume. Methods: Google Trends is a publicly accessible and free data source that aggregates worldwide Google search data. Google search data were used as a surrogate measure of online health information seeking for 178 days between February 18 and August 18, 2022. Searching data were downloaded across this time period for nonendemic countries with the highest case count (United States, Spain, Germany, United Kingdom, and France) and 5 endemic countries (Democratic Republic of Congo, Nigeria, Ghana, Central African Republic, and Cameroon). Joinpoint regression analysis was used to measure changes in searching trends for mpox preceding and following the announcement of the first human case. Results: Online health information seeking significantly increased after the publication of the first case in all the nonendemic countries—United States, Spain, Germany, United Kingdom, and France, as illustrated by significant joinpoint regression models. Joinpoint analysis revealed that models with 3 significant joinpoints were the most appropriate fit for these data, where the first joinpoint represents the initial rise in mpox searching trend, the second joinpoint reflects the start of the decrease in the mpox searching trend, and the third joinpoint represents searching trends’ return to searching levels prior to the first case announcement. Although this model was also found in 2 endemic countries (ie, Ghana and Nigeria), it was not found in Central African Republic, Democratic Republic of Congo, or Cameroon. Conclusions: Findings demonstrate a surge in online heath information seeking relating to mpox after the first in-country case was publicized in all the nonendemic countries and in Ghana and Nigeria among the endemic counties. The observed increases in mpox searching levels are characterized by sharp but short-lived periods of searching before steep declines back to levels observed prior to the publication of the first case. These findings emphasize the importance of the provision of accurate, relevant online public health information during disease outbreaks. However, online health information seeking behaviors only occur for a short time period, and the provision of accurate information needs to be timely in relation to the publication of new case-related information. %M 37052999 %R 10.2196/42710 %U https://formative.jmir.org/2023/1/e42710 %U https://doi.org/10.2196/42710 %U http://www.ncbi.nlm.nih.gov/pubmed/37052999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42418 %T A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs: Formative Research and Intervention Development %A Glick,Jennifer L %A Zhang,Leanne %A Rosen,Joseph G %A Yaroshevich,Karla %A Atiba,Bakari %A Pelaez,Danielle %A Park,Ju Nyeong %+ Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Suite 904A, Baltimore, MD, 21205, United States, 1 3603937426, jglick5@jhu.edu %K formative research %K harm reduction %K intervention development %K pre-exposure prophylaxis (PrEP) %K people who use drugs (PWUD) %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. Objective: We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. Methods: Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. Results: The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. Conclusions: This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide. %M 37052977 %R 10.2196/42418 %U https://formative.jmir.org/2023/1/e42418 %U https://doi.org/10.2196/42418 %U http://www.ncbi.nlm.nih.gov/pubmed/37052977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42224 %T Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App %A Dittrich,Florian %A Albrecht,Urs-Vito %A Scherer,Julian %A Becker,Sören L %A Landgraeber,Stefan %A Back,David Alexander %A Fessmann,Kai %A Haversath,Marcel %A Beck,Sascha %A Abbara-Czardybon,Mona %A Quitmann,Henning %A Harren,Anna Katharina %A Aitzetmüller,Matthias %A Klietz,Marie Luise %+ Department of Digital Medicine, Medical Faculty Ost-Westfalen-Lippe, Bielefeld University, Bielefeld, Germany, 49 521106867, urs-vito.albrecht@uni-bielefeld.de %K smartphone %K mHealth %K backend %K usability %K UX %K user experience %K mHealth %K mobile health %K health app %K mobile app %K app development %K no-code %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector—the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective: This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods: An end user–operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. %M 37052998 %R 10.2196/42224 %U https://formative.jmir.org/2023/1/e42224 %U https://doi.org/10.2196/42224 %U http://www.ncbi.nlm.nih.gov/pubmed/37052998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40671 %T Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavicius,Kasparas %A Jonusas,Justinas %+ KiloHealth, Antakalnio st. 17, Vilnius, LT 10312, Lithuania, 370 61456067, justinas.jonusas@kilo.health %K depression %K anxiety %K stress %K depressive %K DASS-21 %K mobile application %K CBT %K cognitive behavioral therapy %K psychotherapy %K mHealth %K mobile health %K Sensa %K app %K application %K health care %K intervention %K effectiveness %K assessment %K symptoms %K treatment %K mental health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)–based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. Objective: This study aims to analyze Sensa users’ retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. Methods: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. Results: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. Conclusions: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms. %M 37052990 %R 10.2196/40671 %U https://formative.jmir.org/2023/1/e40671 %U https://doi.org/10.2196/40671 %U http://www.ncbi.nlm.nih.gov/pubmed/37052990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39913 %T Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach %A Brown,Menna %A Lord,Emily %A John,Ann %+ Swansea University Medical School, Swansea University, Singleton park, Swansea, SA2 8PP, United Kingdom, 44 1792 606734, menna.brown@swansea.ac.uk %K participatory design %K well-being %K health promotion %K students %K young persons %K engagement %K participation %K web based %K intervention %K adherence %K digital health %K program %K lifestyle changes %K behavior changes %K acceptance %K mental health %K physical health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons’ mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses. Objective: This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years. Methods: A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2. Results: Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention. Conclusions: Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more. %M 37052994 %R 10.2196/39913 %U https://formative.jmir.org/2023/1/e39913 %U https://doi.org/10.2196/39913 %U http://www.ncbi.nlm.nih.gov/pubmed/37052994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45301 %T Digital Adherence Technologies and Mobile Money Incentives for Management of Tuberculosis Medication Among People Living With Tuberculosis: Mixed Methods Formative Study %A Musiimenta,Angella %A Tumuhimbise,Wilson %A Atukunda,Esther %A Mugaba,Aaron %A Linnemayr,Sebastian %A Haberer,Jessica %+ Faculty of Computing and Informatics, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda, 256 776820598, amusiimenta@must.ac.ug %K digital adherence technologies %K real-time monitoring %K SMS reminders %K mobile money %K financial incentives %K tuberculosis %K medication adherence %K user-centered approach %K mobile wallet %K support medication %K mobile phone %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although there is an increasing use of digital adherence technologies (DATs), such as real-time monitors and SMS reminders in tuberculosis medication adherence, suboptimal patient engagement with various DATs has been reported. Additionally, financial constraints can limit DAT’s utility. The perceived usefulness and the design mechanisms of DATs linked to mobile money financial incentives for tuberculosis medication management remain unclear. Objective: The aim of this study is to describe the perceived usefulness and design mechanisms for a DAT intervention called My Mobile Wallet, which is composed of real-time adherence monitors, SMS reminders, and mobile money incentives to support tuberculosis medication adherence in a low-income setting. Methods: This study used mixed methods approaches among persons with tuberculosis recruited from the Tuberculosis Clinic in the Mbarara Regional Referral Hospital. We purposively sampled 21 persons with tuberculosis aged 18 years and older, who owned cell phones and were able to use SMS text messaging interventions. We also enrolled 9 participants who used DATs in our previous study. We used focus group discussions with the 30 participants to solicit perceptions about the initial version of the My Mobile Wallet intervention, and then iteratively refined subsequent versions of the intervention following a user-centered design approach until the beta version of the intervention that suited their needs was developed. Surveys eliciting information about participants’ cell phone use and perceptions of the intervention were also administered. Content analysis was used to inductively analyze qualitative data to derive categories describing the perceived usefulness of the intervention, concerns, and design mechanisms. Stata (version 13; StataCorp) was used to analyze survey data. Results: Participants expressed the perceived usefulness of the My Mobile Wallet intervention in terms of being reminded to take medication, supported with transport to the clinic, and money to meet other tuberculosis medication–related costs, all of which were perceived to imply care, which could create a sense of connectedness to health care workers. This could consequently cause participants to develop a self-perceived need to prove their commitment to adherence to health care workers who care for them, thereby motivating medication adherence. For fear of unintended tuberculosis status disclosure, 20 (67%) participants suggested using SMS language that is confidential—not easily related to tuberculosis. To reduce the possibilities of using the money for other competing demands, 25 (83%) participants preferred sending the money 1-2 days before the appointment to limit the time lag between receiving the money and visiting the clinic. Conclusions: DATs complemented with mobile money financial incentives could potentially provide acceptable approaches to remind, support, and motivate patients to adhere to taking their tuberculosis medication. Trial Registration: ClinicalTrials.gov NCT05656287; https://clinicaltrials.gov/ct2/show/NCT05656287 %M 37043263 %R 10.2196/45301 %U https://formative.jmir.org/2023/1/e45301 %U https://doi.org/10.2196/45301 %U http://www.ncbi.nlm.nih.gov/pubmed/37043263 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41018 %T Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment %A Son,Changwon %A Hegde,Sudeep %A Markert,Carl %A Zahed,Karim %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mental health %K health coaching %K stress %K biofeedback %K mHealth %K mobile apps %K breathing exercises %K students %K veterans %K COVID-19 %K vulnerable population %K college student %K self-management %K mobile health app %K psychological well-being %K digital health intervention %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health is an increasing concern among vulnerable populations, including college students and veterans. Objective: The purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. Methods: This study evaluated the mobile app “Biofeedback” that provided health coaching on stress self-management for college student veterans’ mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. Results: The deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants’ heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient –0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. Conclusions: Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. %M 36952560 %R 10.2196/41018 %U https://formative.jmir.org/2023/1/e41018 %U https://doi.org/10.2196/41018 %U http://www.ncbi.nlm.nih.gov/pubmed/36952560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45970 %T Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study %A Braun,Pia %A Atik,Ece %A Guthardt,Lisa %A Apolinário-Hagen,Jennifer %A Schückes,Magnus %+ Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany, 49 211 8106477, jennifer.apolinario.hagen@hhu.de %K digital therapeutics %K blended cognitive behavioral therapy %K bCBT %K depression %K anxiety %K acceptance %K user experiences %K university students %K mobile phone %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended cognitive behavioral therapy (bCBT) programs have been proposed to increase the acceptance and adoption of digital therapeutics (DTx) such as digital health apps. These programs allow for more personalized care by combining regular face-to-face therapy sessions with DTx. However, facilitators of and barriers to the use of DTx in bCBT programs have rarely been examined among students, who are particularly at risk for developing symptoms of depression and anxiety disorders. Objective: This study aimed to evaluate the facilitators of and barriers to the use of a bCBT program with the elona therapy app among university students with mild to moderate depression or anxiety symptoms. Methods: Semistructured interviews were conducted via videoconference between January 2022 and April 2022 with 102 students (mean age 23.93, SD 3.63 years; 89/102, 87.2% female) from universities in North Rhine-Westphalia, Germany, after they had completed weekly individual cognitive behavioral therapy sessions (25 minutes each) via videoconference for 6 weeks and regularly used the depression (n=67, 65.7%) or anxiety (n=35, 34.3%) module of the app. The interviews were coded based on grounded theory. Results: Many participants highlighted the intuitive handling of the app and indicated that they perceived it as a supportive tool between face-to-face sessions. Participants listed other benefits, such as increased self-reflection and disorder-specific knowledge as well as the transfer of the content of therapy sessions into their daily lives. Some stated that they would have benefited from more personalized and interactive tasks. In general, participants mentioned the time requirement, increased use of the smartphone, and the feeling of being left alone with potentially arising emotions while working on tasks for the next therapy session as possible barriers to the use of the app. Data security was not considered a major concern. Conclusions: Students mostly had positive attitudes toward elona therapy as part of the bCBT program. Our study shows that DTx complementing face-to-face therapy sessions can be perceived as a helpful tool for university students with mild to moderate anxiety or depression symptoms in their daily lives. Future research could elaborate on whether bCBT programs might also be suitable for students with more severe symptoms of mental disorders. In addition, the methods by which such bCBT programs could be incorporated into the university context to reach students in need of psychological support should be explored. %M 37043272 %R 10.2196/45970 %U https://formative.jmir.org/2023/1/e45970 %U https://doi.org/10.2196/45970 %U http://www.ncbi.nlm.nih.gov/pubmed/37043272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41223 %T Novel Note Templates to Enhance Signal and Reduce Noise in Medical Documentation: Prospective Improvement Study %A Feldman,Jonah %A Goodman,Adam %A Hochman,Katherine %A Chakravartty,Eesha %A Austrian,Jonathan %A Iturrate,Eduardo %A Bosworth,Brian %A Saxena,Archana %A Moussa,Marwa %A Chenouda,Dina %A Volpicelli,Frank %A Adler,Nicole %A Weisstuch,Joseph %A Testa,Paul %+ Department of Medicine, NYU Langone Health, 550 1st avenue, New York, NY, 10016, United States, 1 (212) 263 5800, eesha.chakravartty@nyulangone.org %K medical informatics %K decision support %K hospital data %K clinical documentation %K clinical informatics %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The introduction of electronic workflows has allowed for the flow of raw uncontextualized clinical data into medical documentation. As a result, many electronic notes have become replete of “noise” and deplete clinically significant “signals.” There is an urgent need to develop and implement innovative approaches in electronic clinical documentation that improve note quality and reduce unnecessary bloating. Objective: This study aims to describe the development and impact of a novel set of templates designed to change the flow of information in medical documentation. Methods: This is a multihospital nonrandomized prospective improvement study conducted on the inpatient general internal medicine service across 3 hospital campuses at the New York University Langone Health System. A group of physician leaders representing each campus met biweekly for 6 months. The output of these meetings included (1) a conceptualization of the note bloat problem as a dysfunction in information flow, (2) a set of guiding principles for organizational documentation improvement, (3) the design and build of novel electronic templates that reduced the flow of extraneous information into provider notes by providing link outs to best practice data visualizations, and (4) a documentation improvement curriculum for inpatient medicine providers. Prior to go-live, pragmatic usability testing was performed with the new progress note template, and the overall user experience was measured using the System Usability Scale (SUS). Primary outcome measures after go-live include template utilization rate and note length in characters. Results: In usability testing among 22 medicine providers, the new progress note template averaged a usability score of 90.6 out of 100 on the SUS. A total of 77% (17/22) of providers strongly agreed that the new template was easy to use, and 64% (14/22) strongly agreed that they would like to use the template frequently. In the 3 months after template implementation, general internal medicine providers wrote 67% (51,431/76,647) of all inpatient notes with the new templates. During this period, the organization saw a 46% (2768/6191), 47% (3505/7819), and 32% (3427/11,226) reduction in note length for general medicine progress notes, consults, and history and physical notes, respectively, when compared to a baseline measurement period prior to interventions. Conclusions: A bundled intervention that included the deployment of novel templates for inpatient general medicine providers significantly reduced average note length on the clinical service. Templates designed to reduce the flow of extraneous information into provider notes performed well during usability testing, and these templates were rapidly adopted across all hospital campuses. Further research is needed to assess the impact of novel templates on note quality, provider efficiency, and patient outcomes. %M 36821760 %R 10.2196/41223 %U https://formative.jmir.org/2023/1/e41223 %U https://doi.org/10.2196/41223 %U http://www.ncbi.nlm.nih.gov/pubmed/36821760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40077 %T Examining Recruitment Strategies in the Enrollment Cascade of Youth Living With HIV: Descriptive Findings From a Nationwide Web-Based Adherence Protocol %A Gurung,Sitaji %A Jones,Stephen Scott %A Mehta,Kripa %A Budhwani,Henna %A MacDonell,Karen %A Belzer,Marvin %A Naar,Sylvie %+ Department of Health Sciences, New York City College of Technology, The City University of New York, 285 Jay Street, A811F, Brooklyn, NY, 11201, United States, 1 718 260 5673, Sitaji.Gurung65@citytech.cuny.edu %K recruitment methods %K enrollment challenges %K digital technology %K adherence protocol %K youth living with HIV %K COVID-19 %D 2023 %7 12.4.2023 %9 Early Reports %J JMIR Form Res %G English %X Background: Digital strategies and broadened eligibility criteria may optimize the enrollment of youth living with HIV in mobile health adaptive interventions. Prior research suggests that digital recruitment strategies are more efficient than traditional methods for overcoming enrollment challenges of youth living with HIV in the United States. Objective: This study highlights the challenges and strategies that explain screening and enrollment milestones in a national web-based adherence protocol for youth living with HIV. Methods: Baseline data from a national web-based HIV adherence protocol for youth living with HIV, collected from July 2018 to February 2021, were analyzed. A centralized recruitment procedure was developed, which used web-based recruitment via Online Master Screener; paid targeted advertisements on social media platforms (eg, Facebook and Reddit) and geosocial networking dating apps (eg, Grindr and Jack’d); and site and provider referrals from Subject Recruitment Venues and other AIDS service organizations, website referrals, and text-in recruitment. Results: A total of 3 distinct cohorts of youth living with HIV were identified, marked by changes in recruitment strategies. Overall, 3270 individuals consented to screening, 2721 completed screening, 581 were eligible, and 83 completed enrollment. We examined sociodemographic and behavioral differences in completing milestones from eligibility to full enrollment (ie, submitting antiretroviral therapy and viral load data and completing the baseline web-based survey). Those with the most recent viral load tests >6 months ago were half as likely to enroll (odds ratio 0.45, 95% CI 0.21-0.94). Moreover, eligible participants with self-reported antiretroviral therapy adherence (SRA) between 50% and 80% were statistically significant (P<.001 to P=.03) and more likely to enroll than those with SRA >80%. Conclusions: The findings add to our knowledge on the use of digital technologies for youth living with HIV before and during the COVID-19 pandemic and provide insight into the impact of expanding eligibility criteria on enrollment. As the COVID-19 pandemic continues and the use of and engagement with social media and dating apps among youth living with HIV changes, these platforms should continue to be investigated as potential recruitment tools. Using a wide variety of recruitment strategies such as using social media and dating apps as well as provider referral mechanisms, increasing compensation amounts, and including SRA in enrollment criteria should continue to be studied with respect to their ability to successfully recruit and enroll eligible participants. International Registered Report Identifier (IRRID): RR2-10.2196/11183 %M 36745773 %R 10.2196/40077 %U https://formative.jmir.org/2023/1/e40077 %U https://doi.org/10.2196/40077 %U http://www.ncbi.nlm.nih.gov/pubmed/36745773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35112 %T Developing a Digital Medication Adherence Intervention for and With Patients With Asthma and Low Health Literacy: Protocol for a Participatory Design Approach %A Faber,Jasper S %A Poot,Charlotte C %A Dekkers,Tessa %A Romero Herrera,Natalia %A Chavannes,Niels H %A Meijer,Eline %A Visch,V T %+ Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 640850881, j.s.faber@tudelft.nl %K participatory design %K low health literacy %K eHealth %K medication adherence %K asthma %K mHealth %K health literacy %K participatory medicine %K health care %K medication %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Current eHealth interventions are poorly adopted by people with low health literacy (LHL) as they often fail to meet their needs, skills, and preferences. A major reason for this poor adoption is the generic, one-size-fits-all approach taken by designers of these interventions, without addressing the needs, skills, and preferences of disadvantaged groups. Participatory design approaches are effective for developing interventions that fit the needs of specific target groups; yet, very little is known about the practical implications of executing a participatory design project for and with people with LHL. Objective: This study aimed to demonstrate the application of participatory design activities specifically selected to fit the needs and skills of people with LHL and how these were manifested within an overarching eHealth design process. In addition, the study aims to present reflections and implications of these activities that could support future designers to engage people with LHL in their design processes. Methods: We used the design process of a smart asthma inhaler for people with asthma and LHL to demonstrate participatory design activities. The study was framed under 5 stages of design thinking: empathize, define, ideate, prototype, and test within 2 major iteration cycles. We integrated 3 participatory design activities deemed specifically appropriate for people with LHL: co-constructing stories, experience prototype exhibition, and video prototype evaluation. Results: Co-constructing stories was found to deepen the understanding of the participant’s motivation to use or not to use maintenance medication. This understanding informed and facilitated the subsequent development of diverse preliminary prototypes of possible interventions. Discussing these prototypes in the experience prototype exhibition helped provoke reactions, thoughts, and feelings about the interventions, and potential scenarios of use. Through the video prototype evaluation, we were able to clearly communicate the goal and functionality of the final version of our intervention and gather appropriate responses from our participants. Conclusions: This study demonstrates a participatory design approach for and with patients with asthma and LHL. We demonstrated that careful consideration and selection of activities can result in participants that are engaged and feel understood. This paper provides insight into the practical implications of participatory activities with people with LHL and supports and inspires future designers to engage with this disadvantaged target group. %M 37043260 %R 10.2196/35112 %U https://formative.jmir.org/2023/1/e35112 %U https://doi.org/10.2196/35112 %U http://www.ncbi.nlm.nih.gov/pubmed/37043260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43738 %T Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial %A Coteur,Kristien %A Van Nuland,Marc %A Schoenmakers,Birgitte %A Anthierens,Sibyl %A Van den Broeck,Kris %+ Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium, 32 16194265, kristien.coteur@kuleuven.be %K benzodiazepines %K long-term use %K deprescriptions %K deprescribing %K telemedicine %K general practice %K insomnia %K cognitive behavioral therapy %K eHealth %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term use of benzodiazepine receptor agonists (BZRAs) remains common despite European guidelines advising that these drugs be used in the lowest possible dose and for the shortest possible duration. Half of all BZRAs are prescribed in family practice. This creates a window of opportunity for discontinuation in primary care. Therefore, the effectiveness of blended care for the discontinuation of long-term BZRA use in adult primary care patients with chronic insomnia disorder was tested in a multicenter, pragmatic, and cluster randomized controlled superiority trial in Belgium. In the literature, information on implementing blended care in a primary care setting is scarce. Objective: The study aimed to contribute to a framework for the successful implementation of blended care in a primary care setting by increasing our understanding of this complex intervention through an evaluation of e-tool use and views and ideas of participants in a BZRA discontinuation trial. Methods: Based on a theoretical framework, this study evaluated the processes of recruitment, delivery, and response using 4 components: a survey on recruitment (n=76), semistructured in-depth interviews with patients (n=18), web-based asynchronous focus groups with general practitioners (GPs; n=19), and usage data of the web-based tool. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: For recruitment, the most common barriers were refusal by the patient and the lack of digital literacy, while facilitators were starting the conversation and the curiosity of patients. The delivery of the intervention to the patients was diverse, ranging from GPs who never informed the patient about their access to the e-tool to GPs consulting the e-tool in between consultations to have discussion points when the patient visited. Concerning response, patients’ and GPs’ narratives also showed much variety. For some GPs, daily practice changed because they received more positive reactions than expected and felt empowered to talk more often about BZRA discontinuation. Conversely, some GPs reported no changes in practice or among patients. In general, patients found follow-up by an expert to be the most important component in blended care, whereas GPs deemed the intrinsic motivation of patients to be the key element of success. An important barrier to implementation by the GP was time. Conclusions: Overall, the participants who had used the e-tool were positive about its structure and content. Nevertheless, many patients desired a more tailored application with feedback from an expert and personal tapering schedules. Strict pragmatic implementation of blended care seems to only reach GPs with an interest in digitalization. Although not superior to usual care, blended care could be a complementary tool that allows tailoring the discontinuation process to the personal style of the GP and the needs of the patient. Trial Registration: ClinicalTrials.gov NCT03937180; https://clinicaltrials.gov/ct2/show/NCT03937180 %M 37027198 %R 10.2196/43738 %U https://formative.jmir.org/2023/1/e43738 %U https://doi.org/10.2196/43738 %U http://www.ncbi.nlm.nih.gov/pubmed/37027198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43115 %T Mental Health Practitioners’ and Young People’s Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study %A Derges,Jane %A Bould,Helen %A Gooberman-Hill,Rachael %A Moran,Paul %A Linton,Myles-Jay %A Rifkin-Zybutz,Raphael %A Biddle,Lucy %+ Population Health Sciences, Bristol University Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 0117 455 6004, jd13527@bristol.ac.uk %K young people %K digital technology and social media %K mental health consultations %K clinician and young people’s experiences %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing concerns among mental health care professionals have focused on the impact of young people’s use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. Objective: This study aimed to explore mental health practitioners’ and young people’s experiences of talking about young people’s web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. Methods: A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people’s mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. Results: Practitioners and young people agreed that talking about young people’s web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. Conclusions: Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners’ desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety. %M 37027182 %R 10.2196/43115 %U https://formative.jmir.org/2023/1/e43115 %U https://doi.org/10.2196/43115 %U http://www.ncbi.nlm.nih.gov/pubmed/37027182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42207 %T Time Spent on Instagram and Body Image, Self-esteem, and Physical Comparison Among Young Adults in Spain: Observational Study %A Alfonso-Fuertes,Isabel %A Alvarez-Mon,Miguel Angel %A Sanchez del Hoyo,Rafael %A Ortega,Miguel A %A Alvarez-Mon,Melchor %A Molina-Ruiz,Rosa M %+ Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario, C/ 19, Av de Madrid, Km 33,600, Alcala de Henares, 28871, Spain, 34 918854505, maalvarezdemon@icloud.com %K Instagram %K self-esteem %K body image %K physical comparison %K young adults %K social media %K assessment %K tool %K questionnaire %K satisfaction %K physical appearance %K usage %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Instagram is a social media platform based on photos and videos that encourages interaction and comparison between users. Its growing popularity, especially among young people, has generated interest in the impact its use can have on users´ mental health, specifically on their self-esteem and degree of satisfaction with their own body image. Objective: We aimed to analyze the relationships between the use of Instagram, both the hours of daily use and the type of content viewed, and self-esteem, tendency to make physical comparisons, and satisfaction with body image. Methods: In this cross-sectional study, we recruited 585 participants aged between 18 years and 40 years. Individuals who were interested in participating but had a personal history of eating disorders or had previously been diagnosed with a psychiatric disorder were excluded. The assessment tools consisted of (1) a questionnaire that collected sociodemographic data and Instagram use variables and was created by the research team specifically for this study; (2) the self-esteem scale by Rosenberg; (3) Physical Appearance Comparison Scale-Revised (PACS-R); and (4) Body Shape Questionnaire (BSQ). The recruitment and evaluation processes were carried out in January 2021. Results: Of the participants, 234 (234/585, 40%) used Instagram less than 1 hour a day, 303 (303/585, 51.8%) used Instagram between 1 hour and 3 hours a day, and 48 participants (48/585, 8.2%) used it more than 3 hours per day. We found statistically significant differences (P<.05) between the 3 groups in the scores obtained on the self-esteem test by Rosenberg, PACS-R, and BSQ. Participants who spent more time on Instagram had higher levels of body dissatisfaction, greater comparisons of physical appearance, and lower self-esteem. Moreover, we analyzed the relationship between the score obtained on the different scales and the types of content viewed, with no differences between those who mainly viewed professional content and those who primarily consumed fashion and beauty or sport and nutrition content. Conclusions: The results of this study indicate that the use of Instagram is associated with poorer body image satisfaction and self-esteem, mediated by the tendency to compare physical appearance in relation to the daily duration of Instagram use. %M 37027197 %R 10.2196/42207 %U https://formative.jmir.org/2023/1/e42207 %U https://doi.org/10.2196/42207 %U http://www.ncbi.nlm.nih.gov/pubmed/37027197 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42087 %T Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study %A Ha,Jaeyoung %A Park,Jungmi %A Lee,Sangyi %A Lee,Jeong %A Choi,Jin-Young %A Kim,Junhyoung %A Cho,Sung-il %A Jeon,Gyeong-Suk %+ Department of Nursing, Mokpo National University, 1666 Yeongsan-ro, Dorim-ri, Cheonggye-myeon, Muan, 58554, Republic of Korea, 82 61 450 2675, gsj64@naver.com %K wearable health devices %K HBM %K UTAUT2 %K habitual use %K metabolic syndrome %K wearables %K digital intervention %K health promotion %K predictors of use %K acceptability %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prevention of the risk factors for metabolic syndrome (MetS) in middle-aged individuals is an important public health issue. Technology-mediated interventions, such as wearable health devices, can aid in lifestyle modification, but they require habitual use to sustain healthy behavior. However, the underlying mechanisms and predictors of habitual use of wearable health devices among middle-aged individuals remain unclear. Objective: We investigated the predictors of habitual use of wearable health devices among middle-aged individuals with risk factors for MetS. Methods: We proposed a combined theoretical model based on the health belief model, the Unified Technology of Acceptance and Use of Technology 2, and perceived risk. We conducted a web-based survey of 300 middle-aged individuals with MetS between September 3 and 7, 2021. We validated the model using structural equation modeling. Results: The model explained 86.6% of the variance in the habitual use of wearable health devices. The goodness-of-fit indices revealed that the proposed model has a desirable fit with the data. Performance expectancy was the core variable explaining the habitual use of wearable devices. The direct effect of the performance expectancy on habitual use of wearable devices was greater (β=.537, P<.001) than that of intention to continue use (β=.439, P<.001), and the total effect estimate of the performance expectancy was 0.909 (P<.001), including the indirect effect (β=.372, P=.03) on habitual use of wearable devices via intention to continue use. Furthermore, performance expectancy was influenced by health motivation (β=.497, P<.001), effort expectancy (β=.558, P<.001), and risk perception (β=.137, P=.02). Perceived vulnerability (β=.562, P<.001) and perceived severity (β=.243, P=.008) contributed to health motivation. Conclusions: The results suggest the importance of the users’ performance expectations for wearable health devices for the intention of continued use for self-health management and habituation. Based on our results, developers and health care practitioners should find better ways to meet the performance expectations of middle-aged individuals with MetS risk factors. They also should generate device use easier and find a way to encourage users’ health motivation, thereby reducing users’ effort expectancy and resulting in a reasonable performance expectancy of the wearable health device, to induce users’ habitual use behaviors. %M 37023419 %R 10.2196/42087 %U https://formative.jmir.org/2023/1/e42087 %U https://doi.org/10.2196/42087 %U http://www.ncbi.nlm.nih.gov/pubmed/37023419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40509 %T Digital Intervention Barriers Scale–7 (DIBS-7): Development, Evaluation, and Preliminary Validation %A Ramos,Giovanni %A Montoya,Amanda Kay %A Hammons,Hayley Renee %A Smith,Danielle %A Chavira,Denise April %A Rith-Najarian,Leslie Rose %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, United States, 1 7865642448, gioramos@ucla.edu %K barriers %K development %K digital mental health intervention %K measure %K psychometrics %K scale %K validation %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The translation of mental health services into digital formats, deemed digital mental health interventions (DMHIs), has the potential to address long-standing obstacles to accessing care. However, DMHIs have barriers of their own that impact enrollment, adherence, and attrition in these programs. Unlike in traditional face-to-face therapy, there is a paucity of standardized and validated measures of barriers in DMHIs. Objective: In this study, we describe the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale-7 (DIBS-7). Methods: Following an iterative QUAN → QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n=259) who completed a DMHI trial for anxiety and depression and identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 treatment completers (mean age 23.02 years; 438/559, 78.4% female; 374/559, 69.9% racially or ethnically minoritized). Exploratory factor analyses and confirmatory factor analyses were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs. Results: Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α=.82, ω=0.89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr=–0.25), number of modules with activity (pr=–0.55), number of weekly check-ins (pr=–0.28), and treatment satisfaction (pr=–0.71). Conclusions: Overall, these results provide preliminary support for the use of the DIBS-7 as a potentially useful short scale for clinicians and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs. %M 37023417 %R 10.2196/40509 %U https://formative.jmir.org/2023/1/e40509 %U https://doi.org/10.2196/40509 %U http://www.ncbi.nlm.nih.gov/pubmed/37023417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43165 %T Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis %A Monteiro,Maristela Goldnadel %A Pantani,Daniela %A Pinsky,Ilana %A Hernandes Rocha,Thiago Augusto %+ Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2029743108, monteirm@paho.org %K alcohol use %K alcohol risk assessment %K digital health worker %K artificial intelligence %K health literacy %K digital health %K chatbot %K misinformation %K online health information %K digital health education %K alcohol use %K health risk %K COVID-19 %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective: This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods: The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results: The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions: Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people. %M 36961920 %R 10.2196/43165 %U https://formative.jmir.org/2023/1/e43165 %U https://doi.org/10.2196/43165 %U http://www.ncbi.nlm.nih.gov/pubmed/36961920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42346 %T Characterizing e-Cigarette–Related Videos on TikTok: Observational Study %A Xie,Zidian %A Xue,Siyu %A Gao,Yankun %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarette %K TikTok %K video %K provaping %K antivaping %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As a popular social networking platform for sharing short videos, TikTok has been widely used for sharing e-cigarettes or vaping-related videos, especially among the youth. Objective: This study aims to characterize e-cigarette or vaping-related videos and their user engagement on TikTok through descriptive analysis. Methods: From TikTok, a total of 417 short videos, posted between October 4, 2018, and February 27, 2021, were collected using e-cigarette or vaping-related hashtags. Two human coders independently hand-coded the video category and the attitude toward vaping (provaping or antivaping) for each vaping-related video. The social media user engagement measures (eg, the comment count, like count, and share count) for each video category were compared within provaping and antivaping groups. The user accounts posting these videos were also characterized. Results: Among 417 vaping-related TikTok videos, 387 (92.8%) were provaping, and 30 (7.2%) were antivaping videos. Among provaping TikTok videos, the most popular category is vaping tricks (n=107, 27.65%), followed by advertisement (n=85, 21.95%), customization (n=75, 19.38%), TikTok trend (n=70, 18.09%), others (n=44, 11.37%), and education (n=6, 1.55%). By comparison, videos showing the TikTok trend had significantly higher user engagement (like count per video) than other provaping videos. Antivaping videos included 15 (50%) videos with the TikTok trend, 10 (33.33%) videos on education, and 5 (16.67%) videos about others. Videos with education have a significantly lower number of likes than other antivaping videos. Most TikTok users posting vaping-related videos are personal accounts (119/203, 58.62%). Conclusions: Vaping-related TikTok videos are dominated by provaping videos focusing on vaping tricks, advertisement, customization, and TikTok trend. Videos with the TikTok trend have higher user engagement than other video categories. Our findings provide important information on vaping-related videos shared on TikTok and their user engagement levels, which might provide valuable guidance on future policy making, such as possible restrictions on provaping videos posted on TikTok, as well as how to effectively communicate with the public about the potential health risks of vaping. %M 37018026 %R 10.2196/42346 %U https://formative.jmir.org/2023/1/e42346 %U https://doi.org/10.2196/42346 %U http://www.ncbi.nlm.nih.gov/pubmed/37018026 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45920 %T Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study %A Hjorth-Johansen,Elin %A Børøsund,Elin %A Martinsen Østen,Ingeborg %A Holmstrøm,Henrik %A Moen,Anne %+ Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, E2 4th Floor, Sognsvannsveien 20, Oslo, 0372, Norway, 47 98676884, ehjorth@ous-hf.no %K congenital heart disease %K readiness for discharge %K mobile app %K follow-up, health services %K mHealth %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents’ understanding and management of their child’s condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant’s primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents’ receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an “everyday app” and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals’ attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant’s condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents’ receptivity. By doing so, parents may be confident to know what to look for regarding their child’s health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. %M 37018028 %R 10.2196/45920 %U https://formative.jmir.org/2023/1/e45920 %U https://doi.org/10.2196/45920 %U http://www.ncbi.nlm.nih.gov/pubmed/37018028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43823 %T The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a “No-Code” Mobile App Builder: Development and Usability Study %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mobile health %K mHealth %K usability study %K financial incentive %K physical activity %K mobile phone %K smartphone %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive–driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the “no-code” app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. %M 37018038 %R 10.2196/43823 %U https://formative.jmir.org/2023/1/e43823 %U https://doi.org/10.2196/43823 %U http://www.ncbi.nlm.nih.gov/pubmed/37018038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42782 %T Susceptibility to Breast Cancer Misinformation Among Chinese Patients: Cross-sectional Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %A Xu,Xiaofei %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Camperdown, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K susceptibility %K breast cancer misinformation %K Chinese patients %K logistic regression %K predicting factors %K cancer %K misinformation %K China %K breast cancer %K policy %K age %K gender %K education %K literacy %K clinical %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect. Objective: This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making. Methods: We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the “Internal” subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients. Results: All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between “knowing a lot” and “knowing some.” The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients’ health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients’ limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence. Conclusions: Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making. %M 37018020 %R 10.2196/42782 %U https://formative.jmir.org/2023/1/e42782 %U https://doi.org/10.2196/42782 %U http://www.ncbi.nlm.nih.gov/pubmed/37018020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41269 %T Comparative Performance Evaluation of the Public Health Surveillance Systems in 6 Gulf Cooperation Countries: Cross-sectional Study %A Albali,Nawaf %A Almudarra,Sami %A Al-Farsi,Yahya %A Alarifi,Abdullah %A Al Wahaibi,Adil %A Penttinen,Pasi %+ Health & Public Sector, Accenture Saudi Arabia, 2412 Airport Road, Business Gate Complex, Riyadh, 11616, Saudi Arabia, 966 563673334, nawaf.albali@gmail.com %K Gulf Cooperation Council %K surveillance systems %K program evaluation %K performance evaluation %K disease monitoring %K emerging technologies %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Evaluating public health surveillance systems is important to ensure that events of public health importance are appropriately monitored. Evaluation studies based on the Centers for Disease Control and Prevention (CDC) guidelines have been used to appraise surveillance systems globally. Previous evaluation studies undertaken in member countries of the Gulf Cooperation Council (GCC) were limited to specific illnesses within a single nation. Objective: We aimed to evaluate public health surveillance systems in GCC countries using CDC guidelines and recommend necessary improvements to enhance these systems. Methods: The CDC guidelines were used for evaluating the surveillance systems in GCC countries. A total of 6 representatives from GCC countries were asked to rate 43 indicators across the systems’ level of usefulness, simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, data quality, stability, and timeliness. Descriptive data analysis and univariate linear regression analysis were performed. Results: All surveillance systems in the GCC covered communicable diseases, and approximately two-thirds (4/6, 67%, 95% CI 29.9%-90.3%) of them covered health care–associated infections. The mean global score was 147 (SD 13.27). The United Arab Emirates scored the highest in the global score with a rating of 167 (83.5%, 95% CI 77.7%-88.0%), and Oman obtained the highest scores for usefulness, simplicity, and flexibility. Strong correlations were observed between the global score and the level of usefulness, flexibility, acceptability, representativeness, and timeliness, and a negative correlation was observed between stability and timeliness score. Disease coverage was the most substantial predictor of the GCC surveillance global score. Conclusions: GCC surveillance systems are performing optimally and have shown beneficial outcomes. GCC countries must use the lessons learned from the success of the systems of the United Arab Emirates and Oman. To maintain GCC surveillance systems so that they are viable and adaptable to future potential health risks, measures including centralized information exchange, deployment of emerging technologies, and system architecture reform are necessary. %M 37018033 %R 10.2196/41269 %U https://formative.jmir.org/2023/1/e41269 %U https://doi.org/10.2196/41269 %U http://www.ncbi.nlm.nih.gov/pubmed/37018033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43041 %T Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study %A Cunningham-Erves,Jennifer %A Wilkins,Consuelo H %A Dempsey,Amanda F %A Jones,Jessica L %A Thompson,Chris %A Edwards,Kathryn %A Davis,Megan %A Mayberry,Lindsay S %A Landsittal,Douglas %A Hull,Pamela C %+ Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States, 1 6153275692, jerves@mmc.edu %K human papillomavirus %K HPV %K vaccine %K hesitancy %K parent-child communication %K theory %K mobile health %K mHealth %K adolescents %K patient education %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers’ limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone–based, family-focused intervention guided by theory to address concerns of HPV vaccine–hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine–hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine–hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents’ corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child’s physician, and an optional adolescents’ corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine–hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies). %M 37014680 %R 10.2196/43041 %U https://formative.jmir.org/2023/1/e43041 %U https://doi.org/10.2196/43041 %U http://www.ncbi.nlm.nih.gov/pubmed/37014680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42832 %T Predicting Measles Outbreaks in the United States: Evaluation of Machine Learning Approaches %A Ru,Boshu %A Kujawski,Stephanie %A Lee Afanador,Nelson %A Baumgartner,Richard %A Pawaskar,Manjiri %A Das,Amar %+ Merck & Co, Inc, 770 Sumneytown Pike, Main Stop: WP37A, West Point, PA, 19486, United States, 1 2156524301, boshu.ru@merck.com %K measles %K measles outbreaks %K measles epidemiology %K machine learning %K epidemiology %K hybrid machine learning %K infectious disease modeling %K infectious disease outbreak prediction %K unsupervised machine learning %K supervised machine learning %K infectious disease %K model %K predict %K outbreak %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Measles, a highly contagious viral infection, is resurging in the United States, driven by international importation and declining domestic vaccination coverage. Despite this resurgence, measles outbreaks are still rare events that are difficult to predict. Improved methods to predict outbreaks at the county level would facilitate the optimal allocation of public health resources. Objective: We aimed to validate and compare extreme gradient boosting (XGBoost) and logistic regression, 2 supervised learning approaches, to predict the US counties most likely to experience measles cases. We also aimed to assess the performance of hybrid versions of these models that incorporated additional predictors generated by 2 clustering algorithms, hierarchical density-based spatial clustering of applications with noise (HDBSCAN) and unsupervised random forest (uRF). Methods: We constructed a supervised machine learning model based on XGBoost and unsupervised models based on HDBSCAN and uRF. The unsupervised models were used to investigate clustering patterns among counties with measles outbreaks; these clustering data were also incorporated into hybrid XGBoost models as additional input variables. The machine learning models were then compared to logistic regression models with and without input from the unsupervised models. Results: Both HDBSCAN and uRF identified clusters that included a high percentage of counties with measles outbreaks. XGBoost and XGBoost hybrid models outperformed logistic regression and logistic regression hybrid models, with the area under the receiver operating curve values of 0.920-0.926 versus 0.900-0.908, the area under the precision-recall curve values of 0.522-0.532 versus 0.485-0.513, and F2 scores of 0.595-0.601 versus 0.385-0.426. Logistic regression or logistic regression hybrid models had higher sensitivity than XGBoost or XGBoost hybrid models (0.837-0.857 vs 0.704-0.735) but a lower positive predictive value (0.122-0.141 vs 0.340-0.367) and specificity (0.793-0.821 vs 0.952-0.958). The hybrid versions of the logistic regression and XGBoost models had slightly higher areas under the precision-recall curve, specificity, and positive predictive values than the respective models that did not include any unsupervised features. Conclusions: XGBoost provided more accurate predictions of measles cases at the county level compared with logistic regression. The threshold of prediction in this model can be adjusted to align with each county’s resources, priorities, and risk for measles. While clustering pattern data from unsupervised machine learning approaches improved some aspects of model performance in this imbalanced data set, the optimal approach for the integration of such approaches with supervised machine learning models requires further investigation. %M 37014694 %R 10.2196/42832 %U https://formative.jmir.org/2023/1/e42832 %U https://doi.org/10.2196/42832 %U http://www.ncbi.nlm.nih.gov/pubmed/37014694 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41222 %T Usability Testing of a Web-Based Empathy Training Portal: Mixed Methods Study %A Lobchuk,Michelle %A Hoplock,Lisa %A Harder,Nicole %A Friesen,Marcia %A Rempel,Julie %A Bathi,Prachotan Reddy %+ College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Rm 315 - 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada, 1 2044747135, Michelle.Lobchuk@umanitoba.ca %K web application %K usability %K mixed design research %K internet %K empathy %K mobile phone %K mobile devices %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The prepandemic period saw a rise in web-based teaching. However, web-based tools for teaching the essential clinical skill of cognitive empathy (also known as perspective taking) remain limited. More of these tools are needed and require testing for ease of use and understanding by students. Objective: This study aimed to evaluate the usability of the In Your Shoes web-based empathy training portal application for students using quantitative and qualitative methods. Methods: This 3-phase formative usability study used a mixed methods design. In mid-2021, we conducted a remote observation of student participants interacting with our portal application. Their qualitative reflections were captured, followed by data analysis and iterative design refinements of the application. Overall, 8 third- and fourth-year nursing students from an undergraduate baccalaureate program at a Canadian university, in the western province of Manitoba, were included in this study. Participants in phases 1 and 2 were remotely observed by 3 research personnel while engaged in predefined tasks. In phase 3, two student participants were asked to use the application as they liked in their own environments, after which a video-recorded exit interview with a think-aloud process was conducted as participants responded to the System Usability Scale. We calculated descriptive statistics and performed content analysis to analyze the results. Results: This small study included 8 students with a range of technology skills. Usability themes were based on participants’ comments on the application’s appearance, content, navigation, and functionality. The biggest issues that participants experienced were with navigating the application’s “tagging” features during video analysis and the length of educational material. We also observed variations in 2 participants’ system usability scores in phase 3. This may be because of their different comfort levels with technology; however, additional research is required. We made iterative refinements to our prototype application (eg, added pop-up messages and provided a narrated video on the application’s “tagging” function) based on participant feedback. Conclusions: With increasing engagement in web-based teaching, technology has become an essential medium for receiving health care education. We developed a novel prototype application as a supplemental classroom tool to foster students’ self-directed learning of empathy. This study provided direction for refinements to optimize the usability of and satisfaction with this innovative application. Qualitative feedback revealed favorable input toward learning perspective taking place on the web and helpful recommendations for improving user experiences with the application. We could not fully assess the application’s key functions owing to the COVID-19 protocols. Thus, our next step is to obtain feedback from a larger sample of student users, whose experiences performing “live” video capture, annotation, and analysis will be more authentic and wholesome with the refined application. We discuss our findings in relation to research on nursing education, perspective taking, and adaptive e-learning. %M 37014693 %R 10.2196/41222 %U https://formative.jmir.org/2023/1/e41222 %U https://doi.org/10.2196/41222 %U http://www.ncbi.nlm.nih.gov/pubmed/37014693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42967 %T Development of a Mobile App to Monitor the Effectiveness of a Hydrolyzed Cartilage Matrix Supplement on Joint Discomfort: Real-World Study %A Newman,Christie %A Adriaens,Els %A Virgilio,Nicolina %A Vleminckx,Sara %A de Pelsmaeker,Sara %A Prawitt,Janne %A F Silva,Catarina I %+ Rousselot BV, Meulestedekaai 81, Gent, 9000, Belgium, 31 61 271 0263, catarina.silva@rousselot.com %K digital tool %K hydrolyzed cartilage matrix %K hydrolyzed collagen %K chondroitin sulfate %K joint discomfort %K real-world study %K dietary supplement %K mobile application %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Joint discomfort is a widespread and growing problem in active adults. The rising interest in preventative nutrition has increased the demand for supplements reducing joint discomfort. Protocols assessing the effect of a nutritional intervention on health commonly involve a series of face-to-face meetings between participants and study staff that can weigh on resources, participant availabilities, and even increase dropout rates. Digital tools are increasingly added to protocols to facilitate study conduct, but fully digitally run studies are still scarce. With the increasing interest in real-world studies, the development of health apps for mobile devices to monitor study outcomes is of great importance. Objective: The purpose of this real-world study was to develop a specific mobile app, Ingredients for Life, to conduct a 100% digital study testing the effectiveness of a hydrolyzed cartilage matrix (HCM) supplement on joint discomfort in a heterogeneous group of healthy, active consumers. Methods: The Ingredients for Life mobile app using a visual analog scale was specifically developed to monitor the variation in joint pain after exercise by the study participants. A total of 201 healthy and physically active women and men (18-72 years old) with joint pain completed the study over a period of 16 weeks. Participants were randomly allocated to the study groups and did not receive any dietary or lifestyle advice. Each participant indicated one area of joint pain and logged the type and duration of their weekly activities. They received blinded study supplements and took a daily regimen of 1 g of HCM (HCM group) or 1 g of maltodextrin (placebo group) for 12 weeks while weekly logging joint pain scores in the app. This was followed by a 4-week washout period during which participants continued reporting their joint pain scores (until the end of week 16). Results: Joint pain was reduced within 3 weeks of taking a low dosage of HCM (1 g/day), regardless of gender, age group, and activity intensity when compared with the placebo group. After stopping supplementation, joint pain scores gradually increased but still remained significantly lower than those of the placebo group after 4 weeks of washout. The low dropout rate (<6% of participants, mainly in the placebo group) demonstrates that the digital study was well received by the study population. Conclusions: The digital tool allowed us to measure a heterogeneous group of active adults in a real-world setting (without any lifestyle intervention), thus promoting inclusivity and diversity. With low dropout rates, it demonstrates that mobile apps can generate qualitative, quantifiable, real-world data showcasing supplement effectiveness. The study confirmed that the oral intake of a low dose (1 g/day) of HCM led to a significant reduction of joint pain from 3 weeks after starting supplementation. %M 36848035 %R 10.2196/42967 %U https://formative.jmir.org/2023/1/e42967 %U https://doi.org/10.2196/42967 %U http://www.ncbi.nlm.nih.gov/pubmed/36848035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41346 %T New Ways for Patients to Make Sense of Their Electronic Health Record Data Using the Discovery Web Application: Think-Aloud Evaluation Study %A Nakikj,Drashko %A Kreda,David %A Gehlenborg,Nils %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, MA, 02115, United States, 1 857 272 5075, nils@hms.harvard.edu %K patient %K sensemaking %K electronic health records %K personal health records %K multiple providers %K design %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, patients can access their electronic health record (EHR) data through patient portals. However, current patient portals are mainly focused on a single provider, with very limited data sharing capabilities and put low emphasis on independent sensemaking of the EHR data. This makes it very challenging for patients to switch between different portals and aggregate the data to obtain a complete picture of their medical history and to make sense of it. Owing to this fragmentation, patients are exposed to numerous inconveniences such as medical errors, repeated tests, and limited self-advocacy. Objective: To overcome the limitations of EHR patient portals, we designed and developed Discovery—a web-based application that aggregates EHR data from multiple providers and present them to the patient for efficient exploration and sensemaking. To learn how well Discovery meets the patients’ sensemaking needs and what features should such applications include, we conducted an evaluation study. Methods: We conducted a remote study with 14 participants. In a 60-minute session and relying on the think-aloud protocol, participants were asked to complete a variety of sensemaking tasks and provide feedback upon completion. The audio materials were transcribed for analysis and the video recordings of the users’ interactions with Discovery were annotated to provide additional context. These combined textual data were thematically analyzed to surface themes that reflect how participants used Discovery’s features, what sensemaking of their EHR data really entails, and what features are desirable to support that process better. Results: We found that Discovery provided much needed features and could be used in a variety of everyday scenarios, especially for preparing and during clinical visits and also for raising awareness, reflection, and planning. According to the study participants, Discovery provided a robust set of features for supporting independent exploration and sensemaking of their EHR data: summary and quick overview of the data, finding prevalence, periodicity, co-occurrence, and pre-post of medical events, as well as comparing medical record types and subtypes across providers. In addition, we extracted important design implications from the user feedback on data exploration with multiple views and nonstandard user interface elements. Conclusions: Patient-centered sensemaking tools should have a core set of features that can be learned quickly and support common use cases for a variety of users. The patients should be able to detect time-oriented patterns of medical events and get enough context and explanation on demand in a single exploration view that feels warm and familiar and relies on patient-friendly language. However, this view should have enough plasticity to adjust to the patient’s information needs as the sensemaking unfolds. Future designs should include the physicians in the patient’s sensemaking process and improve the communication in clinical visits and via messaging. %M 37010887 %R 10.2196/41346 %U https://formative.jmir.org/2023/1/e41346 %U https://doi.org/10.2196/41346 %U http://www.ncbi.nlm.nih.gov/pubmed/37010887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42452 %T Real-Time Prediction of Sepsis in Critical Trauma Patients: Machine Learning–Based Modeling Study %A Li,Jiang %A Xi,Fengchan %A Yu,Wenkui %A Sun,Chuanrui %A Wang,Xiling %+ School of Public Health and Key Laboratory of Public Health Safety, Fudan University, No 130 Dongan Road, Xuhui District, Shanghai, 200032, China, 86 021 54237051, erinwang@fudan.edu.cn %K sepsis %K trauma %K intensive care unit %K machine learning %K real-time prediction %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sepsis is a leading cause of death in patients with trauma, and the risk of mortality increases significantly for each hour of delay in treatment. A hypermetabolic baseline and explosive inflammatory immune response mask clinical signs and symptoms of sepsis in trauma patients, making early diagnosis of sepsis more challenging. Machine learning–based predictive modeling has shown great promise in evaluating and predicting sepsis risk in the general intensive care unit (ICU) setting, but there has been no sepsis prediction model specifically developed for trauma patients so far. Objective: To develop a machine learning model to predict the risk of sepsis at an hourly scale among ICU-admitted trauma patients. Methods: We extracted data from adult trauma patients admitted to the ICU at Beth Israel Deaconess Medical Center between 2008 and 2019. A total of 42 raw variables were collected, including demographics, vital signs, arterial blood gas, and laboratory tests. We further derived a total of 485 features, including measurement pattern features, scoring features, and time-series variables, from the raw variables by feature engineering. The data set was randomly split into 70% for model development with stratified 5-fold cross-validation, 15% for calibration, and 15% for testing. An Extreme Gradient Boosting (XGBoost) model was developed to predict the hourly risk of sepsis at prediction windows of 4, 6, 8, 12, and 24 hours. We evaluated model performance for discrimination and calibration both at time-step and outcome levels. Clinical applicability of the model was evaluated with varying levels of precision, and the potential clinical net benefit was assessed with decision curve analysis (DCA). A Shapley additive explanation algorithm was applied to show the effect of features on the prediction model. In addition, we trained an L2-regularized logistic regression model to compare its performance with XGBoost. Results: We included 4603 trauma patients in the study, 1196 (26%) of whom developed sepsis. The XGBoost model achieved an area under the receiver operating characteristics curve (AUROC) ranging from 0.83 to 0.88 at the 4-to-24-hour prediction window in the test set. With a ratio of 9 false alerts for every true alert, it predicted 73% (386/529) of sepsis-positive timesteps and 91% (163/179) of sepsis events in the subsequent 6 hours. The DCA showed our model had a positive net benefit in the threshold probability range of 0 to 0.6. In comparison, the logistic regression model achieved lower performance, with AUROC ranging from 0.76 to 0.84 at the 4-to-24-hour prediction window. Conclusions: The machine learning–based model had good discrimination and calibration performance for sepsis prediction in critical trauma patients. Using the model in clinical practice might help to identify patients at risk of sepsis in a time window that enables personalized intervention and early treatment. %M 37000488 %R 10.2196/42452 %U https://formative.jmir.org/2023/1/e42452 %U https://doi.org/10.2196/42452 %U http://www.ncbi.nlm.nih.gov/pubmed/37000488 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39383 %T Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study %A Wittenauer,Rachel %A Dolan,Samantha B %A Njoroge,Anne %A Onyango,Penina %A Owiso,George %A Rabinowitz,Peter %A Puttkammer,Nancy %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 6502694771, rwitten1@uw.edu %K workflow %K digital health %K electronic immunization registry %K usability %K acceptability %K health care worker %K technology adoption %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. Objective: This study aimed to evaluate HCWs’ perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. Methods: We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. Results: HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs’ perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Conclusions: Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya’s program and for other efforts around the globe, as digital health interventions become more widely used. %M 36995755 %R 10.2196/39383 %U https://formative.jmir.org/2023/1/e39383 %U https://doi.org/10.2196/39383 %U http://www.ncbi.nlm.nih.gov/pubmed/36995755 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43222 %T Optimizing an Adolescent Hybrid Telemedical Mental Health Service Through Staff Scheduling Using Mathematical Programming: Model Development Study %A Palmer,Abigail %A Johns,Gemma %A Ahuja,Alka %A Gartner,Daniel %+ School of Mathematics, Cardiff University, Senghennydd road, Cardiff, CF24 4AG, United Kingdom, 44 7843747862, gartnerd@cardiff.ac.uk %K linear Programming %K telemedicine %K remote consultation %K mental health %K teen %K adolescent %K mental disorder %K disorder %K disease %K youth %K decision %K support %K tool %K model %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, globally, one in seven 10- to 19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. Half of all mental illnesses begin by the age of 14 years and some teenagers with severe presentations must be admitted to the hospital and assessed by highly skilled mental health care practitioners. Digital telehealth solutions can be useful for the assessment of young individuals remotely. Ultimately, this technology can save travel costs for the health service rather than assessing adolescents in person at the corresponding hospital. Especially in rural regions, where travel times can be high, this innovative approach can make a difference to patients by providing quicker assessments. Objective: The aim of this study is to share insights on how we developed a decision support tool to assign staff to days and locations where adolescent mental health patients are assessed face to face. Where possible, patients are seen through video consultation. The model not only seeks to reduce travel times and consequently carbon emissions but also can be used to find a minimum number of staff to run the service. Methods: To model the problem, we used integer linear programming, a technique that is used in mathematical modeling. The model features 2 objectives: first, we aim to find a minimum coverage of staff to provide the service and second, to reduce travel time. The constraints that are formulated algebraically are used to ensure the feasibility of the schedule. The model is implemented using an open-source solver backend. Results: In our case study, we focus on real-world demand coming from different hospital sites in the UK National Health Service (NHS). We incorporate our model into a decision support tool and solve a realistic test instance. Our results reveal that the tool is not only capable of solving this problem efficiently but also shows the benefits of using mathematical modeling in health services. Conclusions: Our approach can be used by NHS managers to better match capacity and location-dependent demands within an increasing need for hybrid telemedical services, and the aims to reduce traveling and the carbon footprint within health care organizations. %M 36976622 %R 10.2196/43222 %U https://formative.jmir.org/2023/1/e43222 %U https://doi.org/10.2196/43222 %U http://www.ncbi.nlm.nih.gov/pubmed/36976622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45211 %T Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers %A Dinh,Alana %A Tseng,Emily %A Yin,Andrew Lukas %A Estrin,Deborah %A Greenwald,Peter %A Fortenko,Alexander %+ Medical College, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, United States, 1 212 746 1067, ald4006@med.cornell.edu %K augmented reality %K telemedicine %K telehealth %K emergency medicine %K education %K mobile phone %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR’s implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. Objective: This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Methods: Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR’s potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Results: Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR’s adoption. Conclusions: AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine. %M 36976628 %R 10.2196/45211 %U https://formative.jmir.org/2023/1/e45211 %U https://doi.org/10.2196/45211 %U http://www.ncbi.nlm.nih.gov/pubmed/36976628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e26077 %T MyGood Trip, a Telemedicine Intervention for Physical Activity Recovery After Bariatric Surgery: Randomized Controlled Trial %A Lurbe i Puerto,Katia %A Bruzzi,Matthieu %A Rives-Lange,Claire %A Poghosyan,Tigran %A Bretault,Marion %A Chatellier,Gilles %A Vilfaillot,Aurelie %A Chevallier,Jean-Marc %A Czernichow,Sebastien %A Carette,Claire %+ Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, Paris, 75015, France, 33 1 56 09 55 21, claire.carette@aphp.fr %K bariatric surgery %K telemedicine %K physical activity %K RCT %K gastric bypass %K sleeve gastrectomy %K connected pedometer %K eHealth %K mixed methods research %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first year following surgery. The addition of telemedicine to standard care could support patients with engaging in a more active lifestyle and thus improve clinical outcomes. Objective: Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices, teleconsultation, and telemonitoring the first 6 months following bariatric surgery. Methods: This study employed a mixed methods design based on an open-label randomized controlled trial. Patients were included during the first week after bariatric surgery; then, they were randomized into 2 intervention groups: The TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation involving diet coaching. Data were collected using a watch pedometer and body weight scale, both of which were connected wirelessly. The primary outcome was the difference between the 2 groups in the mean numbers of steps at the first and sixth postoperative months. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided. Results: Among the 90 patients (mean age 40.6, SD 10.4 years; 73/90, 81% women; 62/90, 69% gastric bypass), 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet), and 18 participants agreed to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase in the mean number of steps between the first and sixth months was found in both groups, but this change was significant only in the TeleDiet group (P=.01). No difference was found when comparing both intervention groups. Interviewed participants reported having appreciated the teleconsultations, as the individualized tailored counseling helped them to make better choices about behaviors that could increase their likelihood of a daily life in better health. Weight loss followed by social factors (such as social support) were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activity, and lack of accessibility to sport infrastructure were their major barriers to postoperative lifestyle adherence. Conclusions: Our study did not show any difference in mobility recovery after bariatric surgery related to a telemedicine intervention dedicated to physical activity. The early postoperative timing for our intervention may explain the null findings. eHealth interventions aiming to change behaviors and carried out by clinicians require support from structured public health policies that tackle patients’ obesogenic environment in order to be efficient in their struggle against sedentary lifestyle–related pathologies. Further research will need to focus on long-term interventions. Trial Registration: ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480 %M 36976624 %R 10.2196/26077 %U https://formative.jmir.org/2023/1/e26077 %U https://doi.org/10.2196/26077 %U http://www.ncbi.nlm.nih.gov/pubmed/36976624 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36562 %T Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mHealth %K physical activity %K financial incentive %K hypertension %K mobile health %K exercise %K lifestyle health %K cardiovascular disease %K mortality %K heart disease %K incentive %K motivation %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. Objective: The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. Methods: In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. Results: Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP −0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP −2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). Conclusions: The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted. %M 36961486 %R 10.2196/36562 %U https://formative.jmir.org/2023/1/e36562 %U https://doi.org/10.2196/36562 %U http://www.ncbi.nlm.nih.gov/pubmed/36961486 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43255 %T Overcoming Language Barriers in Paramedic Care With an App Designed to Improve Communication With Foreign-Language Patients: Nonrandomized Controlled Pilot Study %A Müller,Frank %A Schröder,Dominik %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 55139 68193, evamaria.noack@med.uni-goettingen.de %K app %K emergency medical technicians %K language barriers %K limited language proficiency %K migrant %K paramedic %K prehospital emergency care %K refugee %K translator %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Communication across language barriers is a particular challenge for health care providers. In emergency medical services, interpreters are mostly not available on rescue scenes, which jeopardizes safe and high-quality medical care. In a cocreative process together with paramedics and software designers, we developed a fixed-phrase translation app with 600 phrases and 18 supported languages that supports paramedics when providing care to foreign-language patients. This paper reports on the results of a pilot study to evaluate the app’s effect on paramedic-patient communication. Objective: This study aims to gain insights into the efficacy and feasibility of a multilingual app that helps paramedics to communicate with patients who are not proficient in the local language. Methods: A 3-armed nonrandomized interventional pilot study was conducted in 4 rescue stations in the German Federal State of Lower Saxony: 3 rural areas and 1 in urban environment. The intervention group comprised rescue missions with patients with limited German language proficiency (LGP) with whom the app was used; control group 1 comprised LGP patients without app usage; and control group 2 consisted of rescue missions with German-speaking patients. For each rescue operation with LGP patients, paramedics filled out questionnaires about the communications with patients. From standardized Rescue Service Case Protocols, we extracted information on patient demographics (age and sex), clinical aspects (preliminary diagnosis and Glasgow Coma Scale), and rescue operation characteristics (time spent on emergency scene and additional dispatch of emergency physicians). The primary outcome was the paramedics’ perceived quality of communication with LGP patients. The secondary outcome was the ability to obtain necessary information from patients and the ability to provide important information to patients. A linear regression model was applied to assess the impact of the app on perceived communication, controlling demographic factors, and severity of illness. Results: A total of 22 LGP patients were recruited into the intervention group and 122 into control group 1. The control group 2 included 27,212 German-speaking patients. LGP patients were more than 2 decades younger than German-speaking patients. App usage among LGP patients was associated with higher perceived overall quality of communication (0.7 points on a 5-point Likert scale, P=.03). Applying a linear regression model controlling for age, sex, and Glasgow Coma Scale, the quality of communication was associated with an increase of 0.9 points (95% CI 0.2-1.6, P=.01). Compared to either German-speaking patients or LGP patients, paramedics spent 6-7 minutes longer on an emergency scene when the app was used (P=.24). Conclusions: The use of the app suggests a relevant improvement in communication with patients with limited proficiency in the locally spoken language in paramedic care. The small sample size and the lack of randomization reduce the generalizability of the findings. Trial Registration: German Clinical Trials Register DRKS00016719; https://drks.de/search/de/trial/DRKS00016719 %M 36951895 %R 10.2196/43255 %U https://formative.jmir.org/2023/1/e43255 %U https://doi.org/10.2196/43255 %U http://www.ncbi.nlm.nih.gov/pubmed/36951895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42888 %T Patient-Reported Outcomes Collection at an Urban HIV Clinic Associated With a Historically Black Medical College in the Southern United States: Qualitative Interview Study Among Patients With HIV %A Parisot III,Paul E %A Wheeler,Facerlyn %A Bonnet,Kemberlee %A Rebeiro,Peter F %A Schember,Cassandra O %A McCainster,Korlu %A Cooper,Robert L %A Berthaud,Vladimir %A Schlundt,David G %A Pettit,April C %+ Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, United States, 1 615 853 1156, paul.parisot@vumc.org %K patient-reported outcomes %K HIV infection %K HIV continuum of care %K HIV epidemic %K questionnaire experience %K cognitive behavioral model %K implementation %K vulnerable population %K racial disparity %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black Americans, particularly in the southern United States, are disproportionately affected by the US HIV epidemic. Patient-reported outcome (PRO) data collection can improve patient outcomes and provide oft-overlooked data on mental health, substance use, and patient adherence to antiretroviral therapy. Objective: We piloted the use of an electronic tablet to collect PRO data on social and behavioral determinants of health among people with HIV at the Meharry Community Wellness Center, an HIV clinic affiliated with a Historically Black Medical College in Nashville, Tennessee. Our primary objective was to better understand patients’ experiences and comfort with using an electronic PRO tool through patient interviews. Methods: We enrolled 100 people with HIV in care at the Meharry Community Wellness Center consecutively to completely validate PRO tools using the Research Electronic Data Capture platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the cognitive-behavioral model, in which thoughts, feelings, and behaviors are interrelated. IDIs were audio recorded, transcribed, deidentified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach. Results: Among the 100 people with HIV enrolled, the median age was 50 (IQR 42-54) years; 89% (n=89) were Black, 60% (n=60) were male, and 82% (n=82) were living below 100% of the federal poverty level in 2016. Five major interview themes emerged: overall experience, question content, sensitive topics, clinic visit impact, and future recommendations. IDI participants felt that the tablet was easy to use and that the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful, and most would complete these surveys without compensation at future visits if offered. Conclusions: The use of an electronic tablet to complete PRO data collection was well received by this cohort of vulnerable persons in HIV care in the southern United States. Despite some discomfort related to question content, our cohort overwhelmingly believed this was a meaningful part of their medical experience and expressed a high desire for truthfulness. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner while obtaining input from providers and staff to ensure that the collected data are both applicable and actionable. %M 36947109 %R 10.2196/42888 %U https://formative.jmir.org/2023/1/e42888 %U https://doi.org/10.2196/42888 %U http://www.ncbi.nlm.nih.gov/pubmed/36947109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38504 %T A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design %A Mak,Winnie W S %A Ng,Sin Man %A Leung,Florence H T %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong, 852 39436577, wwsmak@cuhk.edu.hk %K user-centered design %K qualitative research %K usability testing %K mental health %K self-care %K stratified stepped care %K internet-based psychological interventions %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users’ continued adoption and practice of self-care for their mental health. Objective: The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users’ perceptions on mental self-care and feedback on the platform design and incorporates them into the design. Methods: The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. Results: In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. Conclusions: The design process and findings presented in the study are important in developing a user-centric platform to optimize users’ acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users’ perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web. %M 36947112 %R 10.2196/38504 %U https://formative.jmir.org/2023/1/e38504 %U https://doi.org/10.2196/38504 %U http://www.ncbi.nlm.nih.gov/pubmed/36947112 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44122 %T Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study %A Day,Sarah %A Ncube,Vuyolwethu %A Maja,Lactricia %A Wasunna,Beatrice %A Pienaar,Jacqueline %A Setswe,Geoffrey %A Waweru,Evelyn %A Feldacker,Caryl %+ International Training and Education Center for Health, University of Washington, 908 Jefferson Street, 13th Floor, Seattle, WA, 98104-2499, United States, 1 (314) 600 6743, cfeld@uw.edu %K digital health innovation %K usability %K health care workers perspectives %K low- and middle-income countries %K two-way texting %K postoperative telehealth %K male circumcision %K South Africa %K mobile phone %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Voluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)–based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. Objective: Embedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT’s usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. Methods: A total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. Results: Most HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. Conclusions: In this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men’s homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services. %M 36947127 %R 10.2196/44122 %U https://formative.jmir.org/2023/1/e44122 %U https://doi.org/10.2196/44122 %U http://www.ncbi.nlm.nih.gov/pubmed/36947127 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38125 %T How Natural Language Processing Can Aid With Pulmonary Oncology Tumor Node Metastasis Staging From Free-Text Radiology Reports: Algorithm Development and Validation %A Puts,Sander %A Nobel,Martijn %A Zegers,Catharina %A Bermejo,Iñigo %A Robben,Simon %A Dekker,Andre %+ GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Doctor Tanslaan 12, Maastricht, 6229 ET, Netherlands, 31 614255188, putssander@gmail.com %K radiology %K reporting %K natural language processing %K free text %K classification system %K oncology %K pulmonary %K clinical decision %K clinical %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Natural language processing (NLP) is thought to be a promising solution to extract and store concepts from free text in a structured manner for data mining purposes. This is also true for radiology reports, which still consist mostly of free text. Accurate and complete reports are very important for clinical decision support, for instance, in oncological staging. As such, NLP can be a tool to structure the content of the radiology report, thereby increasing the report’s value. Objective: This study describes the implementation and validation of an N-stage classifier for pulmonary oncology. It is based on free-text radiological chest computed tomography reports according to the tumor, node, and metastasis (TNM) classification, which has been added to the already existing T-stage classifier to create a combined TN-stage classifier. Methods: SpaCy, PyContextNLP, and regular expressions were used for proper information extraction, after additional rules were set to accurately extract N-stage. Results: The overall TN-stage classifier accuracy scores were 0.84 and 0.85, respectively, for the training (N=95) and validation (N=97) sets. This is comparable to the outcomes of the T-stage classifier (0.87-0.92). Conclusions: This study shows that NLP has potential in classifying pulmonary oncology from free-text radiological reports according to the TNM classification system as both the T- and N-stages can be extracted with high accuracy. %M 36947118 %R 10.2196/38125 %U https://formative.jmir.org/2023/1/e38125 %U https://doi.org/10.2196/38125 %U http://www.ncbi.nlm.nih.gov/pubmed/36947118 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38042 %T Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study %A Elledge,Daniel K %A Lee,Simon Craddock %A Stewart,Sunita M %A Pop,Radu %A Trivedi,Madhukar H %A Hughes,Jennifer L %+ Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, United States, 1 214 648 0188, madhukar.trivedi@utsouthwestern.edu %K youth %K prevention %K resilience %K mental health app %K mobile phone %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. %M 36947113 %R 10.2196/38042 %U https://formative.jmir.org/2023/1/e38042 %U https://doi.org/10.2196/38042 %U http://www.ncbi.nlm.nih.gov/pubmed/36947113 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44725 %T A Pilot of Digital Whiteboards for Improving Patient Satisfaction in the Emergency Department: Nonrandomized Controlled Trial %A Marshall,Andrew D A %A Hasdianda,Mohammad Adrian %A Miyawaki,Steven %A Jambaulikar,Guruprasad D %A Cao,Chenze %A Chen,Paul %A Baugh,Christopher W %A Zhang,Haipeng %A McCabe,Jonathan %A Steinbach,Lee %A King,Scott %A Friedman,Jason %A Su,Jennifer %A Landman,Adam B %A Chai,Peter Ray %+ Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States, 1 6159448967, amarshall8@bwh.harvard.edu %K digital whiteboard %K digital intervention %K health technology %K electronic paper %K E-paper %K patient satisfaction %K communication %K emergency department experience %K experience %K emergency %K hospital %K satisfaction %K patient facing software %K infrastructure %K patient care %K emergency department %K patient communication %K hospital setting %K patient experience %K perception %K match pair %K statistics %K user experience %K learning %K Media and Technology Usage and Attitudes Scale %K MTUAS %K user interface %K interface %K design %K Likert %K Wilcoxon rank %K Wilcox %K exploratory data analysis %K EDA %K x^2 %K x2 %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic paper (E-paper) screens use electrophoretic ink to provide paper-like low-power displays with advanced networking capabilities that may potentially serve as an alternative to traditional whiteboards and television display screens in hospital settings. E-paper may be leveraged in the emergency department (ED) to facilitate communication. Providing ED patient status updates on E-paper screens could improve patient satisfaction and overall experience and provide more equitable access to their health information. Objective: We aimed to pilot a patient-facing digital whiteboard using E-paper to display relevant orienting and clinical information in real time to ED patients. We also sought to assess patients’ satisfaction after our intervention and understand our patients’ overall perception of the impact of the digital whiteboards on their stay. Methods: We deployed a 41-inch E-paper digital whiteboard in 4 rooms in an urban, tertiary care, and academic ED and enrolled 110 patients to understand and evaluate their experience. Participants completed a modified Hospital Consumer Assessment of Health Care Provider and Systems satisfaction questionnaire about their ED stay. We compared responses to a matched control group of patients triaged to ED rooms without digital whiteboards. We designed the digital whiteboard based on iterative feedback from various departmental stakeholders. After establishing IT infrastructure to support the project, we enrolled patients on a convenience basis into a control and an intervention (digital whiteboard) group. Enrollees were given a baseline survey to evaluate their comfort with technology and an exit survey to evaluate their opinions of the digital whiteboard and overall ED satisfaction. Statistical analysis was performed to compare baseline characteristics as well as satisfaction. Results: After the successful prototyping and implementation of 4 digital whiteboards, we screened 471 patients for inclusion. We enrolled 110 patients, and 50 patients in each group (control and intervention) completed the study protocol. Age, gender, and racial and ethnic composition were similar between groups. We saw significant increases in satisfaction on postvisit surveys when patients were asked about communication regarding delays (P=.03) and what to do after discharge (P=.02). We found that patients in the intervention group were more likely to recommend the facility to family and friends (P=.04). Additionally, 96% (48/50) stated that they preferred a room with a digital whiteboard, and 70% (35/50) found the intervention “quite a bit” or “extremely” helpful in understanding their ED stay. Conclusions: Digital whiteboards are a feasible and acceptable method of displaying patient-facing data in the ED. Our pilot suggested that E-paper screens coupled with relevant, real-time clinical data and packaged together as a digital whiteboard may positively impact patient satisfaction and the perception of the facility during ED visits. Further study is needed to fully understand the impact on patient satisfaction and experience. Trial Registration: ClinicalTrials.gov NCT04497922; https://clinicaltrials.gov/ct2/show/NCT04497922 %M 36943360 %R 10.2196/44725 %U https://formative.jmir.org/2023/1/e44725 %U https://doi.org/10.2196/44725 %U http://www.ncbi.nlm.nih.gov/pubmed/36943360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39917 %T Training and Profiling a Pediatric Facial Expression Classifier for Children on Mobile Devices: Machine Learning Study %A Banerjee,Agnik %A Mutlu,Onur Cezmi %A Kline,Aaron %A Surabhi,Saimourya %A Washington,Peter %A Wall,Dennis Paul %+ Department of Pediatrics (Systems Medicine), Stanford University, 3145 Porter Drive, Stanford, CA, 94304, United States, 1 650 666 7676, dpwall@stanford.edu %K edge computing %K affective computing %K autism spectrum disorder %K autism %K ASD %K classifier %K classification %K model %K algorithm %K mobile health %K computer vision %K deep learning %K machine learning for health %K pediatrics %K emotion recognition %K mHealth %K diagnostic tool %K digital therapy %K child %K developmental disorder %K smartphone %K image analysis %K machine learning %K Image classification %K neural network %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Implementing automated facial expression recognition on mobile devices could provide an accessible diagnostic and therapeutic tool for those who struggle to recognize facial expressions, including children with developmental behavioral conditions such as autism. Despite recent advances in facial expression classifiers for children, existing models are too computationally expensive for smartphone use. Objective: We explored several state-of-the-art facial expression classifiers designed for mobile devices, used posttraining optimization techniques for both classification performance and efficiency on a Motorola Moto G6 phone, evaluated the importance of training our classifiers on children versus adults, and evaluated the models’ performance against different ethnic groups. Methods: We collected images from 12 public data sets and used video frames crowdsourced from the GuessWhat app to train our classifiers. All images were annotated for 7 expressions: neutral, fear, happiness, sadness, surprise, anger, and disgust. We tested 3 copies for each of 5 different convolutional neural network architectures: MobileNetV3-Small 1.0x, MobileNetV2 1.0x, EfficientNetB0, MobileNetV3-Large 1.0x, and NASNetMobile. We trained the first copy on images of children, second copy on images of adults, and third copy on all data sets. We evaluated each model against the entire Child Affective Facial Expression (CAFE) set and by ethnicity. We performed weight pruning, weight clustering, and quantize-aware training when possible and profiled each model’s performance on the Moto G6. Results: Our best model, a MobileNetV3-Large network pretrained on ImageNet, achieved 65.78% accuracy and 65.31% F1-score on the CAFE and a 90-millisecond inference latency on a Moto G6 phone when trained on all data. This accuracy is only 1.12% lower than the current state of the art for CAFE, a model with 13.91x more parameters that was unable to run on the Moto G6 due to its size, even when fully optimized. When trained solely on children, this model achieved 60.57% accuracy and 60.29% F1-score. When trained only on adults, the model received 53.36% accuracy and 53.10% F1-score. Although the MobileNetV3-Large trained on all data sets achieved nearly a 60% F1-score across all ethnicities, the data sets for South Asian and African American children achieved lower accuracy (as much as 11.56%) and F1-score (as much as 11.25%) than other groups. Conclusions: With specialized design and optimization techniques, facial expression classifiers can become lightweight enough to run on mobile devices and achieve state-of-the-art performance. There is potentially a “data shift” phenomenon between facial expressions of children compared with adults; our classifiers performed much better when trained on children. Certain underrepresented ethnic groups (e.g., South Asian and African American) also perform significantly worse than groups such as European Caucasian despite similar data quality. Our models can be integrated into mobile health therapies to help diagnose autism spectrum disorder and provide targeted therapeutic treatment to children. %M 35962462 %R 10.2196/39917 %U https://formative.jmir.org/2023/1/e39917 %U https://doi.org/10.2196/39917 %U http://www.ncbi.nlm.nih.gov/pubmed/35962462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42584 %T Reliability and Validity of the Arabic Version of the Game Experience Questionnaire: Pilot Questionnaire Study %A Rebhi,Mahmoud %A Ben Aissa,Mohamed %A Tannoubi,Amayra %A Saidane,Mouna %A Guelmami,Noomen %A Puce,Luca %A Chen,Wen %A Chalghaf,Nasr %A Azaiez,Fairouz %A Zghibi,Makrem %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, robertobragazzi@gmail.com %K Arab countries %K game experience %K reliability %K scale %K validity %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nowadays, digital gaming occupies a central position in the entertainment industry where it has developed into a cherished kind of entertainment in markets all over the world. In addition, it provides other sectors with various social and economic benefits. The Game Experience Questionnaire (GEQ) is a free, quantitative, and comprehensive self-report measure that was developed to assess the player game experience. Despite having been widely used by many research projects in the past, it has not been adapted into Arabic. Furthermore, several components of the scale proved problematic from a psychometric point of view. Therefore, a modified version of the scale is needed to measure the gaming experience of the Arab population. Objective: The aim of this study was to validate and examine the psychometrics of an adapted Arabic version of the GEQ in Tunisia. Methods: A total of 771 volunteer participants completed an online survey, which included an Arabic version of the GEQ, gaming data, and a sociodemographic questionnaire. Subjects were randomized in order to complete two phases of the study: exploratory and confirmatory. The exploratory data were acquired from 360 respondents whose mean age was 23.89 (SD 2.29) years. Out of 360 respondents, 111 (30.8%) were female and 249 (69.2%) were male. Confirmatory data were obtained from the remaining 411 subjects whose mean age was 21.94 (SD 1.80) years. Out of 411 subjects, 169 (41.1%) were female and 242 (58.9%) were male. Results: After the elimination of two items, the exploratory and the confirmatory factor analyses provided an adequate factor structure of the Arabic version of the GEQ. In addition, the internal consistency coefficients suggested the reliability of the instrument. Significant differences were revealed for three subcomponents: flow by age (η2=0.013, P=.002), gender (η2=0.007, P=.02), and game type (η2=0.03, P<.001). For competence (η2=0.01, P=.03) and immersion (η2=0.02, P=.01), significant differences were highlighted by the type of game. The discriminant and convergent validities of the instrument were supported by calculating the average variance extracted (AVE) and comparing the square roots of the AVE values to the correlation coefficients, respectively. Conclusions: The Arabic adapted version of the GEQ is valid and reliable and can be administered to measure the game experience in Arab countries. %M 36482747 %R 10.2196/42584 %U https://formative.jmir.org/2023/1/e42584 %U https://doi.org/10.2196/42584 %U http://www.ncbi.nlm.nih.gov/pubmed/36482747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41829 %T Developing a Virtual Reality Educational Tool to Stimulate Emotions for Learning: Focus Group Study %A Lie,Silje Stangeland %A Røykenes,Kari %A Sæheim,Aleksandra %A Groven,Karen Synne %+ Faculty of Health Studies, VID Specialized University, Misjonsmarka 12, Stavanger, 4024, Norway, 47 990 90 005, silje.lie@vid.no %K virtual reality %K 360° video %K learning %K experiences %K emotions %K health care and social work higher education %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: By watching 360° videos in virtual reality headsets, students may experience being immersed in the portrayed situation. There is a paucity of empirical studies on the application of immersive 360° videos watched in virtual reality headsets for students in health care and social work education and the pedagogical theory guiding the development of such educational tools. This led to our interest in exploring how a virtual reality educational tool involving 360° videos can stimulate emotions and how this can be used as a pedagogical tool in these educational programs. Objective: The aim of this study was to explore the experiences of faculty members and students regarding a prototype 360° video watched in virtual reality headsets during the development phase of an educational project. We addressed the following research questions: How does the virtual reality prototype stimulate emotions? How can virtual reality be used in higher education for health care and social work students? Methods: We used a qualitative design and collected data through focus group interviews with project participants. The data were analyzed using qualitative content analysis. Results: Our analysis identified 2 main themes in participants’ experiences with the virtual reality prototype. The first theme highlights that when participants experienced watching the 360° video in a virtual reality headset, it stimulated their emotions as an authentic professional experience would. The second theme, contextualization of virtual reality, highlights participants’ perceptions of how the virtual reality experience should be incorporated into a safe educational context. Conclusions: Our findings suggest that 360° videos with human actors who use eye contact with the camera can trigger emotions in the viewer and therefore serve as a pedagogic tool that can create authentic professional experiences for students. The participants expressed the view that the virtual reality educational tool could be used to prepare students for real-life practice in health care and social work. However, they underlined that 360° videos in virtual reality need to be contextualized in educational programs to create a safe environment for learning and to ensure follow-up on the emotions such experiences can trigger in students. Our results highlight the perceived importance of allowing students to reflect on the virtual reality experience in a safe setting and of follow-up by faculty members. In-person follow-up with students can be resource intensive for programs with large numbers of students and makes it challenging to offer repeated training, something that has been identified as one of the benefits of virtual reality. %M 36939819 %R 10.2196/41829 %U https://formative.jmir.org/2023/1/e41829 %U https://doi.org/10.2196/41829 %U http://www.ncbi.nlm.nih.gov/pubmed/36939819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41516 %T Calibrating a Transformer-Based Model’s Confidence on Community-Engaged Research Studies: Decision Support Evaluation Study %A Ferrell,Brian %A Raskin,Sarah E %A Zimmerman,Emily B %+ Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA, 23284, United States, 1 8043505426, ferrellbj@vcu.edu %K explainable artificial intelligence %K XAI %K Bidirectional Encoder Representations From Transformers %K BERT %K transformer-based models %K text classification %K community engagement %K community-engaged research %K deep learning %K decision support %K trust %K confidence %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Deep learning offers great benefits in classification tasks such as medical imaging diagnostics or stock trading, especially when compared with human-level performances, and can be a viable option for classifying distinct levels within community-engaged research (CEnR). CEnR is a collaborative approach between academics and community partners with the aim of conducting research that is relevant to community needs while incorporating diverse forms of expertise. In the field of deep learning and artificial intelligence (AI), training multiple models to obtain the highest validation accuracy is common practice; however, it can overfit toward that specific data set and not generalize well to a real-world population, which creates issues of bias and potentially dangerous algorithmic decisions. Consequently, if we plan on automating human decision-making, there is a need for creating techniques and exhaustive evaluative processes for these powerful unexplainable models to ensure that we do not incorporate and blindly trust poor AI models to make real-world decisions. Objective: We aimed to conduct an evaluation study to see whether our most accurate transformer-based models derived from previous studies could emulate our own classification spectrum for tracking CEnR studies as well as whether the use of calibrated confidence scores was meaningful. Methods: We compared the results from 3 domain experts, who classified a sample of 45 studies derived from our university’s institutional review board database, with those from 3 previously trained transformer-based models, as well as investigated whether calibrated confidence scores can be a viable technique for using AI in a support role for complex decision-making systems. Results: Our findings reveal that certain models exhibit an overestimation of their performance through high confidence scores, despite not achieving the highest validation accuracy. Conclusions: Future studies should be conducted with larger sample sizes to generalize the results more effectively. Although our study addresses the concerns of bias and overfitting in deep learning models, there is a need to further explore methods that allow domain experts to trust our models more. The use of a calibrated confidence score can be a misleading metric when determining our AI model’s level of competency. %M 36939830 %R 10.2196/41516 %U https://formative.jmir.org/2023/1/e41516 %U https://doi.org/10.2196/41516 %U http://www.ncbi.nlm.nih.gov/pubmed/36939830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38563 %T Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study) %A Andreasen,Karen %A Zapata-Calvente,Antonella Ludmila %A Martín-de-las-Heras,Stella %A Bueno-Cavanillas,Aurora %A Schei,Berit %A Dokkedahl,Sarah %A de León de León,Sabina %A Fernandez Lopez,Rodrigo %A Oviedo-Gutiérrez,Alba %A Ankerstjerne,Lea Bo Sønderlund %A Megías,Jesús L %A Khan,Khalid Saeed %A Rasch,Vibeke %A Linde,Ditte S %+ Department of Gyneacology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th floor, Odense, 5000, Denmark, 45 65414606, karen.andreasen2@rsyd.dk %K intimate partner violence %K gender-based violence %K domestic violence %K abuse %K telemedicine %K video counseling %K app %K acceptance %K safety %K feasibility %K empowerment %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. Results: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. Conclusions: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care. %M 36939835 %R 10.2196/38563 %U https://formative.jmir.org/2023/1/e38563 %U https://doi.org/10.2196/38563 %U http://www.ncbi.nlm.nih.gov/pubmed/36939835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43183 %T Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study %A Torres-Slimming,Paola A %A Carcamo,Cesar %A Martínez-Pérez,Guillermo Z %A Mallma,Patricia %A Pflucker,Cristina %A Shilton,Sonjelle %+ Universidad Peruana Cayetano Heredia, Av Honorio Delgado 430, San Martín de Porres, Lima, 15102, Peru, 51 3190000, paola.torres.s@upch.pe %K Peru, COVID-19 %K self-testing %K diagnostics %K qualitative research %K testing %K virus %K detection %K health %K decision-making %K public %K willingness %K health system %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. Objective: This study aims to explore decision makers’ values and attitudes around SARS-CoV-2 self-testing. Methods: In 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public’s attitudes around self-testing. Results: In total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. Conclusions: In Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests’ features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru. %M 36867689 %R 10.2196/43183 %U https://formative.jmir.org/2023/1/e43183 %U https://doi.org/10.2196/43183 %U http://www.ncbi.nlm.nih.gov/pubmed/36867689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39061 %T Public Awareness of the Fencing Response as an Indicator of Traumatic Brain Injury: Quantitative Study of Twitter and Wikipedia Data %A Roe,Kyle L %A Giordano,Katherine R %A Ezzell,Gary A %A Lifshitz,Jonathan %+ Phoenix Veteran Affairs Health Care System, 475 N Fifth St, 7th Floor, Phoenix, AZ, 85004, United States, 1 6028272002, jlifshitz@email.arizona.edu %K athlete %K brain %K concussion %K fencing response %K health communication %K health information %K injury pattern %K posture %K public education %K science communication %K social media %K sport %K trauma %K traumatic brain injury %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Traumatic brain injury (TBI) is a disruption in normal brain function caused by an impact of external forces on the head. TBI affects millions of individuals per year, many potentially experiencing chronic symptoms and long-term disability, creating a public health crisis and an economic burden on society. The public discourse around sport-related TBIs has increased in recent decades; however, recognition of a possible TBI remains a challenge. The fencing response is an immediate posturing of the limbs, which can occur in individuals who sustain a TBI and can be used as an overt indicator of TBI. Typically, an individual demonstrating the fencing response exhibits extension in 1 arm and flexion in the contralateral arm immediately upon impact to the head; variations of forearm posturing among each limb have been observed. The tonic posturing is retained for several seconds, sufficient for observation and recognition of a TBI. Since the publication of the original peer-reviewed article on the fencing response, there have been efforts to raise awareness of the fencing response as a visible sign of TBI through publicly available web-based platforms, such as Twitter and Wikipedia. Objective: We aimed to quantify trends that demonstrate levels of public discussion and awareness of the fencing response over time using data from Twitter and Wikipedia. Methods: Raw Twitter data from January 1, 2010, to December 31, 2019, were accessed using the RStudio package academictwitteR and queried for the text “fencing response.” Data for page views of the Fencing Response Wikipedia article from January 1, 2010, to December 31, 2019, were accessed using the RStudio packages wikipediatrend and pageviews. Data were clustered by weekday, month, half-year (to represent the American football season vs off-season), and year to identify trends over time. Seasonal regression analysis was used to analyze the relationship between the number of fencing response tweets and page views and month of the year. Results: Twitter mentions of the fencing response and Wikipedia page views increased overall from 2010 to 2019, with hundreds of tweets and hundreds of thousands of Wikipedia page views per year. Twitter mentions peaked during the American football season, especially on and following game days. Wikipedia page views did not demonstrate a clear weekday or seasonal pattern, but instead had multiple peaks across various months and years, with January having more page views than May. Conclusions: Here, we demonstrated increased awareness of the fencing response over time using public data from Twitter and Wikipedia. Effective scientific communication through free public platforms can help spread awareness of clinical indicators of TBI, such as the fencing response. Greater awareness of the fencing response as a “red-flag” sign of TBI among coaches, athletic trainers, and sports organizations can help with medical care and return-to-play decisions. %M 36930198 %R 10.2196/39061 %U https://formative.jmir.org/2023/1/e39061 %U https://doi.org/10.2196/39061 %U http://www.ncbi.nlm.nih.gov/pubmed/36930198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43600 %T Clinical and Psychosocial Outcomes Associated With a Tele-behavioral Health Platform for Families: Retrospective Study %A Loo,Theoren %A Hunt,Justin %A Grodberg,David %A Bravata,Dena %+ Child Study Center, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, United States, 1 203 785 2513, david.grodberg@yale.edu %K adolescent %K child %K family health %K resilience, psychological %K mental health %K caregiver stress %K anxiety %K depression %K behavior %K program %K educational psychotherapy %K psychiatry %K care %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The burden of pediatric mental illness in the United States has steadily worsened over the past decade. A recent increase in employer-sponsored behavioral health programs has focused on the needs of the general population. However, these programs do not provide the specialty mental health care required for children, adolescents, and their families. Objective: This study aimed to evaluate the effects of a technology-enabled pediatric and family behavioral health service on clinical outcomes among children and caregiver strain. The service is available to commercially insured populations and provides educational content; tele-behavioral health care, including coaching, therapy, and psychiatry; and care escalation and coordination. Methods: A retrospective cohort analysis of members using the service between February and September 2022 was conducted. Clinical outcomes for children and their caregivers were collected using the Pediatric Symptom Checklist-17 (PSC-17), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 8-item (PHQ-8), and Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Rates of reliable improvement were determined by calculating the reliable change index for each outcome. Paired, 2-tailed t tests were used to evaluate significant changes in assessment scores at follow-up compared to baseline. Results: Of the 4139 participants who enrolled with the service, 48 (1.2%) were referred out for more intensive care, 2393 (57.8%) were referred to coaching, and 1698 (41%) were referred to therapy and psychiatry. Among the 703 members who completed the intervention and provided pre- and postintervention outcomes data, 386 (54.9%) used psychoeducational content, 345 (49.1%) received coaching, and 358 (50.9%) received therapy and psychiatry. In coaching, 75% (183/244) of participants showed reliable improvement on the PSC-17 total score, 72.5% (177/244) on the PSC-17 internalizing score, and 31.5% (105/333) on the CGSQ-SF7 total score (average improvement: PSC-17 total score, 3.37 points; P<.001; PSC-17 internalizing score, 1.58 points; P<.001; and CGSQ-SF7 total score, 1.02 points; P<.001). In therapy and psychiatry, 68.8% (232/337) of participants showed reliable improvement on the PSC-17 total score, 70.6% (238/337) on the PSC-17 internalizing score, 65.2% (219/336) on the CGSQ-SF7 total score, 70.7% (82/116) on the GAD-7 score, and 67.5% (77/114) on the PHQ-8 score (average improvement: PSC-17 total score, 3.16 points; P<.001; PSC-17 internalizing score, 1.66 points; P<.001; CGSQ-SF7 total score, 1.06 points; P<.001; GAD-7 score, 3.00 points; P<.001; and PHQ-8 score, 2.91 points; P<.001). Conclusions: Tele-behavioral health offerings can be effective in improving caregiver strain and psychosocial functioning and depression and anxiety symptoms in a pediatric population. Moreover, these digital mental health offerings may provide a scalable solution to children and their families who lack access to essential pediatric mental health services. %M 36930214 %R 10.2196/43600 %U https://formative.jmir.org/2023/1/e43600 %U https://doi.org/10.2196/43600 %U http://www.ncbi.nlm.nih.gov/pubmed/36930214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44633 %T Factors Associated With Open Access Publishing Costs in Oncology Journals: Cross-sectional Observational Study %A Koong,Alex %A Gardner,Ulysses Grant %A Burton,Jason %A Stewart,Caleb %A Thompson,Petria %A Fuller,Clifton David %A Ludmir,Ethan Bernard %A Rooney,Michael Kevin %+ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77045, United States, 1 346 212 1728, mkrooney@mdanderson.org %K academic publishing %K article processing charge %K open access %K oncology %K open access publishing %K scholarly communication %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Open access (OA) publishing represents an exciting opportunity to facilitate the dissemination of scientific information to global audiences. However, OA publishing is often associated with significant article processing charges (APCs) for authors, which may thus serve as a barrier to publication. Objective: In this observational cohort study, we aimed to characterize the landscape of OA publishing in oncology and, further, identify characteristics of oncology journals that are predictive of APCs. Methods: We identified oncology journals using the SCImago Journal & Country Rank database. All journals with an OA publication option and APC data openly available were included. We searched journal websites and tabulated journal characteristics, including APC amount (in US dollars), OA model (hybrid vs full), 2-year impact factor (IF), H-index, number of citable documents, modality/treatment specific (if applicable), and continent of origin. All APCs were converted to US-dollar equivalents for final analyses. Selecting variables with significant associations in the univariable analysis, we generated a multiple regression model to identify journal characteristics independently associated with OA APC amount. An audit of a random 10% sample of the data was independently performed by 2 authors to ensure data accuracy, precision, and reproducibility. Results: Of 367 oncology journals screened, 251 met the final inclusion criteria. The median APC was US $2957 (IQR 1958-3450). The majority of journals (n=156, 62%) adopted the hybrid OA publication model and were based in Europe (n=119, 47%) or North America (n=87, 35%). The median (IQR) APC for all journals was US $2957 (1958-3540). Twenty-five (10%) journals had APCs greater than US $4000. There were 10 (4%) journals that offered OA publication with no publication charge. Univariable testing showed that journals with a greater number of citable documents (P<.001), higher 2-year IF (P<.001), higher H-index (P<.001), and those using the hybrid OA model (P<.001), or originating in Europe or North America (P<.001) tended to have higher APCs. In our multivariable model, the number of citable documents (β=US $367, SD US $133; P=.006), 2-year IF (US $1144, SD US $177; P<.001), hybrid OA publishing model (US $991, SD US $189; P<.001), and North American origin (US $838, SD US $186; P<.001) persisted as significant predictors of processing charges. Conclusions: OA publication costs are greater in oncology journals that publish more citable articles, use the hybrid OA model, have a higher IF, and are based in North America or Europe. These findings may inform targeted action to help the oncology community fully appreciate the benefits of open science. %M 36927553 %R 10.2196/44633 %U https://formative.jmir.org/2023/1/e44633 %U https://doi.org/10.2196/44633 %U http://www.ncbi.nlm.nih.gov/pubmed/36927553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40542 %T Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists’ Technological Perspective %A Cataldo,Francesco %A Mendoza,Antonette %A Chang,Shanton %A Buchanan,George %A Van Dam,Nicholas T %+ School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Carlton VIC, 700 Swanston St, Melbourne, 3053, Australia, 61 444574920, fcataldo@student.unimelb.edu.au %K videoconference psychotherapy %K therapeutic relationship %K therapeutic alliance %K telehealth %K technology %K therapeutic processes %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. Objective: This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists’ therapeutic work through augmented VCP. Methods: In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. Results: The analysis resulted in the generation of 9 themes (input themes: psychologists’ attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. Conclusions: Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions. %M 36927506 %R 10.2196/40542 %U https://formative.jmir.org/2023/1/e40542 %U https://doi.org/10.2196/40542 %U http://www.ncbi.nlm.nih.gov/pubmed/36927506 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39777 %T Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows %A Dolan,Samantha B %A Wittenauer,Rachel %A Njoroge,Anne %A Onyango,Penina %A Owiso,George %A Shearer,Jessica C %A Lober,William B %A Liu,Shan %A Puttkammer,Nancy %A Rabinowitz,Peter %+ Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, 98109, United States, 1 206 709 3100, sdolan11@gmail.com %K immunizations %K electronic immunization registry %K workflow %K time and motion %K digital health intervention %K mixed methods evaluation %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. Objective: We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual–data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). Methods: We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient’s total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Results: Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR’s performance and ability to connect to the internet were particularly insightful about potential causes of delays. Conclusions: We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology. %M 36927606 %R 10.2196/39777 %U https://formative.jmir.org/2023/1/e39777 %U https://doi.org/10.2196/39777 %U http://www.ncbi.nlm.nih.gov/pubmed/36927606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43334 %T Characterizing Heated Tobacco Products Marketing on Instagram: Observational Study %A Chen,Jiarui %A Xue,Siyu %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K IQOS %K Instagram %K heated tobacco products %K web-based tobacco marketing %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heated tobacco products (HTPs), including I Quit Ordinary Smoking (IQOS), are new tobacco products that use an electronic device to heat compressed tobacco leaves to generate an aerosol for consumers to inhale. Marketing of HTPs is prevalent on Instagram, a popular social media platform. Objective: This study aims to characterize posts related to HTPs on Instagram and their associations with user engagement. Methods: Through the Instagram application programming interface, 979 Instagram posts were collected using keywords related to HTPs, such as “IQOS” and “heat-not-burn.” Among them, 596 posts were related to IQOS and other HTP marketing. The codebook was developed from a randomly selected 200 posts on the post content by hand coding, which was applied to the remaining 396 Instagram posts. Summary statistics were calculated, and statistical hypothesis testing was conducted to understand the popularity of Instagram posts on HTPs. Negative binomial regression models were applied to identify Instagram post characteristics associated with user engagement (eg, count). Results: Among Instagram posts related to HTP marketing (N=596), “product display” was dominant (n=550, 92.28%), followed by “brand promotion” (n=41, 6.88%), and “others” (n=5, 0.84%). Among posts within “product display,” “device only” was the most popular (n=338, 61.45%), followed by “heatstick only” (n=80, 14.55%), “accessory” (n=66, 12%), “device and heatstick” (n=56, 10.18%), and “capsule” (n=10, 1.82%). A univariate negative binomial regression model with pairwise comparisons across “product display” types showed that the number of likes for posts with HTP heatsticks was significantly lower compared to posts with HTP devices, accessories, and device-heatstick sets. Multivariate negative binomial regression models showed that HTP-related Instagram posts with a model or lifestyle elements (;=.60, 95% CI 0.36-0.84) or without obvious product advertising information (=.69, 95% CI 0.49-0.89) received more likes. Conclusions: It is shown that posts with product displays were dominant among HTP-related posts on Instagram. Posts with model or lifestyle elements are associated with high user engagement, which might be one of the web-based marketing strategies of HTPs. %M 36920463 %R 10.2196/43334 %U https://formative.jmir.org/2023/1/e43334 %U https://doi.org/10.2196/43334 %U http://www.ncbi.nlm.nih.gov/pubmed/36920463 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41685 %T Wrist Accelerometer Estimates of Physical Activity Intensity During Walking in Older Adults and People Living With Complex Health Conditions: Retrospective Observational Data Analysis Study %A Weber,Kyle S %A Godkin,F Elizabeth %A Cornish,Benjamin F %A McIlroy,William E %A Van Ooteghem,Karen %+ Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, kvanooteghem@uwaterloo.ca %K neurodegenerative disease %K aging %K older adults %K wearable sensors %K physical activity %K activity intensity %K activity monitoring %K exercise prescription %K accelerometry %K health technology %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application. Objective: The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates. Methods: A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking. Results: Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t16=4.24, P<.001) and had more variable wrist movement (t16=2.13, P=.049) compared to those in the lowest quartile. Conclusions: The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups. %M 36920452 %R 10.2196/41685 %U https://formative.jmir.org/2023/1/e41685 %U https://doi.org/10.2196/41685 %U http://www.ncbi.nlm.nih.gov/pubmed/36920452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41178 %T Smartphone and Wearable Sensors for the Estimation of Facioscapulohumeral Muscular Dystrophy Disease Severity: Cross-sectional Study %A Zhuparris,Ahnjili %A Maleki,Ghobad %A Koopmans,Ingrid %A Doll,Robert J %A Voet,Nicoline %A Kraaij,Wessel %A Cohen,Adam %A van Brummelen,Emilie %A De Maeyer,Joris H %A Groeneveld,Geert Jan %+ Centre for Human Drug Research (CHDR), Zernikedreef 8, Leiden, 2333 CL, Netherlands, 31 0715246400, ggroeneveld@chdr.nl %K facioscapulohumeral muscular dystrophy %K FSHD %K smartphone %K wearables %K machine learning %K Time Up and Go %K regression %K mobile phone %K neuromuscular disease %K mHealth %K mobile health %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Facioscapulohumeral muscular dystrophy (FSHD) is a progressive neuromuscular disease. Its slow and variable progression makes the development of new treatments highly dependent on validated biomarkers that can quantify disease progression and response to drug interventions. Objective: We aimed to build a tool that estimates FSHD clinical severity based on behavioral features captured using smartphone and remote sensor data. The adoption of remote monitoring tools, such as smartphones and wearables, would provide a novel opportunity for continuous, passive, and objective monitoring of FSHD symptom severity outside the clinic. Methods: In total, 38 genetically confirmed patients with FSHD were enrolled. The FSHD Clinical Score and the Timed Up and Go (TUG) test were used to assess FSHD symptom severity at days 0 and 42. Remote sensor data were collected using an Android smartphone, Withings Steel HR+, Body+, and BPM Connect+ for 6 continuous weeks. We created 2 single-task regression models that estimated the FSHD Clinical Score and TUG separately. Further, we built 1 multitask regression model that estimated the 2 clinical assessments simultaneously. Further, we assessed how an increasingly incremental time window affected the model performance. To do so, we trained the models on an incrementally increasing time window (from day 1 until day 14) and evaluated the predictions of the clinical severity on the remaining 4 weeks of data. Results: The single-task regression models achieved an R2 of 0.57 and 0.59 and a root-mean-square error (RMSE) of 2.09 and 1.66 when estimating FSHD Clinical Score and TUG, respectively. Time spent at a health-related location (such as a gym or hospital) and call duration were features that were predictive of both clinical assessments. The multitask model achieved an R2 of 0.66 and 0.81 and an RMSE of 1.97 and 1.61 for the FSHD Clinical Score and TUG, respectively, and therefore outperformed the single-task models in estimating clinical severity. The 3 most important features selected by the multitask model were light sleep duration, total steps per day, and mean steps per minute. Using an increasing time window (starting from day 1 to day 14) for the FSHD Clinical Score, TUG, and multitask estimation yielded an average R2 of 0.65, 0.79, and 0.76 and an average RMSE of 3.37, 2.05, and 4.37, respectively. Conclusions: We demonstrated that smartphone and remote sensor data could be used to estimate FSHD clinical severity and therefore complement the assessment of FSHD outside the clinic. In addition, our results illustrated that training the models on the first week of data allows for consistent and stable prediction of FSHD symptom severity. Longitudinal follow-up studies should be conducted to further validate the reliability and validity of the multitask model as a tool to monitor disease progression over a longer period. Trial Registration: ClinicalTrials.gov NCT04999735; https://www.clinicaltrials.gov/ct2/show/NCT04999735 %M 36920465 %R 10.2196/41178 %U https://formative.jmir.org/2023/1/e41178 %U https://doi.org/10.2196/41178 %U http://www.ncbi.nlm.nih.gov/pubmed/36920465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39425 %T Objective Prediction of Next-Day’s Affect Using Multimodal Physiological and Behavioral Data: Algorithm Development and Validation Study %A Jafarlou,Salar %A Lai,Jocelyn %A Azimi,Iman %A Mousavi,Zahra %A Labbaf,Sina %A Jain,Ramesh C %A Dutt,Nikil %A Borelli,Jessica L %A Rahmani,Amir %+ Donald Bren School of Information and Computer Sciences, University of California, Irvine, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 (949) 824 7427, jafarlos@uci.edu %K wearable devices %K mental health %K affective computing %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Affective states are important aspects of healthy functioning; as such, monitoring and understanding affect is necessary for the assessment and treatment of mood-based disorders. Recent advancements in wearable technologies have increased the use of such tools in detecting and accurately estimating mental states (eg, affect, mood, and stress), offering comprehensive and continuous monitoring of individuals over time. Objective: Previous attempts to model an individual’s mental state relied on subjective measurements or the inclusion of only a few objective monitoring modalities (eg, smartphones). This study aims to investigate the capacity of monitoring affect using fully objective measurements. We conducted a comparatively long-term (12-month) study with a holistic sampling of participants’ moods, including 20 affective states. Methods: Longitudinal physiological data (eg, sleep and heart rate), as well as daily assessments of affect, were collected using 3 modalities (ie, smartphone, watch, and ring) from 20 college students over a year. We examined the difference between the distributions of data collected from each modality along with the differences between their rates of missingness. Out of the 20 participants, 7 provided us with 200 or more days’ worth of data, and we used this for our predictive modeling setup. Distributions of positive affect (PA) and negative affect (NA) among the 7 selected participants were observed. For predictive modeling, we assessed the performance of different machine learning models, including random forests (RFs), support vector machines (SVMs), multilayer perceptron (MLP), and K-nearest neighbor (KNN). We also investigated the capability of each modality in predicting mood and the most important features of PA and NA RF models. Results: RF was the best-performing model in our analysis and performed mood and stress (nervousness) prediction with ~81% and ~72% accuracy, respectively. PA models resulted in better performance compared to NA. The order of the most important modalities in predicting PA and NA was the smart ring, phone, and watch, respectively. SHAP (Shapley Additive Explanations) analysis showed that sleep and activity-related features were the most impactful in predicting PA and NA. Conclusions: Generic machine learning–based affect prediction models, trained with population data, outperform existing methods, which use the individual’s historical information. Our findings indicated that our mood prediction method outperformed the existing methods. Additionally, we found that sleep and activity level were the most important features for predicting next-day PA and NA, respectively. %M 36920456 %R 10.2196/39425 %U https://formative.jmir.org/2023/1/e39425 %U https://doi.org/10.2196/39425 %U http://www.ncbi.nlm.nih.gov/pubmed/36920456 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37550 %T A Digital Health Initiative (COVIDsmart) for Remote Data Collection and Study of COVID-19’s Impact on the State of Virginia: Prospective Cohort Study %A Schilling,Josh %A Klein,Dave %A Bartholmae,Marilyn M %A Shokouhi,Sepideh %A Toepp,Angela J %A Roess,Amira A %A Sill,Joshua M %A Karpov,Matvey V %A Maney,Kathleen %A Brown,K Pearson %A Levy,Brian L %A Renshaw,Keith D %A Dodani,Sunita %A Jain,Praduman %+ Vibrent Health, 4114 Legato Rd, Fairfax, VA, 22033, United States, 1 571 459 2372, pj@vibrenthealth.com %K COVID-19 %K digital health technology %K human subjects %K partnership %K community health %K diversity %K mobile health %K mHealth %K medical subject headings %K MeSH %K medical informatics %K internet %K digital health %K digital solution %K digital recruitment %K precision medicine %K digital marketing %K decision-making %K COVIDsmart %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. COVID-19–induced economic setbacks have also likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. We describe how digital tools were used to capture the effects of the pandemic on the overall well-being of diverse communities across large geographical areas within the state of Virginia. Objective: The aim is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share the preliminary study results. Methods: COVIDsmart conducted digital recruitment, e-Consent, and survey collection through a Health Insurance Portability and Accountability Act–compliant digital health platform. This is an alternative to the traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over 3 months using widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education or work functioning, social or family functioning, and economic impact. Data were collected using validated questionnaires or surveys, completed in a cyclical fashion and reviewed by an expert panel. To retain a high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving a monthly gift card and one of multiple grand prizes. Results: Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3737), and 782 (21.1%) consented to participate in the study. The most successful recruitment technique was the effective use of newsletters or emails (n=326, 41.7%). The primary reason for contributing as a study participant was advancing research (n=625, 79.9%), followed by the need to give back to their community (n=507, 64.8%). Incentives were only reported as a reason among 21% (n=164) of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6% (n=693). Conclusions: The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic’s effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies. %M 36795656 %R 10.2196/37550 %U https://formative.jmir.org/2023/1/e37550 %U https://doi.org/10.2196/37550 %U http://www.ncbi.nlm.nih.gov/pubmed/36795656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40285 %T A Digital Platform and Smartphone App to Increase Physical Activity in Patients With Type 2 Diabetes: Overview Of a Technical Solution %A Bonn,Stephanie E %A Alexandrou,Christina %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 16, Stockholm, 171 76, Sweden, 46 8 517 791 83, stephanie.bonn@ki.se %K methods %K mHealth %K mobile app %K self-management %K smartphone %K digital %K platform %K physical activity %K diabetes %K technical %K engagement %K self-care %K development %K app %K walking %K effective %D 2023 %7 14.3.2023 %9 Viewpoint %J JMIR Form Res %G English %X Mobile Health (mHealth) solutions can be used to increase patients’ engagement in self-care. Descriptions of the technical solutions behind mHealth smartphone apps may guide the development of future apps. Here, we aim to describe the technical background and visual display of the DiaCert system, which was developed to support daily walking among patients with type 2 diabetes. The DiaCert system publishes one application program interface developed for patient devices (ie, smartphone apps running on iOS or Android) and another for web-based health care provider components (ie, administrative components). An individual care plan is created for each patient on the caregiver platform, and data on physical activity (ie, steps), blood samples, and questionnaires are shared between patient and caregiver in the DiaCert system. Technical solutions such as this enable us to reach more individuals at a lower cost compared to traditional health care. An advantage to the DiaCert technical solution is that it is built on a simple architecture and therefore is easily scalable. However, as it is a separate solution, it means adding yet another process for health care personnel to integrate into their work, which must be acknowledged. We hope that the technical description and visual display of the DiaCert system herein can guide researchers in the design and building of new and effective mHealth solutions.International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5026-4 %M 36917156 %R 10.2196/40285 %U https://formative.jmir.org/2023/1/e40285 %U https://doi.org/10.2196/40285 %U http://www.ncbi.nlm.nih.gov/pubmed/36917156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39775 %T Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability %A Dolan,Samantha B %A Wittenauer,Rachel  %A Shearer,Jessica C %A Njoroge,Anne %A Onyango,Penina %A Owiso,George %A Lober,William B %A Liu,Shan %A Puttkammer,Nancy %A Rabinowitz,Peter %+ Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, 98109, United States, 1 206 709 3100, sdolan11@gmail.com %K immunizations %K electronic immunization registry %K workflow %K usability %K realist research %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. Objective: In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry’s usability. Methods: Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Results: Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1—ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2—confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3—identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4—make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. Conclusions: We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users’ workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users’ needs and again after scale-up to ensure that interventions are suitable for all user settings. %M 36917157 %R 10.2196/39775 %U https://formative.jmir.org/2023/1/e39775 %U https://doi.org/10.2196/39775 %U http://www.ncbi.nlm.nih.gov/pubmed/36917157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38491 %T Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study %A Chen,Emily %A Hollowell,Adam %A Truong,Tracy %A Bentley-Edwards,Keisha %A Myers,Evan %A Erkanli,Alaattin %A Holt,Lauren %A Swartz,Jonas J %+ Department of Obstetrics & Gynecology, Duke University Medical Center, DUMC 3084, Durham, NC, 27710, United States, 1 919 668 7594, jonas.swartz@duke.edu %K COVID-19 %K contraception %K college %K disparities %K LARC %K sexual health %K social media %K health promotion %K telehealth %K health messaging %K health resource %K health disparity %K risk factor %K healthcare access %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students’ access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants’ sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. %M 36827491 %R 10.2196/38491 %U https://formative.jmir.org/2023/1/e38491 %U https://doi.org/10.2196/38491 %U http://www.ncbi.nlm.nih.gov/pubmed/36827491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37549 %T Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study %A Howard,A Fuchsia %A Noga,Heather %A Parmar,Gurkiran %A Kennedy,Lan %A Aragones,Sarah %A Bassra,Roop %A Gelfer,Lauren %A Lopez de Arbina,Edurne %A Sutherland,Jessica %A Allaire,Catherine %A Oliffe,John L %A Currie,Leanne M %A Yager,Holly %A Yong,Paul J %+ School of Nursing, The University of British Columbia, 201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 6048224372, fuchsia.howard@ubc.ca %K digital storytelling %K endometriosis %K pain %K chronic pain %K painful sex %K dyspareunia %K integrated knowledge translation %K patient-oriented research %K community-based participatory research %K qualitative research %K arts-based research %K group therapy %K sex therapy %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences. Objective: The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers’ experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers’ willingness to share their stories with broader audiences as a method for knowledge translation. Methods: This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach. Results: A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants’ experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website. Conclusions: Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention. %M 36917164 %R 10.2196/37549 %U https://formative.jmir.org/2023/1/e37549 %U https://doi.org/10.2196/37549 %U http://www.ncbi.nlm.nih.gov/pubmed/36917164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41408 %T Assessment of Stakeholder Perceptions and Attitudes Toward Health Data Governance Principles in Botswana: Web-Based Survey %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Chibemba,Star %A Wanyee,Steven %A Oluoch,Tom %+ Department of Health Information Management, Botho University, Botho Education Park, Diratsame Mosielele, Gaborone, PO Box 501564, Botswana, 267 3919999, kabelo.mauco@bothouniversity.ac.bw %K health data %K governance %K Botswana %K digital health %K decision-making %K health care stakeholders %K perceptions %K health policy %K data governance %K data policy %K implementation %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of information and communication technologies for health—eHealth—is described as having potential to improve the quality of health care service delivery. Consequently, there is an increased global trend toward adoption of eHealth interventions by health care systems worldwide. Despite the proliferation of eHealth solutions, many health care institutions especially in transitioning countries are struggling to attain effective data governance approaches. The Ministry of Health in Botswana is an exemplar institution continually seeking better approaches to strengthen health data governance (HDG) approaches following the adoption of eHealth solutions. Recognizing the need for a global HDG framework, the Transform Health coalition conceptualized HDG principles that are structured around 3 interconnected objectives: protecting people, promoting the value of health, and prioritizing equity. Objective: The aim of the study is to solicit and evaluate perceptions and attitudes of health sector workers in Botswana toward the HDG principles by Transform Health and derive any future guidance. Methods: Purposive sampling was used to select participants. A total of 23 participants from various health care organizations in Botswana completed a web-based survey and 10 participated in a follow-up remote round-table discussion. The aim of the round-table discussion was to gain further insight into participants’ responses from the web-based survey. Participants were from the following health care cadres: nurses, doctors, information technology professionals, and health informaticians. Both validity and reliability testing were performed for the survey tool before sharing it with study participants. An analysis of participants’ close-ended responses from the survey was performed using descriptive statistics. Thematic analysis of open-ended responses from the questionnaire and the round-table discussion was achieved using the Delve software and the widely accepted principles of thematic analysis. Results: Although some participants highlighted having measures in place similar to the HDG principles, there were some who either did not know or disagreed that their organizations already had in place mechanisms similar to the proposed HDG principles. Participants further expressed relevance and importance of the HDG principles in the context of Botswana. However, some modifications to the principles were also suggested. Conclusions: This study highlights the necessity of data governance in health care particularly toward meeting the requirements for Universal Health Coverage. The existence of other health data governance frameworks calls for a critical analysis to assess the most appropriate and applicable framework in the context of Botswana and similar transitioning countries. An organization-centered approach may be most appropriate, as well as strengthening of existing organizations’ HDG practices with the Transform Health principles. %M 36912870 %R 10.2196/41408 %U https://formative.jmir.org/2023/1/e41408 %U https://doi.org/10.2196/41408 %U http://www.ncbi.nlm.nih.gov/pubmed/36912870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41273 %T Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial %A Thabrew,Hiran %A Kumar,Harshali %A Steadman,Evandah %+ Department of Psychological Medicine, The University go Auckland, 20-22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 021402055, h.thabrew@auckland.ac.nz %K youth %K suicide %K self-harm %K depression %K support %K application %K mobile phone %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 %M 36912882 %R 10.2196/41273 %U https://formative.jmir.org/2023/1/e41273 %U https://doi.org/10.2196/41273 %U http://www.ncbi.nlm.nih.gov/pubmed/36912882 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45218 %T Diagnostic Ability of a Smartphone App for Dry Eye Disease: Protocol for a Multicenter, Open-Label, Prospective, and Cross-sectional Study %A Nagino,Ken %A Okumura,Yuichi %A Yamaguchi,Masahiro %A Sung,Jaemyoung %A Nagao,Masashi %A Fujio,Kenta %A Akasaki,Yasutsugu %A Huang,Tianxiang %A Hirosawa,Kunihiko %A Iwagami,Masao %A Midorikawa-Inomata,Akie %A Fujimoto,Keiichi %A Eguchi,Atsuko %A Okajima,Yukinobu %A Kakisu,Koji %A Tei,Yuto %A Yamaguchi,Takefumi %A Tomida,Daisuke %A Fukui,Masaki %A Yagi-Yaguchi,Yukari %A Hori,Yuichi %A Shimazaki,Jun %A Nojiri,Shuko %A Morooka,Yuki %A Yee,Alan %A Miura,Maria %A Ohno,Mizu %A Inomata,Takenori %+ Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358021228, tinoma@juntendo.ac.jp %K digital health %K digital therapeutics %K dry eye disease %K Japanese version of the Ocular Surface Disease Index %K maximum blink interval %K mobile health %K smartphone %K smartphone app %K tear film breakup time %K telemedicine %D 2023 %7 13.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dry eye disease (DED) is one of the most common ocular surface diseases. Numerous patients with DED remain undiagnosed and inadequately treated, experiencing various subjective symptoms and a decrease in quality of life and work productivity. A mobile health smartphone app, namely, the DEA01, has been developed as a noninvasive, noncontact, and remote screening device, in the context of an ongoing paradigm shift in the health care system, to facilitate a diagnosis of DED. Objective: This study aimed to evaluate the capabilities of the DEA01 smartphone app to facilitate a DED diagnosis. Methods: In this multicenter, open-label, prospective, and cross-sectional study, the test method will involve using the DEA01 smartphone app to collect and evaluate DED symptoms, based on the Japanese version of the Ocular Surface Disease Index (J-OSDI), and to measure the maximum blink interval (MBI). The standard method will then involve a paper-based J-OSDI evaluation of subjective symptoms of DED and tear film breakup time (TFBUT) measurement in an in-person encounter. We will allocate 220 patients to DED and non-DED groups, based on the standard method. The primary outcome will be the sensitivity and specificity of the DED diagnosis according to the test method. Secondary outcomes will be the validity and reliability of the test method. The concordance rate, positive and negative predictive values, and the likelihood ratio between the test and standard methods will be assessed. The area under the curve of the test method will be evaluated using a receiver operating characteristic curve. The internal consistency of the app-based J-OSDI and the correlation between the app-based J-OSDI and paper-based J-OSDI will be assessed. A DED diagnosis cutoff value for the app-based MBI will be determined using a receiver operating characteristic curve. The app-based MBI will be assessed to determine a correlation between a slit lamp–based MBI and TFBUT. Adverse events and DEA01 failure data will be collected. Operability and usability will be assessed using a 5-point Likert scale questionnaire. Results: Patient enrollment will start in February 2023 and end in July 2023. The findings will be analyzed in August 2023, and the results will be reported from March 2024 onward. Conclusions: This study may have implications in identifying a noninvasive, noncontact route to facilitate a diagnosis of DED. The DEA01 may enable a comprehensive diagnostic evaluation within a telemedicine setting and facilitate early intervention for undiagnosed patients with DED confronting health care access barriers. Trial Registration: Japan Registry of Clinical Trials jRCTs032220524; https://jrct.niph.go.jp/latest-detail/jRCTs032220524 International Registered Report Identifier (IRRID): PRR1-10.2196/45218 %M 36912872 %R 10.2196/45218 %U https://www.researchprotocols.org/2023/1/e45218 %U https://doi.org/10.2196/45218 %U http://www.ncbi.nlm.nih.gov/pubmed/36912872 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44254 %T Implementing an Activity Tracker to Increase Motivation for Physical Activity in Patients With Diabetes in Primary Care: Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis %A Pelletier,Cynthia %A Chabot,Christian %A Gagnon,Marie-Pierre %A Rhéaume,Caroline %+ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Local 4617, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC, G1V 0A6, Canada, 1 418 656 8711 ext 5172, caroline.rheaume@fmed.ulaval.ca %K activity tracker %K type 2 diabetes %K family medicine research %K SWOT analysis %K physical activity %K physical activity motivation %K diabetes %K implementation %K chronic disease %K intervention %K questionnaire %K tool %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many projects related to technology implementation in the context of chronic diseases have been developed over the years to better manage lifestyle medicine interventions and improve patient care. However, technology implementation in primary care settings remains challenging. Objective: The aim is to carry out a strengths, weaknesses, opportunities, and threats (SWOT) analysis (1) to assess satisfaction among patients with type 2 diabetes using an activity tracker to increase motivation for physical activity (PA) and (2) to explore the research and health care team’s perceptions of this technology’s implementation in a primary care setting. Methods: A 3-month hybrid type 1 study, which included 2 stages, was conducted in an academic primary health center in Quebec City, Quebec, Canada. In stage 1, a total of 30 patients with type 2 diabetes were randomized to the intervention (activity tracker) group or the control group. In stage 2, a SWOT analysis was performed on both patients and health care professionals to determine the components of successful technology implementation. Two questionnaires were used to gather feedback: a satisfaction and acceptability questionnaire concerning an activity tracker (15 patients in the intervention group) and a questionnaire based on the SWOT elements (15 patients in the intervention group and 7 health care professionals). Both questionnaires contained quantitative and qualitative questions. Qualitative variables from open questions were synthesized in a matrix and ranked according to apparition frequency and global importance. A thematic analysis was performed by the first author and validated by 2 coauthors separately. The information gathered was triangulated to propose recommendations that were then approved by the team. Both quantitative (randomized controlled trial participants) and qualitative (randomized controlled trial participants and team) results were combined for recommendations. Results: In total, 86% (12/14) of the participants were satisfied with their activity tracker use and 75% (9/12) felt that it incited them to stick to their PA program. The main strengths of the team members’ perspectives were the project initiation and involvement of a patient partner, the study design, the team, and the device. The weaknesses were the budgetary constraints, the turnover, and the technical issues. The opportunities were the primary care setting, the loan of equipment, and common technology. The threats were recruitment issues, administrative challenges, technological difficulties, and a single research site. Conclusions: Patients with type 2 diabetes were satisfied with their activity tracker used to improve motivation for PA. Health care team members agreed that implementation can be done in primary care, but some challenges remain in using this technological tool in clinical practice regularly. Trial Registration: ClinicalTrials.gov NCT03709966; https://clinicaltrials.gov/ct2/show/NCT03709966 %M 36897642 %R 10.2196/44254 %U https://formative.jmir.org/2023/1/e44254 %U https://doi.org/10.2196/44254 %U http://www.ncbi.nlm.nih.gov/pubmed/36897642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41694 %T Technology Use During the COVID-19 Pandemic and the Ways in Which Technology Can Support Adolescent Well-being: Qualitative Exploratory Study %A Rimel,Sarah E %A Bam,Dina %A Farren,Laura %A Thaanum,Ayana %A Smith,Alessandro %A Park,Susanna Y %A Boeldt,Debra L %A Nicksic Sigmon,Chloe A %+ National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, CO, 80045, United States, 1 8433430100, sarah@vxvymentalhealth.com %K adolescents %K mental health %K technology use %K well-being %K COVID-19 %K compassion %K social connectedness %K mobile phone %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most adolescents in the United States engage with technology. Social isolation and disruptions in activities owing to the COVID-19 pandemic have been linked to worsening mood and overall decreased well-being in adolescents. Although studies on the direct impacts of technology on adolescent well-being and mental health are inconclusive, there are both positive and negative associations depending on various factors, such as how the technology is used and by whom under certain settings. Objective: This study applied a strengths-based approach and focused on the potential to leverage technology to benefit adolescent well-being during a public health emergency. This study aimed to gain an initial and nuanced understanding of how adolescents have used technology to support their wellness throughout the pandemic. In addition, this study aimed to further motivate future large-scale research on how technology can be leveraged to benefit adolescent well-being. Methods: This study used an exploratory qualitative approach and was conducted in 2 phases. Phase 1 consisted of interviewing subject matter experts who work with adolescents to inform the creation of a semistructured interview for phase 2. Subject matter experts were recruited from existing connections with the Hemera Foundation and National Mental Health Innovation Center’s (NMHIC) networks. In phase 2, adolescents (aged 14-18 years) were recruited nationally through social media (eg, Facebook, Twitter, LinkedIn, and Instagram) and via email to institutions (eg, high schools, hospitals, and health technology companies). High school and early college interns at NMHIC led the interviews via Zoom (Zoom Video Communications) with an NMHIC staff member on the call in an observational role. A total of 50 adolescents completed interviews regarding their technology use and its role during the COVID-19 pandemic. Results: The overarching themes identified from the data were COVID-19’s impact on adolescent lives, positive role of technology, negative role of technology, and resiliency. Adolescents engaged with technology as a way to foster and maintain connection in a time of extended isolation. However, they also demonstrated an awareness of when technology was negatively affecting their well-being, prompting them to turn to other fulfilling activities that do not involve technology. Conclusions: This study highlights how adolescents have used technology for well-being throughout the COVID-19 pandemic. Guidelines based on insights from the results of this study were created for adolescents, parents, caregivers, and teachers to provide recommendations for how adolescents can use technology to bolster overall well-being. Adolescents’ ability to recognize when they need to engage in nontechnology-related activities and their ability to use technology to reach a larger community indicate that technology can be facilitated in positive ways to benefit their overall well-being. Future research should focus on increasing the generalizability of recommendations and identifying additional ways to leverage mental health technologies. %M 36795671 %R 10.2196/41694 %U https://formative.jmir.org/2023/1/e41694 %U https://doi.org/10.2196/41694 %U http://www.ncbi.nlm.nih.gov/pubmed/36795671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43296 %T Combining Experience Sampling and Mobile Sensing for Digital Phenotyping With m-Path Sense: Performance Study %A Niemeijer,Koen %A Mestdagh,Merijn %A Verdonck,Stijn %A Meers,Kristof %A Kuppens,Peter %+ Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Tiensestraat 102, Post box 3717, Leuven, 3000, Belgium, 32 16 37 2580, koen.niemeijer@kuleuven.be %K digital phenotyping %K mobile health %K mHealth %K mobile sensing %K passive sensing %K ambulatory assessment %K experience sampling %K ecological momentary assessment %K smartphones %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience sampling methodology (ESM) has long been considered as the gold standard for gathering data in everyday life. In contrast, current smartphone technology enables us to acquire data that are much richer, more continuous, and unobtrusive than is possible via ESM. Although data obtained from smartphones, known as mobile sensing, can provide useful information, its stand-alone usefulness is limited when not combined with other sources of information such as data from ESM studies. Currently, there are few mobile apps available that allow researchers to combine the simultaneous collection of ESM and mobile sensing data. Furthermore, such apps focus mostly on passive data collection with only limited functionality for ESM data collection. Objective: In this paper, we presented and evaluated the performance of m-Path Sense, a novel, full-fledged, and secure ESM platform with background mobile sensing capabilities. Methods: To create an app with both ESM and mobile sensing capabilities, we combined m-Path, a versatile and user-friendly platform for ESM, with the Copenhagen Research Platform Mobile Sensing framework, a reactive cross-platform framework for digital phenotyping. We also developed an R package, named mpathsenser, which extracts raw data to an SQLite database and allows the user to link and inspect data from both sources. We conducted a 3-week pilot study in which we delivered ESM questionnaires while collecting mobile sensing data to evaluate the app’s sampling reliability and perceived user experience. As m-Path is already widely used, the ease of use of the ESM system was not investigated. Results: Data from m-Path Sense were submitted by 104 participants, totaling 69.51 GB (430.43 GB after decompression) or approximately 37.50 files or 31.10 MB per participant per day. After binning accelerometer and gyroscope data to 1 value per second using summary statistics, the entire SQLite database contained 84,299,462 observations and was 18.30 GB in size. The reliability of sampling frequency in the pilot study was satisfactory for most sensors, based on the absolute number of collected observations. However, the relative coverage rate—the ratio between the actual and expected number of measurements—was below its target value. This could mostly be ascribed to gaps in the data caused by the operating system pushing away apps running in the background, which is a well-known issue in mobile sensing. Finally, some participants reported mild battery drain, which was not considered problematic for the assessed participants’ perceived user experience. Conclusions: To better study behavior in everyday life, we developed m-Path Sense, a fusion of both m-Path for ESM and Copenhagen Research Platform Mobile Sensing. Although reliable passive data collection with mobile phones remains challenging, it is a promising approach toward digital phenotyping when combined with ESM. %M 36881444 %R 10.2196/43296 %U https://formative.jmir.org/2023/1/e43296 %U https://doi.org/10.2196/43296 %U http://www.ncbi.nlm.nih.gov/pubmed/36881444 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35045 %T Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study %A Emery,Joanne %A Huang,Yue %A Naughton,Felix %A Cooper,Sue %A McDaid,Lisa %A Dickinson,Anne %A Clark,Miranda %A Kinahan-Goodwin,Darren %A Thomson,Ross %A Phillips,Lucy %A Lewis,Sarah %A Coleman,Tim %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 456161, joanne.emery@uea.ac.uk %K smoking cessation %K pregnancy %K nicotine replacement therapy %K treatment adherence measurement %K smartphone app %K questionnaires %K ecological momentary assessment %K mHealth %K mobile health %K smoking %K nicotine %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. Objective: In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. Methods: Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. Results: Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. Conclusions: Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants. %M 36881452 %R 10.2196/35045 %U https://formative.jmir.org/2023/1/e35045 %U https://doi.org/10.2196/35045 %U http://www.ncbi.nlm.nih.gov/pubmed/36881452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41799 %T Effects of the COVID-19 Pandemic on the Decision and Doubts About Vaccination in Catalonia: Online Cross-sectional Questionnaire %A Huguet-Feixa,Agnes %A Artigues-Barberà,Eva %A Sol,Joaquim %A Godoy,Pere %A Ortega Bravo,Marta %A , %+ Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Rambla Ferran, 44, Lleida, 25007, Spain, 34 973728255 ext 1809, mortega.lleida.ics@gencat.cat %K COVID-19 %K vaccines %K vaccine hesitancy %K anti-vaccine %K decision-making %K disease %K questionnaire %K electronic %K pandemic %K vaccination %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hesitancy to get vaccinated during the COVID-19 pandemic may decrease vaccination coverage and facilitate the occurrence of local or global outbreaks. Objective: The objective of this study was to analyze the impact of the COVID-19 pandemic in Catalonia on 3 aspects: the decision to get vaccinated against COVID-19, changes in opinion about vaccination in general, and the decision to get vaccinated against other diseases. Methods: We performed an observational study with the population of Catalonia aged 18 years or over, obtaining information through a self-completed questionnaire in electronic format. Differences between groups were determined using the chi-square test, Mann-Whitney U test, or the Student t test. Results: We analyzed the answers from 1188 respondents, of which 870 were women, 47.0% (558/1187) had sons or daughters under the age of 14 years, and 71.7% (852/1188) had studied at university. Regarding vaccination, 16.3% (193/1187) stated that they had refused a vaccine on some occasion, 76.3% (907/1188) totally agreed with vaccines, 1.9% (23/1188) were indifferent, and 3.5% (41/1188) and 1.2% (14/1188) slightly or totally disagreed with vaccination, respectively. As a result of the pandemic, 90.8% (1069/1177) stated that they would get vaccinated against COVID-19 when they are asked, while 9.2% (108/1177) stated the opposite. A greater intention to get vaccinated was observed among women; people older than 50 years; people without children under 15 years of age; people with beliefs, culture, or family in favor of vaccination; respondents who had not previously rejected other vaccines, were totally in favor of vaccines, or had not increased their doubts about vaccination; and respondents who had not changed their decision about vaccines as a result of the pandemic. Finally, 30.3% (359/1183) reported an increase in their doubts regarding vaccination, and 13.0% (154/1182) stated that they had changed their decision about routinely recommended vaccines as a result of the pandemic. Conclusions: The population studied was predominantly in favor of vaccination; however, the percentage of people specifically rejecting vaccination against COVID-19 was high. As a result of the pandemic, we detected an increase in doubts about vaccines. Although the final decision about vaccination did not primarily change, some of the respondents did change their opinion about routine vaccinations. This seed of doubt about vaccines may be worrisome as we aim to maintain high vaccination coverage. %M 36877561 %R 10.2196/41799 %U https://formative.jmir.org/2023/1/e41799 %U https://doi.org/10.2196/41799 %U http://www.ncbi.nlm.nih.gov/pubmed/36877561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40104 %T The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study %A Ryan,Arthur Thomas %A Brenner,Lisa Anne %A Ulmer,Christi S %A Mackintosh,Margaret-Anne %A Greene,Carolyn J %+ Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, United States, 1 720 723 7493, arthur.ryan@va.gov %K cognitive behavioral therapy for insomnia %K CBT-I %K insomnia %K digital mental health intervention %K digital MH intervention %K internet-delivered %K veterans %K Path to Better Sleep %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). Objective: We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. Methods: A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists’ feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. Results: The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course’s sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. Conclusions: The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers. %M 36877553 %R 10.2196/40104 %U https://formative.jmir.org/2023/1/e40104 %U https://doi.org/10.2196/40104 %U http://www.ncbi.nlm.nih.gov/pubmed/36877553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41575 %T Improving Implementation of an Electronic Prescription System for COVID-19 Vaccination in the Czech Republic: Process Modeling Approach %A Berger,Jiri %A Bruthans,Jan %A Kofránek,Jiří %+ Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Nám Sítná 3105, Kladno, 27201, Czech Republic, 420 723426288, jan@bruthans.cz %K eHealth %K electronic prescription %K process modeling %K state diagram %K COVID-19 %K vaccination %K vaccine %K medical %K communication %K platform %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: It is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent “Method and system for automated requirements modeling” was used successfully in the Czech Republic for the first time. Objective: The aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system. Methods: The method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement. Results: This method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas. Conclusions: The vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard. %M 36787233 %R 10.2196/41575 %U https://formative.jmir.org/2023/1/e41575 %U https://doi.org/10.2196/41575 %U http://www.ncbi.nlm.nih.gov/pubmed/36787233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41115 %T A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences %A Leiner,Johannes %A König,Sebastian %A Mouratis,Konstantinos %A Kim,Igor %A Schmitz,Pia %A Joshi,Tanvi %A Schanner,Carolin %A Wohlrab,Lisa %A Hohenstein,Sven %A Pellissier,Vincent %A Nitsche,Anne %A Kuhlen,Ralf %A Hindricks,Gerhard %A Bollmann,Andreas %+ Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, 04289, Germany, 49 341865251573, johannes.leiner@helios-gesundheit.de %K mHealth %K wearable %K patient-reported outcomes %K electrocardiogram %K cardiovascular disease %K atrial fibrillation %K telemedicine %K mobile health %K telehealth %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients’ quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. Objective: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. Methods: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). Results: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform’s functionality and usability. Conclusions: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth. %M 36867450 %R 10.2196/41115 %U https://formative.jmir.org/2023/1/e41115 %U https://doi.org/10.2196/41115 %U http://www.ncbi.nlm.nih.gov/pubmed/36867450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e29480 %T Real-time Symptom Assessment in Patients With Endometriosis: Psychometric Evaluation of an Electronic Patient-Reported Outcome Measure, Based on the Experience Sampling Method %A van Barneveld,Esther %A Lim,Arianne %A van Hanegem,Nehalennia %A van Osch,Frits %A Vork,Lisa %A Kruimel,Joanna %A Bongers,Marlies %A Leue,Carsten %+ Department of Gynaecology and Obstetrics, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 613403725, esthervb@gmail.com %K endometriosis %K pelvic pain %K positive affect %K negative affect %K patient-reported outcome measure %K momentary symptom assessment %K experience sampling method %K pain %K PROM %K outcome %K patient-reported %K assessment %K symptom %K sampling %K method %K evaluation %K psychometric %K real-time %K prospective %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience sampling method (ESM) holds advantages over traditional retrospective questionnaires including a high ecological validity, no recall bias, the ability to assess fluctuation of symptoms, and the ability to analyze the temporal relationship between variables. Objective: This study aimed to evaluate the psychometric properties of an endometriosis-specific ESM tool. Methods: This is a short-term follow-up prospective study, including patients with premenopausal endometriosis aged ≥18 years who reported dysmenorrhea, chronic pelvic pain, or dyspareunia between December 2019 and November 2020. An ESM-based questionnaire was sent out by a smartphone application 10 times a day during 1 week on randomly chosen moments. Additionally, patients completed questionnaires concerning demographics, end-of-day pain scores, and end-of-week symptom scores. The psychometric evaluation included compliance, concurrent validity, and internal consistency. Results: Twenty-eight patients with endometriosis completed the study. Compliance for answering the ESM questions was as high as 52%. End-of-week pain scores were higher than ESM mean scores and showed peak reporting. ESM scores showed strong concurrent validity when compared with symptoms scored by the Gastrointestinal Symptom Rating Scale–Irritable Bowel Syndrome, 7-item Generalized Anxiety Disorders Scale, 9-question Patient Health Questionnaire, and the majority of questions of the 30-item Endometriosis Health Profile. Cronbach α coefficients demonstrated a good internal consistency for abdominal symptoms, general somatic symptoms, and positive affect, and an excellent internal consistency for negative affect. Conclusions: This study supports the validity and reliability of a newly developed electronic instrument for the measurement of symptoms in women with endometriosis, based on momentary assessments. This ESM patient-reported outcome measure has the advantage of providing a more detailed view on individual symptom patterns and offers the possibility for patients to have insight in their symptomatology, leading to more individualized treatment strategies that can improve the quality of life of women with endometriosis. %M 36867439 %R 10.2196/29480 %U https://formative.jmir.org/2023/1/e29480 %U https://doi.org/10.2196/29480 %U http://www.ncbi.nlm.nih.gov/pubmed/36867439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38667 %T COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study %A Brusk,John J %A Bensley,Robert J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Bldng, 1903 W. Michigan Ave., Kalamazoo, MI, 49008, United States, 1 2697162301, bobbensley@gmail.com %K COVID-19 %K user engagement %K infodemic %K Women, Infants, and Children %K WIC %K educational resource %K health care %K digital health %K nutrition %K web-based education %K web-based nutrition %K pediatric %K parenting %K dashboard %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. %M 36787232 %R 10.2196/38667 %U https://formative.jmir.org/2023/1/e38667 %U https://doi.org/10.2196/38667 %U http://www.ncbi.nlm.nih.gov/pubmed/36787232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37527 %T Faculty-Wide Peer-Support Program During the COVID-19 Pandemic: Design and Preliminary Results %A Liu,Jenny J W %A Lum,P Andrea %A Foxcroft,Laura %A Lim,Rod %A Richardson,J Don %+ Schulich School of Medicine & Dentistry, Western University, Mental Health Care Building, F4-430, London, ON, N6A 5C1, Canada, 1 519 685 8500 ext 75694, jenny.liu@sjhc.london.on.ca %K physician %K doctor %K medical professional %K health care professional %K peer support %K burnout %K mental distress %K stress %K work %K job %K peer leadership %K mental health %K occupational health %K COVID-19 %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physicians experience higher rates of burnout relative to the general population. Concerns of confidentiality, stigma, and professional identities as health care providers act as barriers to seeking and receiving appropriate support. In the context of the COVID-19 pandemic, factors that contribute to burnout and barriers to seeking support have been amplified, elevating the overall risks of mental distress and burnout for physicians. Objective: This paper aimed to describe the rapid development and implementation of a peer support program within a health care organization located in London, Ontario, Canada. Methods: A peer support program leveraging existing infrastructures within the health care organization was developed and launched in April 2020. The “Peers for Peers” program drew from the work of Shapiro and Galowitz in identifying key components within hospital settings that contributed to burnout. The program design was derived from a combination of the peer support frameworks from the Airline Pilot Assistance Program and the Canadian Patient Safety Institute. Results: Data gathered over 2 waves of peer leadership training and program evaluations highlighted a diversity of topics covered through the peer support program. Further, enrollment continued to increase in size and scope over the 2 waves of program deployments into 2023. Conclusions: Findings suggest that the peer support program is acceptable to physicians and can be easily and feasibly implemented within a health care organization. The structured program development and implementation can be adopted by other organizations in support of emerging needs and challenges. %M 36862464 %R 10.2196/37527 %U https://formative.jmir.org/2023/1/e37527 %U https://doi.org/10.2196/37527 %U http://www.ncbi.nlm.nih.gov/pubmed/36862464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36619 %T Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized Controlled Trial %A Atukunda,Esther C %A Siedner,Mark J %A Obua,Celestino %A Musiimenta,Angella %A Ware,Norma C %A Mugisha,Samuel %A Najjuma,Josephine N %A Mugyenyi,Godfrey R %A Matthews,Lynn T %+ Mbarara University of Science and Technology, P.O Box 1410, Kabale Road, Mbarara, 256, Uganda, 256 702949832, eatukunda@must.ac.ug %K mobile health app %K mHealth app %K feasibility and acceptability %K messaging %K health education %K health promotion %K app development %K mobile phone %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messaging and other mobile health (mHealth) interventions may improve knowledge transfer, strengthen access to social support (SS), and promote positive health behaviors among women in the perinatal period. However, few mHealth apps have been taken to scale in sub-Saharan Africa. Objective: We evaluated the feasibility, acceptability, and preliminary efficacy of a novel, mHealth-based, and patient-centered messaging app designed using behavioral science frameworks to promote maternity service use among pregnant women in Uganda. Methods: We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in Southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC; control), scheduled SMS text or audio messages from a novel messaging prototype (scheduled messaging [SM]), and SM plus SMS text messaging reminders to 2 participant-identified social supporters (SS). Participants completed face-to-face surveys at enrollment and in the postpartum period. The primary outcomes were feasibility and acceptability of the messaging prototype. Other outcomes included ANC attendance, skilled delivery, and SS. We conducted qualitative exit interviews with 15 women from each intervention arm to explore the intervention mechanisms. Quantitative and qualitative data were analyzed using STATA and NVivo, respectively. Results: More than 85% and 75% of participants received ≥85% of the intended SMS text messages or voice calls, respectively. More than 85% of the intended messages were received within 1 hour of the expected time; 18% (7/40) of women experienced network issues for both intervention groups. Over 90% (36/40) of the intervention participants found this app useful, easy to use, engaging, and compatible and strongly recommended it to others; 70% (28/40), 78% (31/40), and 98% (39/40; P=.04) of women in the control, SM, and SS arms, respectively, had a skilled delivery. Half (20/40), 83% (33/40), and all (40/40; P=.001) of the women in the control, SM, and SS arms attended ≥4 ANC visits, respectively. Women in the SS arm reported the highest support (median 3.4, IQR 2.8-3.6; P=.02); <20% (8/40; P=.002) missed any scheduled ANC visit owing to lack of transportation. Qualitative data showed that women liked the app; they were able to comprehend ANC and skilled delivery benefits and easily share and discuss tailored information with their significant others, who in turn committed to providing them the needed support to prepare and seek help. Conclusions: We demonstrated that developing a novel patient-centered and tailored messaging app that leverages SS networks and relationships is a feasible, acceptable, and useful approach to communicate important targeted health-related information and support pregnant women in rural Southwestern Uganda to use available maternity care services. Further evaluation of maternal-fetal outcomes and integration of this intervention into routine care is needed. Trial Registration: ClinicalTrials.gov NCT04313348; https://clinicaltrials.gov/ct2/show/NCT04313348 %M 36862461 %R 10.2196/36619 %U https://formative.jmir.org/2023/1/e36619 %U https://doi.org/10.2196/36619 %U http://www.ncbi.nlm.nih.gov/pubmed/36862461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34958 %T An Augmented Reality Technology to Provide Demonstrative Inhaler Technique Education for Patients With Asthma: Interview Study Among Patients, Health Professionals, and Key Community Stakeholders %A O'Connor,Antonia %A Sharrad,Kelsey %A King,Charmaine %A Carson-Chahhoud,Kristin %+ Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 83020453, kristin.carson-chahhoud@unisa.edu.au %K augmented reality %K asthma %K disease management %K smartphone %K inhaler technique %K mobile phone %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people with asthma use incorrect inhaler technique, resulting in suboptimal disease management and increased health service use. Novel ways of delivering appropriate instructions are needed. Objective: This study explored stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. Methods: On the basis of existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was developed. Using AR technology via a free smartphone app, the poster launched video demonstrations of correct inhaler technique for each device. In total, 21 semistructured, one‐on‐one interviews with health professionals, people with asthma, and key community stakeholders were conducted, and data were analyzed thematically using the Triandis model of interpersonal behavior. Results: A total of 21 participants were recruited into the study, and data saturation was achieved. People with asthma were confident with inhaler technique (mean score 9.17, SD 1.33, out of 10). However, health professionals and key community stakeholders identified that this perception was misguided (mean 7.25, SD 1.39, and mean 4.5, SD 0.71, for health professionals and key community stakeholders, respectively) and facilitates persistent incorrect inhaler use and suboptimal disease management. Delivering inhaler technique education using AR was favored by all participants (21/21, 100%), particularly around ease of use, with the ability to visually display inhaler techniques for each device. There was a strongly held belief that the technology has the capacity for improving inhaler technique across all participant groups (mean 9.25, SD 0.89, for participants; mean 9.83, SD 0.41, for health professionals; and mean 9.5, SD 0.71, for key community stakeholders). However, all participants (21/21, 100%) identified some barriers, particularly regarding access and appropriateness of AR for older people. Conclusions: AR technology may be a novel means to address poor inhaler technique among certain cohorts of patients with asthma and serve as a prompt for health professionals to initiate review of inhaler devices. A randomized controlled trial design is needed to evaluate the efficacy of this technology for use in the clinical care setting. %M 36862496 %R 10.2196/34958 %U https://formative.jmir.org/2023/1/e34958 %U https://doi.org/10.2196/34958 %U http://www.ncbi.nlm.nih.gov/pubmed/36862496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40440 %T Effects of Text4Hope-Addiction Support Program on Cravings and Mental Health Symptoms: Results of a Longitudinal Cross-sectional Study %A Obuobi-Donkor,Gloria %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Hrabok,Marianne %A Gusnowski,April %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent IO %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, vn602367@dal.ca %K addiction %K substance craving %K depression %K anxiety %K Text4Hope %K satisfaction %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities. Objective: This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program. Methods: Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program. Results: In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (−2.17, 95% CI –0.62 to 3.72), PHQ-9 scores, P=.004 (−5.08, 95% CI −1.65 to −8.51), and GAD-7 scores, P=.02 (−3.02, 95% CI −0.48 to −5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders. Conclusions: Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used. %M 36857114 %R 10.2196/40440 %U https://formative.jmir.org/2023/1/e40440 %U https://doi.org/10.2196/40440 %U http://www.ncbi.nlm.nih.gov/pubmed/36857114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36608 %T Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study %A Howell,Pamella %A Abdelhamid,Mohamed %+ Department of Information Systems, California State University Long Beach, 1250 Bellflower Blvd., Long Beach, CA, 90480, United States, 1 562 985 2361, mohamed.abdelhamid@csulb.edu %K COVID-19 %K mobile tracing app %K protection motivation theory %K privacy concerns %K global health %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person’s COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved. Objective: This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals’ perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status. Methods: The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling. Results: After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (β=0.688; P<.001), self-efficacy (β=0.292; P<.001), and an individual’s prior infection with COVID-19 (β=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β=−0.360; P<.001), risk aversion (β=−0.150; P=.09), and a family member’s prior infection with COVID-19 (β=−0.139; P=.02) had statistically significant negative influences on a person’s intention to use mobile tracing apps. Conclusions: This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement. %M 36735838 %R 10.2196/36608 %U https://formative.jmir.org/2023/1/e36608 %U https://doi.org/10.2196/36608 %U http://www.ncbi.nlm.nih.gov/pubmed/36735838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43101 %T Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit %A Bazzano,Alessandra N %A Noel,Lesley-Ann %A Patel,Tejal %A Dominique,C Chantel %A Haywood,Catherine %A Moore,Shenitta %A Mantsios,Andrea %A Davis,Patricia A %+ Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 5049882338, abazzano@tulane.edu %K health equity %K patient participation %K health behavior %K universal design %K human-centered design %K COVID-19 %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. Objective: This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Methods: Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Results: Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. Conclusions: The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity. %M 36649162 %R 10.2196/43101 %U https://formative.jmir.org/2023/1/e43101 %U https://doi.org/10.2196/43101 %U http://www.ncbi.nlm.nih.gov/pubmed/36649162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42324 %T Classifying COVID-19 Patients From Chest X-ray Images Using Hybrid Machine Learning Techniques: Development and Evaluation %A Phumkuea,Thanakorn %A Wongsirichot,Thakerng %A Damkliang,Kasikrit %A Navasakulpong,Asma %+ Division of Computational Science, Faculty of Science, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand, 66 846414784, thakerng.w@psu.ac.th %K COVID-19 %K machine learning %K medical informatics %K coronavirus %K diagnosis %K model %K detection %K healthy %K unhealthy %K public %K usage %K data %K database %K accuracy %K development %K x-ray %K imaging %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has raised global concern, with moderate to severe cases displaying lung inflammation and respiratory failure. Chest x-ray (CXR) imaging is crucial for diagnosis and is usually interpreted by experienced medical specialists. Machine learning has been applied with acceptable accuracy, but computational efficiency has received less attention. Objective: We introduced a novel hybrid machine learning model to accurately classify COVID-19, non-COVID-19, and healthy patients from CXR images with reduced computational time and promising results. Our proposed model was thoroughly evaluated and compared with existing models. Methods: A retrospective study was conducted to analyze 5 public data sets containing 4200 CXR images using machine learning techniques including decision trees, support vector machines, and neural networks. The images were preprocessed to undergo image segmentation, enhancement, and feature extraction. The best performing machine learning technique was selected and combined into a multilayer hybrid classification model for COVID-19 (MLHC-COVID-19). The model consisted of 2 layers. The first layer was designed to differentiate healthy individuals from infected patients, while the second layer aimed to classify COVID-19 and non-COVID-19 patients. Results: The MLHC-COVID-19 model was trained and evaluated on unseen COVID-19 CXR images, achieving reasonably high accuracy and F measures of 0.962 and 0.962, respectively. These results show the effectiveness of the MLHC-COVID-19 in classifying COVID-19 CXR images, with improved accuracy and a reduction in interpretation time. The model was also embedded into a web-based MLHC-COVID-19 computer-aided diagnosis system, which was made publicly available. Conclusions: The study found that the MLHC-COVID-19 model effectively differentiated CXR images of COVID-19 patients from those of healthy and non-COVID-19 individuals. It outperformed other state-of-the-art deep learning techniques and showed promising results. These results suggest that the MLHC-COVID-19 model could have been instrumental in early detection and diagnosis of COVID-19 patients, thus playing a significant role in controlling and managing the pandemic. Although the pandemic has slowed down, this model can be adapted and utilized for future similar situations. The model was also integrated into a publicly accessible web-based computer-aided diagnosis system. %M 36780315 %R 10.2196/42324 %U https://formative.jmir.org/2023/1/e42324 %U https://doi.org/10.2196/42324 %U http://www.ncbi.nlm.nih.gov/pubmed/36780315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40506 %T Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach %A Voss,Claire %A Liu,Jianyi %A Chang,Angela %A Kosmas,Jacqueline A %A Biehl,Abigail %A Flynn,Rebecca L %A Kruzan,Kaylee P %A Wildes,Jennifer E %A Graham,Andrea K %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 5266, andrea.graham@northwestern.edu %K binge eating %K weight loss expectations %K overvaluation of weight and shape %K digital intervention %K human-centered design %K weight loss %K user expectations %K behavioral change %K eating disorder %K obesity %K overweight %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. Objective: The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. Methods: A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Results: Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. Conclusions: In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals’ intended treatment goals to facilitate engagement and successful outcomes in a digital intervention. %M 36853750 %R 10.2196/40506 %U https://formative.jmir.org/2023/1/e40506 %U https://doi.org/10.2196/40506 %U http://www.ncbi.nlm.nih.gov/pubmed/36853750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40403 %T Development of a COVID-19–Related Anti-Asian Tweet Data Set: Quantitative Study %A Mokhberi,Maryam %A Biswas,Ahana %A Masud,Zarif %A Kteily-Hawa,Roula %A Goldstein,Abby %A Gillis,Joseph Roy %A Rayana,Shebuti %A Ahmed,Syed Ishtiaque %+ Department of Computer Science, University of Toronto, 145 Cosburn Ave, East York, Toronto, ON, M4J 2L2, Canada, 1 4166680689, zarif.masud@gmail.com %K COVID-19 %K stigma %K hate speech %K classification %K annotation %K data set %K Sinophobia %K Twitter %K BERT %K pandemic %K data %K online %K community %K Asian %K research %K discrimination %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the advent of the COVID-19 pandemic, individuals of Asian descent (colloquial usage prevalent in North America, where “Asian” is used to refer to people from East Asia, particularly China) have been the subject of stigma and hate speech in both offline and online communities. One of the major venues for encountering such unfair attacks is social networks, such as Twitter. As the research community seeks to understand, analyze, and implement detection techniques, high-quality data sets are becoming immensely important. Objective: In this study, we introduce a manually labeled data set of tweets containing anti-Asian stigmatizing content. Methods: We sampled over 668 million tweets posted on Twitter from January to July 2020 and used an iterative data construction approach that included 3 different stages of algorithm-driven data selection. Finally, we found volunteers who manually annotated the tweets by hand to arrive at a high-quality data set of tweets and a second, more sampled data set with higher-quality labels from multiple annotators. We presented this final high-quality Twitter data set on stigma toward Chinese people during the COVID-19 pandemic. The data set and instructions for labeling can be viewed in the Github repository. Furthermore, we implemented some state-of-the-art models to detect stigmatizing tweets to set initial benchmarks for our data set. Results: Our primary contributions are labeled data sets. Data Set v3.0 contained 11,263 tweets with primary labels (unknown/irrelevant, not-stigmatizing, stigmatizing-low, stigmatizing-medium, stigmatizing-high) and tweet subtopics (eg, wet market and eating habits, COVID-19 cases, bioweapon). Data Set v3.1 contained 4998 (44.4%) tweets randomly sampled from Data Set v3.0, where a second annotator labeled them only on the primary labels and then a third annotator resolved conflicts between the first and second annotators. To demonstrate the usefulness of our data set, preliminary experiments on the data set showed that the Bidirectional Encoder Representations from Transformers (BERT) model achieved the highest accuracy of 79% when detecting stigma on unseen data with traditional models, such as a support vector machine (SVM) performing at 73% accuracy. Conclusions: Our data set can be used as a benchmark for further qualitative and quantitative research and analysis around the issue. It first reaffirms the existence and significance of widespread discrimination and stigma toward the Asian population worldwide. Moreover, our data set and subsequent arguments should assist other researchers from various domains, including psychologists, public policy authorities, and sociologists, to analyze the complex economic, political, historical, and cultural underlying roots of anti-Asian stigmatization and hateful behaviors. A manually annotated data set is of paramount importance for developing algorithms that can be used to detect stigma or problematic text, particularly on social media. We believe this contribution will help predict and subsequently design interventions that will significantly help reduce stigma, hate, and discrimination against marginalized populations during future crises like COVID-19. %M 36693148 %R 10.2196/40403 %U https://formative.jmir.org/2023/1/e40403 %U https://doi.org/10.2196/40403 %U http://www.ncbi.nlm.nih.gov/pubmed/36693148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39077 %T German Medical Named Entity Recognition Model and Data Set Creation Using Machine Translation and Word Alignment: Algorithm Development and Validation %A Frei,Johann %A Kramer,Frank %+ IT Infrastructure for Translational Medical Research, University of Augsburg, Alter Postweg 101, Augsburg, 86159, Germany, 49 17691464136, johann.frei@informatik.uni-augsburg.de %K natural language processing %K named entity recognition %K information extraction %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Data mining in the field of medical data analysis often needs to rely solely on the processing of unstructured data to retrieve relevant data. For German natural language processing, few open medical neural named entity recognition (NER) models have been published before this work. A major issue can be attributed to the lack of German training data. Objective: We developed a synthetic data set and a novel German medical NER model for public access to demonstrate the feasibility of our approach. In order to bypass legal restrictions due to potential data leaks through model analysis, we did not make use of internal, proprietary data sets, which is a frequent veto factor for data set publication. Methods: The underlying German data set was retrieved by translation and word alignment of a public English data set. The data set served as a foundation for model training and evaluation. For demonstration purposes, our NER model follows a simple network architecture that is designed for low computational requirements. Results: The obtained data set consisted of 8599 sentences including 30,233 annotations. The model achieved a class frequency–averaged F1 score of 0.82 on the test set after training across 7 different NER types. Artifacts in the synthesized data set with regard to translation and alignment induced by the proposed method were exposed. The annotation performance was evaluated on an external data set and measured in comparison with an existing baseline model that has been trained on a dedicated German data set in a traditional fashion. We discussed the drop in annotation performance on an external data set for our simple NER model. Our model is publicly available. Conclusions: We demonstrated the feasibility of obtaining a data set and training a German medical NER model by the exclusive use of public training data through our suggested method. The discussion on the limitations of our approach includes ways to further mitigate remaining problems in future work. %M 36853741 %R 10.2196/39077 %U https://formative.jmir.org/2023/1/e39077 %U https://doi.org/10.2196/39077 %U http://www.ncbi.nlm.nih.gov/pubmed/36853741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43019 %T Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study %A Clement,Meredith Edwards %A Lovett,Aish %A Caldwell,Sylvia %A Beckford,Jeremy %A Hilgart,Michelle %A Corneli,Amy %A Flickinger,Tabor %A Dillingham,Rebecca %A Ingersoll,Karen %+ Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, 1542 Tulane Ave, Suite 331C, New Orleans, LA, 701120000, United States, 1 5045685204, mclem5@lsuhsc.edu %K pre-exposure prophylaxis %K HIV %K mobile apps %K mobile phone %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective: In this study, we introduced an existing PrEP adherence app to new potential users—BMSM engaged in PrEP care in New Orleans—to guide app adaptation with STI prevention features and tailoring for the local context. Methods: Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results: Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep’d app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions: A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes. %M 36848209 %R 10.2196/43019 %U https://formative.jmir.org/2023/1/e43019 %U https://doi.org/10.2196/43019 %U http://www.ncbi.nlm.nih.gov/pubmed/36848209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40207 %T Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong %A Chau,Siu Long %A Wong,Yiu Cheong %A Zeng,Ying Pei %A Lee,Jung Jae %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6636, mpwang@hku.hk %K instant messaging apps %K mobile phone %K WhatsApp %K alcohol reduction intervention %K alcohol use %K university students %K young adults %K instant messaging %K alcohol reduction %K adverse lifestyle %K intervention %K health promotion %K text messages %K health behaviours %K health behaviors %K apps %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 %M 36848207 %R 10.2196/40207 %U https://formative.jmir.org/2023/1/e40207 %U https://doi.org/10.2196/40207 %U http://www.ncbi.nlm.nih.gov/pubmed/36848207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43550 %T Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study %A Jackman,Kevon-Mark P %A Tilchin,Carla %A Wagner,Jessica %A Flinn,Ryan E %A Trent,Maria %A Latkin,Carl %A Ruhs,Sebastian %A Fields,Errol L %A Hamill,Matthew M %A Mahaffey,Carlos %A Greenbaum,Adena %A Jennings,Jacky M %+ Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street | Room 2061, Baltimore, MD, 21287, United States, 1 443 287 4993, kjackma2@jhmi.edu %K patient portal %K HIV %K STI %K prevention %K risk factor %K communication %K disclosure %K digital technology %K men who have sex with men %K gay %K homosexual %K sexual minority %K African American %D 2023 %7 24.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal. Objective: Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals. Methods: Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness. Results: Of the 245 participants, 71% (n=174) were Black and 22% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80% of participants. Specifically, tools to help manage HIV (n=183, 75%) and information about pre- and postexposure prophylaxis (both 71%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95% CI 1.23-1.93). Conclusions: Our findings indicate what features Black sexual minority men envision may be included in the patient portal’s design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men’s willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events. %M 36826983 %R 10.2196/43550 %U https://formative.jmir.org/2023/1/e43550 %U https://doi.org/10.2196/43550 %U http://www.ncbi.nlm.nih.gov/pubmed/36826983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42881 %T Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study %A Parpia,Camilla %A Moore,Clara %A Beatty,Madison %A Miranda,Susan %A Adams,Sherri %A Stinson,Jennifer %A Desai,Arti %A Bartlett,Leah %A Culbert,Erin %A Cohen,Eyal %A Orkin,Julia %+ Temerty Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, Toronto, ON, M5S 3H7, Canada, 1 6472292363, camilla.parpia@mail.utoronto.ca %K secure messaging %K children with medical complexity %K patient-physician relationship %K care coordination %K partnership %K email communication %K online information %K children %K pediatrics %K caregiver %K information sharing %K electronic medical record %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The Connecting2gether (C2) platform is a web and mobile–based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child’s care team members (CTMs) in a timely manner. Objective: The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs’ and CTMs’ perceptions and experiences using secure messaging as a method of communication. Methods: This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child’s care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. Results: A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child’s life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. Conclusions: Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child’s health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging. %M 36821356 %R 10.2196/42881 %U https://formative.jmir.org/2023/1/e42881 %U https://doi.org/10.2196/42881 %U http://www.ncbi.nlm.nih.gov/pubmed/36821356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37987 %T Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype %A Tesema,Naomi %A Guillaume,Dominique %A Francis,Sherilyn %A Paul,Sudeshna %A Chandler,Rasheeta %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 7980, dguilla@emory.edu %K Black women %K HIV prevention %K mobile health %K mHealth app %K mobile technology %K reproductive health %K women’s health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non–sexually active counterparts. The emerging themes from the focus group session were Black women’s health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app–based interventions. %M 36821362 %R 10.2196/37987 %U https://formative.jmir.org/2023/1/e37987 %U https://doi.org/10.2196/37987 %U http://www.ncbi.nlm.nih.gov/pubmed/36821362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42935 %T Association Between the Severity of Depressive Symptoms and Human-Smartphone Interactions: Longitudinal Study %A Yang,Xiao %A Knights,Jonathan %A Bangieva,Victoria %A Kambhampati,Vinayak %+ Mindstrong Health, 101 Jefferson Dr. Suite 228, Menlo Park, CA, 94025, United States, 1 8889952230, vwendy@gmail.com %K depression %K human-smartphone interaction %K longitudinal data analysis %K within-person effect %K between-person effect %K nonergodicity %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Various behavioral sensing research studies have found that depressive symptoms are associated with human-smartphone interaction behaviors, including lack of diversity in unique physical locations, entropy of time spent in each location, sleep disruption, session duration, and typing speed. These behavioral measures are often tested against the total score of depressive symptoms, and the recommended practice to disaggregate within- and between-person effects in longitudinal data is often neglected. Objective: We aimed to understand depression as a multidimensional process and explore the association between specific dimensions and behavioral measures computed from passively sensed human-smartphone interactions. We also aimed to highlight the nonergodicity in psychological processes and the importance of disaggregating within- and between-person effects in the analysis. Methods: Data used in this study were collected by Mindstrong Health, a telehealth provider that focuses on individuals with serious mental illness. Depressive symptoms were measured by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult Survey every 60 days for a year. Participants’ interactions with their smartphones were passively recorded, and 5 behavioral measures were developed and were expected to be associated with depressive symptoms according to either theoretical proposition or previous empirical evidence. Multilevel modeling was used to explore the longitudinal relations between the severity of depressive symptoms and these behavioral measures. Furthermore, within- and between-person effects were disaggregated to accommodate the nonergodicity commonly found in psychological processes. Results: This study included 982 records of DSM Level 1 depressive symptom measurements and corresponding human-smartphone interaction data from 142 participants (age range 29-77 years; mean age 55.1 years, SD 10.8 years; 96 female participants). Loss of interest in pleasurable activities was associated with app count (γ10=−0.14; P=.01; within-person effect). Depressed mood was associated with typing time interval (γ05=0.88; P=.047; within-person effect) and session duration (γ05=−0.37; P=.03; between-person effect). Conclusions: This study contributes new evidence for associations between human-smartphone interaction behaviors and the severity of depressive symptoms from a dimensional perspective, and it highlights the importance of considering the nonergodicity of psychological processes and analyzing the within- and between-person effects separately. %M 36811951 %R 10.2196/42935 %U https://formative.jmir.org/2023/1/e42935 %U https://doi.org/10.2196/42935 %U http://www.ncbi.nlm.nih.gov/pubmed/36811951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42767 %T Integrating User Preferences for Asthma Tools and Clinical Guidelines Into Primary Care Electronic Medical Records: Mixed Methods Study %A Moloney,Max %A MacKinnon,Madison %A Bullock,Emma %A Morra,Alison %A Barber,David %A Gupta,Samir %A Queenan,John A %A Digby,Geneviève C %A To,Teresa %A Lougheed,M Diane %+ Asthma Research Unit, Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada, 1 7059573673, max.moloney@queensu.ca %K asthma %K electronic medical records %K quality improvement %K knowledge translation %K qualitative analysis %D 2023 %7 21.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a chronic respiratory disease that poses a substantial burden on individuals and the health care system. Despite published national guidelines for the diagnosis and management of asthma, considerable care gaps exist. Suboptimal adherence to asthma diagnosis and management guidelines contributes to poor patient outcomes. The integration of electronic tools (eTools) into electronic medical records (EMRs) represents a knowledge translation opportunity to support best practices. Objective: The purpose of this study was to determine how best to integrate evidence-based asthma eTools into primary care EMRs across Ontario and Canada to improve adherence to guidelines as well as measure and monitor performance. Methods: In total, 2 focus groups comprising physicians and allied health professionals who were considered experts in primary care, asthma, and EMRs were convened. One focus group also included a patient participant. Focus groups used a semistructured discussion-based format to consider the optimal methods for integrating asthma eTools into EMRs. Discussions were held on the web via Microsoft Teams (Microsoft Corp). The first focus group discussed integrating asthma indicators into EMRs using eTools, and participants completed a questionnaire evaluating the clarity, relevance, and feasibility of collecting asthma performance indicator data at the point of care. The second focus group addressed how to incorporate eTools for asthma into a primary care setting and included a questionnaire evaluating the perceived utility of various eTools. Focus group discussions were recorded and analyzed using thematic qualitative analysis. The responses to focus group questionnaires were assessed using descriptive quantitative analysis. Results: Qualitative analysis of the 2 focus group discussions revealed 7 key themes: designing outcome-oriented tools, gaining stakeholder trust, facilitating open lines of communication, prioritizing the end user, striving for efficiency, ensuring adaptability, and developing within existing workflows. In addition, 24 asthma indicators were rated according to clarity, relevance, feasibility, and overall usefulness. In total, 5 asthma performance indicators were identified as the most relevant. These included smoking cessation support, monitoring using objective measures, the number of emergency department visits and hospitalizations, assessment of asthma control, and presence of an asthma action plan. The eTool questionnaire responses revealed that the Asthma Action Plan Wizard and Electronic Asthma Quality of Life Questionnaire were perceived to be the most useful in primary care. Conclusions: Primary care physicians, allied health professionals, and patients consider that eTools for asthma care present a unique opportunity to improve adherence to best-practice guidelines in primary care and collect performance indicators. The strategies and themes identified in this study can be leveraged to overcome barriers associated with asthma eTool integration into primary care EMRs. The most beneficial indicators and eTools, along with the key themes identified, will guide future asthma eTool implementation. %M 36809175 %R 10.2196/42767 %U https://formative.jmir.org/2023/1/e42767 %U https://doi.org/10.2196/42767 %U http://www.ncbi.nlm.nih.gov/pubmed/36809175 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42861 %T Effects of a Social Media–Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial %A Sui,Yufang %A Kor,Patrick Pui Kin %A Li,Mengli %A Wang,Jingjing %+ School of Nursing, The Hong Kong Polytechnic University, FG421, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 2766 5622, patrick.kor@polyu.edu.hk %K mind-body intervention %K acupressure %K mindfulness meditation %K social media %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media–based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence. Objective: The aim of this study was to test the feasibility and preliminary effects of a social media–based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial. Methods: A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media–based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). Results: The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention. Conclusions: The findings support the feasibility and preliminary effects of social media–based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031 %M 36804167 %R 10.2196/42861 %U https://formative.jmir.org/2023/1/e42861 %U https://doi.org/10.2196/42861 %U http://www.ncbi.nlm.nih.gov/pubmed/36804167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38439 %T Nighttime Continuous Contactless Smartphone-Based Cough Monitoring for the Ward: Validation Study %A Barata,Filipe %A Cleres,David %A Tinschert,Peter %A Iris Shih,Chen-Hsuan %A Rassouli,Frank %A Boesch,Maximilian %A Brutsche,Martin %A Fleisch,Elgar %+ Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 35 0, fbarata@ethz.ch %K cough monitoring %K ward monitoring %K mobile sensing %K machine learning %K convolutional neural network %K COVID-19 %K mobile phone %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical deterioration can go unnoticed in hospital wards for hours. Mobile technologies such as wearables and smartphones enable automated, continuous, noninvasive ward monitoring and allow the detection of subtle changes in vital signs. Cough can be effectively monitored through mobile technologies in the ward, as it is not only a symptom of prevalent respiratory diseases such as asthma, lung cancer, and COVID-19 but also a predictor of acute health deterioration. In past decades, many efforts have been made to develop an automatic cough counting tool. To date, however, there is neither a standardized, sufficiently validated method nor a scalable cough monitor that can be deployed on a consumer-centric device that reports cough counts continuously. These shortcomings limit the tracking of coughing and, consequently, hinder the monitoring of disease progression in prevalent respiratory diseases such as asthma, chronic obstructive pulmonary disease, and COVID-19 in the ward. Objective: This exploratory study involved the validation of an automated smartphone-based monitoring system for continuous cough counting in 2 different modes in the ward. Unlike previous studies that focused on evaluating cough detection models on unseen data, the focus of this work is to validate a holistic smartphone-based cough detection system operating in near real time. Methods: Automated cough counts were measured consistently on devices and on computers and compared with cough and noncough sounds counted manually over 8-hour long nocturnal recordings in 9 patients with pneumonia in the ward. The proposed cough detection system consists primarily of an Android app running on a smartphone that detects coughs and records sounds and secondarily of a backend that continuously receives the cough detection information and displays the hourly cough counts. Cough detection is based on an ensemble convolutional neural network developed and trained on asthmatic cough data. Results: In this validation study, a total of 72 hours of recordings from 9 participants with pneumonia, 4 of whom were infected with SARS-CoV-2, were analyzed. All the recordings were subjected to manual analysis by 2 blinded raters. The proposed system yielded a sensitivity and specificity of 72% and 99% on the device and 82% and 99% on the computer, respectively, for detecting coughs. The mean differences between the automated and human rater cough counts were −1.0 (95% CI −12.3 to 10.2) and −0.9 (95% CI −6.5 to 4.8) coughs per hour within subject for the on-device and on-computer modes, respectively. Conclusions: The proposed system thus represents a smartphone cough counter that can be used for continuous hourly assessment of cough frequency in the ward. %M 36655551 %R 10.2196/38439 %U https://formative.jmir.org/2023/1/e38439 %U https://doi.org/10.2196/38439 %U http://www.ncbi.nlm.nih.gov/pubmed/36655551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43092 %T Development of an Open-source and Lightweight Sensor Recording Software System for Conducting Biomedical Research: Technical Report %A Single,Michael %A Bruhin,Lena C %A Schütz,Narayan %A Naef,Aileen C %A Hegi,Heinz %A Reuse,Pascal %A Schindler,Kaspar A %A Krack,Paul %A Wiest,Roland %A Chan,Andrew %A Nef,Tobias %A Gerber,Stephan M %+ Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 31 664 09 83, stephan.m.gerber@unibe.ch %K sensor recording software %K on-demand deployment %K digital measures %K sensor platform %K biomedical research %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital sensing devices have become an increasingly important component of modern biomedical research, as they help provide objective insights into individuals’ everyday behavior in terms of changes in motor and nonmotor symptoms. However, there are significant barriers to the adoption of sensor-enhanced biomedical solutions in terms of both technical expertise and associated costs. The currently available solutions neither allow easy integration of custom sensing devices nor offer a practicable methodology in cases of limited resources. This has become particularly relevant, given the need for real-time sensor data that could help lower health care costs by reducing the frequency of clinical assessments performed by specialists and improve access to health assessments (eg, for people living in remote areas or older adults living at home). Objective: The objective of this paper is to detail the end-to-end development of a novel sensor recording software system that supports the integration of heterogeneous sensor technologies, runs as an on-demand service on consumer-grade hardware to build sensor systems, and can be easily used to reliably record longitudinal sensor measurements in research settings. Methods: The proposed software system is based on a server-client architecture, consisting of multiple self-contained microservices that communicated with each other (eg, the web server transfers data to a database instance) and were implemented as Docker containers. The design of the software is based on state-of-the-art open-source technologies (eg, Node.js or MongoDB), which fulfill nonfunctional requirements and reduce associated costs. A series of programs to facilitate the use of the software were documented. To demonstrate performance, the software was tested in 3 studies (2 gait studies and 1 behavioral study assessing activities of daily living) that ran between 2 and 225 days, with a total of 114 participants. We used descriptive statistics to evaluate longitudinal measurements for reliability, error rates, throughput rates, latency, and usability (with the System Usability Scale [SUS] and the Post-Study System Usability Questionnaire [PSSUQ]). Results: Three qualitative features (event annotation program, sample delay analysis program, and monitoring dashboard) were elaborated and realized as integrated programs. Our quantitative findings demonstrate that the system operates reliably on consumer-grade hardware, even across multiple months (>420 days), providing high throughput (2000 requests per second) with a low latency and error rate (<0.002%). In addition, the results of the usability tests indicate that the system is effective, efficient, and satisfactory to use (mean usability ratings for the SUS and PSSUQ were 89.5 and 1.62, respectively). Conclusions: Overall, this sensor recording software could be leveraged to test sensor devices, as well as to develop and validate algorithms that are able to extract digital measures (eg, gait parameters or actigraphy). The proposed software could help significantly reduce barriers related to sensor-enhanced biomedical research and allow researchers to focus on the research questions at hand rather than on developing recording technologies. %M 36800219 %R 10.2196/43092 %U https://formative.jmir.org/2023/1/e43092 %U https://doi.org/10.2196/43092 %U http://www.ncbi.nlm.nih.gov/pubmed/36800219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43758 %T Design, Development, and Evaluation of an Automated Solution for Electronic Information Exchange Between Acute and Long-term Postacute Care Facilities: Design Science Research %A Gottumukkala,Madhu %+ College of Business & Information Systems, Dakota State University, 820 Washington Ave N, Madison, SD, 57042, United States, 1 6052565111, madhu.gottumukkala@trojans.dsu.edu %K information exchange %K interoperability %K care transition %K health information technology %K health information exchange %K open standards %K long-term and postacute care %K LTPAC %K design science research %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, considerable delays in care, and even readmissions. Unfortunately, long-term and postacute care facilities often lag behind other health care facilities in adopting health information technologies, increasing difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients’ health records between these facilities. Objective: This study aimed to design and evaluate an open standards–based interoperability solution that facilitates seamless bidirectional information exchange between acute care and long-term and postacute care facilities using 2 vendor electronic health record (EHR) systems. Methods: Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute care and long-term care (LTC) facilities using different EHR systems. Different approaches were applied in the study with a focus on the relevance cycle, including eliciting detailed requirements from stakeholders in the health system who understand the complex data formats, constraints, and workflows associated with transferring patient records between 2 different EHR systems. We performed literature reviews and sought experts in the health care industry from different organizations with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact was evaluated at a health care organization with a combined footprint of acute and postacute care operations using 2 different EHR systems. Results: The resulting interoperability solution offered integrations with source systems and was proven to facilitate bidirectional information exchange for patients transferring between an acute care facility using an Epic EHR system and an LTC facility using a PointClickCare EHR system. This solution serves as a proof of concept for bidirectional data exchange between Epic and PointClickCare for medications, yet the solution is designed to expand to additional data elements such as allergies, problem lists, and diagnoses. Conclusions: Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and LTC settings, there are differences in patients’ needs and delivery of care workflows that are distinctly unique. In addition, the health care system’s components that offer long-term and acute care in the United States have evolved independently and separately. This study demonstrates that the interoperability solution improves the information exchange between acute and LTC facilities by simplifying data transfer, eliminating manual processes, and reducing data discrepancies using a design science research methodology. %M 36800213 %R 10.2196/43758 %U https://formative.jmir.org/2023/1/e43758 %U https://doi.org/10.2196/43758 %U http://www.ncbi.nlm.nih.gov/pubmed/36800213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40536 %T Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study %A Askman,Sanna %A Löf,Marie %A Maddison,Ralph %A Nourse,Rebecca %+ Department of Health, Medicine and Caring Sciences, Linköping University, Norra Skolgatan 18, Malmö, 21152, Sweden, 46 0730773773, sanna.askman@hotmail.se %K heart failure %K HF %K life logging %K self-management %K cardiovascular disease %K wearable devices %K self management %K self-care %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. Objective: The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. Methods: A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. Results: The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. Conclusions: Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care. %M 36800215 %R 10.2196/40536 %U https://formative.jmir.org/2023/1/e40536 %U https://doi.org/10.2196/40536 %U http://www.ncbi.nlm.nih.gov/pubmed/36800215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35659 %T Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study %A Choi,Isabella %A Mestroni,Gemma %A Hunt,Caroline %A Glozier,Nick %+ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Office 4, Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 2050, Australia, 61 0286277240, isabella.choi@sydney.edu.au %K help seeking %K mental health %K international students %K Chinese international students %K mental health awareness %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. Objective: This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application’s uptake and engagement. Methods: The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person’s symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. Results: A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools’ Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. Conclusions: There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students’ mental health literacy, stigma, and help seeking. %M 36800231 %R 10.2196/35659 %U https://formative.jmir.org/2023/1/e35659 %U https://doi.org/10.2196/35659 %U http://www.ncbi.nlm.nih.gov/pubmed/36800231 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42887 %T Reasons That Lead People to End Up Buying Fake Medicines on the Internet: Qualitative Interview Study %A Almomani,Hamzeh %A Patel,Nilesh %A Donyai,Parastou %+ Department of Pharmacy Practice, Reading School of Pharmacy, University of Reading, Whiteknights campus, Reading, RG6 6UR, United Kingdom, 44 118 378 8462, h.q.m.almomani@pgr.reading.ac.uk %K fake medicines %K prescription-only medicines %K internet %K theory of planned behavior %K interviews %K thematic analysis %K the United Kingdom %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people in the United Kingdom are turning to the internet to obtain prescription-only medicines (POMs). This introduces substantial concerns for patient safety, particularly owing to the risk of buying fake medicines. To help reduce the risks to patient safety, it is important to understand why people buy POMs on the web in the first place. Objective: This study aimed to identify why people in the United Kingdom purchase medicines, specifically POMs, from the internet, and their perceptions of risks posed by the availability of fake medicines on the web. Methods: Semistructured interviews were conducted with adults from the United Kingdom who had previously purchased medicines on the web. Purposive sampling was adopted using various methods to achieve diversity in participants’ experiences and demographics. The recruitment was continued until data saturation was reached. Thematic analysis was employed, with the theory of planned behavior acting as a framework to develop the coding of themes. Results: A total of 20 participants were interviewed. Participants had bought various types of POMs or medicines with the potential to be misused or that required a higher level of medical oversight (eg, antibiotics and controlled medicines). Participants demonstrated awareness of the presence and the risks of fake medicines available on the internet. The factors that influence participants’ decision to buy medicines on the web were grouped into themes, including the advantages (avoiding long waiting times, bypassing gatekeepers, availability of medicines, lower costs, convenient process, and privacy), disadvantages (medicine safety concerns, medicine quality concerns, higher costs, web-based payment risks, lack of accountability, and engaging in an illegal behavior) of purchasing medicines on the web, social influencing factors (interactions with health care providers, other consumers’ reviews and experiences, word of mouth by friends, and influencers’ endorsement), barriers (general barriers and website-specific barriers) and facilitators (facilitators offered by the illegal sellers of medicines, facilitators offered by internet platforms, COVID-19 outbreak as a facilitating condition, and participants’ personality) of the purchase, and factors that lead people to trust the web-based sellers of medicines (website features, product appearance, and past experience). Conclusions: In-depth insights into what drives people in the United Kingdom to buy medicines on the web could enable the development of effective and evidence-based public awareness campaigns that warn consumers about the risks of buying fake medicines from the internet. The findings enable researchers to design interventions to minimize the purchasing of POMs on the web. A limitation of this study is that although the interviews were in-depth and data saturation was reached, the findings may not be generalizable, as this was a qualitative study. However, the theory of planned behavior, which informed the analysis, has well-established guidelines for developing a questionnaire for a future quantitative study. %M 36795460 %R 10.2196/42887 %U https://formative.jmir.org/2023/1/e42887 %U https://doi.org/10.2196/42887 %U http://www.ncbi.nlm.nih.gov/pubmed/36795460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39146 %T Tobacco-Derived Nicotine Pouch Brands and Marketing Messages on Internet and Traditional Media: Content Analysis %A Ling,Pamela M %A Hrywna,Mary %A Talbot,Eugene M %A Lewis,M Jane %+ Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA, 94143, United States, 1 4155148627, pamela.ling@ucsf.edu %K nicotine pouch %K marketing %K tobacco industry %K web-based advertising %K advertising %K advertisement %K smoking %K tobacco %K nicotine %K smoker %K addiction %K industry %K industrial %K economic %K economy %K commercial %K commerce %K consumer %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nicotine pouches and lozenges are increasingly available in the United States, and sales are growing. The brands of nicotine pouch products with the largest market share are produced by tobacco companies. Objective: The aim of this study is to examine the marketing of 5 oral nicotine products sold by tobacco companies. Methods: Internet, radio, television, print, and web-based display advertisements between January 2019 and March 2020 for 6 brands of nicotine pouches and lozenges were identified through commercially available marketing surveillance systems supplemented by a manual search of trade press and a review of brand websites. A total of 711 advertisements (122 unique) were analyzed to identify characteristics, themes, marketing strategies, and target audiences, and qualitatively compared by brand. All 5 brand websites were also analyzed. Coders examined the entirety of each advertisement or website for products, marketing claims, and features and recorded the presence or absence of 27 marketing claims and lifestyle elements. Results: All 6 brands of nicotine pouch products spent a total of US $11.2 million on advertising in 2019, with the most (US $10.7 million) spent by the brand Velo, and 86.1% (n=105) of the unique advertisements were web-based. Of the 711 total nicotine pouch advertisements run in 2019, the 2 brands Velo (n=407, 57%) and ZYN (n=303, 42%) dominated. These brands also made the greatest number of advertising claims in general. These claims focused on novelty, modernity, and use in a variety of contexts, including urban contexts, workplaces, transportation, and leisure activities. Of the 122 unique advertisements, ZYN’s most common claims were to be “tobacco-free,” featuring many flavors or varieties, and modern. Velo was the only brand to include urban contexts (n=14, 38.9% of advertisements) or freedom (n=8, 22.2%); Velo advertisements portrayed use in the workplace (n=15, 41.7%), bars or clubs (n=5, 13.9%), leisure activities (n=4, 11.1%), transportation (n=4, 11.1%), sports (n=3, 8.3%), cooking (n=2, 5.6%), and with alcohol (n=1, 2.8%). Velo and ZYN also included most of the images of people, including women and people of color. The 36 Velo ads included people in advertising in 77.8% (n=28) of advertisements, and of those advertisements with identifiable people, 40% (n=4) were young adults and 50% (n=5) were middle-aged. About one-third (n=11, 35.5%) of the 31 unique ZYN advertisements included people, and most identifiable models appeared to be young adults. Brands such as Rogue, Revel, Dryft, and on! focused mainly on product features. All nicotine pouch products made either tobacco-free, smoke-free, spit-free, or vape-free claims. The most common claim overall was “tobacco-free,” found in advertisements from Rogue (1/1, 100%), ZYN (30/31, 96.8%), Velo (19/36, 52.8%), and Dryft (1/3, 33.3%), but not Revel. Conclusions: Nicotine pouches and lozenges may expand the nicotine market as tobacco-free claims alleviate concerns about health harms and advertising features a greater diversity of people and contexts than typical smokeless tobacco advertising. The market leaders and highest-spending brands, ZYN and Velo, included more lifestyle claims. Surveillance of nicotine pouch marketing and uptake, including influence on tobacco use behaviors, is necessary. %M 36790840 %R 10.2196/39146 %U https://formative.jmir.org/2023/1/e39146 %U https://doi.org/10.2196/39146 %U http://www.ncbi.nlm.nih.gov/pubmed/36790840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35601 %T Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study %A Duong,Huong Thien %A Hopfer,Suellen %+ Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 856 Health Sciences Quad, Irvine, CA, 92697-3957, United States, 1 949 824 5519, huongd@uci.edu %K cancer prevention %K Vietnamese %K family communication %K intervention %K colorectal cancer %K human papillomavirus vaccine %K HPV vaccine %K Papanicolaou test %K mobile phone %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. Objective: In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members’ motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. Methods: Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. Results: In total, 13 (65%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members’ receptivity to the messages. Themes that could potentially impact family members’ willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of hỏi thăm, respect for a physician’s recommendation, prevention versus symptom orientation, the family health advocate’s bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. Conclusions: The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families. %M 36790844 %R 10.2196/35601 %U https://formative.jmir.org/2023/1/e35601 %U https://doi.org/10.2196/35601 %U http://www.ncbi.nlm.nih.gov/pubmed/36790844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42796 %T Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study %A Bønes,Erlend %A Granja,Conceição %A Solvoll,Terje %+ Norwegian Centre for e-Health Research, University Hospital of North Norway, PO Box 35, Tromsø, 9019, Norway, 47 97655680, erlend.bones@ehealthresearch.no %K mental health %K FACT %K electronic health records %K eHealth %K EHR %K electronic whiteboards %K community %K treatment %K qualitative %K COVID-19 %K patient care %K mental illness %K information technology %K thematic analysis %K data access %K information and communication solutions %K ICT %K Norway %K semistructured interviews %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient’s health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective: The aim of this study was to explore Norwegian FACT teams’ experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. %M 36730062 %R 10.2196/42796 %U https://formative.jmir.org/2023/1/e42796 %U https://doi.org/10.2196/42796 %U http://www.ncbi.nlm.nih.gov/pubmed/36730062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42390 %T Comparing the Feasibility and Acceptability of a Virtual Human, Teletherapy, and an e-Manual in Delivering a Stress Management Intervention to Distressed Adult Women: Pilot Study %A Loveys,Kate %A Antoni,Michael %A Donkin,Liesje %A Sagar,Mark %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599 ext 86756, e.broadbent@auckland.ac.nz %K stress %K cognitive behavioral stress management %K telehealth %K conversational agent %K virtual human %K e-manual %K pilot randomized controlled trial %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual humans (VHs), teletherapy, and self-guided e-manuals may increase the accessibility of psychological interventions. However, there is limited research on how these technologies compare in terms of their feasibility and acceptability in delivering stress management interventions. Objective: We conducted a preliminary comparison of the feasibility and acceptability of a VH, teletherapy, and an e-manual at delivering 1 module of cognitive behavioral stress management (CBSM) to evaluate the feasibility of the trial methodology in preparation for a future randomized controlled trial (RCT). Methods: A pilot RCT was conducted with a parallel, mixed design. A community sample of distressed adult women were randomly allocated to receive 1 session of CBSM involving training in cognitive and behavioral techniques by a VH, teletherapy, or an e-manual plus homework over 2 weeks. Data were collected on the feasibility of the intervention technologies (technical support and homework access), trial methods (recruitment methods, questionnaire completion, and methodological difficulty observations), intervention acceptability (intervention completion, self-report ratings, therapist rapport, and trust), and acceptability of the trial methods (self-report ratings and observations). Qualitative data in the form of written responses to open-ended questions were collected to enrich and clarify the findings on intervention acceptability. Results: Overall, 38 participants’ data were analyzed. A VH (n=12), teletherapy (n=12), and an e-manual (n=14) were found to be feasible and acceptable for delivering 1 session of CBSM to distressed adult women based on the overall quantitative and qualitative findings. Technical difficulties were minimal and did not affect intervention completion, and no significant differences were found between the conditions (P=.31). The methodology was feasible, although improvements were identified for a future trial. All conditions achieved good satisfaction and perceived engagement ratings, and no significant group differences were found (P>.40). Participants had similar willingness to recommend each technology (P=.64). There was a nonsignificant trend toward participants feeling more open to using the VH and e-manual from home than teletherapy (P=.10). Rapport (P<.001) and trust (P=.048) were greater with the human teletherapist than with the VH. The qualitative findings enriched the quantitative results by revealing the unique strengths and limitations of each technology that may have influenced acceptability. Conclusions: A VH, teletherapy, and a self-guided e-manual were found to be feasible and acceptable methods of delivering 1 session of a stress management intervention to a community sample of adult women. The technologies were found to have unique strengths and limitations that may affect which works best for whom and in what circumstances. Future research should test additional CBSM modules for delivery by these technologies and conduct a larger RCT to compare their feasibility, acceptability, and effectiveness when delivering a longer home-based stress management program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000859987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380114&isReview=true %M 36757790 %R 10.2196/42390 %U https://formative.jmir.org/2023/1/e42390 %U https://doi.org/10.2196/42390 %U http://www.ncbi.nlm.nih.gov/pubmed/36757790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39945 %T Reducing Health Anxiety in Patients With Inflammatory Bowel Disease Using Video Testimonials: Pilot Assessment of a Video Intervention %A Shor,Joel %A Miyatani,Yusuke %A Arita,Etsuko %A Chen,Pohung %A Ito,Yusuke %A Kayama,Hiroki %A Reiter,Jacob %A Kobayashi,Kaho %A Kobayashi,Taku %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 650 253 0000, joelshor@google.com %K anxiety %K bowel disease %K chronic condition %K chronic disease %K chronic illness %K Crohn disease %K digital health %K digital intervention %K digital video testimonial %K eHealth %K experience %K fear %K gastroenterologist %K gastroenterology %K gastrointestinal %K health anxiety %K inflammatory bowel disease %K internal medicine %K Japan %K life narrative %K mental health %K perception %K perspective %K pilot study %K relaxation %K stories %K testimonial %K ulcerative colitis %K video %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health anxiety has many damaging effects on patients with chronic illness. Physicians are often unable to alleviate concerns related to living with a disease that has an impact on daily life, and unregulated websites can overrepresent extreme anxiety-inducing outcomes. Educational clinician video interventions have shown some success as an acute anxiolytic in health settings. However, little research has evaluated if peer-based video interventions would be a feasible alternative or improvement. Objective: This pilot study assesses the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. It investigates the degree to which patient testimonials can affect state anxiety, and whether patients are comfortable enough with the technology to share their stories. Methods: Patients with CD (n=51) and those with UC (n=49) were shown testimonial videos of patients with CD during their physician consultations at Kitasato University Kitasato Institute Hospital in Japan. The video testimonials were collected from Dipex Japan, the Japan branch of an international organization specializing in understanding patient experiences. Patients completed a Visual Analogue Scale for Anxiety before and after viewing the videos, a Hospital Anxiety and Depression Scale (HADS) survey before the videos, and satisfaction surveys. Patients receiving infusion therapy participated in the study while receiving treatment to minimize hospital workflow disruption. Results: Anxiety reduction, on the Visual Analog Scale for Anxiety, was significant in the entire cohort both when viewed as an ordinal variable (P=.003, t98=1086.5) and as a continuous variable (P=.01, t94=–2.54, 90% CI –3.47 to –0.72). Eighty percent (n=15) of patients with high HADS Anxiety (HADS-A) scores and 71% (n=24) of patients with high starting state anxiety experienced reduced anxiety after watching testimonials. Patients with high state anxiety but low HADS-A scores experienced anxiety reduction (69%, n=16). Forty-two percent (n=100) of patients responded that they would share their stories for future users. When patients with UC received testimonials from patients with CD, 71% (n=49) of patients reported that they were relevant despite differences in condition. Conclusions: Our pilot results suggest that patient testimonial videos can reduce illness-related state anxiety for patients with CD and those with UC, especially in those with higher baseline state anxiety. The success of this study in reducing anxiety and achieving patient involvement suggests that video interventions for reducing anxiety might be a low-cost intervention that could scale to any number of hospitals, suggesting that technology can help scale up efforts to record and share patient testimonials. Future work can establish whether patient testimonials can be helpful in other contexts, such as before major surgeries or when a family member receives a difficult diagnosis. %M 36757761 %R 10.2196/39945 %U https://formative.jmir.org/2023/1/e39945 %U https://doi.org/10.2196/39945 %U http://www.ncbi.nlm.nih.gov/pubmed/36757761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35312 %T Perspectives of Patients With Orthopedic Trauma on Fully Automated Digital Physical Activity Measurement at Home: Cross-sectional Survey Study %A Scherer,Julian %A Yogarasa,Vithush %A Rauer,Thomas %A Pape,Hans-Christoph %A Heining,Sandro-Michael %+ Department of Traumatology, University Hospital of Zurich, Raemistr. 100, Zurich, 8091, Switzerland, 41 44 255 1111, julian.scherer@usz.ch %K digital %K survey %K telehealth %K follow-up %K orthopedic trauma %K trauma %K attitude %K physical activity %K rehabilitation %K surveillance %K surgical procedure %K patients %K orthopedic %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The automated digital surveillance of physical activity at home after surgical procedures could facilitate the monitoring of postoperative follow-up, reduce costs, and enhance patients’ satisfaction. Data on the willingness of patients with orthopedic trauma to undergo automated home surveillance postoperatively are lacking. Objective: The aims of this study were to assess whether patients with orthopedic trauma would be generally willing to use the proposed automated digital home surveillance system and determine what advantages and disadvantages the system could bring with it. Methods: Between June 2021 and October 2021, a survey among outpatients with orthopedic trauma who were treated at a European level 1 trauma center was conducted. The only inclusion criterion was an age of at least 16 years. The paper questionnaire first described the possibility of fully automated movement and motion detection (via cameras or sensors) at home without any action required from the patient. The questionnaire then asked for the participants’ demographics and presented 6 specific questions on the study topic. Results: In total, we included 201 patients whose mean age was 46.9 (SD 18.6) years. Most of the assessed patients (124/201, 61.7%) were male. Almost half of the patients (83/201, 41.3%) were aged between 30 and 55 years. The most stated occupation was a nine-to-five job (62/199, 30.8%). The majority of the participants (120/201, 59.7%) could imagine using the proposed measurement system, with no significant differences among the genders. An insignificant higher number of younger patients stated that they would use the automated surveillance system. No significant difference was seen among different occupations (P=.41). Significantly more young patients were using smartphones (P=.004) or electronic devices with a camera (P=.008). Less than half of the surveyed patients (95/201, 47.3%) stated that they were using tracking apps. The most stated advantages were fewer physician visits (110/201, 54.7%) and less effort (102/201, 50.7%), whereas the most prevalent disadvantage was the missing physician-patient contact (144/201, 71.6%). Significantly more patients with a part-time job or a nine-to-five job stated that data analysis contributes to medical progress (P=.047). Conclusions: Most of the assessed participants (120/201, 59.7%) stated that they would use the automated digital measurement system to observe their postoperative follow-up and recovery. The proposed system could be used to reduce costs and ease hospital capacity issues. In order to successfully implement such systems, patients’ concerns must be addressed, and further studies on the feasibility of these systems are needed. %M 36757791 %R 10.2196/35312 %U https://formative.jmir.org/2023/1/e35312 %U https://doi.org/10.2196/35312 %U http://www.ncbi.nlm.nih.gov/pubmed/36757791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43844 %T Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment %A Cantos,Valeria D %A Hagen,Kimberly %A Duarte,Ana Paula %A Escobar,Carolina %A Batina,Isabella %A Orozco,Humberto %A Rodriguez,Josue %A Camacho-Gonzalez,Andres %A Siegler,Aaron J %+ Division of Infectious Diseases, Emory University School of Medicine, 46 Armstrong Street, Atlanta, GA, 30303, United States, 1 404 251 8717, vcantos@emory.edu %K pre-exposure prophylaxis %K PrEP %K Latino %K sexual minority men %K SMM %K mobile health %K mHealth %K HIV prevention %K HIV %K technology %K minority %K men %K development %K biomedical intervention %K mobile technology %K mobile app %K community %K app %K barrier %K mobile phone %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disproportionally impacts Latino sexual minority men (SMM). Uptake of pre-exposure prophylaxis (PrEP), an effective biomedical intervention to prevent HIV, is low in this group compared with White SMM. Mobile health technology represents an innovative strategy to increase PrEP uptake among Latino SMM. Objective: We aimed to describe the qualitative process leading to the development of SaludFindr, a comprehensive HIV prevention mobile app aiming to increase PrEP uptake, HIV testing, and condom use by Latino SMM. Methods: We conducted 13 in-depth interviews with Latino SMM living in the Atlanta area to explore their main barriers and facilitators to PrEP uptake and to analyze their opinions of potential SaludFindr app functionalities. To explore potential app functions, we used HealthMindr, an existing HIV prevention app, as a template and added new proposed features intended to address the specific community needs. Results: We identified general PrEP uptake barriers that, although common among non-Latino groups, had added complexities such as the influence of religion and family on stigma. Low perceived PrEP eligibility, intersectional stigma, lack of insurance, cost concerns, and misconceptions about PrEP side effects were described as general barriers. We also identified Latino-specific barriers that predominantly hinder access to existing services, including a scarcity of PrEP clinics that are prepared to provide culturally concordant services, limited availability of Spanish language information related to PrEP access, distrust of peers as credible sources of information, perceived ineligibility for low-cost services owing to undocumented status, fear of immigration authorities, and competing work obligations that prevent PrEP clinic attendance. Health care providers represented a trusted source of information, and 3 provider characteristics were identified as PrEP facilitators: familiarity with prescribing PrEP; being Latino; and being part of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) group or ally. The proposed app was very well accepted, with a particularly high interest in features that facilitate PrEP access, including a tailored list of clinics that meet the community needs and a private platform to seek PrEP information. Spanish language availability and free or low-cost PrEP care represented the 2 main clinic criteria that would facilitate PrEP uptake. Latino representation in clinic staff and providers; clinic perception as a safe space for undocumented patients; and LGBTQIA+ representation was listed as additional criteria. Only 8 of 47 clinics listed on the Centers for Diseases Control and Prevention PrEP locator website for the Atlanta area fulfilled at least 2 main criteria. Conclusions: This study provides further evidence of the substantial PrEP uptake barriers that Latino SMM face; exposes the urgent need to increase the number of accessible PrEP-providing clinics for Latino SMM; and proposes an innovative, community-driven, and mobile technology–based tool as a future intervention to overcome some of these barriers. %M 36625855 %R 10.2196/43844 %U https://formative.jmir.org/2023/1/e43844 %U https://doi.org/10.2196/43844 %U http://www.ncbi.nlm.nih.gov/pubmed/36625855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43007 %T Voice Assistants’ Responses to Questions About the COVID-19 Vaccine: National Cross-sectional Study %A Sossenheimer,Philip %A Hong,Grace %A Devon-Sand,Anna %A Lin,Steven %+ Department of Medicine, Stanford University School of Medicine, 211 Quarry Road, Suite 405, Palo Alto, CA, 94304, United States, 1 650 725 7966, stevenlin@stanford.edu %K artificial intelligence %K mHealth %K misinformation %K public health %K vaccination hesitancy %K vaccination %K online %K COVID-19 %K public health %K information %K users %K smartphone %K mobile phone %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence-powered voice assistants (VAs), such as Apple Siri, Google Assistant, and Amazon Alexa, interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information. Objective: In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. Methods: A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed was conducted online from April 22 to 28, 2021. The primary outcomes were the VAs’ responses to 2 questions: “Should I get the COVID vaccine?” and “Is the COVID vaccine safe?” Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi-square or Fisher exact test for categorical variables. Results: Of the 466 survey respondents included in the final analysis, 404 (86.7%) used Apple Siri, 53 (11.4%) used Google Assistant, and 9 (1.9%) used Amazon Alexa. In response to the question “Is the COVID vaccine safe?” 419 (89.9%) users received a direct response, of which 408 (97.3%) had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3% (11/207) had a positive connotation and 94.7% (196/207) had a neutral connotation. In response to the question “Should I get the COVID vaccine?” 93.1% (434/466) of users received a list of websites, of which 91.5% (1155/1262) had a neutral connotation. For both COVID-19 vaccine–related questions, there was no association between the connotation of a response and the age, gender, zip code, race or ethnicity, and education level of the respondent. Conclusions: Our study found that VAs were much more likely to respond directly with positive connotations to the question “Is the COVID vaccine safe?” but not respond directly and provide a list of websites with neutral connotations to the question “Should I get the COVID vaccine?” To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination. %M 36719815 %R 10.2196/43007 %U https://formative.jmir.org/2023/1/e43007 %U https://doi.org/10.2196/43007 %U http://www.ncbi.nlm.nih.gov/pubmed/36719815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42219 %T A Tablet-Based Aphasia Assessment System “STELA”: Feasibility and Validation Study %A Inamoto,Yoko %A Mukaino,Masahiko %A Imaeda,Sayuri %A Sawada,Manami %A Satoji,Kumi %A Nagai,Ayako %A Hirano,Satoshi %A Okazaki,Hideto %A Saitoh,Eiichi %A Sonoda,Shigeru %A Otaka,Yohei %+ Deparment of Rehabilitation Medicine, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648, Japan, 81 11 706 6065, masahikovn@gmail.com %K aphasia %K tablet %K assessment %K validity %K internal consistency %K psychometric %K psychological health %K stress %K digital mental health intervention %K digital health intervention %K heuristic evaluation %K system usability %K auditory comprehension %K reading comprehension %K naming and sentence formation %K repetition %K reading aloud %K Cronbach α %K speech %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process. Objective: The aim of this paper is to assess the administration time, internal consistency, and validity of the STELA. Methods: The STELA consists of a tablet app, a microphone, and an input keypad for clinician’s use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points). Results: The time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA’s total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former’s concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach α obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach α was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17). Conclusions: Our study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system. %M 36753308 %R 10.2196/42219 %U https://formative.jmir.org/2023/1/e42219 %U https://doi.org/10.2196/42219 %U http://www.ncbi.nlm.nih.gov/pubmed/36753308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43175 %T Actual Use Behavior Assessment of a Novel Puff Recording Electronic Nicotine Delivery System: Observation Study %A Gao,Xiang %A Humberstone,Liam %A Liu,Yatao %+ Scientific Horizons Consulting, 5270 California Ave, Suite 300, Irvine, CA, 92617, United States, 1 5106798062, xiang.gao@scientifichorizonsconsulting.com %K e-cigarettes %K electronic nicotine delivery system %K behavior assessment %K nicotine addiction %K PR-ENDS %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared with combustible cigarettes, electronic cigarettes (e-cigarettes) can deliver a sufficient amount of nicotine with a significantly reduced emission of toxicants, which renders them as potential harm reduction candidates for tobacco and smoking replacement. However, the use of e-cigarettes is not harm free and the long-term health effect of using e-cigarettes is yet to be established. Given the high prevalence of e-cigarette use across the globe and its potential health concerns, it is imperative to conduct actual use behavior assessments to better understand how e-cigarettes are being consumed in real-world conditions. However, with the currently available technologies, there is still a lack of noninvasive, noninterventional, and convenient instruments for the real-time and real-world use behavior monitoring of e-cigarette product use. Novel technology-based systems that do not primarily rely on self-report or intrusive measurements to monitor e-cigarette use behaviors are therefore highly desired. Objective: The primary goal of this study is to investigate the e-cigarette actual use behaviors in the real world via a novel puff recording electronic nicotine delivery system (PR-ENDS). Specifically, we aim to analyze and summarize the survey and PR-ENDS use data and to study the relationships and effects of different factors on these variables. Methods: In real-world conditions, 61 enrolled UK e-cigarette users were instructed to use PR-ENDS as the primary source of nicotine with their selected e-liquids for at least 3 weeks (21 days). A baseline survey was conducted to collect information about participants’ demographics and nicotine use history (cigarette and ENDS). The puff data (ie, puff number, puff duration for each puff, device power, e-liquid nicotine concentrations) were directly recorded by PR-ENDS and uploaded to the cloud for further analyses. The nicotine emission and nicotine consumption were estimated based on recorded puff data. Results: Middle-aged adults with a nicotine history represented the major user profile during the PR-ENDS trial. A wide range of device power and e-liquid nicotine concentrations was applied and their combinations during actual use were found to be rather complex. Various puff parameters (ie, puff duration, puff number, nicotine emission) were assessed with contributing factors from device, e-liquid, and user nicotine history in different effect sizes. The real-time observation revealed substantial intra- and interindividual variabilities in PR-ENDS use behaviors. The use pattern of a quick adaptation followed by consistent product use was recognized for at least 3 weeks during actual use. Conclusions: The actual use behavior assessment of PR-ENDS was conducted as a proof-of-concept application. The complex interactions of product attributes and significant intra- and interindividual variabilities in e-cigarette use behaviors provided new insights of compensatory behavior, which can inspire future studies in the field of nicotine addiction and abuse liability behavior assessment. %M 36592426 %R 10.2196/43175 %U https://formative.jmir.org/2023/1/e43175 %U https://doi.org/10.2196/43175 %U http://www.ncbi.nlm.nih.gov/pubmed/36592426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41873 %T Promoting Digital Proficiency and Health Literacy in Middle-aged and Older Adults Through Mobile Devices With the Workshops for Online Technological Inclusion (OITO) Project: Experimental Study %A Quialheiro,Anna %A Miranda,André %A Garcia Jr,Miguel %A Carvalho,Adriana Camargo de %A Costa,Patrício %A Correia-Neves,Margarida %A Santos,Nadine Correia %+ Life and Health Sciences Research Institute, School of Medicine, University of Minho, Campus Gualtar, Braga, 4710-057, Portugal, 351 915398814, aquialheiro@med.uminho.pt %K digital proficiency %K health literacy %K older adults %K mobile devices %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition. Objective: The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers. Methods: The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarães, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale. Results: Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. Conclusions: The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period. %M 36753331 %R 10.2196/41873 %U https://formative.jmir.org/2023/1/e41873 %U https://doi.org/10.2196/41873 %U http://www.ncbi.nlm.nih.gov/pubmed/36753331 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44144 %T A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study %A Vanterpool,Karen B %A Gacki-Smith,Jessica %A Kuramitsu,Brianna %A Downey,Max %A Nordstrom,Michelle J %A Luken,Michelle %A Riggleman,Tiffany %A Fichter,Shannon %A Altema,Withney %A Brucker,James B %A Cooney,Carisa M %A Dumanian,Gregory %A Jensen,Sally %A Levan,Macey %A Tintle,Scott M %A Brandacher,Gerald %A Gordon,Elisa J %+ Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, D-4314 MCN, Nashville, TN, 37232-2730, United States, 1 708 646 7973, elisa.gordon@vumc.org %K hand transplantation %K patient education %K upper limb amputation %K interviews %K focus groups %K disability %K decision-making %K accessible %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Upper extremity (UE) vascularized composite allotransplantation (VCA; hand transplantation) is a reconstructive treatment option for patients with UE loss. Approximately 37 UE VCAs have been performed in the United States to date; thus, little is known about long-term psychosocial outcomes and whether the benefits outweigh the risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available providing unbiased, comprehensive information about UE VCA. Objective: This paper described the development of a neutral, and accessible, educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. Methods: Website content development was informed by 9 focus groups conducted with individuals with UE amputations at 3 study sites. After initial website development, we conducted usability testing to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Participants were administered the After-Scenario Questionnaire to assess user performance after completing navigational tasks, System Usability Scale to measure the perceived usability of the website, and Net Promoter Score to measure user satisfaction. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using rapid thematic analysis. Results: A total of 44 individuals with UE amputations participated in focus groups (n=37, 84%) and usability testing (n=14, 32%). Most participants in the focus groups and usability testing were male (24/37, 65% and 11/14, 79%, respectively) and White (27/37, 73% and 9/14, 64%, respectively), had unilateral limb loss (22/37, 59% and 12/14, 86%, respectively), and had mean ages of 48 (SD 9.2) and 50 (SD 12.0) years, respectively. Focus group results are organized into accessibility, website design, website development, website tone and values, sitemap, terminology, images and videos, and tables and graphics. Usability testing revealed that participants had a positive impression of the website. The mean After-Scenario Questionnaire score of 1.3 to 2.3 across task scenarios indicated high satisfaction with website usability, the mean System Usability Scale score of 88.9 indicated user satisfaction with website usability, and the mean Net Promoter Score of 9.6 indicated that users were enthusiastic and would likely refer individuals to the website. Conclusions: The findings suggest that our educational website, Within Reach, provides neutral, patient-centered information and may be a useful resource about UE VCA for individuals with UE amputations, their families, and health care professionals. Health care professionals may inform UE VCA candidates about Within Reach to supplement current VCA education processes. Within Reach serves as a resource about treatment options for patients preparing for scheduled or recovering from traumatic UE amputations. Future research should assess whether Within Reach improves knowledge about UE VCA and enhances informed decision-making about UE VCA as a treatment option. %M 36749618 %R 10.2196/44144 %U https://formative.jmir.org/2023/1/e44144 %U https://doi.org/10.2196/44144 %U http://www.ncbi.nlm.nih.gov/pubmed/36749618 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41137 %T Fine-tuning Strategies for Classifying Community-Engaged Research Studies Using Transformer-Based Models: Algorithm Development and Improvement Study %A Ferrell,Brian J %+ Center for Community Engagement and Impact, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA, 23284, United States, 1 804 350 5426, ferrellbj@vcu.edu %K fine-tuning %K BERT %K transformer-based models %K text classification %K community-engagement %K prototype %K IRB research %K community-engaged research, participatory research %K deep learning %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Community-engaged research (CEnR) involves institutions of higher education collaborating with organizations in their communities to exchange resources and knowledge to benefit a community’s well-being. While community engagement is a critical aspect of a university's mission, tracking and reporting CEnR metrics can be challenging, particularly in terms of external community relations and federally funded research programs. In this study, we aimed to develop a method for classifying CEnR studies that have been submitted to our university's institutional review board (IRB) to capture the level of community involvement in research studies. Tracking studies in which communities are “highly engaged” enables institutions to obtain a more comprehensive understanding of the prevalence of CEnR. Objective: We aimed to develop an updated experiment to classify CEnR and capture the distinct levels of involvement that a community partner has in the direction of a research study. To achieve this goal, we used a deep learning–based approach and evaluated the effectiveness of fine-tuning strategies on transformer-based models. Methods: In this study, we used fine-tuning techniques such as discriminative learning rates and freezing layers to train and test 135 slightly modified classification models based on 3 transformer-based architectures: BERT (Bidirectional Encoder Representations from Transformers), Bio+ClinicalBERT, and XLM-RoBERTa. For the discriminative learning rate technique, we applied different learning rates to different layers of the model, with the aim of providing higher learning rates to layers that are more specialized to the task at hand. For the freezing layers technique, we compared models with different levels of layer freezing, starting with all layers frozen and gradually unfreezing different layer groups. We evaluated the performance of the trained models using a holdout data set to assess their generalizability. Results: Of the models evaluated, Bio+ClinicalBERT performed particularly well, achieving an accuracy of 73.08% and an F1-score of 62.94% on the holdout data set. All the models trained in this study outperformed our previous models by 10%-23% in terms of both F1-score and accuracy. Conclusions: Our findings suggest that transfer learning is a viable method for tracking CEnR studies and provide evidence that the use of fine-tuning strategies significantly improves transformer-based models. Our study also presents a tool for categorizing the type and volume of community engagement in research, which may be useful in addressing the challenges associated with reporting CEnR metrics. %M 36749611 %R 10.2196/41137 %U https://formative.jmir.org/2023/1/e41137 %U https://doi.org/10.2196/41137 %U http://www.ncbi.nlm.nih.gov/pubmed/36749611 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38894 %T The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study %A Trinidad,Susan Brown %A Shane,Aliassa L %A Guinn,Tiffany R %A Apok,Charlene R %A Collier,Ann F %A Avey,Jaedon P %A Donovan,Dennis M %+ Department of Bioethics and Humanities, School of Medicine, University of Washington, Box 357120, Seattle, WA, 98195-7120, United States, 1 206 543 2508, sbtrini@uw.edu %K alcohol misuse %K sobriety support %K peer support %K smartphone app %K community reinforcement approach %K mobile phone %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. Methods: From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ≥21 years and 8 providers in a tribal health care organization in south-central Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users. %M 36473107 %R 10.2196/38894 %U https://formative.jmir.org/2023/1/e38894 %U https://doi.org/10.2196/38894 %U http://www.ncbi.nlm.nih.gov/pubmed/36473107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38555 %T mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App %A Tan,Jamaica Pei Ying %A Tan,Michelle W J %A Towle,Rachel Marie %A Lee,Joanne Sze Win %A Lei,Xiaofeng %A Liu,Yong %A Goh,Rick Siow Mong %A Chee Ping,Franklin Tan %A Tan,Teck Choon %A Ting,Daniel Shu Wei %A Lee,Chen Ee %A Low,Lian Leng %+ Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, SingHealth Tower Level 7, Singapore, 168582, Singapore, 65 69703018, low.lian.leng@singhealth.com.sg %K mobile health %K mHealth %K rapid development %K remote care %K COVID-19 %K hospital-at-home %K mobile app %K app development %K virtual care %K Telegram service %K clinical care %K continuity of care %K digital health %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients’ vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed–days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. %M 36649223 %R 10.2196/38555 %U https://formative.jmir.org/2023/1/e38555 %U https://doi.org/10.2196/38555 %U http://www.ncbi.nlm.nih.gov/pubmed/36649223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38298 %T Developing and Evaluating a Measure of the Willingness to Use Pandemic-Related mHealth Tools Using National Probability Samples in the United States: Quantitative Psychometric Analyses and Tests of Sociodemographic Group Differences %A Vincent,Wilson %+ Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 404 200 4193, wvincent1804@gmail.com %K COVID-19 %K psychometric properties %K mHealth %K digital health %K digital screening %K digital tracking %K pandemic %K national survey %K mobile health %K digital health tool %K vulnerable population %K demographic characteristic %K instrument validation %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are no psychometrically validated measures of the willingness to engage in public health screening and prevention efforts, particularly mobile health (mHealth)–based tracking, that can be adapted to future crises post–COVID-19. Objective: The psychometric properties of a novel measure of the willingness to participate in pandemic-related screening and tracking, including the willingness to use pandemic-related mHealth tools, were tested. Methods: Data were from a cross-sectional, national probability survey deployed in 3 cross-sectional stages several weeks apart to adult residents of the United States (N=6475; stage 1 n=2190, 33.82%; stage 2 n=2238, 34.56%; and stage 3 n=2047, 31.62%) from the AmeriSpeak probability-based research panel covering approximately 97% of the US household population. Five items asked about the willingness to use mHealth tools for COVID-19–related screening and tracking and provide biological specimens for COVID-19 testing. Results: In the first, exploratory sample, 3 of 5 items loaded onto 1 underlying factor, the willingness to use pandemic-related mHealth tools, based on exploratory factor analysis (EFA). A 2-factor solution, including the 3-item factor, fit the data (root mean square error of approximation [RMSEA]=0.038, comparative fit index [CFI]=1.000, standardized root mean square residual [SRMR]=0.005), and the factor loadings for the 3 items ranged from 0.849 to 0.893. In the second, validation sample, the reliability of the 3-item measure was high (Cronbach α=.90), and 1 underlying factor for the 3 items was confirmed using confirmatory factor analysis (CFA): RMSEA=0, CFI=1.000, SRMR=0 (a saturated model); factor loadings ranged from 1.000 to 0.962. The factor was independently associated with COVID-19–preventive behaviors (eg, “worn a face mask”: r=0.313, SE=0.041, P<.001; “kept a 6-foot distance from those outside my household”: r=0.282, SE=0.050, P<.001) and the willingness to provide biological specimens for COVID-19 testing (ie, swab to cheek or nose: r=0.709, SE=0.017, P<.001; small blood draw: r=0.684, SE=0.019, P<.001). In the third, multiple-group sample, the measure was invariant, or measured the same thing in the same way (ie, difference in CFI [ΔCFI]<0.010 across all grouping categories), across age groups, gender, racial/ethnic groups, education levels, US geographic region, and population density (ie, rural, suburban, urban). When repeated across different samples, factor-analytic findings were essentially the same. Additionally, there were mean differences (ΔM) in the willingness to use mHealth tools across samples, mainly based on race or ethnicity and population density. For example, in SD units, suburban (ΔM=–0.30, SE=0.13, P=.001) and urban (ΔM=–0.42, SE=0.12, P<.001) adults showed less willingness to use mHealth tools than rural adults in the third sample collected on May 30-June 8, 2020, but no differences were detected in the first sample collected on April 20-26, 2020. Conclusions: Findings showed that the screener is psychometrically valid. It can also be adapted to future public health crises. Racial and ethnic minority adults showed a greater willingness to use mHealth tools than White adults. Rural adults showed more mHealth willingness than suburban and urban adults. Findings have implications for public health screening and tracking and understanding digital health inequities, including lack of uptake. %M 36689545 %R 10.2196/38298 %U https://formative.jmir.org/2023/1/e38298 %U https://doi.org/10.2196/38298 %U http://www.ncbi.nlm.nih.gov/pubmed/36689545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39334 %T Implementation of a Knowledge Management System in Mental Health and Addictions: Mixed Methods Case Study %A Chorney,Jill %A Johnson Emberly,Debbie %A Jeffrey,Jennifer %A Hundert,Amos %A Pakkanlilar,Onur %A Abidi,Sabina %A Bagnell,Alexa %A Brennan,Maureen %A Campbell,Leslie Anne %A Clark,Sharon %A Bradley,Kristina %A Ross,Olivia %+ Mental Health and Addictions Program, IWK Health, 5850 University Ave, Halifax, NS, B3K 6R8, Canada, 1 902 470 7707, jill.chorney@iwk.nshealth.ca %K mental health %K knowledge management %K information %K technology %K capacity building %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health and addictions (MHA) care is complex and individualized and requires coordination across providers and areas of care. Knowledge management is an essential facilitator and common challenge in MHA services. Objective: This paper aimed to describe the development of a knowledge management system (KMS) and the associated processes in 1 MHA program. We also aimed to examine the uptake and use, satisfaction, and feedback on implementation among a group of pilot testers. Methods: This project was conducted as a continuous quality-improvement initiative. Integrated stakeholder engagement was used to scope the content and design the information architecture to be implemented using a commercially available knowledge management platform. A group of 30 clinical and administrative staff were trained and tested with the KMS over a period of 10 weeks. Feedback was collected via surveys and focus groups. System analytics were used to characterize engagement. The content, design, and full-scale implementation planning of the KMS were refined based on the results. Results: Satisfaction with accessing the content increased from baseline to after the pilot. Most testers indicated that they would recommend the KMS to a colleague, and satisfaction with KMS functionalities was high. A median of 7 testers was active each week, and testers were active for a median of 4 days over the course of the pilot. Focus group themes included the following: the KMS was a solution to problems for staff members, functionality of the KMS was important, quality content matters, training was helpful and could be improved, and KMS access was required to be easy and barrier free. Conclusions: Knowledge management is an ongoing need in MHA services, and KMSs hold promise in addressing this need. Testers in 1 MHA program found a KMS that is easy to use and would recommend it to colleagues. Opportunities to improve implementation and increase uptake were identified. Future research is needed to understand the impact of KMSs on quality of care and organizational efficiency. %M 36745489 %R 10.2196/39334 %U https://formative.jmir.org/2023/1/e39334 %U https://doi.org/10.2196/39334 %U http://www.ncbi.nlm.nih.gov/pubmed/36745489 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41788 %T Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers’ Motivations and Challenges %A Ma,Kris Pui Kwan %A Stephens,Kari A %A Geyer,Rachel E %A Prado,Maria G %A Mollis,Brenda L %A Zbikowski,Susan M %A Waters,Deanna %A Masterson,Jo %A Zhang,Ying %+ Department of Family Medicine, University of Washington, Box 354696, 4225 Roosevelt Way NE, Suite 308, Seattle, WA, 98105, United States, 1 206 543 9252, krisma@uw.edu %K chronic pain %K pain management %K primary care %K digital therapeutics %K mHealth %K mobile health %K human-centered design %K digital health %K pain %K qualitative %K interview %K challenge %K perspective %K health care provider %K physician %K doctor %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital therapeutics are growing as a solution to manage pain for patients; yet, they are underused in primary care where over half of the patients with chronic pain seek care. Little is known about how to successfully engage primary care providers in recommending digital therapeutics to their patients. Exploring provider motivations in chronic pain management would potentially help to improve their engagement and inform the development of digital therapeutics. Objective: This study examined primary care providers’ motivations for chronic pain management, including their strategies and challenges, to inform the future development of chronic pain-related digital therapeutics tailored to primary care settings. Methods: We conducted qualitative semistructured interviews with health care providers recruited from 3 primary care clinics in Washington and 1 clinic in Colorado between July and October 2021. The sample (N=11) included 7 primary care physicians, 2 behavioral health providers, 1 physician assistant, and 1 nurse. Most providers worked in clinics affiliated with urban academic health systems. Guided by the human-centered design approach and Christensen’s Job-to-be-Done framework, we asked providers their goals and priorities in chronic pain management, their experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. Results: We found that primary care providers were motivated but challenged to strengthen the patient-provider alliance, provide team-based care, track and monitor patients’ progress, and address social determinants of health in chronic pain management. Specifically, providers desired additional resources to improve patient-centered communication, pain education and counseling, and goal setting with patients. Providers also requested greater accessibility to multidisciplinary care team consultations and nonpharmacological pain treatments. When managing chronic pain at the population level, providers need infrastructure and systems to systematically track and monitor patients’ pain and provide wraparound health and social services for underserved patients. Recommendations on digital therapeutic features that might address provider challenges in achieving these motivations were discussed. Conclusions: Given the findings, to engage primary care providers, digital therapeutics for chronic pain management need to strengthen the patient-provider alliance, increase access to nonpharmacological treatment options, support population health tracking and management, and provide equitable reach. Leveraging digital therapeutics in a feasible, appropriate, and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider motivations at an individual care and clinic or system level. %M 36735284 %R 10.2196/41788 %U https://formative.jmir.org/2023/1/e41788 %U https://doi.org/10.2196/41788 %U http://www.ncbi.nlm.nih.gov/pubmed/36735284 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39969 %T To Act or Not to Act—a Sense of Control Is Important for People With Chronic Obstructive Pulmonary Disease to Increase Physical Activity: Grounded Theory Study %A Marklund,Sarah %A Sörlin,Ann %A Stenlund,Tobias %A Wadell,Karin %A Nyberg,Andre %+ Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Linnaeus väg 9, Umeå, 90736, Sweden, 46 7869835, sarah.marklund@umu.se %K physical activity %K chronic obstructive pulmonary disease %K COPD %K eHealth %K interviews %K eHealth tools %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factors for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychological elements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites have shown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutions might be used to support positive changes in PA behavior in people with COPD. Objective: This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool among people with COPD. Methods: This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 13 (n=7, 54% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone. Results: The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question. Conclusions: The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending on other environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030788 %M 36735302 %R 10.2196/39969 %U https://formative.jmir.org/2023/1/e39969 %U https://doi.org/10.2196/39969 %U http://www.ncbi.nlm.nih.gov/pubmed/36735302 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40466 %T Internet Use for Obtaining Medicine Information: Cross-sectional Survey %A Bergmo,Trine Strand %A Sandsdalen,Vilde %A Manskow,Unn Sollid %A Småbrekke,Lars %A Waaseth,Marit %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Sykehusveien 23, Tromsø, N-9019, Norway, 47 48003565, trine.bergmo@ehealthresearch.no %K credibility %K credible %K cross-sectional %K eHealth %K health information %K information behavior %K information retrieval %K information science %K information seeking %K internet %K medication %K medicine information %K misinformation %K patient education %K pharmaceutical %K pharmacist %K pharmacy %K survey %K trust %K web-based information %D 2023 %7 2.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. Objective: The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. Methods: This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. Results: A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. Conclusions: Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities. %M 36729577 %R 10.2196/40466 %U https://formative.jmir.org/2023/1/e40466 %U https://doi.org/10.2196/40466 %U http://www.ncbi.nlm.nih.gov/pubmed/36729577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38822 %T Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study %A Triplett,Noah S %A Johnson,Clara %A Kiche,Sharon %A Dastrup,Kara %A Nguyen,Julie %A Daniels,Alayna %A Mbwayo,Anne %A Amanya,Cyrilla %A Munson,Sean %A Collins,Pamela Y %A Weiner,Bryan J %A Dorsey,Shannon %+ Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A, Seattle, WA, 98195, United States, 1 206 543 2640, nst7@uw.edu %K task shifting %K human-centered design %K supervision %K global mental health %K acceptability %K feasibility %K mobile phone %D 2023 %7 2.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. Objective: Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. Methods: Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants’ choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. Results: Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. Conclusions: Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. International Registered Report Identifier (IRRID): RR2-10.1186/s43058-020-00102-9 %M 36729591 %R 10.2196/38822 %U https://formative.jmir.org/2023/1/e38822 %U https://doi.org/10.2196/38822 %U http://www.ncbi.nlm.nih.gov/pubmed/36729591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44138 %T Outcomes of a Live Messaging, Blended Care Coaching Program Among Adults With Symptoms of Anxiety: Pragmatic Retrospective Cohort Study %A Owusu,Jocelynn T %A Wang,Pam %A Wickham,Robert E %A Smith,Sarah F %A Lee,Jennifer L %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Avenue, Burlingame, CA, 94010, United States, 1 877 505 7147, jowusu@lyrahealth.com %K text-based coaching %K anxiety %K blended care %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders are common and can be debilitating. In addition, various barriers exist that can hinder access to adequate care. Coaching that is grounded in evidence-based interventions and delivered via synchronous (ie, live) text-based messaging could potentially increase the reach of mental health services among populations who select this modality instead of other services (eg, face-to-face coaching and psychotherapy). In addition, the delivery of live messaging coaching within a blended care model has the potential to combine the benefits of coaching with those of evidence-based digital mental health tools. Objective: This real-world study evaluates the anxiety and satisfaction outcomes of live messaging coaching blended with digital tools (ie, digital exercises and activities). Methods: This was a retrospective cohort study of 121 adults with moderate levels of anxiety symptoms at the beginning of coaching (Generalized Anxiety Disorder-7 [GAD-7] scores: range 8-14). Participants received an employer-offered blended messaging coaching (BMC) program, and those who opted to receive all live coaching sessions via text-based messaging were included. Anxiety symptom severity was regularly measured by using the GAD-7 scale. Using growth curve models, the change in GAD-7 scores over the course of BMC was evaluated, as were the effects of text-based coaching sessions on GAD-7 scores. The proportion of participants that had a reliable improvement in anxiety symptom severity (GAD-7 score reduction of ≥4) or subclinical symptom severity (GAD-7 score of <8) at the end of care was also estimated. Participants also self-reported their likelihood of recommending their live messaging coach to someone with similar needs. Results: At baseline, the average GAD-7 score was 9.88 (SD 1.80). Anxiety symptom severity significantly decreased with each week in the BMC program (week: b=−1.04; P<.001), and the rate of decline in anxiety symptom severity decreased over time (week2: b=0.06; P<.001). Each live messaging coaching session was associated with significantly lower anxiety symptom severity during the week of the coaching session (b=−1.56; P<.001) and the week immediately following the session (b=−1.03; P<.001). Overall, 86% (104/121) of participants had subclinical symptom severity or a reliable reduction in anxiety symptom severity by the end of care. Further, 33.1% (40/121) of participants reported coaching satisfaction levels; of the 40 participants in this subset, 37 (92.5%) were likely or extremely likely to recommend their live messaging coach. Conclusions: BMC that provides coaching sessions via live messaging can be beneficial for adults with moderate symptoms of anxiety who qualify for and self-select this care modality. Large-scale studies with longer follow-ups are needed. %M 36724014 %R 10.2196/44138 %U https://formative.jmir.org/2023/1/e44138 %U https://doi.org/10.2196/44138 %U http://www.ncbi.nlm.nih.gov/pubmed/36724014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43557 %T A Digital Health Intervention for Concussion: Development and Clinical Feasibility Study %A d'Offay,Christine %A Ng,Xin Yi %A Alexander,Laura %A Grant,Alison %A Grahamslaw,Julia %A Pagliari,Claudia %A Reed,Matthew J %A Carson,Alan %A Gillespie,David C %A Jamjoom,Aimun A B %+ Centre for Clinical Brain Sciences, The University of Edinburgh, Chancellors Building, Edinburgh, EH16 4SA, United Kingdom, 44 131 650 1000, v1ajamjo@ed.ac.uk %K concussion %K digital intervention %K behavior change %K feasibility study %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Concussion is a common condition that can lead to a constellation of symptoms that affect quality of life, social integration, and return to work. There are several evidence-based behavioral and psychological interventions that have been found to improve postconcussion symptom burden. However, these are not routinely delivered, and individuals receive limited support during their concussion recovery. Objective: This study aimed to develop and test the feasibility of a digital health intervention using a systematic evidence-, theory-, and person-based approach. Methods: This was a mixed methodology study involving a scoping review (n=21), behavioral analysis, and logic model to inform the intervention design and content. During development, the intervention was optimized with feedback from individuals who had experienced concussions (n=12) and health care professionals (n=11). The intervention was then offered to patients presenting to the emergency department with a concussion (n=50). Participants used the intervention freely and input symptom data as part of the program. A number of outcome measures were obtained, including participant engagement with the intervention, postconcussion symptom burden, and attitudes toward the intervention. A selection of participants (n=15) took part in in-depth qualitative interviews to understand their attitudes toward the intervention and how to improve it. Results: Engagement with the intervention functionality was 90% (45/50) for the symptom diary, 62% (31/50) for sleep time setting, 56% (28/50) for the alcohol tracker, 48% (24/50) for exercise day setting, 34% (17/50) for the thought diary, and 32% (16/50) for the goal setter. Metrics indicated high levels of early engagement that trailed off throughout the course of the intervention, with an average daily completion rate of the symptom diary of 28.23% (494/1750). A quarter of the study participants (13/50, 26%) were classified as high engagers who interacted with all the functionalities within the intervention. Quantitative and qualitative feedback indicated a high level of usability and positive perception of the intervention. Daily symptom diaries (n=494) demonstrated a wide variation in individual participant symptom burden but a decline in average burden over time. For participants with Rivermead scores on completion of HeadOn, there was a strong positive correlation (r=0.86; P<.001) between their average daily HeadOn symptom diary score and their end-of-program Rivermead score. Insights from the interviews were then fed back into development to optimize the intervention and facilitate engagement. Conclusions: Using this systematic approach, we developed a digital health intervention for individuals who have experienced a concussion that is designed to facilitate positive behavior change. Symptom data input as part of the intervention provided insights into postconcussion symptom burden and recovery trajectories. Trial Registration: ClinicalTrials.gov NCT05069948; https://clinicaltrials.gov/ct2/show/NCT05069948 %M 36724010 %R 10.2196/43557 %U https://formative.jmir.org/2023/1/e43557 %U https://doi.org/10.2196/43557 %U http://www.ncbi.nlm.nih.gov/pubmed/36724010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40237 %T Forensic Psychiatric Outpatients’ and Therapists’ Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study %A ter Harmsel,Janna F %A Smulders,Lisanne M %A Noordzij,Matthijs L %A Swinkels,Lise T A %A Goudriaan,Anna E %A Popma,Arne %A van der Pol,Thimo M %+ Inforsa Forensic Mental Healthcare, Vlaardingenlaan 5, Amsterdam, 1059 GL, Netherlands, 31 205904578, annemieke.ter.harmsel@inforsa.nl %K biocueing %K biofeedback %K aggression %K behavior change %K forensic psychiatry %K wearable technology %K mobile health %K mHealth %K implementation %K mobile phone %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor–based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. Objective: The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. Methods: A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Results: Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients’ motivation, and both therapists’ and patients’ knowledge and skills. Integration into treatment, expertise within the therapists’ team, and provision of time and materials were identified as facilitators. Conclusions: The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients’ and therapists’ perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care. %M 36724008 %R 10.2196/40237 %U https://formative.jmir.org/2023/1/e40237 %U https://doi.org/10.2196/40237 %U http://www.ncbi.nlm.nih.gov/pubmed/36724008 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40145 %T Web-Based Mind-Body Tactical Resilience Training Program for First Responders: Pre-Post Study Assessing Feasibility, Acceptability, and Usability %A Tan,Leona %A Deady,Mark %A Mead,Olivia %A Foright,Rebecca M %A Brenneman,Eric M %A Yeager,Jamie R %A Bryant,Richard A %A Harvey,Samuel B %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 290659135, leona.tan@unsw.edu.au %K resilience training %K first responders %K web-based intervention %K mental health %K mind-body %K posttraumatic stress disorder %K PTSD %K prevention %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: First responders report elevated rates of mental disorders, including posttraumatic stress disorder (PTSD), yet many are reluctant to seek care. Preventative resilience training programs attempt to proactively address this issue, and there is evidence showing promise for programs targeting cognitive processes. However, these programs rarely address the physical health conditions associated with PTSD. There is emerging evidence of mind-body exercise training improving PTSD symptoms as well as its associated physical health symptoms. However, the feasibility and acceptability of delivering a web-based mind-body resilience training among first responders are not yet known. Objective: This study aimed to evaluate the feasibility, usability, and acceptability of a web-based mind-body tactical resilience training program designed for first responders. In addition, we explored the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies, and work productivity. Methods: A total of 42 first responders based in the United States enrolled in the web-based training program. Participants were administered web-based surveys before enrolling in the 6-week web-based program and at the end of the program. The primary outcomes of feasibility were measured using the number of training hours, program adherence rates, and self-reported data on frequency of practice. Acceptability and usability were measured using self-reported data. Secondary outcomes were symptoms of PTSD, psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance. Results: Overall, the training program was feasible based on the median number of training hours spent on the web-based program (7.57 hours out of an expected total of 6 to 9 hours), and 55% (23/42) of the enrolled participants completed more than half of the program. Although acceptability, usability, and frequency of practice were rated as high, this was based on only 29% (12/42) of the respondents who provided follow-up data. Secondary outcomes showed a significant improvement in the adaptive cognitive strategy of the stress mindset, with a mean difference of –5.42 (SD 4.81; 95% CI −8.475 to −2.358; t11=−3.898; P=.002). All other secondary outcomes were not significant. However, the secondary outcomes were exploratory only, and this study was neither designed nor powered to adequately assess efficacy. Conclusions: These findings suggest that a mind-body tactical resilience training program delivered in a web-based format is feasible and acceptable among first responders; however, further refinements may be required to improve adherence rates. Further research using a larger, more rigorous trial design is warranted to examine the effectiveness of this type of training as a possible prevention or treatment strategy for this population. %M 36724011 %R 10.2196/40145 %U https://formative.jmir.org/2023/1/e40145 %U https://doi.org/10.2196/40145 %U http://www.ncbi.nlm.nih.gov/pubmed/36724011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41577 %T Prediction of Next Glucose Measurement in Hospitalized Patients by Comparing Various Regression Methods: Retrospective Cohort Study %A Zale,Andrew D %A Abusamaan,Mohammed S %A McGready,John %A Mathioudakis,Nestoras %+ Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument Street, Baltimore, MD, 21205, United States, 1 667 306 8085, nmathio1@jhmi.edu %K hospital %K glucose %K inpatient %K prediction %K regression %K machine learning %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous glucose monitors have shown great promise in improving outpatient blood glucose (BG) control; however, continuous glucose monitors are not routinely used in hospitals, and glucose management is driven by point-of-care (finger stick) and serum glucose measurements in most patients. Objective: This study aimed to evaluate times series approaches for prediction of inpatient BG using only point-of-care and serum glucose observations. Methods: Our data set included electronic health record data from 184,320 admissions, from patients who received at least one unit of subcutaneous insulin, had at least 4 BG measurements, and were discharged between January 1, 2015, and May 31, 2019, from 5 Johns Hopkins Health System hospitals. A total of 2,436,228 BG observations were included after excluding measurements obtained in quick succession, from patients who received intravenous insulin, or from critically ill patients. After exclusion criteria, 2.85% (3253/113,976), 32.5% (37,045/113,976), and 1.06% (1207/113,976) of admissions had a coded diagnosis of type 1, type 2, and other diabetes, respectively. The outcome of interest was the predicted value of the next BG measurement (mg/dL). Multiple time series predictors were created and analyzed by comparing those predictors and the index BG measurement (sample-and-hold technique) with next BG measurement. The population was classified by glycemic variability based on the coefficient of variation. To compare the performance of different time series predictors among one another, R2, root mean squared error, and Clarke Error Grid were calculated and compared with the next BG measurement. All these time series predictors were then used together in Cubist, linear, random forest, partial least squares, and k-nearest neighbor methods. Results: The median number of BG measurements from 113,976 admissions was 12 (IQR 5-24). The R2 values for the sample-and-hold, 2-hour, 4-hour, 16-hour, and 24-hour moving average were 0.529, 0.504, 0.481, 0.467, and 0.459, respectively. The R2 values for 4-hour moving average based on glycemic variability were 0.680, 0.480, 0.290, and 0.205 for low, medium, high, and very high glucose variability, respectively. The proportion of BG predictions in zone A of the Clarke Error Grid analysis was 61%, 59%, 27%, and 53% for 4-hour moving average, 24-hour moving average, 3 observation rolling regression, and recursive regression predictors, respectively. In a fully adjusted Cubist, linear, random forest, partial least squares, and k-nearest neighbor model, the R2 values were 0.563, 0.526, 0.538, and 0.472, respectively. Conclusions: When analyzing time series predictors independently, increasing variability in a patient’s BG decreased predictive accuracy. Similarly, inclusion of older BG measurements decreased predictive accuracy. These relationships become weaker as glucose variability increases. Machine learning techniques marginally augmented the performance of time series predictors for predicting a patient’s next BG measurement. Further studies should determine the potential of using time series analyses for prediction of inpatient dysglycemia. %M 36719713 %R 10.2196/41577 %U https://formative.jmir.org/2023/1/e41577 %U https://doi.org/10.2196/41577 %U http://www.ncbi.nlm.nih.gov/pubmed/36719713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40194 %T Black and Latinx Primary Caregiver Considerations for Developing and Implementing a Machine Learning–Based Model for Detecting Child Abuse and Neglect With Implications for Racial Bias Reduction: Qualitative Interview Study With Primary Caregivers %A Landau,Aviv Y %A Blanchard,Ashley %A Atkins,Nia %A Salazar,Stephanie %A Cato,Kenrick %A Patton,Desmond U %A Topaz,Maxim %+ School of Social Policy & Practice, University of Pennsylvania, 3901 Walnut st, Philadelphia, PA, 19104, United States, 1 215 746 6290, landauay@upenn.edu %K child abuse and neglect %K pediatric emergency departments %K machine learning–based risk models %K electronic health records %K primary caregivers %K child %K abuse %K neglect %K model %K epidemic %K development %K implementation %K community %K machine learning %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Child abuse and neglect, once viewed as a social problem, is now an epidemic. Moreover, health providers agree that existing stereotypes may link racial and social class issues to child abuse. The broad adoption of electronic health records (EHRs) in clinical settings offers a new avenue for addressing this epidemic. To reduce racial bias and improve the development, implementation, and outcomes of machine learning (ML)–based models that use EHR data, it is crucial to involve marginalized members of the community in the process. Objective: This study elicited Black and Latinx primary caregivers' viewpoints regarding child abuse and neglect while living in underserved communities to highlight considerations for designing an ML-based model for detecting child abuse and neglect in emergency departments (EDs) with implications for racial bias reduction and future interventions. Methods: We conducted a qualitative study using in-depth interviews with 20 Black and Latinx primary caregivers whose children were cared for at a single pediatric tertiary-care ED to gain insights about child abuse and neglect and their experiences with health providers. Results: Three central themes were developed in the coding process: (1) primary caregivers’ perspectives on the definition of child abuse and neglect, (2) primary caregivers’ experiences with health providers and medical documentation, and (3) primary caregivers’ perceptions of child protective services. Conclusions: Our findings highlight essential considerations from primary caregivers for developing an ML-based model for detecting child abuse and neglect in ED settings. This includes how to define child abuse and neglect from a primary caregiver lens. Miscommunication between patients and health providers can potentially lead to a misdiagnosis, and therefore, have a negative impact on medical documentation. Additionally, the outcome and application of the ML-based models for detecting abuse and neglect may cause additional harm than expected to the community. Further research is needed to validate these findings and integrate them into creating an ML-based model. %M 36719717 %R 10.2196/40194 %U https://formative.jmir.org/2023/1/e40194 %U https://doi.org/10.2196/40194 %U http://www.ncbi.nlm.nih.gov/pubmed/36719717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37596 %T Helping Patients With Chronic Conditions Overcome Challenges of High-Deductible Health Plans: Mixed Methods Study %A Hu,Tiffany Yung-Shin %A Ali,Iman %A Heisler,Michele %A Levy,Helen %A Fagerlin,Angela %A Kullgren,Jeffrey T %+ University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, United States, 1 203 824 4785, tyshu@umich.edu %K high-deductible health plan %K HDHP %K chronic conditions %K cost-conscious strategies %K consumer behaviors %K health care costs %K out-of-pocket spending %K OOP %K behavioral intervention %K mobile phone %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population. Objective: This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care. Methods: In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants’ health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care. Results: Approximately half (11/20, 55%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year. Conclusions: Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending. %M 36719718 %R 10.2196/37596 %U https://formative.jmir.org/2023/1/e37596 %U https://doi.org/10.2196/37596 %U http://www.ncbi.nlm.nih.gov/pubmed/36719718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38378 %T The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial %A Koeryaman,Mira Trisyani %A Pallikadavath,Saseendran %A Ryder,Isobel Helen %A Kandala,Ngianga %+ Maternity Nursing Department, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21, Fakultas Keperawatan, Jatinangor, 45363, Indonesia, 62 22 7795596, mira.koeryaman@port.ac.uk %K web-based application %K nutrition %K pregnant women %K pregnancy %K mobile app %K diet %K dietary intake %K application %K Indonesia %K randomized controlled trial %K tool %K consumption %K maternal %K weight %K weight gain %K intervention %K control group %K treatment %K vitamins %K minerals %K healthy diet %K calorie %K food %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods:  First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=–1.39; P=.002), 102.43 g of carbohydrates (95% CI –125.2 to –79.60; d=–1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI –13.71 to –8.20; d=–1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions:  Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 %M 36716078 %R 10.2196/38378 %U https://formative.jmir.org/2023/1/e38378 %U https://doi.org/10.2196/38378 %U http://www.ncbi.nlm.nih.gov/pubmed/36716078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42172 %T Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies %A Stuart,Avelie %A Yan,Ronnie Jieru %A Harkin,Lydia Jo %A Katz,Dmitri %A Stevenson,Clifford %A Mehta,Vikram %A Giles,Emilie %A Talbot,Catherine %A Gooch,Daniel %A Bennasar,Mohamed %A Self,Tara %A Nuseibeh,Bashar %A Price,Blaine %+ Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908653545, blaine.price@open.ac.uk %K loneliness %K older adults %K digital connections %K reflection %K social identity %K user-centered design %K social network %K well-being apps %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults. Objective: We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app. Methods: We used technology probes to elicit older adults’ reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12). Results: Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities. Conclusions: Smartphone apps have the potential to increase older adults’ awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults’ experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing. %M 36705962 %R 10.2196/42172 %U https://formative.jmir.org/2023/1/e42172 %U https://doi.org/10.2196/42172 %U http://www.ncbi.nlm.nih.gov/pubmed/36705962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41422 %T ReachCare Mobile Apps for Patients Experiencing Suicidality in the Emergency Department: Development and Usability Testing Using Mixed Methods %A Larkin,Celine %A Djamasbi,Soussan %A Boudreaux,Edwin D %A Varzgani,Fatima %A Garner,Roscoe %A Siddique,Mariam %A Pietro,John %A Tulu,Bengisu %+ Department of Emergency Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave, Worcester, MA, 01655, United States, 1 7743291688, celine.larkin@umassmed.edu %K suicide %K emergency department %K mobile app %K usability %K engagement %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption. Objective: On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk. Methods: Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created. Results: We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4). Conclusions: By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings. %M 36705961 %R 10.2196/41422 %U https://formative.jmir.org/2023/1/e41422 %U https://doi.org/10.2196/41422 %U http://www.ncbi.nlm.nih.gov/pubmed/36705961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40594 %T A Serious Game for Patients With Eating Disorders (Maze Out): Pilot User Experience and Acceptance Study %A Guala,Maria Mercedes %A Bul,Kim %A Skårderud,Finn %A Søgaard Nielsen,Anette %+ Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws vej 18, Odense, 5000, Denmark, 45 65503671, mguala@health.sdu.dk %K eating disorders %K serious games %K mHealth %K coproduction %K mobile health %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Eating disorders (EDs) are severe mental disorders associated with notable impairments in the quality of life. Despite the severity of the disorders and extensive research in the field, effective treatment for EDs is lacking. Digital interventions are gaining an evidence-based position in mental health, providing new perspectives in psychiatric treatment. Maze Out is a serious game coproduced by patients and therapists that focuses on supporting patients with EDs. Objective: The aim of this study was to investigate the experiences of engaging in and acceptability of Maze Out among patients with EDs and therapists. Methods: This study is a qualitative pilot study involving data collected through focus groups and individual interviews and user analytics collected through the game. The participants were recruited from the Odense Mental Health Service of the Region of Southern Denmark. Qualitative interviews analyzed by thematical analysis and interpreted by interpretative phenomenological analysis were used to evaluate the acceptance and experience of Maze Out among patients and therapists. The mobile health evidence reporting and assessment checklist was used to describe the content, context, and technical features of the game in a standardized manner for mobile health apps. Results: The participants found Maze Out to be engaging, easy to use, and a good platform for reflecting on their disorder. They primarily used Maze Out as a conversational tool with their close relationships, giving them insights into the experiences and daily life struggles of someone with EDs. Conclusions: Maze Out seems to be a promising tool supplementing the current ED treatment. Further research should focus on evaluating the effectiveness of the game and its potential to support patients with different types of EDs. %M 36705956 %R 10.2196/40594 %U https://formative.jmir.org/2023/1/e40594 %U https://doi.org/10.2196/40594 %U http://www.ncbi.nlm.nih.gov/pubmed/36705956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40188 %T Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones %A Hakun,Jonathan G %A Roque,Nelson A %A Gerver,Courtney R %A Cerino,Eric S %+ Department of Neurology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033, United States, 1 717 531 0003 ext 287082, jgh5196@psu.edu %K ecological momentary assessment %K EMA %K mobile cognitive assessment %K working memory capacity %K measurement burst design %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an “ambulatory” cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Objective: Across 3 studies, we adapted “complex span” tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. Methods: In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Results: Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Conclusions: Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed. %M 36705953 %R 10.2196/40188 %U https://formative.jmir.org/2023/1/e40188 %U https://doi.org/10.2196/40188 %U http://www.ncbi.nlm.nih.gov/pubmed/36705953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38877 %T A Novel Approach to Assess Weekly Self-efficacy for Meeting Personalized Physical Activity Goals Via a Cellphone: 12-Week Longitudinal Study %A Oh,Yoo Jung %A Hoffmann,Thomas J %A Fukuoka,Yoshimi %+ Department of Communication, University of California, Davis, 469 Kerr Hall, Davis, CA, 95616, United States, 1 530 760 5509, yjeoh@ucdavis.edu %K self-efficacy %K physical activity %K exercise %K cellphone %K mobile phone %K application %K app %K Ecological Momentary Assessment %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the health benefits of engaging in regular physical activity (PA), the majority of American adults do not meet the PA guidelines for aerobic and muscle-strengthening activities. Self-efficacy, the belief that one can execute specific actions, has been suggested to be a strong determinant of PA behaviors. With the increasing availability of digital technologies, collecting longitudinal real-time self-efficacy and PA data has become feasible. However, evidence in longitudinal real-time assessment of self-efficacy in relation to objectively measured PA is scarce. Objective: This study aimed to examine a novel approach to measure individuals' real-time weekly self-efficacy in response to their personalized PA goals and performance over the 12-week intervention period in community-dwelling women who were not meeting PA guidelines. Methods: In this secondary data analysis, 140 women who received a 12-week PA intervention were asked to report their real-time weekly self-efficacy via a study mobile app. PA (daily step counts) was measured by an accelerometer every day for 12 weeks. Participants rated their self-efficacy on meeting PA goals (ranging from “not confident” to “very confident”) at the end of each week via a mobile app. We used a logistic mixed model to examine the association between weekly self-efficacy and weekly step goal success, controlling for age, BMI, self-reported White race, having a college education or higher, being married, and being employed. Results: The mean age was 52.7 (SD 11.5, range 25-68) years. Descriptive analyses showed the dynamics of real-time weekly self-efficacy on meeting PA goals and weekly step goal success. The majority (74.4%) of participants reported being confident in the first week, whereas less than half of them (46.4%) reported confidence in the final week of the intervention. Participants who met weekly step goals were 4.41 times more likely to be confident about achieving the following week's step goals than those who did not meet weekly step goals (adjusted odds ratio 4.41; 95% CI 2.59-7.50; P<.001). Additional analysis revealed that participants who were confident about meeting the following week’s step goals were 2.07 times more likely to meet their weekly step goals in the following week (adjusted odds ratio 2.07; 95% CI 1.16-3.70; P=.01). The significant bidirectional association between real-time self-efficacy and weekly step goal success was confirmed in a series of sensitivity analyses. Conclusions: This study demonstrates the potential utility of a novel approach to examine self-efficacy in real time for analysis of self-efficacy in conjunction with objectively measured PA. Discovering the dynamic patterns and changes in weekly self-efficacy on meeting PA goals may aid in designing a personalized PA intervention. Evaluation of this novel approach in an RCT is warranted. %M 36705945 %R 10.2196/38877 %U https://formative.jmir.org/2023/1/e38877 %U https://doi.org/10.2196/38877 %U http://www.ncbi.nlm.nih.gov/pubmed/36705945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38518 %T Improving Patient Access to Hospital Pharmacists Using eConsults: Retrospective Descriptive Study %A Weinberg,Vera %A van Haren,Eva %A Gombert-Handoko,Kim B %+ Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, Netherlands, 31 071 5262790, v.weinberg@lumc.nl %K eConsult %K online consultation %K eHealth %K electronic patient portal %K hospital pharmacy %K medication reconciliation %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eConsults are increasingly used worldwide to reduce specialist referrals and increase access to medical care. An additional benefit of using an eConsult tool is a reduction of health care costs while improving the quality of health care and patient participation. Currently, shared decision making is increasingly implemented and preferred by patients. eConsults are also a promising tool to improve access to the hospital pharmacist. Patients often have questions about their medication. When medication is started during a hospital admission or outpatient visit, community pharmacists are not always sufficiently informed to answer patient questions. Direct contact with hospital pharmacists may be more appropriate and efficient. This contact is facilitated through the eConsult feature in the hospital’s patient portal. Objective: This study aims to evaluate the prevalence and contents of the eConsults sent by patients to hospital pharmacists. Methods: A first retrospective descriptive study was conducted at the Leiden University Medical Center in the Netherlands. Patients who sent at least one eConsult to a hospital pharmacist between March 2017 and December 2021 were included. Patient characteristics and the number of medications taken were extracted from electronic health records. The content of eConsults was analyzed and grouped into different subjects. Time of sending of the eConsults was analyzed. A comparison was made between the number of eConsults sent to the hospital pharmacy and the number sent to the medical center. Finally, the appropriateness for evaluation by the hospital pharmacist was assessed in all eConsults. Results: During the study period, 983 eConsults (from 808 patients) were sent to the hospital pharmacist. The average patient age was 56 (SD 15.9) years, and 51.4% (415/808) were male; 47.8% (386/808) of the patients used 0 to 4 medications, 33.0% (267/808) used 5 to 9 medications, and 19.2% (155/808) used ≥10 medications. Of the eConsults, 10.9% (107/983) were excluded due to not being medication-related or not intended for the hospital pharmacist. Patients being treated in 31 medical specialties sent eConsults to the hospital pharmacist. The most common medical specialty was cardiology with 22.5% (197/876) of the eConsults. Most eConsults were sent during office hours (614/876, 70.2%). eConsult subjects were medication verification (372/876, 42.5%), logistics (243/876, 27.7%), therapeutic effect and adverse events (100/876, 11.4%), use of medication (87/876, 9.9%), and other subjects (74/876, 8.4%). Conclusions: Introducing eConsults allows patients to ask medication-related questions directly to hospital pharmacists. Our study shows that patients send medication reconciliation–related eConsults most often. Use of the eConsult tool leads to fast, direct, and documented communication between patient and hospital pharmacist. This can reduce medication-related errors, improve patient empowerment, and increase access to the hospital pharmacist. %M 36705957 %R 10.2196/38518 %U https://formative.jmir.org/2023/1/e38518 %U https://doi.org/10.2196/38518 %U http://www.ncbi.nlm.nih.gov/pubmed/36705957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43167 %T The Effect of Mobile Payment on Payment Waiting Time for Outpatients With Medical Insurance: Historically Controlled Study %A Xie,Wanhua %A Cao,Xiaojun %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China, 86 13725370379, xiewanhua1@126.com %K smartphone %K mobile payment for health insurance %K waiting time %K outpatient service %K patient satisfaction %K medical insurance %K mobile payment %K mobile app %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Waiting for a long time to make payments in outpatient wards and long queues of insured patients at the checkout window are common in many hospitals across China. To alleviate the problem of long queues for payment, many hospitals in China have established various mobile apps that those without health insurance can use. However, medically insured outpatients are still required to pay manually at the checkout window. Therefore, it is urgent to use information technology to innovate and optimize the outpatient service process, implement mobile payment for medically insured outpatients, and shorten the waiting time for outpatients, especially in the context of the COVID-19 epidemic. Furthermore, smartphone-based mobile payment for outpatients with health insurance could be superior to on-site cashier billing. Objective: This study aimed to investigate the impact of smartphone-based mobile payment in relation to different aspects, such as waiting time, satisfaction with patients’ waiting time, payment experience, the proportion of those dissatisfied with payment, total outpatient satisfaction, and outpatient volume, and compare mobile payment with on-site payment. Methods: This was a historically controlled study. This study analyzed the outpatients’ waiting time to make a medical insurance payment, their satisfaction with the waiting time and payment experience, the proportion of those dissatisfied with payment, and the outpatient volume of patients at Guangzhou Women and Children’s Medical Center 1 year before and after the implementation of mobile payment for medical insurance in January 2021. An independent sample 2-tailed t test was used to compare waiting time, satisfaction with waiting time, and overall satisfaction. Paired sample 2-tailed t test was used to compare monthly outpatient visits. The chi-square test was used to compare the percentages of patients dissatisfied with payment. Results: After the implementation of mobile payment for medical insurance outpatients, the patients’ payment waiting time was significantly shortened (mean 45.28, SD 10.35 min vs mean 1.02, SD 0.25 min; t9014=53.396; P<.001), and satisfaction with waiting time and payment experience were significantly improved (mean 82.08, SD 3.17 vs mean 90.36, SD 3.45; t9014=–118.65; P<.001). Dissatisfaction with payment significantly decreased (10.27%, SD 2.18% vs 1.19% vs SD 0.30%; P<.001). The total satisfaction of outpatients significantly improved (mean 86.91, SD 3.23 vs mean 89.98, SD 3.31; t9014=–44.57; P<.001), and the outpatient volume increased (248,105.58, SD 89,280.76 vs 303,194.75, SD 53,773.12; t11=2.414; P=.03). Furthermore, payment efficiency improved, and the number of the on-site cashiers substantially decreased. Conclusions: Mobile payment for health insurance significantly shortened patients’ payment waiting time; improved patient satisfaction on waiting time and payment experience and overall satisfaction; reduced the proportion of patients who were dissatisfied with payment and the cashier at the hospital; and increased monthly outpatient volume. This approach was effective and thus worthy of promoting. %M 36696970 %R 10.2196/43167 %U https://formative.jmir.org/2023/1/e43167 %U https://doi.org/10.2196/43167 %U http://www.ncbi.nlm.nih.gov/pubmed/36696970 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41913 %T Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis %A Sinha,Chaitali %A Meheli,Saha %A Kadaba,Madhura %+ Wysa, 131 Dartmouth St, Boston, MA, 02116, United States, 1 6177129979, chaitali@wysa.io %K digital mental health %K COVID-19 %K engagement %K retention %K perceived needs %K pandemic waves %K chatbot %K conversational agent %K mental health app %K mobile health %K digital health intervention %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app’s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre–COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence–led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. %M 36540052 %R 10.2196/41913 %U https://formative.jmir.org/2023/1/e41913 %U https://doi.org/10.2196/41913 %U http://www.ncbi.nlm.nih.gov/pubmed/36540052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 0 %N %P e0 %T Improvements in Glycemic Control and Depressive Symptoms Among Adults With Type 2 Diabetes: Retrospective Study %A Venkatesan,Aarathi %A Zimmermann,Gretchen %A Rawlings,Kelly %A Ryan,Claudia %A Voelker,Louise %A Edwards,Caitlyn %+ Vida Health, 100 Montgomery St #750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, caitlyn.edwards@vida.com %K type 2 diabetes %K digital health %K diabetes intervention %K diabetes %K diabetic %K health app %K coaching %K patient education %K mobile health %K mHealth %K app-based %K health coaching %K hemoglobin A1c %K HbA1c %K depression %K depressive %K anxiety %K mental health %K glycemic control %K diabetes management %K health management %K digital health intervention %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of diabetes remains high, with traditional lifestyle interventions demonstrating limited success in improving diabetes-related outcomes, particularly among individuals with diabetes-related mental health comorbidities. Digital health interventions provide the ability to ease the sustained and rigorous self-management needs associated with diabetes care and treatment. Current interventions though, are plagued by small sample sizes, underpowered pilot studies, and immense heterogeneity in program intervention, duration, and measured outcomes. Objective: Therefore, this work aimed to evaluate the effectiveness of a mobile health diabetes management program on measures of glycemic control in a high-risk population with type 2 diabetes (hemoglobin A1c [HbA1c] ≥8.0%), utilizing a sample of 1128 participants who provided baseline and follow-up data. The sustainability of this change in glycemic control was examined in a subset of participants (n=455) at 6 months and 1 year following program enrollment. A secondary analysis examined changes in glycemic control among a subset of participants with self-reported mild-to-moderate depression at baseline. Methods: This study utilized a single-arm, retrospective design. Participants were enrolled in the Vida Health Diabetes Management Program. This app-based intervention utilized one-on-one remote sessions with a health coach, registered dietitian nutritionist, and/or a certified diabetes care and education specialist and structured lessons and tools related to diabetes management and self-care. Participants provided baseline (–365 to 21 days of program enrollment) as well as follow-up (at least 90 days following program enrollment) HbA1c values. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up time points. The 8-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale were utilized to assess self-reported depressive and anxiety symptoms, respectively. Paired t tests and linear regression modeling accounting for pertinent covariates were used to evaluate changes in mental health symptom acuity and their relationship with changes in glycemic control. Results: We observed a significant decrease in HbA1c of –1.35 points between baseline (mean 9.84, SD 1.64) and follow-up (mean 8.48, SD 1.77; t=22.56, P<.001) among this large, high-risk sample. This decrease was sustained up to 1 year following program enrollment. Additionally, a significant relationship between improvements in depressive symptom acuity and improvements in HbA1c was observed (β=–0.74, P=.03). Conclusions: This study demonstrates clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Diabetes Management Program. Additionally, this work presents one of the largest studied samples of participants enrolled in a digital health diabetes management program to date. %R 10.2196/41880 %U https://formative.jmir.org/2023/0/e0/ %U https://doi.org/10.2196/41880 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42394 %T Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study %A Collombon,Eline H G M %A Peels,Denise A %A Bolman,Catherine A W %A de Bruijn,Gert-Jan %A Lechner,Lilian %+ Faculty of Psychology, Open Universiteit, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 455762888, Eline.Collombon@ou.nl %K prototype %K pilot test %K eHealth %K mHealth %K physical activity %K older adults %K development %K usability %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described. Objective: This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years. Methods: A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results. Results: The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation. Conclusions: During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/31677 %M 36696157 %R 10.2196/42394 %U https://formative.jmir.org/2023/1/e42394 %U https://doi.org/10.2196/42394 %U http://www.ncbi.nlm.nih.gov/pubmed/36696157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34989 %T Relationship Between Valence and Arousal for Subjective Experience in a Real-life Setting for Supportive Housing Residents: Results From an Ecological Momentary Assessment Study %A Nandy,Rajesh %A Nandy,Karabi %A Walters,Scott T %+ Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States, 1 2063296441, Rajesh.Nandy@unthsc.edu %K permanent supportive housing %K circumplex model of affect %K ecological momentary assessment %K emotion %K valence %K arousal %K mobile phone %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The circumplex model of affect posits that valence and arousal are the principal dimensions of affect. The center of the 2D space represents a neutral state of valence and a medium state of arousal. The role of valence and arousal in human emotion has been studied extensively. However, no consistent relationship between valence and arousal has been established. Most of the prior studies investigating the relationship have been conducted in relatively controlled laboratory settings. Objective: Ecological momentary assessment (EMA) of affect from participants residing in permanent supportive housing was used to study the relationship between valence and arousal in real-life settings. The goal of this study was to explore the relationship between valence and arousal in a person’s natural environment. Methods: Participants were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. A subset of participants completed daily (morning) EMAs of emotions and other behaviors. The sample comprised 78 women and 77 men, and the average age was 52 (SD 8) years. From the circumplex model of affect, the EMA included 9 questions related to the participant’s current emotional state (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate 2 composite scores for valence and arousal. Results: Statistical models uniformly showed a dominant linear relation between valence and arousal and a significant difference in the slopes among races. None of the other effects were statistically significant. Compared with previous studies, the effects were quite robust. Conclusions: Our findings may provide a window to the fundamental structure of affect. We found a strong positive linear relationship between valence and arousal at the nomothetic level, which may provide insight into a universal structure of affect. However, the study needs to be replicated for different populations to determine whether our findings can be generalized beyond the population studied here. %M 36696164 %R 10.2196/34989 %U https://formative.jmir.org/2023/1/e34989 %U https://doi.org/10.2196/34989 %U http://www.ncbi.nlm.nih.gov/pubmed/36696164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43535 %T Improvement of Selected Psychological Parameters and Quality of Life of Patients With Type 1 Diabetes Mellitus Undergoing Transition From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to the MiniMed 780G Advanced Hybrid Closed-Loop System: Post hoc Analysis of a Randomized Control Study %A Cyranka,Katarzyna %A Matejko,Bartłomiej %A Juza,Anna %A Kieć-Wilk,Beata %A Krzyżowska,Sabina %A Cohen,Ohad %A Da Silva,Julien %A Lushchyk,Maxim %A Malecki,Maciej T %A Klupa,Tomasz %+ Department of Metabolic Diseases, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, 30-688, Poland, 48 664680001, katarzyna.cyranka@gmail.com %K type 1 diabetes mellitus %K personal insulin pump %K advanced hybrid closed loop %K quality of life %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: While introducing new technologies and methods of treatment for type 1 diabetes mellitus (T1DM), it seems essential to monitor whether modern technologies in diabetes treatment may improve the psychological and emotional status of patients. Objective: This study aims to assess the baseline psychological parameters of patients with T1DM during investigation of the direct transition from multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG) to the MiniMed 780G advanced hybrid closed-loop (AHCL) system and to evaluate changes in the psychological well-being and quality of life (QoL) after the transition in these individuals versus the control group. Methods: The trial was a 2-center, randomized controlled, parallel group study. In total, 41 patients with T1DM managed with MDI or SMBG were enrolled and randomized either to the AHCL or the MDI+SMBG group. Of these, 37 (90%) participants (mean age 40.3 years, SD 8.0 years; mean duration of diabetes 17.3, SD 12.1 years; mean hemoglobin A1c [HbA1c] 7.2%, SD 1.0%) completed the study (AHCL: n=20, 54%; MDI+SMBG: n=17, 46%). Psychological parameters (level of stress, coping mechanisms, level of anxiety, self-efficacy level, acceptance of illness, locus of control of illness, life satisfaction, QoL) were measured at baseline and at the end of the study using 10 psychological questionnaires. Results: At baseline, the general level of stress of the examined patients was higher than in the general healthy Polish population (P=.001), but coping strategies used in stressful situations were significantly more effective and the level of self-efficacy (P<.001) was much higher than in the general population. The patients in this study accepted their illness more than patients with diabetes from the general Polish population (P<.001), but they felt that their health does not depend on them compared to the general population (P<.001). The overall life satisfaction was similar to that of the general population (P=.161). After 3 months from transition, the AHCL group reported an increase in 4 scales of the QoL—feeling well (P=.042), working (P=.012), eating as I would like (P=.011), and doing normal things (P=.034)—in comparison to the control group, where no significant change occurred. The level of both state anxiety and trait anxiety decreased in the AHCL group: State-Trait Anxiety Inventory (STAI) X1 scores (P=.009), STAI X1 stens (P=.013), and STAI X2 scores (P=.022). The AHCL group became more emotion oriented in stressful situations (Coping Inventory for Stressful Situations [CISS] E; P=.043) and significantly less self-blaming after 3 months of the study (P=.020). Conclusions: The results indicate that the patients who decided to take part in the transition study were characterized by higher levels of stress than the general healthy population but had better coping strategies and self-efficacy. Furthermore, transitioning from MDI+SMBG treatment to the AHCL in patients naive to technology may significantly improve psychological well-being and QoL within 3 months. The rapidity of these changes suggests that they may be related to the significant improvement in glycemic outcomes but also significantly less burdened diabetes self-management. Trial Registration: ClinicalTrials.gov NCT04616391; https://clinicaltrials.gov/ct2/show/NCT04616391 %M 36692945 %R 10.2196/43535 %U https://formative.jmir.org/2023/1/e43535 %U https://doi.org/10.2196/43535 %U http://www.ncbi.nlm.nih.gov/pubmed/36692945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42266 %T User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavičius,Kasparas %A Jonusas,Justinas %A Lileikienė,Angelė %+ Lithuania Business University of Applied Sciences, Turgaus st 21, Klaipėda, 91249, Lithuania, 370 26311099, justinas.jonusas@kilo.health %K intermittent fasting %K fasting %K weight %K weight loss %K mobile application %K body composition %K mHealth %K mobile health %K diet %K dietary intervention %K weight loss outcome %K adherence %K engagement %K mobile app %K motivation %K intervention outcome %K fasting apps %K dietary interventions %K obesity %K regression analysis %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. Objective: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. Methods: We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. Results: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. Conclusions: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass. %M 36692936 %R 10.2196/42266 %U https://formative.jmir.org/2023/1/e42266 %U https://doi.org/10.2196/42266 %U http://www.ncbi.nlm.nih.gov/pubmed/36692936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38630 %T Reaching Populations at Risk for HIV Through Targeted Facebook Advertisements: Cost-Consequence Analysis %A Hanna,John J %A Saleh,Sameh N %A Lehmann,Christoph U %A Nijhawan,Ank E %A Medford,Richard J %+ Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States, 1 214 648 0234, john.hanna@utsouthwestern.edu %K human immunodeficiency virus %K social media %K Facebook %K health behavior %K health care seeking behavior %K consumer health %K HIV diagnosis %K HIV testing %D 2023 %7 20.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: An undiagnosed HIV infection remains a public health challenge. In the digital era, social media and digital health communication have been widely used to accelerate research, improve consumer health, and facilitate public health interventions including HIV prevention. Objective: We aimed to evaluate and compare the projected cost and efficacy of different simulated Facebook (FB) advertisement (ad) approaches targeting at-risk populations for HIV based on new HIV diagnosis rates by age group and geographic region in the United States. Methods: We used the FB ad platform to simulate (without actually launching) an automatically placed video ad for a 10-day duration targeting at-risk populations for HIV. We compared the estimated total ad audience, daily reach, daily clicks, and cost. We tested ads for the age group of 13 to 24 years (in which undiagnosed HIV is most prevalent), other age groups, US geographic regions and states, and different campaign budgets. We then estimated the ad cost per new HIV diagnosis based on HIV positivity rates and the average health care industry conversion rate. Results: On April 20, 2021, the potential reach of targeted ads to at-risk populations for HIV in the United States was approximately 16 million for all age groups and 3.3 million for age group 13 to 24 years, with the highest potential reach in California, Texas, Florida, and New York. When using different FB ad budgets, the daily reach and daily clicks per US dollar followed a cumulative distribution curve of an exponential function. Using multiple US $10 ten-day ads, the cost per every new HIV diagnosis ranged from US $13.09 to US $37.82, with an average cost of US $19.45. In contrast, a 1-time national ad had a cost of US $72.76 to US $452.25 per new HIV diagnosis (mean US $166.79). The estimated cost per new HIV diagnosis ranged from US $13.96 to US $55.10 for all age groups (highest potential reach and lowest cost in the age groups 20-29 and 30-39 years) and from US $12.55 to US $24.67 for all US regions (with the highest potential reach of 6.2 million and the lowest cost per new HIV diagnosis at US $12.55 in the US South). Conclusions: Targeted personalized FB ads are a potential means to encourage at-risk populations for HIV to be tested, especially those aged 20 to 39 years in the US South, where the disease burden and potential reach on FB are high and the ad cost per new HIV diagnosis is low. Considering the cost efficiency of ads, the combined cost of multiple low-cost ads may be more economical than a single high-cost ad, suggesting that local FB ads could be more cost-effective than a single large-budget national FB ad. %M 36662551 %R 10.2196/38630 %U https://formative.jmir.org/2023/1/e38630 %U https://doi.org/10.2196/38630 %U http://www.ncbi.nlm.nih.gov/pubmed/36662551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37811 %T Public Use of the “Your COVID Recovery” Website Designed to Help Individuals Manage Their COVID-19 Recovery: Observational Study %A Baldwin,Molly M %A Daynes,Enya %A Chaplin,Emma %A Goddard,Amye %A Lloyd-Evans,Phoebe H I %A Mills,George %A Hong,Annabel %A Gardiner,Nikki %A Singh,Sally J %+ Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116 258 ext 3652, molly.baldwin@uhl-tr.nhs.uk %K COVID-19 %K coronavirus %K pandemic %K symptom management %K digital healthcare %K Google Analytics %K website analysis %K digital health tool %K user behavior %K healthcare platform %D 2023 %7 20.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: At the start of the COVID-19 pandemic, unprecedented pressure was placed on health care services globally. An opportunity to alleviate this pressure was to introduce a digital health platform that provided COVID-19–related advice and helped individuals understand and manage their COVID-19 symptoms. Therefore, in July 2020, the Your COVID Recovery website was launched by the National Health Service of England with the aim of creating a practical tool that provides advice and support to individuals recovering from COVID-19. The website includes information on many of the key COVID-19 symptoms. To date, public use of the Your COVID Recovery website and user behavior remain unknown. However, this information is likely to afford insight into the impact of the website and most commonly experienced COVID-19 symptoms. Objective: This study aimed to evaluate public use of the Your COVID Recovery website, a digital health platform that provides support to individuals recovering from COVID-19, and determine user behavior during its first year of operation. Methods: Google Analytics software that was integrated into the Your COVID Recovery website was used to assess website use and user behavior between July 31, 2020, and July 31, 2021. Variables that were tracked included the number of users, user country of residence, traffic source, number of page views, number of session views, and mean session duration. User data were compared to COVID-19 case data downloaded from the UK government’s website. Results: During the study period, 2,062,394 users accessed the Your COVID Recovery website. The majority of users were located in the United Kingdom (1,265,061/2,062,394, 61.30%) and accessed the website via a search engine (1,443,057/2,062,394, 69.97%). The number of daily website users (n=15,298) peaked on January 18, 2021, during the second wave of COVID-19 in the United Kingdom. The most frequently visited pages after the home page were for the following COVID-19 symptoms: Cough (n=550,190, 12.17%), Fatigue (n=432,421, 9.56%), Musculoskeletal pain (n=406,859, 9.00%), Taste and smell (n=270,599, 5.98%), and Breathlessness (n=203,136, 4.49%). The average session duration was 1 minute 13 seconds. Conclusions: A large cohort of individuals actively sought help with their COVID-19 recovery from the website, championing the potential of this tool to target an unmet health care need. User behavior demonstrated that individuals were primarily seeking advice on how to relieve and manage COVID-19 symptoms, especially symptoms of cough, fatigue, and musculoskeletal pain. COVID-19 rehabilitation programs should use the results of this study to ensure that the program content meets the needs of the post–COVID-19 population. %M 36626648 %R 10.2196/37811 %U https://formative.jmir.org/2023/1/e37811 %U https://doi.org/10.2196/37811 %U http://www.ncbi.nlm.nih.gov/pubmed/36626648 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40135 %T Effects of a Neuroscience-Based Mindfulness Meditation Program on Psychological Health: Pilot Randomized Controlled Trial %A Lynn,Sarah %A Basso,Julia C %+ Department of Human Nutrition, Foods and Exercise, Virginia Tech, Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, VA, 24060, United States, 1 8567456363, jbasso@vt.edu %K meditation %K mindfulness %K mental health %K compassion %K self-compassion %K digital %K medical education %K neuroscience education %K depression %K psychological health %K mental illness %K anxiety %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindfulness and meditation have a rich historical tradition, and a growing scientific base of evidence supports their use in creating positive psychological and neuroplastic changes for practitioners. Although meditation can be taught in various ways, the scientific community has yet to systematically study the impact of different types of meditation on neuropsychological outcomes, especially as it pertains to digital implementation. Therefore, it is critical that the instruction of mindfulness be evidence based because meditation is being used in both scientific and clinical settings. Objective: This study investigated the use of teacher cueing and the integration of neuroscience education into a meditation program. Compassion cueing was chosen as the element of experimental manipulation because traditional lineages of Buddhist meditation teach compassion for self and others as one of the primary outcomes of meditation. We hypothesized that participants receiving compassion cueing would have enhanced neuropsychological outcomes compared with those receiving functional cueing and that gains in neuroscience knowledge would relate to positive neuropsychological outcomes. Methods: Participants (n=89) were randomized to receive either functional cueing (control group) or compassion cueing (experimental group) and engaged with five 10-minute meditation sessions a week for 4 weeks. All intervention sessions were administered through digital presentation. All participants completed ecological momentary assessments before and after the daily intervention, as well as pre- and postintervention questionnaires. Results: Participants demonstrated significant benefits over time, including increased mindfulness and self-compassion, decreased depression, and gains in neuroscience content (all P<.001); however, no significant between-group differences were found. Daily scores from each day of the intervention showed a statistically significant shift from active toward settled. Importantly, long-term increases in mindfulness were positively correlated to changes in compassion (r=0.326; P=.009) and self-compassion (r=0.424; P<.001) and negatively correlated to changes in anxiety (r=–0.266; P=.03) and depression (r=–0.271; P=.03). Finally, the acute effects of meditation were significantly correlated to the longitudinal outcomes (with a small-to-medium effect size), especially those relevant to mindfulness. Conclusions: We developed a novel neuroscience-based education–meditation program that enhanced self-regulation as evidenced by improved mindfulness, self-compassion, and mood state. Our findings demonstrate the behavioral importance of engaging with mindfulness meditation and reinforce the idea that the benefits of meditation are independent of teacher cueing behavior. Future studies will need to investigate the brain-based changes underlying these meditation-induced outcomes. %M 36656631 %R 10.2196/40135 %U https://formative.jmir.org/2023/1/e40135 %U https://doi.org/10.2196/40135 %U http://www.ncbi.nlm.nih.gov/pubmed/36656631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38831 %T Content Recommendation Systems in Web-Based Mental Health Care: Real-world Application and Formative Evaluation %A Chaturvedi,Akhil %A Aylward,Brandon %A Shah,Setu %A Graziani,Grant %A Zhang,Joan %A Manuel,Bobby %A Telewa,Emmanuel %A Froelich,Stefan %A Baruwa,Olalekan %A Kulkarni,Prathamesh Param %A Ξ,Watson %A Kunkle,Sarah %+ Headspace Health, 595 Market St, 7th floor, San Francisco, CA, 94105, United States, 1 720 243 4668, akhilchatur@gmail.com %K behavioral coaching %K recommender systems %K mental health %K machine learning %K natural language processing %K telemental health %K mobile health %K mHealth %K digital health %K digital coaching %K health platform %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Recommender systems have great potential in mental health care to personalize self-guided content for patients, allowing them to supplement their mental health treatment in a scalable way. Objective: In this paper, we describe and evaluate 2 knowledge-based content recommendation systems as parts of Ginger, an on-demand mental health platform, to bolster engagement in self-guided mental health content. Methods: We developed two algorithms to provide content recommendations in the Ginger mental health smartphone app: (1) one that uses users' responses to app onboarding questions to recommend content cards and (2) one that uses the semantic similarity between the transcript of a coaching conversation and the description of content cards to make recommendations after every session. As a measure of success for these recommendation algorithms, we examined the relevance of content cards to users’ conversations with their coach and completion rates of selected content within the app measured over 14,018 users. Results: In a real-world setting, content consumed in the recommendations section (or “Explore” in the app) had the highest completion rates (3353/7871, 42.6%) compared to other sections of the app, which had an average completion rate of 37.35% (21,982/58,614; P<.001). Within the app’s recommendations section, conversation-based content recommendations had 11.4% (1108/2364) higher completion rates per card than onboarding response-based recommendations (1712/4067; P=.003) and 26.1% higher than random recommendations (534/1440; P=.005). Studied via subject matter experts’ annotations, conversation-based recommendations had a 16.1% higher relevance rate for the top 5 recommended cards, averaged across sessions of varying lengths, compared to a random control (110 conversational sessions). Finally, it was observed that both age and gender variables were sensitive to different recommendation methods, with responsiveness to personalized recommendations being higher if the users were older than 35 years or identified as male. Conclusions: Recommender systems can help scale and supplement digital mental health care with personalized content and self-care recommendations. Onboarding-based recommendations are ideal for “cold starting” the process of recommending content for new users and users that tend to use the app just for content but not for therapy or coaching. The conversation-based recommendation algorithm allows for dynamic recommendations based on information gathered during coaching sessions, which is a critical capability, given the changing nature of mental health needs during treatment. The proposed algorithms are just one step toward the direction of outcome-driven personalization in mental health. Our future work will involve a robust causal evaluation of these algorithms using randomized controlled trials, along with consumer feedback–driven improvement of these algorithms, to drive better clinical outcomes. %M 36656628 %R 10.2196/38831 %U https://formative.jmir.org/2023/1/e38831 %U https://doi.org/10.2196/38831 %U http://www.ncbi.nlm.nih.gov/pubmed/36656628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38399 %T Predicting Openness of Communication in Families With Hereditary Breast and Ovarian Cancer Syndrome: Natural Language Processing Analysis %A Baroutsou,Vasiliki %A Cerqueira Gonzalez Pena,Rodrigo %A Schweighoffer,Reka %A Caiata-Zufferey,Maria %A Kim,Sue %A Hesse-Biber,Sharlene %A Ciorba,Florina M %A Lauer,Gerhard %A Katapodi,Maria %A , %+ Department of Clinical Research, University of Basel, Missionstrasse 64, Basel, 4055, Switzerland, 41 612070430, maria.katapodi@unibas.ch %K cascade testing %K dictionary-based approach %K family communication %K hereditary breast and ovarian cancer %K HBOC %K sentiment analysis %K text mining %K natural language processing %K cancer %K hereditary %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In health care research, patient-reported opinions are a critical element of personalized medicine and contribute to optimal health care delivery. The importance of integrating natural language processing (NLP) methods to extract patient-reported opinions has been gradually acknowledged over the past years. One form of NLP is sentiment analysis, which extracts and analyses information by detecting feelings (thoughts, emotions, attitudes, etc) behind words. Sentiment analysis has become particularly popular following the rise of digital interactions. However, NLP and sentiment analysis in the context of intrafamilial communication for genetic cancer risk is still unexplored. Due to privacy laws, intrafamilial communication is the main avenue to inform at-risk relatives about the pathogenic variant and the possibility of increased cancer risk. Objective: The study examined the role of sentiment in predicting openness of intrafamilial communication about genetic cancer risk associated with hereditary breast and ovarian cancer (HBOC) syndrome. Methods: We used narratives derived from 53 in-depth interviews with individuals from families that harbor pathogenic variants associated with HBOC: first, to quantify openness of communication about cancer risk, and second, to examine the role of sentiment in predicting openness of communication. The interviews were conducted between 2019 and 2021 in Switzerland and South Korea using the same interview guide. We used NLP to extract and quantify textual features to construct a handcrafted lexicon about interpersonal communication of genetic testing results and cancer risk associated with HBOC. Moreover, we examined the role of sentiment in predicting openness of communication using a stepwise linear regression model. To test model accuracy, we used a split-validation set. We measured the performance of the training and testing model using area under the curve, sensitivity, specificity, and root mean square error. Results: Higher “openness of communication” scores were associated with higher overall net sentiment score of the narrative, higher fear, being single, having nonacademic education, and higher informational support within the family. Our results demonstrate that NLP was highly effective in analyzing unstructured texts from individuals of different cultural and linguistic backgrounds and could also reliably predict a measure of “openness of communication” (area under the curve=0.72) in the context of genetic cancer risk associated with HBOC. Conclusions: Our study showed that NLP can facilitate assessment of openness of communication in individuals carrying a pathogenic variant associated with HBOC. Findings provided promising evidence that various features from narratives such as sentiment and fear are important predictors of interpersonal communication and self-disclosure in this context. Our approach is promising and can be expanded in the field of personalized medicine and technology-mediated communication. %M 36656633 %R 10.2196/38399 %U https://formative.jmir.org/2023/1/e38399 %U https://doi.org/10.2196/38399 %U http://www.ncbi.nlm.nih.gov/pubmed/36656633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41427 %T Effects of Customized Digital Health Care Service on Metabolic Syndrome Status and Lifestyle Using a Health Care App: Clinical Trial %A Bae,ChulYoung %A Kim,Bo-Seon %A Cho,KyungHee %A Kim,Ji-Hyun %A Kim,In-Hee %A Kim,Jeong-Hoon %+ Mediage Research Center, 42 Changup-ro (Gyeonggi Business Growth Center), Sujeong-gu, Seongnamsi, Gyeonggi-do, Seongnamsi, 13449, Republic of Korea, 82 70 4947 3567, qhtjs0104@mediage.co.kr %K biomarkers %K health care %K lifestyle %K metabolic syndrome %K telemedicine %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Untact cultures have rapidly spread around the world as a result of the prolongation of the COVID-19 pandemic, leading to various types of research and technological developments in the fields of medicine and health care, where digital health care refers to health care services provided in a digital environment. Previous studies relating to digital health care demonstrated its effectiveness in managing chronic diseases such as hypertension and diabetes. While many studies have applied digital health care to various diseases, daily health care is needed for healthy individuals before they are diagnosed with a disease. Accordingly, research on individuals who have not been diagnosed with a disease is also necessary. Objective: This study aimed to identify the effects of using a customized digital health care service (CDHCS) on risk factors for metabolic syndrome (MS) and lifestyle improvement. Methods: The population consisted of 63 adults who underwent a health checkup at the National Health Insurance Service Ilsan (NHIS) Hospital in 2020. Measured variables include basic clinical indicators, MS-related variables, and lifestyle variables. All items were measured at NHIS Ilsan Hospital before the use of the CDHCS and 3 months thereafter. The CDHCS used in this study is a mobile app that analyzes the health condition of the user by identifying their risk factors and provides appropriate health care content. For comparison between before and after CDHCS use (pre-post comparison), paired t test was used for continuous variables, and a chi-square test was used for nominal variables. Results: The study population included 30 (47.6%) male and 33 (52.4%) female participants, and the mean age was 47.61 (SD 13.93) years. The changes in clinical indicators before and after intervention results showed a decrease in weight, waist circumference, triglyceride, and high-density lipoprotein cholesterol and increases in systolic blood pressure and diastolic blood pressure. The distribution of the risk group increased from 32 (50.8%) to 34 (54%) and that of the MS group decreased from 18 (28.6%) to 16 (25.4%). The mean metabolic syndrome age–chronological age before the CDHCS was 2.20 years, which decreased to 1.72 years after CDHCS, showing a decrease of 0.48 years in the mean metabolic syndrome age–chronological age after the intervention. While all lifestyle variables, except alcohol consumption, showed a tendency toward improvement, the differences were not statistically significant. Conclusions: Although there was no statistical significance in the variables under study, this pilot study will provide a foundation for more accurate verification of CDHCS in future research. %M 36652290 %R 10.2196/41427 %U https://formative.jmir.org/2023/1/e41427 %U https://doi.org/10.2196/41427 %U http://www.ncbi.nlm.nih.gov/pubmed/36652290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39422 %T Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study %A Engdahl,Patrik %A Svedberg,Petra %A Lexén,Annika %A Tjörnstrand,Carina %A Strid,Catharina %A Bejerholm,Ulrika %+ Department of Health Science, Lund University, Margaretavägen 1B, 222 40 Lund, Box 157, Lund, 222 40, Sweden, 46 735401126, patrik.engdahl@med.lu.se %K co-design %K mental health %K mobile health %K return-to-work %K supported employment %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders’ needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. Objective: This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. Methods: A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study’s findings. Results: The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users’ strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. Conclusions: Stakeholders’ experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources. %M 36652285 %R 10.2196/39422 %U https://formative.jmir.org/2023/1/e39422 %U https://doi.org/10.2196/39422 %U http://www.ncbi.nlm.nih.gov/pubmed/36652285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35669 %T Predictors of Adolescents’ Response to a Web-Based Intervention to Improve Psychosocial Adjustment to Having an Appearance-Affecting Condition (Young Person’s Face IT): Prospective Study %A Zelihić,Deniz %A Feragen,Kristin J Billaud %A Pripp,Are Hugo %A Nordgreen,Tine %A Williamson,Heidi %A Kling,Johanna %+ Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, Børrestuveien 3, Oslo, 0373, Norway, 47 23075340, denizz@student.sv.uio.no %K visible difference %K web-based interventions %K eHealth %K body esteem %K social anxiety %K adolescents %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with a condition affecting their appearance that results in a visible difference can be at risk of psychosocial distress and impaired adjustment. Evidence for the effectiveness of existing interventions in improving psychosocial outcomes is limited, and relevant treatment can be difficult to access. Young Person’s Face IT (YPF), a self-guided web-based intervention, has demonstrated potential in reducing social anxiety in adolescents with a visible difference. However, more knowledge is needed about the variables that contribute to variations in intervention effects to identify those who may benefit most from YPF. Objective: This study aimed to investigate demographic, psychosocial, and intervention-related variables as predictors of overall intervention effects after adolescents’ use of YPF. Methods: We used longitudinal data collected as part of a larger, ongoing mixed methods project and randomized controlled trial (ClinicalTrials.gov NCT03165331) investigating the effectiveness of the Norwegian version of YPF. Participants were 71 adolescents (mean age 13.98, SD 1.74 years; range 11-18 years; 43/71, 61% girls) with a wide range of visible differences. The adolescents completed primary (body esteem and social anxiety symptoms) and secondary (perceived stigmatization, life disengagement, and self-rated health satisfaction) outcome measures at baseline and postintervention measurement. The predictor variables were demographic (age and gender), psychosocial (frequency of teasing experiences related to aspects of the body and appearance as well as depressive and anxiety symptoms), and intervention-related (time spent on YPF) variables. Results: Two-thirds (47/71, 66%) of the adolescents completed all YPF sessions and spent an average of 265 (SD 125) minutes on the intervention. Backward multiple regression analyses with a 2-tailed P-value threshold of .20 revealed that several variables were retained in the final models and predicted postintervention outcome changes. Body esteem was predicted by age (P=.14) and frequency of teasing experiences (P=.09). Social anxiety symptoms were predicted by gender (P=.12), frequency of teasing experiences (P=.03), depressive and anxiety symptoms (P=.08), and time spent on YPF (P=.06). Perceived stigmatization was predicted by age (P=.09), gender (P=.09), frequency of teasing experiences (P=.19), and depressive and anxiety symptoms (P=.06). Life disengagement was predicted by gender (P=.03), depressive and anxiety symptoms (P=.001), and time spent on YPF (P=.14). Self-rated health satisfaction was predicted by age (P=.008). However, the results were limited by relatively low explained postintervention variance, ranging from 1.6% to 24.1%. Conclusions: This study suggests that adolescent boys, adolescents who experience higher levels of psychosocial distress related to their visible difference, and adolescents who spend sufficient time on YPF may obtain better overall intervention effects. %M 36652281 %R 10.2196/35669 %U https://formative.jmir.org/2023/1/e35669 %U https://doi.org/10.2196/35669 %U http://www.ncbi.nlm.nih.gov/pubmed/36652281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41011 %T Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study %A Lenoir,Kristin M %A Sandberg,Joanne C %A Miller,David P %A Wells,Brian J %+ Department of Biostatistics and Data Science, Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States, 1 717 808 4012, klenoir@wakehealth.edu %K mobile health %K diabetes screening %K electronic health records %K text messaging %K clinical decision support %K mHealth %K diabetes %K mHealth intervention %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of “cold texts” to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. Objective: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. Methods: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Results: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants’ understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. Conclusions: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient’s relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process. %M 36649056 %R 10.2196/41011 %U https://formative.jmir.org/2023/1/e41011 %U https://doi.org/10.2196/41011 %U http://www.ncbi.nlm.nih.gov/pubmed/36649056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42792 %T Screening of Mild Cognitive Impairment Through Conversations With Humanoid Robots: Exploratory Pilot Study %A Yoshii,Kenta %A Kimura,Daiki %A Kosugi,Akihiro %A Shinkawa,Kaoru %A Takase,Toshiro %A Kobayashi,Masatomo %A Yamada,Yasunori %A Nemoto,Miyuki %A Watanabe,Ryohei %A Ota,Miho %A Higashi,Shinji %A Nemoto,Kiyotaka %A Arai,Tetsuaki %A Nishimura,Masafumi %+ Department of Informatics, Graduate School of Intergraded Science and Technology, Shizuoka University, 3-5-1 Johoku, Naka-ku, Hamamatsu, 432-8011, Japan, 81 70 8432 8701, yoshii.kenta.14@shizuoka.ac.jp %K mild cognitive impairment %K Alzheimer disease %K neuropsychiatric symptoms %K neuropsychological assessment %K simple screening %K humanoid robot %K robot %K symptoms %K neuropsychological %K monitoring %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rising number of patients with dementia has become a serious social problem worldwide. To help detect dementia at an early stage, many studies have been conducted to detect signs of cognitive decline by prosodic and acoustic features. However, many of these methods are not suitable for everyday use as they focus on cognitive function or conversational speech during the examinations. In contrast, conversational humanoid robots are expected to be used in the care of older people to help reduce the work of care and monitoring through interaction. Objective: This study focuses on early detection of mild cognitive impairment (MCI) through conversations between patients and humanoid robots without a specific examination, such as neuropsychological examination. Methods: This was an exploratory study involving patients with MCI and cognitively normal (CN) older people. We collected the conversation data during neuropsychological examination (Mini-Mental State Examination [MMSE]) and everyday conversation between a humanoid robot and 94 participants (n=47, 50%, patients with MCI and n=47, 50%, CN older people). We extracted 17 types of prosodic and acoustic features, such as the duration of response time and jitter, from these conversations. We conducted a statistical significance test for each feature to clarify the speech features that are useful when classifying people into CN people and patients with MCI. Furthermore, we conducted an automatic classification experiment using a support vector machine (SVM) to verify whether it is possible to automatically classify these 2 groups by the features identified in the statistical significance test. Results: We obtained significant differences in 5 (29%) of 17 types of features obtained from the MMSE conversational speech. The duration of response time, the duration of silent periods, and the proportion of silent periods showed a significant difference (P<.001) and met the reference value r=0.1 (small) of the effect size. Additionally, filler periods (P<.01) and the proportion of fillers (P=.02) showed a significant difference; however, these did not meet the reference value of the effect size. In contrast, we obtained significant differences in 16 (94%) of 17 types of features obtained from the everyday conversations with the humanoid robot. The duration of response time, the duration of speech periods, jitter (local, relative average perturbation [rap], 5-point period perturbation quotient [ppq5], difference of difference of periods [ddp]), shimmer (local, amplitude perturbation quotient [apq]3, apq5, apq11, average absolute differences between the amplitudes of consecutive periods [dda]), and F0cov (coefficient of variation of the fundamental frequency) showed a significant difference (P<.001). In addition, the duration of response time, the duration of silent periods, the filler period, and the proportion of fillers showed significant differences (P<.05). However, only jitter (local) met the reference value r=0.1 (small) of the effect size. In the automatic classification experiment for the classification of participants into CN and MCI groups, the results showed 66.0% accuracy in the MMSE conversational speech and 68.1% accuracy in everyday conversations with the humanoid robot. Conclusions: This study shows the possibility of early and simple screening for patients with MCI using prosodic and acoustic features from everyday conversations with a humanoid robot with the same level of accuracy as the MMSE. %M 36637896 %R 10.2196/42792 %U https://formative.jmir.org/2023/1/e42792 %U https://doi.org/10.2196/42792 %U http://www.ncbi.nlm.nih.gov/pubmed/36637896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39206 %T “I Haven’t Been Diagnosed, but I Should Be”—Insight Into Self-diagnoses of Common Mental Health Disorders: Cross-sectional Study %A Rutter,Lauren A %A Howard,Jacqueline %A Lakhan,Prabhvir %A Valdez,Danny %A Bollen,Johan %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E Tenth Street, Bloomington, IN, 47405, United States, 1 8128569953, larutter@iu.edu %K assessment %K depression %K anxiety %K self-report %K social media %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, social media has become a rich source of mental health data. However, there is a lack of web-based research on the accuracy and validity of self-reported diagnostic information available on the web. Objective: An analysis of the degree of correspondence between self-reported diagnoses and clinical indicators will afford researchers and clinicians higher levels of trust in social media analyses. We hypothesized that self-reported diagnoses would correspond to validated disorder-specific severity questionnaires across 2 large web-based samples. Methods: The participants of study 1 were 1123 adults from a national Qualtrics panel (mean age 34.65, SD 12.56 years; n=635, 56.65% female participants,). The participants of study 2 were 2237 college students from a large university in the Midwest (mean age 19.08, SD 2.75 years; n=1761, 75.35% female participants). All participants completed a web-based survey on their mental health, social media use, and demographic information. Additionally, the participants reported whether they had ever been diagnosed with a series of disorders, with the option of selecting “Yes”; “No, but I should be”; “I don’t know”; or “No” for each condition. We conducted a series of ANOVA tests to determine whether there were differences among the 4 diagnostic groups and used post hoc Tukey tests to examine the nature of the differences. Results: In study 1, for self-reported mania (F3,1097=2.75; P=.04), somatic symptom disorder (F3,1060=26.75; P<.001), and alcohol use disorder (F3,1097=77.73; P<.001), the pattern of mean differences did not suggest that the individuals were accurate in their self-diagnoses. In study 2, for all disorders but bipolar disorder (F3,659=1.43; P=.23), ANOVA results were consistent with our expectations. Across both studies and for most conditions assessed, the individuals who said that they had been diagnosed with a disorder had the highest severity scores on self-report questionnaires, but this was closely followed by individuals who had not been diagnosed but believed that they should be diagnosed. This was especially true for depression, generalized anxiety, and insomnia. For mania and bipolar disorder, the questionnaire scores did not differentiate individuals who had been diagnosed from those who had not. Conclusions: In general, if an individual believes that they should be diagnosed with an internalizing disorder, they are experiencing a degree of psychopathology similar to those who have already been diagnosed. Self-reported diagnoses correspond well with symptom severity on a continuum and can be trusted as clinical indicators, especially in common internalizing disorders such as depression and generalized anxiety disorder. Researchers can put more faith into patient self-reports, including those in web-based experiments such as social media posts, when individuals report diagnoses of depression and anxiety disorders. However, replication and further study are recommended. %M 36637885 %R 10.2196/39206 %U https://formative.jmir.org/2023/1/e39206 %U https://doi.org/10.2196/39206 %U http://www.ncbi.nlm.nih.gov/pubmed/36637885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41546 %T Young Adults’ Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Chapman,Julia %A Bhandari,Aparajita %A Bazarova,Natalya %+ Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, Chicago, IL, 60611, United States, 1 312 503 3114, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K self-harm %K digital mental health %K mobile app %K design %K intervention %K peer support %K psychoeducation %D 2023 %7 12.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people’s experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery. Objective: This study aimed to understand young people’s experiences with 2 publicly available digital resources for self-injury—a peer support app and web-based factsheets—and to disentangle potential explanatory mechanisms associated with perceived benefits and harms. Methods: Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants’ overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants’ recovery. Results: Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants’ behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone. Conclusions: Findings contribute a nuanced understanding of young people’s experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure. %M 36633896 %R 10.2196/41546 %U https://formative.jmir.org/2023/1/e41546 %U https://doi.org/10.2196/41546 %U http://www.ncbi.nlm.nih.gov/pubmed/36633896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42158 %T Development and Validation of the Epidemiological Tattoo Assessment Tool to Assess Ink Exposure and Related Factors in Tattooed Populations for Medical Research: Cross-sectional Validation Study %A Foerster,Milena %A Dufour,Lucas %A Bäumler,Wolfgang %A Schreiver,Ines %A Goldberg,Marcel %A Zins,Marie %A Ezzedine,Khaled %A Schüz,Joachim %+ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organisation, 150 cours Albert Thomas, Lyon, 69008, France, 33 4 72 73 89 44, foersterm@iarc.who.int %K tattoos %K cancer %K questionnaire development %K exposure assessment %K cohort studies %K epidemiology %K polycyclic aromatic hydrocarbons %K primary aromatic amines %K metals %K digital surface analysis %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Tattooing, whose popularity is growing worldwide, is an invasive body art that involves the injection of chemical mixtures, the tattoo ink, into the upper layer of the dermis. Although these inks may contain environmental toxins, including known human carcinogens, their long-term health effects are poorly studied. To conduct the urgently required epidemiological studies on tattoos and their long-term health effects, a validated method for assessing the complex tattoo exposure is needed. Objective: We aimed to develop and validate the Epidemiological Tattoo Assessment Tool (EpiTAT), a questionnaire to self-assess tattoo ink exposure in tattooed populations suitable for application in large epidemiological cohort studies. Methods: One of 3 preliminary versions of the EpiTAT using one of the alternative tattoo measurement units hand surface, credit card, or body schemes was randomly filled in by tattooed volunteers in Lyon, France. To identify the most suitable unit of tattoo self-assessment, a validation study was conducted with the selected respondents (N=97) to compare the self-assessments of tattoo surface, color, and coverage with validation measurements made by trained study personnel. Intraclass correlation, the Kendall rank correlation, and 2-tailed t tests were used to statistically compare tattoo size, color area, and tattoo coverage separately for each questionnaire version. Participants’ opinions on the alternative measurement units were also considered in the overall evaluation. For quality control of the validation measures, digital surface analysis of 62 photographs of selected tattoos was performed using Fiji/ImageJ. Results: In general, the results revealed overestimation of self-assessed measures compared with validation measures (eg, mean tattooed body surface 1768, SD 1547, cm2 vs 930, SD 1047, cm2, respectively, for hand surface; P<.001) and validation measures compared with digital image analysis (mean individual tattoo surface 147, SD 303.9, cm2 vs 101, SD 154.7, cm2, respectively; P=.05). Although the measurement unit credit card yielded the most accurate measures for all variables of interest, it had a much lower completion rate (78/129, 60.5%) than hand surface (89/104, 85.6%) and body schemes (90/106, 84.9%). Hand surface measured total tattoo size more accurately than body schemes (absolute agreement intraclass correlation coefficient: 0.71 vs 0.64, respectively). Conclusions: The final version of the EpiTAT contains 21 items and uses hand surface as a visual unit of measurement. Likert scales are used to assess color and coverage as a proportion of the total tattoo area. The overestimation of tattoo size by self-reporting merits further research to identify potential influential factors or predictive patterns that could be considered when calculating exposure. %M 36630184 %R 10.2196/42158 %U https://formative.jmir.org/2023/1/e42158 %U https://doi.org/10.2196/42158 %U http://www.ncbi.nlm.nih.gov/pubmed/36630184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40291 %T Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites %A Kaplan,Samantha %A von Isenburg,Megan %A Waldrop,Lucy %+ Duke University Medical Center Library & Archives, 10 Searle Drive, Durham, NC, 27710, United States, 1 919 660 1124, samantha.kaplan@duke.edu %K antivaccination behavior %K web archiving %K content analysis %K COVID-19 vaccines %K COVID-19 %K vaccine %K website %K web %K pandemic %K safety %K science %K content %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. %M 36548948 %R 10.2196/40291 %U https://formative.jmir.org/2023/1/e40291 %U https://doi.org/10.2196/40291 %U http://www.ncbi.nlm.nih.gov/pubmed/36548948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39034 %T User Experience Regarding Digital Primary Health Care in Santarém, Amazon: Evaluation of Patient Satisfaction and Doctor’s Feedback %A Bin,Kaio Jia %A Santana Alves,Patrícia Gabriela %A Costa,Raquel %A Eiras,Paula Cruz %A Nader de Araujo,Luciano %A Pereira,Antonio José Rodrigues %A Carvalho,Carlos %A Malik,Ana Maria %+ Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 225 - 3º andar, São Paulo, 05403-110, Brazil, 55 1126616208, kaiobin@gmail.com %K telemedicine %K primary health care %K user’s experience %K Amazon %K digital health %K pilot %K patient %K pilot model %K pandemic %K medical care %K assist %K urban %K community %K Brazil %K technology %K consultation %K physician %K survey %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting São Paulo, a mega-metropolis, to Paysandú, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. Objective: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandú, a riverside district in the Amazon. Methods: This is a single-center study following the guidelines “Evaluating digital health products” from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between São Paulo and Santarém in Brazil. A survey was carried out with patients who were treated by a doctor in the city of São Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. Results: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor’s feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% (n=218) of the appointments had a problem with audio or video. Conclusions: This teleconsultation project between São Paulo and Paysandú showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandú District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved. %M 36630164 %R 10.2196/39034 %U https://formative.jmir.org/2023/1/e39034 %U https://doi.org/10.2196/39034 %U http://www.ncbi.nlm.nih.gov/pubmed/36630164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43533 %T The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data %A Guo,Shanshan %A Dang,Yuanyuan %A Vogel,Doug %A She,Bofei %+ School of Business Administration, South China University of Technology, 381 Wushan Road, Tianhe District, Guangzhou, 510641, China, 86 18845095850, dyy_hit@163.com %K medical resources %K online health community %K physician-patient interaction %K online and offline %K social network analysis %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment. Objective: This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels. Methods: The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China’s largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model. Results: The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians’ online contributions (βcontribution=.210; P<.001) and capital availability (βbed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U–shaped effect (βdistance=.199; P<.001 and βdistance2=–.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability. Conclusions: This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care. %M 36626204 %R 10.2196/43533 %U https://formative.jmir.org/2023/1/e43533 %U https://doi.org/10.2196/43533 %U http://www.ncbi.nlm.nih.gov/pubmed/36626204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43263 %T Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2300, Australia, 61 2 404 20738, elizabeth.ditton@uon.edu.au %K medical students %K burnout prevention %K app %K feasibility %K intervention engagement %K psychological flexibility %K acceptance and commitment therapy %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective: This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods: This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results: Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions: This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field. %M 36626191 %R 10.2196/43263 %U https://formative.jmir.org/2023/1/e43263 %U https://doi.org/10.2196/43263 %U http://www.ncbi.nlm.nih.gov/pubmed/36626191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42416 %T Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation %A Young,Stephanie Ruth %A Lattie,Emily Gardiner %A Berry,Andrew B L %A Bui,Lynn %A Byrne,Greg Joseph %A Yoshino Benavente,Julia Noelani %A Bass,Michael %A Gershon,Richard C %A Wolf,Michael S %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, stephanieruth.young@northwestern.edu %K human-centered design %K mobile health %K mHealth %K usability %K cognitive screening %K older adults %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. %M 36626223 %R 10.2196/42416 %U https://formative.jmir.org/2023/1/e42416 %U https://doi.org/10.2196/42416 %U http://www.ncbi.nlm.nih.gov/pubmed/36626223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41354 %T Adaptation of a Personalized Electronic Care Planning Tool for Cancer Follow-up Care: Formative Study %A Sohl,Stephanie J %A Duncan,Pamela W %A Thakur,Elyse %A Puccinelli-Ortega,Nicole %A Salsman,John M %A Russell,Greg %A Pasche,Boris C %A Wentworth,Stacy %A Miller Jr,David P %A Wagner,Lynne I %A Topaloglu,Umit %+ Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, United States, 1 3367135093, ssohl@wakehealth.edu %K cancer survivorship %K cancer survivor %K colorectal cancer %K patient engagement %K shared decision-making %K follow-up care %K patient care planning %K electronic tool %K patient-reported outcomes %K behavior change %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most patients diagnosed with colorectal cancer will survive for at least 5 years; thus, engaging patients to optimize their health will likely improve outcomes. Clinical guidelines recommend patients receive a comprehensive care plan (CP) when transitioning from active treatment to survivorship, which includes support for ongoing symptoms and recommended healthy behaviors. Yet, cancer care providers find this guideline difficult to implement. Future directions for survivorship care planning include enhancing information technology support for developing personalized CPs, using CPs to facilitate self-management, and assessing CPs in clinical settings. Objective: We aimed to develop an electronic tool for colorectal cancer follow-up care (CFC) planning. Methods: Incorporating inputs from health care professionals and patient stakeholders is fundamental to the successful integration of any tool into the clinical workflow. Thus, we followed the Integrate, Design, Assess, and Share (IDEAS) framework to adapt an existing application for stroke care planning (COMPASS-CP) to meet the needs of colorectal cancer survivors (COMPASS-CP CFC). Constructs from the Consolidated Framework for Implementation Research (CFIR) guided our approach. We completed this work in 3 phases: (1) gathering qualitative feedback from stakeholders about the follow-up CP generation design and workflow; (2) adapting algorithms and resource data sources needed to generate a follow-up CP; and (3) optimizing the usability of the adapted prototype of COMPASS-CP CFC. We also quantitatively measured usability (target average score ≥70; range 0-100), acceptability, appropriateness, and feasibility. Results: In the first phase, health care professionals (n=7), and patients and caregivers (n=7) provided qualitative feedback on COMPASS-CP CFC that informed design elements such as selection, interpretation, and clinical usefulness of patient-reported measures. In phase 2, we built a minimal viable product of COMPASS-CP CFC. This tool generated CPs based on the needs identified by patient-completed measures (including validated patient-reported outcomes) and electronic health record data, which were then matched with resources by zip code and preference to support patients’ self-management. Elements of the CFIR assessed revealed that most health care professionals believed the tool would serve patients’ needs and had advantages. In phase 3, the average System Usability Scale score was above our target score for health care professionals (n=5; mean 71.0, SD 15.2) and patients (n=5; mean 95.5, SD 2.1). Participants also reported high levels of acceptability, appropriateness, and feasibility. Additional CFIR-informed feedback, such as desired format for training, will inform future studies. Conclusions: The data collected in this study support the initial usability of COMPASS-CP CFC and will inform the next steps for implementation in clinical care. COMPASS-CP CFC has the potential to streamline the implementation of personalized CFC planning to enable systematic access to resources that will support self-management. Future research is needed to test the impact of COMPASS-CP CFC on patient health outcomes. %M 36626203 %R 10.2196/41354 %U https://formative.jmir.org/2023/1/e41354 %U https://doi.org/10.2196/41354 %U http://www.ncbi.nlm.nih.gov/pubmed/36626203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39965 %T Implementation of Shared Decision-Making Within Internet Hospitals in China Based on Patients’ Needs: Feasibility Study and Content Analysis %A Yu,Tianzhi %A Jin,Chunjie %A Wu,Xiaodan %A Yue,Dianmin %+ School of Economics and Management, Hebei University of Technology, No. 5340 Siping Road Beichen District, Tianjin, 300401, China, 86 13920955339, dmingyue@hebut.edu.cn %K internet hospital %K shared decision-making between doctors and patients %K patient needs %K feasibility %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet hospitals are developing rapidly in China, and their convenient and efficient medical services are being increasingly recognized by patients. Many hospitals have set up their own internet hospitals to provide web-based medical services. Tianjin Medical University General Hospital has established a multidisciplinary and comprehensive internet hospital to provide diversified medical services according to the needs of patients. A way to further improve web-based medical services is by examining how shared decision-making (SDM) can be carried out in internet hospital diagnosis and treatment services, thereby improving patients’ medical experience. Objective: The aim of this study was to analyze the feasibility of implementing doctor-patient SDM in internet hospital diagnosis and treatment services based on patients’ needs in China. Methods: In this study, the medical data of 10 representative departments in the internet hospital of Tianjin Medical University General Hospital from January 1 to January 31, 2022, were extracted as a whole; 25,266 cases were selected. After excluding 2056 cases with incomplete information, 23,210 cases were finally included in this study. A chi-square test was performed to analyze the characteristics and medical service needs of internet hospital patients in order to identify the strengths of SDM in internet hospitals. Results: The internet hospital patients from 10 clinical departments were significantly different in terms of gender (χ29=3425.6; P<.001), age (χ236=27,375.8; P<.001), mode of payment (χ29=3501.1; P<.001), geographic distribution (χ29=347.2; P<.001), and duration of illness (χ236=2863.3; P<.001). Patient medical needs included drug prescriptions, examination prescriptions, medical record explanations, drug use instructions, prehospitalization preparations, further consultations with doctors (unspecified purpose), treatment plan consultations, initial diagnoses based on symptoms, and follow-up consultations after discharge. The medical needs of the patients in different clinical departments were significantly different (χ272=8465.5; P<.001). Conclusions: Our study provides a practical and theoretical basis for the feasibility of doctor-patient SDM in internet hospitals and offers some implementation strategies. We focus on the application of SDM in web-based diagnosis and treatment in internet hospitals rather than on a disease or a disease management software. The medical service needs of different patient groups can be effectively obtained from an internet hospital, which provides the practical conditions for the promotion of doctor-patient SDM. Our findings show that the internet hospital platform expands the scope of SDM and is a new way for the large-scale application of doctor-patient SDM. %M 36607710 %R 10.2196/39965 %U https://formative.jmir.org/2023/1/e39965 %U https://doi.org/10.2196/39965 %U http://www.ncbi.nlm.nih.gov/pubmed/36607710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40773 %T Adolescents’ Assessment of Two Mental Health–Promoting Mobile Apps: Results of Two User Surveys %A Høgsdal,Helene %A Kaiser,Sabine %A Kyrrestad,Henriette %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, UiT The Arctic University of Norway, Campus Tromsø, Breivika, Tromsø, Norway, 47 77 64 66 19, helene.hogsdal@uit.no %K mental health app %K mobile app %K mental health %K mental health promotion %K cyberbullying %K adolescents %K user satisfaction %K system usability %K app quality %K mental health intervention %K health promotion %K app usability %K user experience %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The importance of mental health promotion is irrevocable and is especially important at a young age. More mental health-promoting mobile apps have been developed in the last few years. However, their usability and quality have been rarely assessed. Objective: The aim of this study is to investigate how adolescents assess the usability, quality, and potential goal achievement of Opp and NettOpp. Opp is a universal mental health–promoting mobile app aimed at 13- to 19-year-olds, and NettOpp is a mobile app for children and adolescents between 11 to 16 years of age that have experienced negative incidents online. Methods: A total of 45 adolescents tested either Opp (n=30) or NettOpp (n=15) for a period of 3 weeks and answered a questionnaire. The System Usability Scale (SUS) was used to measure the usability of the apps. A SUS score above 70 indicates acceptable usability. Items from the Mobile Application Rating Scale were adapted for study purposes and used to measure the quality and perceived goal achievement that Opp and NettOpp might have on adolescents’ knowledge, attitudes, and intention to change behavior. Furthermore, adolescents could answer an open comment question. Results: Opp had a mean SUS score of 80.37 (SD 9.27), and NettOpp’s mean SUS score was 80.33 (SD 10.30). In the overall evaluation, Opp and NettOpp were given a mean score of 3.78 (SD 0.42) and 4.20 (SD 0.56), respectively, on a 5-point scale, where 5 was best. Most adolescents who evaluated Opp rated that the app would increase knowledge about mental health and help young people deal with stress and difficult emotions or situations. Most adolescents who evaluated NettOpp agreed that the app would increase awareness and knowledge about cyberbullying, change attitudes toward cyberbullying, and motivate them to address cyberbullying. Some adolescents stated that Opp was difficult to navigate and consisted of too much text. Some of the adolescents that tested NettOpp stated that the app had crashed and that the design was a bit childish. Conclusions: All in all, this study indicates that Opp and NettOpp have good usability and that adolescents are satisfied with both apps. It also indicates that the potential goal achievement of the apps, for example, increasing knowledge about mental health (Opp) or cyberbullying (NettOpp) is promising. While there are some comments from the users that are more difficult to solve (eg, Opp is too text-based), some comments helped improve the apps (eg, that the app crashed). Overall, the user evaluation provided valuable knowledge about how adolescents assess Opp and NettOpp. However, more extensive effectiveness studies are necessary to measure their actual goal achievement. %M 36607734 %R 10.2196/40773 %U https://formative.jmir.org/2023/1/e40773 %U https://doi.org/10.2196/40773 %U http://www.ncbi.nlm.nih.gov/pubmed/36607734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42053 %T The PTSD Family Coach App in Veteran Family Members: Pilot Randomized Controlled Trial %A van Stolk-Cooke,Katherine %A Wielgosz,Joseph %A Hallenbeck,Haijing Wu %A Chang,Andrew %A Rosen,Craig %A Owen,Jason %A Kuhn,Eric %+ Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Palo Alto, CA, 94304, United States, 1 860 335 2021, cvscooke@stanford.edu %K posttraumatic stress disorder %K PTSD %K veterans %K family %K mobile apps %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring. Objective: This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD. Methods: A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods. Results: Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI −0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI −0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI −0.3 to 0.3), anxiety (P=.55; Cohen d=−0.1, 95% CI −0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI −0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=−0.1, 95% CI −0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=−0.2, 95% CI −0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=−0.0, 95% CI −0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (β=−3.62; t281=−2.27; P=.02). Conclusions: Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version’s feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted. Trial Registration: ClinicalTrials.gov NCT02486705; https://clinicaltrials.gov/ct2/show/NCT02486705 %M 36602852 %R 10.2196/42053 %U https://formative.jmir.org/2023/1/e42053 %U https://doi.org/10.2196/42053 %U http://www.ncbi.nlm.nih.gov/pubmed/36602852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40062 %T Characteristics and Weight Loss Practices From a Cohort of 20,000 Patients Using Direct-to-Consumer Telehealth: Observational Cross-sectional Study %A Horn,Deborah Bade %A Pash,Elizabeth %A Zhou,Megan S %A Broffman,Lauren %A Bialonczyk,Damian %A Doron,Tzvi %A Chiquette,Elaine %+ Ro, 4th Floor, 116 West 23rd Street, New York, NY, 10011, United States, 1 716 713 4178, lauren.broffman@ro.co %K obesity %K preobesity %K overweight %K weight management %K direct-to-consumer telehealth %K oral superabsorbent hydrogel %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing prevalence of obesity, the use of pharmacotherapy treatment remains low. Telehealth platforms have the potential to facilitate access to pharmacotherapy interventions, but little is known about telehealth patients. Objective: This study describes a large patient population taking Plenity, an oral superabsorbent hydrogel (OSH) used in the treatment of excess weight or obesity (BMI 25-40 kg/m2). The analysis compared differences in weight loss practices and in-person access to obesity care among telehealth patients with preobesity and obesity. Methods: This was a cross-sectional assessment of a random sample of 20,000 telehealth patients who completed a structured, web-based visit and received at least one prescription of OSH. Patients were eligible to receive care via telehealth if they were adults, were not pregnant, and had a BMI ≥25 kg/m2. During the visit, patients provided baseline health information including comorbidities, diet, and exercise habits. Their zip code of residence was used to determine their proximity to an obesity medicine provider. Descriptive statistical analysis and tests of differences (chi-square and 2-tailed t tests) were used to compare patients with preobesity (BMI 25-29.9 kg/m2) and obesity (BMI 30-40 kg/m2). Results: Most (15,576/20,000, 77.88%) of the cohort were female, with a mean age of 44 (SD 11) years and a mean BMI of 32.4 (SD 4.1) kg/m2. Among the cohort, 32.13% (6426/20,000) had preobesity, and 40.18% (8036/20,000) of all patients had ≥1 weight-related comorbidity. Almost all (19,732/20,000, 98.66%) patients attempted 1 weight loss method before OSH and half (10,067/20,000, 50.34%) tried ≥4 different methods. Exercise and low-calorie diets were the most attempted weight loss methods, and 28.76% (5752/20,000) of patients reported a prior prescription of weight loss medication. Patients with obesity were more likely than patients with preobesity to have previously tried commercial weight loss plans (7294/13,574, 53.74% vs 2791/6426, 43.43%; P<.001), specialized diets (8493/13,574, 62.57% vs 3799/6426, 59.12%; P<.001), over-the-counter supplements (6807/13,574, 50.15% vs 2876/6426, 44.76%; P<.001), and prescription weight loss medications (4407/13,574, 32.47% vs 1345/6426, 20.93%; P<.001). Females were more likely to seek treatment for preobesity (5332/15,576, 34.23% vs 1094/4424, 24.73% male; P<.001) and reported fewer comorbidities (5992/15,576, 38.47% vs 2044/4424, 46.2% male; P<.001), despite >90% of both sexes reporting the belief that excess weight negatively affected their health (14,247/15,576, 91.47% female participants, 4116/4424, 93.04% male participants). Moreover, 29.25% (5850/20,000) of patients lived in the same zip code and 85.15% (17,030/20,000) lived in the same county as an obesity medicine provider. Conclusions: Data from this large patient cohort supports the potential for telehealth to provide prescriptive weight management treatment to a population seeking care. Patients with preobesity are an undertreated population who actively seek new weight management options. Female participants sought weight management treatment earlier in the disease continuum than males, despite reporting fewer comorbidities. %M 36602855 %R 10.2196/40062 %U https://formative.jmir.org/2023/1/e40062 %U https://doi.org/10.2196/40062 %U http://www.ncbi.nlm.nih.gov/pubmed/36602855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37270 %T Assessment and Disruption of Ruminative Episodes to Enhance Mobile Cognitive Behavioral Therapy Just-in-Time Adaptive Interventions in Clinical Depression: Pilot Randomized Controlled Trial %A Wang,Liyuan %A Miller,Lynn %+ Children's Hospital, Los Angeles, Department of Adolescent and Young Adult, 3250 Wilshire Blvd, Suite 1202, Los Angeles, CA, 90027-0000, United States, 1 7654911022, liwang@chla.usc.edu %K depressive rumination %K mobile health %K mHealth %K just-in-time adaptive intervention %K depression %K mental health %K mobile phone %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A just-in-time adaptive intervention (JITAI) is “designed to address the dynamically changing needs of individuals via the provision of the type or amount of support needed, at the right time when needed.” If and how rumination-focused cognitive behavioral therapy (RFCBT), the gold standard, blocks emotional cascades underlying rumination is unclear. Furthermore, cognitive behavioral therapy has been successfully used as a mobile variant, but RFCBT has not been adapted for a mobile variant (mobile RFCBT [MRFCBT]) or for a JITAI variant. Objective: This study aimed to pilot-test a fully automated JITAI leveraging RFCBT and ways to identify and block cascading depressive rumination. Methods: Patients in therapy for clinical depression were recruited for a randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to either of the 2 mobile versions of the RFCBT conditions personalized to the individual’s rumination timing patterns (JITAI-MRFCBT) or a no-treatment control condition through a double-blind procedure. Although the initial design was to have a 3-armed trial with 2 JITAI conditions (a JITAI and a narrative JITAI condition), we later opted to collapse those 2 conditions into 1 JITAI condition because of the low number of participants. All participants were recruited and participated through their smartphones, receiving 5 SMS text message reminders on each of the 35 days to self-report their rumination-related symptoms (eg, rumination episodes and duration). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7 days provided a rumination baseline, and the last 7 days provided a postintervention rumination value. In total, 42% (25/59) of volunteers were eligible and provided their phone numbers, 20% (5/25) of whom never replied to the SMS text message reminding them to start the RCT. A total of 90% (18/20) of volunteers completed it (ie, finishing, as prespecified, 80% of the questionnaires and training tasks) and, therefore, were included in the analysis. Results: Using independent 2-tailed t tests with bootstrapping, results showed that participants in the JITAI-MRFCBT condition, compared with those in the control condition, reported a greater reduction in counts of rumination episodes (mean −25.28, SD 14.50 vs mean 1.44, SD 4.12, P<.001) and greater reduced average time (minutes) spent in rumination (mean −21.53, SD 17.6 vs mean 1.47, SD 1.5; P=.04). Results also suggest that, compared with those in the control group, those in treatment reduced ruminative carryover from one episode to the next. Conclusions: The results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just in time following rumination, thereby blocking the next rumination episode using the same trigger. This study supports a subsequent, full-scale JITAI and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04554706; https://clinicaltrials.gov/ct2/show/NCT04554706 %M 36602841 %R 10.2196/37270 %U https://formative.jmir.org/2023/1/e37270 %U https://doi.org/10.2196/37270 %U http://www.ncbi.nlm.nih.gov/pubmed/36602841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38296 %T Using Web-Based Content to Connect Young People With Real-life Mental Health Support: Qualitative Interview Study %A Adeane,Emily %A Gibson,Kerry %+ School of Psychology, The University of Auckland, Symonds Street, Auckland, 1010, New Zealand, 64 211180431, kl.gibson@auckland.ac.nz %K young people %K mental health %K online help seeking %K internet %K mental health services %K digital interviews %D 2023 %7 4.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experience high rates of mental health problems but make insufficient use of the formal services available to them. As young people are heavy users of the internet, there may be an untapped potential to use web-based content to encourage this hard-to-reach population to make better use of face-to-face mental health services. However, owing to the vast range of content available and the complexities in how young people engage with it, it is difficult to know what web-based content is most likely to resonate with this age group and facilitate their engagement with professional support. Objective: This study aimed to identify the types of web-based content young people identified as more likely to prompt youth engagement with mental health services. Methods: This study used a qualitative design conducted within a social constructionist epistemology that recognized the importance of youth empowerment in mental health. Digital interviews using WhatsApp instant messenger were conducted with 37 young people aged 16-23 years who participated as “expert informants” on the priorities and practices of youth in web-based spaces. The data were analyzed using reflexive thematic analysis to identify the types of web-based content that participants believed would encourage young people to reach out to a face-to-face mental health service for support. Results: The analysis generated 3 main themes related to the research question. First, participants noted that a lack of information about available services and how they worked prevented young people from engaging with face-to-face mental health services. They proposed web-based content that provided clear information about relevant mental health services and how to access them. They also suggested the use of both text and video to provide young people with greater insight into how face-to-face counseling might work. Second, participants recommended content dedicated to combating misconceptions about mental health and negative portrayals of mental health services and professionals that are prevalent in their web-based spaces. They suggested content that challenged the stigma surrounding mental health and help seeking and highlighted the value of mental health services. Finally, participants suggested that young people would be more likely to respond to “relatable” digital stories of using mental health services, recounted in the context of a personal connection with someone they trusted. Conclusions: This study offers recommendations for professionals and service providers on how to better engage young people with real-life mental health support using web-based content. Web-based content can be used to challenge some of the barriers that continue to prevent young people from accessing face-to-face mental health services and underlines the importance of including young people’s voices in the design of web-based mental health content. %M 36598810 %R 10.2196/38296 %U https://formative.jmir.org/2023/1/e38296 %U https://doi.org/10.2196/38296 %U http://www.ncbi.nlm.nih.gov/pubmed/36598810 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37429 %T Participants’ and Health Care Providers’ Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study %A Karimi,Nazgol %A Opie,Rachelle %A Crawford,David %A O’Connell,Stella %A Hamblin,Peter Shane %A Steele,Cheryl %A Ball,Kylie %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Building J, SENS, 221 Burwood Highway, Burwood, Melbourne, VIC 3125, Australia, 61 392517310, karimin@deakin.edu.au %K type 2 diabetes %K healthy eating %K diet %K dietary intervention %K low socioeconomic position %K digitally delivered %K mobile health %K mHealth %K website %K mobile phone %K SMS text message %K qualitative descriptive %D 2023 %7 4.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. Objective: This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. Methods: This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs’ views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention; any concerns or barriers regarding the use of these types of interventions; and feedback from their interactions with patients on the intervention’s content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. Results: In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. Conclusions: The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. International Registered Report Identifier (IRRID): RR2-10.2196/19488 %M 36598815 %R 10.2196/37429 %U https://formative.jmir.org/2023/1/e37429 %U https://doi.org/10.2196/37429 %U http://www.ncbi.nlm.nih.gov/pubmed/36598815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e31903 %T An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study %A Denny,Mary Carter %A Ancer Leal,Andrea %A Montiel,Tahani Casameni %A Wynne,Keona J %A Edquilang,Gabrielle %A Vu,Kim Yen Thi %A Vahidy,Farhaan %A Savitz,Sean I %A Beauchamp,Jennifer ES %A Sharrief,Anjail %+ Department of Neurology, Georgetown University Medical Center, MedStar Health, 3800 Reservoir Road NW, PHC 7, Washington, DC, DC, 20007, United States, 1 202 444 8532, MaryCarter.Denny@medstar.net %K stroke %K stroke prevention %K health literacy %K stroke literacy %K patient education %K transition of care %K risk factors %K cardiac %K digital health %D 2023 %7 4.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy—an understanding of stroke symptoms, risk factors, and treatment—likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. Objective: We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. Methods: The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. Results: A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. Conclusions: An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0171952 %M 35972729 %R 10.2196/31903 %U https://formative.jmir.org/2023/1/e31903 %U https://doi.org/10.2196/31903 %U http://www.ncbi.nlm.nih.gov/pubmed/35972729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38748 %T The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients %A Schlett,Christian %A Röttele,Nicole %A van der Keylen,Piet %A Schöpf-Lazzarino,Andrea Christina %A Klimmek,Miriam %A Körner,Mirjam %A Schnitzius,Kathrin %A Voigt-Radloff,Sebastian %A Maun,Andy %A Sofroniou,Mario %A Farin-Glattacker,Erik %+ Section of Health Care Research and Rehabilitation Research, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, Freiburg, 79106, Germany, 49 27083732, christian.schlett@uniklinik-freiburg.de %K general practice %K primary care %K lower back pain %K digital health intervention %K web-based health information %K eHealth %K patient education %K adherence %K qualitative research %K framework analysis %K mobile phone %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. Objective: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. Methods: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. Results: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. Conclusions: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. International Registered Report Identifier (IRRID): RR2-10.1186/s12875-019-0925-8 %M 36580365 %R 10.2196/38748 %U https://formative.jmir.org/2022/12/e38748 %U https://doi.org/10.2196/38748 %U http://www.ncbi.nlm.nih.gov/pubmed/36580365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37533 %T IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England %A Konteh,Frederick Hassan %A Mannion,Russell %A Jacobs,Rowena %+ Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Park House, Birmingham, B15 2RT, United Kingdom, 44 7401415960, f.konteh@sky.com %K COVID-19 %K mental health care %K information technology %K digital %K inequalities %K sociotechnical systems %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. %M 36423321 %R 10.2196/37533 %U https://formative.jmir.org/2022/12/e37533 %U https://doi.org/10.2196/37533 %U http://www.ncbi.nlm.nih.gov/pubmed/36423321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37144 %T Effectiveness of Secondary Risk–Reducing Strategies in Patients With Unilateral Breast Cancer With Pathogenic Variants of BRCA1 and BRCA2 Subjected to Breast-Conserving Surgery: Evidence-Based Simulation Study %A Maksimenko,Jelena %A Rodrigues,Pedro Pereira %A Nakazawa-Miklaševiča,Miki %A Pinto,David %A Miklaševičs,Edvins %A Trofimovičs,Genadijs %A Gardovskis,Jānis %A Cardoso,Fatima %A Cardoso,Maria João %+ Institute of Oncology, Department of Surgery, Breast Unit, Pauls Stradiņš Clinical University Hospital, Riga Stradiņš University, Dzirciema 16, Riga, Latvia, 371 27038577, jelena.maksimenko@rsu.lv %K BRCA1 and BRCA2 %K secondary prophylactic strategies %K breast-conserving therapy %K breast cancer %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 62% of patients with breast cancer with a pathogenic variant (BRCA1 or BRCA2) undergo primary breast-conserving therapy. Objective: The study aims to develop a personalized risk management decision support tool for carriers of a pathogenic variant (BRCA1 or BRCA2) who underwent breast-conserving therapy for unilateral early-stage breast cancer. Methods: We developed a Bayesian network model of a hypothetical cohort of carriers of BRCA1 or BRCA2 diagnosed with stage I/II unilateral breast cancer and treated with breast-conserving treatment who underwent subsequent second primary cancer risk–reducing strategies. Using event dependencies structured according to expert knowledge and conditional probabilities obtained from published evidence, we predicted the 40-year overall survival rate of different risk-reducing strategies for 144 cohorts of women defined by the type of pathogenic variants (BRCA1 or BRCA2), age at primary breast cancer diagnosis, breast cancer subtype, stage of primary breast cancer, and presence or absence of adjuvant chemotherapy. Results: Absence of adjuvant chemotherapy was the most powerful factor that was linked to a dramatic decline in survival. There was a negligible decline in the mortality in patients with triple-negative breast cancer, who received no chemotherapy and underwent any secondary risk–reducing strategy, compared with surveillance. The potential survival benefit from any risk-reducing strategy was more modest in patients with triple-negative breast cancer who received chemotherapy compared with patients with luminal breast cancer. However, most patients with triple-negative breast cancer in stage I benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy or just risk-reducing salpingo-oophorectomy. Most patients with luminal stage I/II unilateral breast cancer benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy. The impact of risk-reducing salpingo-oophorectomy in patients with luminal breast cancer in stage I/II increased with age. Most older patients with the BRCA1 and BRCA2 pathogenic variants in exons 12-24/25 with luminal breast cancer may gain a similar survival benefit from other risk-reducing strategies or surveillance. Conclusions: Our study showed that it is mandatory to consider the complex interplay between the types of BRCA1 and BRCA2 pathogenic variants, age at primary breast cancer diagnosis, breast cancer subtype and stage, and received systemic treatment. As no prospective study results are available at the moment, our simulation model, which will integrate a decision support system in the near future, could facilitate the conversation between the health care provider and patient and help to weigh all the options for risk-reducing strategies leading to a more balanced decision. %M 36580360 %R 10.2196/37144 %U https://formative.jmir.org/2022/12/e37144 %U https://doi.org/10.2196/37144 %U http://www.ncbi.nlm.nih.gov/pubmed/36580360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e43059 %T Barriers and Facilitators of Obtaining Social Determinants of Health of Patients With Cancer Through the Electronic Health Record Using Natural Language Processing Technology: Qualitative Feasibility Study With Stakeholder Interviews %A Alpert,Jordan %A Kim,Hyehyun (Julia) %A McDonnell,Cara %A Guo,Yi %A George,Thomas J %A Bian,Jiang %A Wu,Yonghui %+ Cleveland Clinic, Center for Value-Based Care Research, 9500 Euclid Ave., mail code: G10, Cleveland, OH, 44195, United States, 1 216 527 5925, alpertj@ccf.org %K natural language processing %K qualitative %K social determinants of health %K electronic health records %K cancer %K technology %K education %K patient %K clinical %K communication %K data %D 2022 %7 27.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social determinants of health (SDoH), such as geographic neighborhoods, access to health care, education, and social structure, are important factors affecting people’s health and health outcomes. The SDoH of patients are scarcely documented in a discrete format in electronic health records (EHRs) but are often available in free-text clinical narratives such as physician notes. Innovative methods like natural language processing (NLP) are being developed to identify and extract SDoH from EHRs, but it is imperative that the input of key stakeholders is included as NLP systems are designed. Objective: This study aims to understand the feasibility, challenges, and benefits of developing an NLP system to uncover SDoH from clinical narratives by conducting interviews with key stakeholders: (1) oncologists, (2) data analysts, (3) citizen scientists, and (4) patient navigators. Methods: Individuals who frequently work with SDoH data were invited to participate in semistructured interviews. All interviews were recorded and subsequently transcribed. After coding transcripts and developing a codebook, the constant comparative method was used to generate themes. Results: A total of 16 participants were interviewed (5 data analysts, 4 patient navigators, 4 physicians, and 3 citizen scientists). Three main themes emerged, accompanied by subthemes. The first theme, importance and approaches to obtaining SDoH, describes how every participant (n=16, 100%) regarded SDoH as important. In particular, proximity to the hospital and income levels were frequently relied upon. Communication about SDoH typically occurs during the initial conversation with the oncologist, but more personal information is often acquired by patient navigators. The second theme, SDoH exists in numerous forms, exemplified how SDoH arises during informal communication and can be difficult to enter into the EHR. The final theme, incorporating SDoH into health services research, addresses how more informed SDoH can be collected. One strategy is to empower patients so they are aware about the importance of SDoH, as well as employing NLP techniques to make narrative data available in a discrete format, which can provide oncologists with actionable data summaries. Conclusions: Extracting SDoH from EHRs was considered valuable and necessary, but obstacles such as narrative data format can make the process difficult. NLP can be a potential solution, but as the technology is developed, it is important to consider how key stakeholders document SDoH, apply the NLP systems, and use the extracted SDoH in health outcome studies. %M 36574288 %R 10.2196/43059 %U https://formative.jmir.org/2022/12/e43059 %U https://doi.org/10.2196/43059 %U http://www.ncbi.nlm.nih.gov/pubmed/36574288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42939 %T Ethical Issues in the Use of Smartphone Apps for HIV Prevention in Malaysia: Focus Group Study With Men Who Have Sex With Men %A Khati,Antoine %A Wickersham,Jeffrey A %A Rosen,Aviana O %A Luces,Jeffrey Ralph B %A Copenhaver,Nicholas %A Jeri-Wahrhaftig,Alma %A Ab Halim,Mohd Akbar %A Azwa,Iskandar %A Gautam,Kamal %A Ooi,Kai Hong %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu %K HIV %K mobile health %K mHealth %K mobile app %K HIV prevention %K men who have sex with men %K privacy %K confidentiality %K Malaysia %K mobile apps %K ethics %K focus group %K implementation %K user privacy %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, mobile health app-based strategies have the potential to open new frontiers for HIV prevention. However, little guidance is available to inform researchers about the ethical concerns that are unique to the development and implementation of app-based HIV prevention programs. Objective: This study aimed to fill this gap by characterizing the attitudes and concerns of Malaysian MSM regarding HIV prevention mobile apps, particularly regarding the ethical aspects surrounding their use. Methods: We conducted web-based focus group discussions with 23 MSM between August and September 2021. Using in-depth semistructured interviews, participants were asked about the risks and ethical issues they perceived to be associated with using mobile apps for HIV prevention. Each session was digitally recorded and transcribed. Transcripts were inductively coded using the Dedoose software (SocioCultural Research Consultants) and analyzed to identify and interpret emerging themes. Results: Although participants were highly willing to use app-based strategies for HIV prevention, they raised several ethical concerns related to their use. Prominent concerns raised by participants included privacy and confidentiality concerns, including fear of third-party access to personal health information (eg, friends or family and government agencies), issues around personal health data storage and management, equity and equitable access, informed consent, and regulation. Conclusions: The study’s findings highlight the role of ethical concerns related to the use of app-based HIV prevention programs. Given the ever-growing nature of such technological platforms that are intermixed with a complex ethical-legal landscape, mobile health platforms must be safe and secure to minimize unintended harm, safeguard user privacy and confidentiality, and obtain public trust and uptake. %M 36563046 %R 10.2196/42939 %U https://formative.jmir.org/2022/12/e42939 %U https://doi.org/10.2196/42939 %U http://www.ncbi.nlm.nih.gov/pubmed/36563046 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40825 %T State-Level COVID-19 Symptom Searches and Case Data: Quantitative Analysis of Political Affiliation as a Predictor for Lag Time Using Google Trends and Centers for Disease Control and Prevention Data %A Turvy,Alex %+ City, Culture, and Community, Department of Sociology, Tulane University, 6823 St Charles Ave, New Orleans, LA, 70118, United States, 1 504 865 5231, aturvy@tulane.edu %K COVID-19 %K search trends %K prediction %K case %K political %K symptom %K pandemic %K data %K google %K disease %K prevention %K model %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Across each state, the emergence of the COVID-19 pandemic in the United States was marked by policies and rhetoric that often corresponded to the political party in power. These diverging responses have sparked broad ongoing discussion about how the political leadership of a state may affect not only the COVID-19 case numbers in a given state but also the subjective individual experience of the pandemic. Objective: This study leverages state-level data from Google Search Trends and Centers for Disease Control and Prevention (CDC) daily case data to investigate the temporal relationship between increases in relative search volume for COVID-19 symptoms and corresponding increases in case data. I aimed to identify whether there are state-level differences in patterns of lag time across each of the 4 spikes in the data (RQ1) and whether the political climate in a given state is associated with these differences (RQ2). Methods: Using publicly available data from Google Trends and the CDC, linear mixed modeling was utilized to account for random state-level intercepts. Lag time was operationalized as number of days between a peak (a sustained increase before a sustained decline) in symptom search data and a corresponding spike in case data and was calculated manually for each of the 4 spikes in individual states. Google offers a data set that tracks the relative search incidence of more than 400 potential COVID-19 symptoms, which is normalized on a 0-100 scale. I used the CDC’s definition of the 11 most common COVID-19 symptoms and created a single construct variable that operationalizes symptom searches. To measure political climate, I considered the proportion of 2020 Trump popular votes in a state as well as a dummy variable for the political party that controls the governorship and a continuous variable measuring proportional party control of federal Congressional representatives. Results: The strongest overall fit was for a linear mixed model that included proportion of 2020 Trump votes as the predictive variable of interest and included controls for mean daily cases and deaths as well as population. Additional political climate variables were discarded for lack of model fit. Findings indicated evidence that there are statistically significant differences in lag time by state but that no individual variable measuring political climate was a statistically significant predictor of these differences. Conclusions: Given that there will likely be future pandemics within this political climate, it is important to understand how political leadership affects perceptions of and corresponding responses to public health crises. Although this study did not fully model this relationship, I believe that future research can build on the state-level differences that I identified by approaching the analysis with a different theoretical model, method for calculating lag time, or level of geographic modeling. %M 36446048 %R 10.2196/40825 %U https://formative.jmir.org/2022/12/e40825 %U https://doi.org/10.2196/40825 %U http://www.ncbi.nlm.nih.gov/pubmed/36446048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40379 %T Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study %A Rowland,Sheri %A Ramos,Athena K %A Trinidad,Natalia %A Quintero,Sophia %A Johnson Beller,Rebecca %A Struwe,Leeza %A Pozehl,Bunny %+ College of Nursing, University of Nebraska Medical Center, 550 N. 19th Street, Lincoln, NE, 68508-0620, United States, 1 402 472 5959, sheri.rowland@unmc.edu %K mHealth %K health behavior %K self-management %K Hispanic/Latino %K rural %K apps %K feasibility %K acceptability %K participation %K engagement %K wearable device %K tracking %K smartphone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. Objective: The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. Methods: A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. Results: A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. Conclusions: Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants’ baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking. %M 36563025 %R 10.2196/40379 %U https://formative.jmir.org/2022/12/e40379 %U https://doi.org/10.2196/40379 %U http://www.ncbi.nlm.nih.gov/pubmed/36563025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40061 %T Perceptions of a Secure Cloud-Based Solution for Data Sharing During Acute Stroke Care: Qualitative Interview Study %A Tuler de Oliveira,Marcela %A Amorim Reis,Lúcio Henrik %A Marquering,Henk %A Zwinderman,Aeilko H %A Delgado Olabarriaga,Sílvia %+ Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 205663273, m.tuler@amsterdamumc.nl %K qualitative interview study %K electronic health records %K cloud-based applications %K acute stroke care %K cross-organization data sharing %K data privacy %K encryption %K data access control %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute stroke care demands fast procedures performed through the collaboration of multiple professionals across multiple organizations. Cloud computing and the wide adoption of electronic medical records (EMRs) enable health care systems to improve data availability and facilitate sharing among professionals. However, designing a secure and privacy-preserving EMR cloud-based application is challenging because it must dynamically control the access to the patient’s EMR according to the needs for data during treatment. Objective: We developed a prototype of a secure EMR cloud-based application. The application explores the security features offered by the eHealth cloud-based framework created by the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Horizon 2020 project. This study aimed to collect impressions, challenges, and improvements for the prototype when applied to the use case of secure data sharing among acute care teams during emergency treatment in the Netherlands. Methods: We conducted 14 semistructured interviews with medical professionals with 4 prominent roles in acute care: emergency call centers, ambulance services, emergency hospitals, and general practitioner clinics. We used in-depth interviews to capture their perspectives about the application’s design and functions and its use in a simulated acute care event. We used thematic analysis of interview transcripts. Participants were recruited until the collected data reached thematic saturation. Results: The participants’ perceptions and feedback are presented as 5 themes identified from the interviews: current challenges (theme 1), quality of the shared EMR data (theme 2), integrity and auditability of the EMR data (theme 3), usefulness and functionality of the application (theme 4), and trust and acceptance of the technology (theme 5). The results reinforced the current challenges in patient data sharing during acute stroke care. Moreover, from the user point of view, we expressed the challenges of adopting the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Acute Stroke Care application in a real scenario and provided suggestions for improving the proposed technology’s acceptability. Conclusions: This study has endorsed a system that supports data sharing among acute care professionals with efficiency, but without compromising the security and privacy of the patient. This explorative study identified several significant barriers to and improvement opportunities for the future acceptance and adoption of the proposed system. Moreover, the study results highlight that the desired digital transformation should consider integrating the already existing systems instead of requesting migration to a new centralized system. %M 36563043 %R 10.2196/40061 %U https://formative.jmir.org/2022/12/e40061 %U https://doi.org/10.2196/40061 %U http://www.ncbi.nlm.nih.gov/pubmed/36563043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e31433 %T Understanding Emergency Room Visits for Nontraumatic Oral Health Conditions in a Hospital Serving Rural Appalachia: Dental Informatics Study %A Khanna,Raj K %A Cecchetti,Alfred A %A Bhardwaj,Niharika %A Muto,Bobbi Steele %A Murughiyan,Usha %+ Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, United States, 1 3046911585, cecchetti@marshall.edu %K dental informatics %K visualization %K nontraumatic dental care %K emergency room %K cost %K utilization %K economic impact %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In the Appalachian region, a variety of factors will impact the ability of patients to maintain good oral health, which is essential for overall health and well-being. Oral health issues have led to high costs within the Appalachian hospital system. Dental informatics examines preventable dental conditions to understand the problem and suggest cost containment. Objective: We aimed to demonstrate the value of dental informatics in dental health care in rural Appalachia by presenting a research study that measured emergency room (ER) use for nontraumatic dental conditions (NTDCs) and the associated economic impact in a hospital system that primarily serves rural Appalachia. Methods: The Appalachian Clinical and Translational Science Institute’s oral health data mart with relevant data on patients (n=8372) with ER encounters for NTDC between 2010 and 2018 was created using Appalachian Clinical and Translational Science Institute’s research data warehouse. Exploratory analysis was then performed by developing an interactive Tableau dashboard. Dental Informatics provided the platform whereby the overall burden of these encounters, along with disparities in burden by age groups, gender, and primary payer, was assessed. Results: Dental informatics was essential in understanding the overall problem and provided an interactive and easily comprehensible visualization of the situation. We found that ER visits for NTDCs declined by 40% from 2010 to 2018, but a higher percentage of visits required inpatient care and surgical intervention. Conclusions: Dental informatics can provide the necessary tools and support to health care systems and state health departments across Appalachia to address serious dental problems. In this case, informatics helped identify that although inappropriate ER use for NTDCs diminished due to ER diversion efforts, they remain a significant burden. Through its visualization and data extraction techniques, dental informatics can help produce policy changes by promoting models that improve access to preventive care. %M 36563041 %R 10.2196/31433 %U https://formative.jmir.org/2022/12/e31433 %U https://doi.org/10.2196/31433 %U http://www.ncbi.nlm.nih.gov/pubmed/36563041 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38471 %T Evaluating User Preferences, Comprehension, and Trust in Apps for Environmental Health Hazards: Qualitative Case Study %A Workman,Annabelle %A Johnston,Fay H %A Campbell,Sharon L %A Williamson,Grant J %A Lucani,Chris %A Bowman,David M J S %A Cooling,Nick %A Jones,Penelope J %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 362267726, penelope.jones@utas.edu.au %K health app %K evaluation %K air pollution %K pollen %K temperature %K mobile phone %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia to provide information on multiple atmospheric health hazards in near real time. The app allows users to view local environmental conditions, and input and track their personal symptoms to enable behaviors that protect health in response to environmental hazards. Objective: This study aimed to develop insights into users’ perceptions of engagement, comprehension, and trust in AirRater to inform the future development of environmental health apps. Specifically, this study explored which AirRater features users engaged with, what additional features or functionality needs users felt they required, users’ self-perception of understanding app information, and their level of trust in the information provided. Methods: A total of 42 adult AirRater users were recruited from 3 locations in Australia to participate in semistructured interviews to capture location- or context-specific experiences. Participants were notified of the recruitment opportunity through multiple avenues including newsletter articles and social media. Informed consent was obtained before participation, and the participants were remunerated for their time and perspectives. A preinterview questionnaire collected data including age range, any preexisting conditions, and location (postcode). All participant data were deidentified. Interviews were recorded, transcribed, and analyzed using thematic analysis in NVivo 12 (QSR International). Results: Participants discussed app features and functionality, as well as their understanding of, and trust in, the information provided by the app. Most (26/42, 62%) participants used and valued visual environmental hazard features, especially maps, location settings, and hazard alerts. Most (33/42, 78%) found information in the app easy to understand and support their needs, irrespective of their self-reported literacy levels. Many (21/42, 50%) users reported that they did not question the accuracy of the data presented in the app. Suggested enhancements include the provision of meteorological information (eg, wind speed or direction, air pressure, UV rating, and humidity), functionality enhancements (eg, forecasting, additional alerts, and the inclusion of health advice), and clarification of existing information (eg, symptom triggers), including the capacity to download personal summary data for a specified period. Conclusions: Participants’ perspectives can inform the future development of environmental health apps. Specifically, participants’ insights support the identification of key elements for the optimal development of environmental health app design, including streamlining, capacity for users to customize, use of real time data, visual cues, credibility, and accuracy of data. The results also suggest that, in the future, iterative collaboration between developers, environmental agencies, and users will likely promote better functional design, user trust in the data, and ultimately better population health outcomes. %M 36548030 %R 10.2196/38471 %U https://formative.jmir.org/2022/12/e38471 %U https://doi.org/10.2196/38471 %U http://www.ncbi.nlm.nih.gov/pubmed/36548030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e34893 %T Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study %A Gonzales,Sarah %A Okusaga,Olaoluwa O %A Reuteman-Fowler,J Corey %A Oakes,Megan M %A Brown,Jamie N %A Moore,Scott %A Lewinski,Allison A %A Rodriguez,Cristin %A Moncayo,Norma %A Smith,Valerie A %A Malone,Shauna %A List,Justine %A Cho,Raymond Y %A Jeffreys,Amy S %A Bosworth,Hayden B %+ Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 W. Chapel Hill Street, Suite 600, Durham, NC, 27701, United States, 1 919 286 0411 ext 7101, hayden.bosworth@duke.edu %K ABILIFY MYCITE %K digital medicine %K adherence %K aripiprazole %K Veterans %K qualitative methods %K mental illness %K mental health %K medication %K mobile phone %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Suboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate. Objective: The primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence. Methods: This open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS. Results: We enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46%) in DMS and 25 (54%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers. Conclusions: There was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS. Trial Registration: ClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449 %M 36548028 %R 10.2196/34893 %U https://formative.jmir.org/2022/12/e34893 %U https://doi.org/10.2196/34893 %U http://www.ncbi.nlm.nih.gov/pubmed/36548028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41735 %T Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study %A Donovan,Gemma %A Hall,Nicola %A Smith,Felicity %A Ling,Jonathan %A Wilkes,Scott %+ Generated Health, Mercury House, 117 Waterloo Road, London, SE1 8UL, United Kingdom, 44 345 5050120, gemma.donovan@pshealthgroup.com %K medication adherence %K text messaging %K human-centered design %K complex interventions %K community pharmacy %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. Objective: This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. Methods: HCD was used to map the intervention “journey” and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. Results: A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. Conclusions: HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process. %M 36542458 %R 10.2196/41735 %U https://formative.jmir.org/2022/12/e41735 %U https://doi.org/10.2196/41735 %U http://www.ncbi.nlm.nih.gov/pubmed/36542458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40166 %T A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing %A Morgan,Kerri A %A Wong,Alex W K %A Walker,Kim %A Desai,Rachel Heeb %A Knepper,Tina M %A Newland,Pamela K %+ Program in Occupational Therapy, St. Louis School of Medicine, Washington University, 5200 Berthold Avenue Suite B, St. Louis, MO, 63110, United States, 1 314 286 1659, morgank@wustl.edu %K fatigue %K disability %K mobile health %K mHealth %K patient activation %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person’s natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. Objective: This study aimed to develop and test a mobile phone–based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. Methods: We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. Results: A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. Conclusions: This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person’s needs. %M 36542466 %R 10.2196/40166 %U https://formative.jmir.org/2022/12/e40166 %U https://doi.org/10.2196/40166 %U http://www.ncbi.nlm.nih.gov/pubmed/36542466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40021 %T A Voice App Design for Heart Failure Self-management: Proof-of-Concept Implementation Study %A Barbaric,Antonia %A Munteanu,Cosmin %A Ross,Heather %A Cafazzo,Joseph A %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital - RFE Building, 4th floor, 190 Elizabeth St, Toronto, ON, M5G2C4, Canada, 1 416 340 4800 ext 4765, antonia.barbaric@mail.utoronto.ca %K heart failure %K self-management %K digital therapeutics %K voice-activated technology %K smart speaker %K formative evaluation %K mobile phone %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Voice user interfaces are becoming more prevalent in health care and are commonly being used for patient engagement. There is a growing interest in identifying the potential this form of interface has on patient engagement with digital therapeutics (DTx) in chronic disease management. Making DTx accessible through an alternative interaction model also has the potential to better meet the needs of some patients, such as older adults and those with physical and cognitive impairments, based on existing research. Objective: This study aimed to evaluate how participants with heart failure interacted with a voice app version of a DTx, Medly, through a proof-of-concept implementation study design. The objective was to understand whether the voice app would enable the participants to successfully interact with the DTx, with a focus on acceptability and feasibility. Methods: A mixed methods concurrent triangulation design was used to better understand the acceptability and feasibility of the use of the Medly voice app with the study participants (N=20) over a 4-week period. Quantitative data included engagement levels, accuracy rates, and questionnaires, which were analyzed using descriptive statistics. Qualitative data included semistructured interviews and were analyzed using a qualitative descriptive approach. Results: The overall average engagement level was 73% (SD 9.5%), with a 14% decline between results of weeks 1 and 4. The biggest difference was between the average engagement levels of the oldest and youngest demographics, 84% and 43%, respectively, but these results were not significant—Kruskal-Wallis test, H(2)=3.8 (P=.14). The Medly voice app had an overall accuracy rate of 97.8% and was successful in sending data to the clinic. From an acceptability perspective, the voice app was ranked in the 80th percentile, and overall, the users felt that the voice app was not a lot of work (average of 2.1 on a 7-point Likert scale). However, the overall average score for whether users would use it in the future declined by 13%. Thematic analysis revealed the following: the theme feasibility of clinical integration had 2 subthemes, namely users adapted to the voice app’s conversational style and device unreliability, and the theme voice app acceptability had 3 subthemes, namely the device integrated well within household and users’ lives, users blamed themselves when problems arose with the voice app, and voice app was missing specific, desirable user features. Conclusions: In conclusion, participants were largely successful in using the Medly voice app despite some of the barriers faced, proving that an app such as this could be feasible to be deployed in the clinic. Our data begin to piece together the patient profile this technology may be most suitable for, namely those who are older, have flexible schedules, are confident in using technology, and are experiencing other medical conditions. %M 36542435 %R 10.2196/40021 %U https://formative.jmir.org/2022/12/e40021 %U https://doi.org/10.2196/40021 %U http://www.ncbi.nlm.nih.gov/pubmed/36542435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37885 %T Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study %A Gagnon,Joel %A Khau,Michelle %A Lavoie-Hudon,Léandre %A Vachon,François %A Drapeau,Vicky %A Tremblay,Sébastien %+ School of Psychology, Faculty of Social Sciences, Laval University, Pavillon Félix-Antoine-Savard, 1144, 2325, rue des Bibliothèques, Québec, QC, G1V 0A6, Canada, 1 8193830645, joel.gagnon.2@ulaval.ca %K Fitbit device %K wearable %K heart rate %K measurement accuracy %K criterion validity %K interdevice agreement %K psychological stress %K stress %K physiological %K behavioral %K mental health %K well-being %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. Objective: This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. Methods: Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. Results: A total of 34 university students were recruited for this study (64% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. Conclusions: Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance. %M 36542432 %R 10.2196/37885 %U https://formative.jmir.org/2022/12/e37885 %U https://doi.org/10.2196/37885 %U http://www.ncbi.nlm.nih.gov/pubmed/36542432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36265 %T Navigating the Systemic Conditions of a Digital Health Ecosystem in Alberta, Canada: Embedded Case Study %A Saunders,Chad %A Currie,Devon %A Virani,Shane %A De Grood,Jill %+ Entrepreneurship & Innovation, Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6075, wsaunder@ucalgary.ca %K digital health %K entrepreneurial ecosystem %K systemic conditions %K policy %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health promises numerous value-creating outcomes. These include improved health, reduced costs, and the creation of lucrative markets, which, in turn, provide high-quality employment, productivity growth, and a climate that attracts investment. For this value creation and capture, the activities of a diverse set of stakeholders within a digital health ecosystem require coordination. However, the antecedents of the coordination needed for an effective digital health ecosystem are not well understood. Objective: The purpose of this study was to investigate the systemic conditions of the digital health ecosystem in Alberta, Canada, as critical antecedents to ecosystem coordination from the perspective of the authors as applicants to an innovative digital health funding program embedded within the larger digital health ecosystem of innovators or entrepreneurs, health system leaders, support partners, and funders. Methods: We employed a qualitative embedded case study of the systemic conditions within the digital health ecosystem in Alberta, Canada (main case) using semistructured interviews with 36 stakeholders representing innovators or entrepreneurs, health system leaders, support partners, and funders (subcases). The interviews were conducted over a 2-month period between May 26 and July 22, 2021. Data were coded for key themes and synthesized around 5 propositions developed from academic publications and policy reports. Results: The findings indicated varying levels of support for each proposition, with moderate support for accessing real problems, data, training, and space for evaluations. However, the most fundamental gap appears to be in ecosystem navigation, in particular, the absence of intermediaries (eg, individuals, organizations, and technology) to provide guidance on the available support services and dependencies among the various ecosystem actors and programs. Conclusions: Navigating the systemic conditions of the digital health ecosystem is extremely challenging for entrepreneurs, especially those without prior health care experience, and this remains an issue even for those with such experience. Policy interventions aimed at increasing collaboration among ecosystem support providers, along with tools and incentives to ensure coordination, are essential as the ecosystem and those dependent on it grow. %M 36542428 %R 10.2196/36265 %U https://formative.jmir.org/2022/12/e36265 %U https://doi.org/10.2196/36265 %U http://www.ncbi.nlm.nih.gov/pubmed/36542428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40058 %T Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics %A Rey Velasco,Elena %A Pedersen,Hanne Sæderup %A Skinner,Timothy %A , %+ Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen, 1353, Denmark, 45 35324800, erv@psy.ku.dk %K telehealth %K telecoaching %K asynchronous communication %K empathy %K systemic functional linguistics %K communication %K health promotion %K coding %K linguistic analysis %K user experience %K coach-user interaction %K tool development %K lifestyle-related disease %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. Objective: This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. Methods: We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. Results: We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). Conclusions: Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users’ EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach’s abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020 %M 36538352 %R 10.2196/40058 %U https://formative.jmir.org/2022/12/e40058 %U https://doi.org/10.2196/40058 %U http://www.ncbi.nlm.nih.gov/pubmed/36538352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e34754 %T Factors Associated With Intention and Use of e–Mental Health by Mental Health Counselors in General Practices: Web-Based Survey %A De Veirman,Ann E M %A Thewissen,Viviane %A Spruijt,Matthijs G %A Bolman,Catherine A W %+ Faculty of Psychology, Open University of the Netherlands, valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 455762626, catherine.bolman@ou.nl %K mental health counselors %K general practices %K e–mental health %K adoption readiness %K eligibility for e–mental health %K e–mental health use %K mental health %K eHealth %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care counselors have a high intention to use e–mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH. Objective: The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model. Methods: To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient. Results: The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38% (mean 0.38, SD 0.22), and it was 49% (mean 0.49, SD 0.25) during the pandemic. In total, 57% of the patient population was considered eligible for EMH. Usefulness and benefits (β=.440; P<.001), Task perception (β=.306; P=.001), and Accessibility (β=.140; P=.02) explained the intention to use EMH (F3,131=54.151; P<.001; R2=0.559). In turn, intention explained patient eligibility (F1,130=34.716; P<.001; R2=0.211), whereas intention and patient eligibility explained EMH use (F2,129=41.047; P<.001; R2=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c′=0.116; P<.001) than indirect effect (c=0.065, 95% CI 0.035-0.099; P<.001). Mental health counselors assessed patients’ eligibility for EMH mainly through the availability of computers and the internet and patient motivation. Conclusions: To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients’ motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use. %M 36538357 %R 10.2196/34754 %U https://formative.jmir.org/2022/12/e34754 %U https://doi.org/10.2196/34754 %U http://www.ncbi.nlm.nih.gov/pubmed/36538357 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42249 %T Using Vocal Characteristics To Classify Psychological Distress in Adult Helpline Callers: Retrospective Observational Study %A Iyer,Ravi %A Nedeljkovic,Maja %A Meyer,Denny %+ Centre for Mental Health, Swinburne University of Technology, 34 Wakefield Street, Hawthorn, 3122, Australia, 61 456 565 575, raviiyer@swin.edu.au %K machine learning %K distress %K voice %K mental distress %K psychological stress %K artificial intelligence %K emotional distress %K voice biomarker %K biomarker %K digital health intervention %K mental health %K mental health intervention %K psychological well being %K speech analysis %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Elevated psychological distress has demonstrated impacts on individuals’ health. Reliable and efficient ways to detect distress are key to early intervention. Artificial intelligence has the potential to detect states of emotional distress in an accurate, efficient, and timely manner. Objective: The aim of this study was to automatically classify short segments of speech obtained from callers to national suicide prevention helpline services according to high versus low psychological distress and using a range of vocal characteristics in combination with machine learning approaches. Methods: A total of 120 telephone call recordings were initially converted to 16-bit pulse code modulation format. Short variable-length segments of each call were rated on psychological distress using the distress thermometer by the responding counselor and a second team of psychologists (n=6) blinded to the initial ratings. Following this, 24 vocal characteristics were initially extracted from 40-ms speech frames nested within segments within calls. After highly correlated variables were eliminated, 19 remained. Of 19 vocal characteristics, 7 were identified and validated as predictors of psychological distress using a penalized generalized additive mixed effects regression model, accounting for nonlinearity, autocorrelation, and moderation by sex. Speech frames were then grouped using k-means clustering based on the selected vocal characteristics. Finally, component-wise gradient boosting incorporating these clusters was used to classify each speech frame according to high versus low psychological distress. Classification accuracy was confirmed via leave-one-caller-out cross-validation, ensuring that speech segments from individual callers were not used in both the training and test data. Results: The sample comprised 87 female and 33 male callers. From an initial pool of 19 characteristics, 7 vocal characteristics were identified. After grouping speech frames into 2 separate clusters (correlation with sex of caller, Cramer’s V =0.02), the component-wise gradient boosting algorithm successfully classified psychological distress to a high level of accuracy, with an area under the receiver operating characteristic curve of 97.39% (95% CI 96.20-98.45) and an area under the precision-recall curve of 97.52 (95% CI 95.71-99.12). Thus, 39,282 of 41,883 (93.39%) speech frames nested within 728 of 754 segments (96.6%) were classified as exhibiting low psychological distress, and 71455 of 75503 (94.64%) speech frames nested within 382 of 423 (90.3%) segments were classified as exhibiting high psychological distress. As the probability of high psychological distress increases, male callers spoke louder, with greater vowel articulation but with greater roughness (subharmonic depth). In contrast, female callers exhibited decreased vocal clarity (entropy), greater proportion of signal noise, higher frequencies, increased breathiness (spectral slope), and increased roughness of speech with increasing psychological distress. Individual caller random effects contributed 68% to risk reduction in the classification algorithm, followed by cluster configuration (23.4%), spectral slope (4.4%), and the 50th percentile frequency (4.2%). Conclusions: The high level of accuracy achieved suggests possibilities for real-time detection of psychological distress in helpline settings and has potential uses in pre-emptive triage and evaluations of counseling outcomes. Trial Registration: ANZCTR ACTRN12622000486729; https://www.anzctr.org.au/ACTRN12622000486729.aspx %M 36534456 %R 10.2196/42249 %U https://formative.jmir.org/2022/12/e42249 %U https://doi.org/10.2196/42249 %U http://www.ncbi.nlm.nih.gov/pubmed/36534456 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42051 %T Assessing and Promoting Cardiovascular Health for Adolescent Women: User-Centered Design Approach %A Bradley,Kolbi %A Arconada Alvarez,Santiago J %A Gilmore,Amanda K %A Greenleaf,Morgan %A Herbert,Aayahna %A Kottke,Melissa J %A Parsell,Maren %A Patterson,Sierra %A Smith,Tymirra %A Sotos-Prieto,Mercedes %A Zeichner,Elizabeth %A Gooding,Holly C %+ Department of Pediatrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 4047781429, holly.gooding@emory.edu %K adolescent %K heart disease %K mHealth %K digital health intervention %K user-centered design %K cardiovascular disease %K CVD %K women's health %K risk assessment %K young adults %K assessment tool %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. Objective: The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. Methods: This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women’s Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Results: Only 10.5% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6%) or family history of CVD (8/67, 11.9%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Conclusions: Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions. %M 36534450 %R 10.2196/42051 %U https://formative.jmir.org/2022/12/e42051 %U https://doi.org/10.2196/42051 %U http://www.ncbi.nlm.nih.gov/pubmed/36534450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e43229 %T Electronic Source Data Transcription for Electronic Case Report Forms in China: Validation of the Electronic Source Record Tool in a Real-world Ophthalmology Study %A Wang,Bin %A Lai,Junkai %A Liu,Mimi %A Jin,Feifei %A Peng,Yifei %A Yao,Chen %+ Peking University Clinical Research Institute, Peking University First Hospital, No 8, Xishiku Street, Xicheng District, Beijing, 100034, China, 86 01083325822, yaochen@hsc.pku.edu.cn %K electronic medical record %K electronic health record %K electronic source %K eSource %K eSource record tool %K real-world data %K data transcription %K data quality %K System Usability Scale %K ophthalmology %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As researchers are increasingly interested in real-world studies (RWSs), improving data collection efficiency and data quality has become an important challenge. An electronic source (eSource) generally includes direct capture, collection, and storage of electronic data to simplify clinical research. It can improve data quality and patient safety and reduce clinical trial costs. Although there are already large projects on eSource technology, there is a lack of experience in using eSource technology to implement RWSs. Our team designed and developed an eSource record (ESR) system in China. In a preliminary prospective study, we selected a cosmetic medical device project to evaluate ESR software’s effect on data collection and transcription. As the previous case verification was simple, we plan to choose more complicated ophthalmology projects to further evaluate the ESR. Objective: We aimed to evaluate the data transcription efficiency and quality of ESR software in retrospective studies to verify the feasibility of using eSource as an alternative to traditional manual transcription of data in RWS projects. Methods: The approved ophthalmic femtosecond laser project was used for ESR case validation. This study compared the efficiency and quality of data transcription between the eSource method using ESR software and the traditional clinical research model of manually transcribing the data. Usability refers to the quality of a user’s experience when interacting with products or systems including websites, software, devices, or applications. To evaluate the system availability of ESR, we used the System Usability Scale (SUS). The questionnaire consisted of the following 2 parts: participant information and SUS evaluation of the electronic medical record (EMR), electronic data capture (EDC), and ESR systems. By accessing log data from the EDC system previously used by the research project, all the time spent from the beginning to the end of the study could be counted. Results: In terms of transcription time cost per field, the eSource method can reduce the time cost by 81.8% (11.2/13.7). Compared with traditional manual data transcription, the eSource method has higher data transcription quality (correct entry rate of 2356/2400, 98.17% vs 47,991/51,424, 93.32%). A total of 15 questionnaires were received with a response rate of 100%. In terms of usability, the average overall SUS scores of the EMR, EDC, and ESR systems were 50.3 (SD 21.9), 51.5 (SD 14.2), and 63.0 (SD 11.3; contract research organization experts: 69.5, SD 11.5; clinicians: 59.8, SD 10.2), respectively. The Cronbach α for the SUS items of the EMR, EDC, and ESR systems were 0.591 (95% CI −0.012 to 0.903), 0.588 (95% CI −0.288 to 0.951), and 0.785 (95% CI 0.576-0.916), respectively. Conclusions: In real-world ophthalmology studies, the eSource approach based on the ESR system can replace the traditional clinical research model that relies on the manual transcription of data. %M 36525285 %R 10.2196/43229 %U https://formative.jmir.org/2022/12/e43229 %U https://doi.org/10.2196/43229 %U http://www.ncbi.nlm.nih.gov/pubmed/36525285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40139 %T End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study %A Anderson,Molly A %A Budney,Alan J %A Jacobson,Nicholas C %A Nahum-Shani,Inbal %A Stanger,Catherine %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7023, catherine.stanger@dartmouth.edu %K cannabis %K formative %K distraction %K mindfulness %K coping %K youth %K public health %K mental health %K health intervention %K ecological momentary intervention %D 2022 %7 15.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of cravings, brief momentary interventions delivered while cravings are elevated may improve the use of strategies to cope with cravings and reduce cannabis use. Objective: The goal of this manuscript is to describe a formative study to develop coping strategy messages for use in a subsequent intervention. Methods: Young adults (aged 19-25 years; n=20) who reported using cannabis >10 of the past 30 days recruited via social media participated in this formative study. Participants rated an initial set of 15 mindfulness and 15 distraction coping strategies on a scale from 1 to 4 (very low degree to very high degree) for clarity, usefulness, and tone. They also provided comments about the content. Results: Participants found the initial distraction messages slightly clearer than mindfulness (mean 3.5, SD 0.4 and mean 3.4, SD 0.4, respectively), both were comparable in tone (mean 3.2, SD 0.5 and mean 3.2, SD 0.4, respectively), and mindfulness messages were more useful than distraction (mean 3.0, SD 0.5 and mean 2.8, SD 0.6, respectively). Of the 30 messages, 29 received a rating of very low or low (<2) on any domain by >3 participants or received a comment suggesting a change. We revised all these messages based on this feedback, and the participants rated the revised messages approximately 2 weeks later. Participants earned US $10 for completing the first and US $20 for the second survey. The ratings improved on usefulness (especially the distraction items) with very little change in clarity and tone. The top 10 messages of each coping type (mindfulness and distraction) were identified by overall average rating (collapsed across all 3 dimensions: all rated >3.0). The final items were comparable in clarity (distraction mean 3.6, SD 0.4; mindfulness mean 3.6, SD 0.4), tone (distraction mean 3.4, SD 0.4; mindfulness mean 3.4, SD 0.4), and usefulness (distraction mean 3.1, SD 0.5; mindfulness mean 3.2, SD 0.5). Conclusions: The inclusion of end users in the formative process of developing these messages was valuable and resulted in improvements to the content of the messages. The majority of the messages were changed in some way including the removal of potentially triggering language. These messages were subsequently used in an ecological momentary intervention. %M 36520509 %R 10.2196/40139 %U https://formative.jmir.org/2022/12/e40139 %U https://doi.org/10.2196/40139 %U http://www.ncbi.nlm.nih.gov/pubmed/36520509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40723 %T Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up %A Toh,Sean Han Yang %A Tan,Jessalin Hui Yan %A Kosasih,Feodora Roxanne %A Sündermann,Oliver %+ Intellect Pte Ltd, 171 Tras St, #02-179 Union Building, Singapore, S079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health %K mHealth %K randomized controlled trial %K RCT %K self-guided interventions %K cognitive behavioral therapy %K CBT %K stress coping %K stress management %K university students %K psychological mindedness %K coping self-efficacy %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective: In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods: University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results: The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta–squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions: This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration: ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896 %M 36515984 %R 10.2196/40723 %U https://formative.jmir.org/2022/12/e40723 %U https://doi.org/10.2196/40723 %U http://www.ncbi.nlm.nih.gov/pubmed/36515984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e43192 %T Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users’ Perspective and Mixed Methods Study %A Borghouts,Judith %A Eikey,Elizabeth V %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole A %A Zheng,Kai %A Wilson,Lorraine %A Caro,Damaris %A Mukamel,Dana B %A Sorkin,Dara H %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 949 438 1337, eeikey@health.ucsd.edu %K older adults %K mental health %K digital mental health intervention %K human support %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. Objective: This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. Methods: A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. Results: A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. Conclusions: Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness. %M 36512387 %R 10.2196/43192 %U https://formative.jmir.org/2022/12/e43192 %U https://doi.org/10.2196/43192 %U http://www.ncbi.nlm.nih.gov/pubmed/36512387 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42191 %T Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study %A Patel,Michele L %A Cleare,Angel E %A Smith,Carly M %A Rosas,Lisa Goldman %A King,Abby C %+ Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 650 549 7047, michele.patel@stanford.edu %K weight loss %K obesity %K behavioral intervention %K self-monitoring %K race %K ethnicity %K digital health %K diet tracking %K engagement %K randomized controlled trial %K RCT %K mobile phone %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. Objective: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. Methods: We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants’ homes and reported descriptively. Results: The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was −3.4 (95% CI −4.6 to −2.2) kg for detailed and −3.3 (95% CI −4.4 to −2.2) kg for simplified. Conclusions: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. Trial Registration: ASPREDICTED #66674; https://aspredicted.org/ka478.pdf %M 36512404 %R 10.2196/42191 %U https://formative.jmir.org/2022/12/e42191 %U https://doi.org/10.2196/42191 %U http://www.ncbi.nlm.nih.gov/pubmed/36512404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38496 %T Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria %A Nicol,Ginger %A Jansen,Madeline %A Haddad,Rita %A Ricchio,Amanda %A Yingling,Michael D %A Schweiger,Julia A %A Keenoy,Katie %A Evanoff,Bradley A %A Newcomer,John W %+ Department of Psychiatry, Washington University School of Medicine, 600 S. Taylor Ave., Suite 121, St. Louis, MO, 63110, United States, 1 13143625939, nicolg@wustl.edu %K obesity %K mentally ill people/persons %K health services %K mobile health %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI. %M 36512399 %R 10.2196/38496 %U https://formative.jmir.org/2022/12/e38496 %U https://doi.org/10.2196/38496 %U http://www.ncbi.nlm.nih.gov/pubmed/36512399 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40837 %T Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study %A Sherman,Kerry Anne %A Pehlivan,Melissa Jade %A Singleton,Anna %A Hawkey,Alexandra %A Redfern,Julie %A Armour,Mike %A Dear,Blake %A Duckworth,Tanya Jane %A Ciccia,Donna %A Cooper,Michael %A Parry,Kelly Ann %A Gandhi,Esther %A Imani,Sara A %+ Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Balaclava Rd, Sydney, 2109, Australia, 61 9850 6874, kerry.sherman@mq.edu.au %K text message %K intervention %K co-design %K development %K endometriosis %K SMS %K mHealth %K self-management %K mobile phone %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis. %M 36485029 %R 10.2196/40837 %U https://formative.jmir.org/2022/12/e40837 %U https://doi.org/10.2196/40837 %U http://www.ncbi.nlm.nih.gov/pubmed/36485029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36390 %T An Emotional Bias Modification for Children With Attention-Deficit/Hyperactivity Disorder: Co-design Study %A Zhang,Melvyn %A Ranganath,Vallabhajosyula %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 11, Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K emotional bias %K cognitive biases %K attention-deficit/hyperactivity disorder %K ADHD %K child psychiatry %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. Objective: The primary aim of this study was to collate health care professionals’ perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. Methods: A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. Results: Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. Conclusions: This study has managed to elucidate health care professionals’ perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates. %M 36485019 %R 10.2196/36390 %U https://formative.jmir.org/2022/12/e36390 %U https://doi.org/10.2196/36390 %U http://www.ncbi.nlm.nih.gov/pubmed/36485019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40404 %T Predicting Overweight and Obesity Status Among Malaysian Working Adults With Machine Learning or Logistic Regression: Retrospective Comparison Study %A Wong,Jyh Eiin %A Yamaguchi,Miwa %A Nishi,Nobuo %A Araki,Michihiro %A Wee,Lei Hum %+ Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 39289 ext 7683, wjeiin@ukm.edu.my %K overweight %K obesity %K prediction %K machine learning %K logistic regression %K etiology %K algorithms %K Malaysia %K adults %K predictive models %K accuracy %K working adults %K surveillance %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status. Objective: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia. Methods: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41% male; n=7048, 41.8% with overweight or obesity) in the Malaysia’s Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2. Results: The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79-0.82), 0.80 (95% CI 0.79-0.81), 0.80 (95% CI 0.78-0.81), and 0.78 (95% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models. Conclusions: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia. %M 36476813 %R 10.2196/40404 %U https://formative.jmir.org/2022/12/e40404 %U https://doi.org/10.2196/40404 %U http://www.ncbi.nlm.nih.gov/pubmed/36476813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40278 %T Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study %A Edwards,Caitlyn %A Orellana,Elisa %A Rawlings,Kelly %A Rodriguez-Pla,Mirta %A Venkatesan,Aarathi %+ Vida Health, 100 Montgomery St, Ste 750, San Francisco, CA, 94104, United States, 1 415 989 1017, caitlyn.edwards@vida.com %K type 2 diabetes %K digital health %K diabetes intervention %K diabetes %K mobile health %K mhealth %K app-based %K health coaching %K HbA1c %K glycemic improvements %K localization %K Spanish %K health application %K health education %K patient education %K nutrition %K digital health intervention %K health management %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. Objective: This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Methods: Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. Results: We observed a significant decrease in HbA1c of –1.23 points between baseline (mean 9.65%, SD 1.56%) and follow-up (mean 8.42%, SD 1.44%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: –1.59%, SD 1.97%; low engagement: –0.84%, SD 1.64%; P<.001). Conclusions: This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community. %M 36476397 %R 10.2196/40278 %U https://formative.jmir.org/2022/12/e40278 %U https://doi.org/10.2196/40278 %U http://www.ncbi.nlm.nih.gov/pubmed/36476397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40065 %T Certified Peer Support Specialists Training in Technology and Delivery of Digital Peer Support Services: Cross-sectional Study %A Fortuna,Karen %A Hill,Julia %A Chalker,Samantha %A Ferron,Joelle %+ Geisel School of Medicine, Department of Psychiatry, Dartmouth College, 2 Pillsbury Street, Suite 401, Concord, NH, 03301, United States, 1 603 722 5727, karen.l.fortuna@dartmouth.edu %K digital peer support %K mHealth %K COVID-19 %K mental health %K remote service %K remote mental health %K telehealth %K peer support %K psychological health %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: When the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved ones, the safety of oneself, overall well-being, unemployment, and loneliness for older individuals. While demand continues to increase and a shortage of mental health professionals persists, understanding the training, technology, media, and delivery of digital peer support services can facilitate community-based support services to assist patients in coping with mental health symptoms between clinical encounters with licensed professionals. Digital peer support consists of asynchronous and synchronous, live or automated, peer support services such as applications, social media, and phone calls. Objective: The purpose of this cross-sectional study is to determine how digital peer support is delivered, by which technologies it is delivered, and how certified digital peer supporters are trained within the United States to inform future delivery of digital peer support. Methods: We used an online cross-sectional self-report survey developed alongside certified peer specialists. The study included questions regarding the types of peer support training and the delivery methods used within their practices. We advertised the survey through a certified peer support specialist listserve, Facebook, and Twitter. Results: Certified peer specialists provide mutual social emotional support to those with a similar mental health condition. Of certified peer specialists trained in CPS, the majority of CPS specialists were trained in peer support (418/426, 98.1%). Peer support specialists deliver services via telephone calls (182/293, 62.1%), via videoconference-based services (160/293, 54.6%), via SMS text messages (123/293, 42%), via smartphone apps (68/293, 23.2%), and via social media (65/293, 22.2%). Certified peer specialists deliver services through virtual reality (11/293, 3.8%) and through video games (6/293, 2%). Virtual reality and video games may represent emerging technologies to develop and deliver community-based support. Conclusions: This study examined the modes of digital peer support intervention as well as the training and demographic background of peer supporters. Given the demand for mental health care, digital peer support emerges as one option to increase access. These results suggest that CPS specialists commonly use SMS text messaging, phone calls, and videoconferences to engage in peer support. Less frequently, they may use diverse modes such as apps, social media, and video games. It is important to consider the backgrounds of peer supporters and the mediums of communication to best accommodate areas where access to peer support is emerging. Larger longitudinal studies and a variety of experimental designs may be considered to understand the efficacy of digital interventions and digital peer support training to direct optimal care. %M 36476983 %R 10.2196/40065 %U https://formative.jmir.org/2022/12/e40065 %U https://doi.org/10.2196/40065 %U http://www.ncbi.nlm.nih.gov/pubmed/36476983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41628 %T Design of a Patient Voice App Experience for Heart Failure Management: Usability Study %A Barbaric,Antonia %A Munteanu,Cosmin %A Ross,Heather %A Cafazzo,Joseph A %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital - RFE Building, 4th floor, 190 Elizabeth St, Toronto, ON, M5G2C4, Canada, 1 416 340 4800 ext 4765, antonia.barbaric@mail.utoronto.ca %K heart failure %K self-management %K digital therapeutics %K voice-activated technology %K smart speaker %K usability study %K formative evaluation %K mobile phone %K smartphone %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups. Objective: This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study. Methods: A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design. Results: Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience. Conclusions: This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology. %M 36472895 %R 10.2196/41628 %U https://formative.jmir.org/2022/12/e41628 %U https://doi.org/10.2196/41628 %U http://www.ncbi.nlm.nih.gov/pubmed/36472895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39647 %T Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey %A Patel,Sharvil Piyush %A Sun,Elizabeth %A Reinhardt,Alec %A Geevarghese,Sanjaly %A He,Simon %A Gazmararian,Julie A %+ Omnimed Inc, 5363 Veterans Parkway, Suite C, Columbus, GA, 31904, United States, 1 706 905 2971, spatel@omnimedinc.org %K digital health %K health accessibility %K utilization %K mobile health %K mHealth %K telemedicine %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. %M 36472905 %R 10.2196/39647 %U https://formative.jmir.org/2022/12/e39647 %U https://doi.org/10.2196/39647 %U http://www.ncbi.nlm.nih.gov/pubmed/36472905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36829 %T Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study %A Kajubi,Phoebe %A Parkes-Ratanshi,Rosalind %A Twimukye,Adelline %A Bwanika Naggirinya,Agnes %A Nabaggala,Maria Sarah %A Kiragga,Agnes %A Castelnuovo,Barbara %A King,Rachel %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, PO Box 22418, Kampala, Uganda, 256 312 307000, phoebekajubi@yahoo.com %K mobile health %K mHealth %K mobile communication technologies %K people living with HIV %K antiretroviral therapy %K quality of life %K Uganda %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. Objective: This qualitative study conducted at 12 months after enrollment assessed patients’ experiences, perceptions, and attitudes regarding CLFU. Methods: We conducted a qualitative substudy within an open-label randomized controlled trial titled “Improving outcomes in HIV patients using mobile phone based interactive software support.” Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to—<25%, between 25% and 50%, and >50%—conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results: There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. Conclusions: Findings showed participants’ appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 %M 36472904 %R 10.2196/36829 %U https://formative.jmir.org/2022/12/e36829 %U https://doi.org/10.2196/36829 %U http://www.ncbi.nlm.nih.gov/pubmed/36472904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36585 %T A Web-Based Program About Sustainable Development Goals Focusing on Digital Learning, Digital Health Literacy, and Nutrition for Professional Development in Ethiopia and Rwanda: Development of a Pedagogical Method %A Bälter,Katarina %A Javan Abraham,Feben %A Mutimukwe,Chantal %A Mugisha,Reuben %A Persson Osowski,Christine %A Bälter,Olle %+ Department of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Universitetsplan 1, Västerås, 722 20, Sweden, 46 021151753, katarina.balter@mdu.se %K digital learning %K digital health literacy %K sustainable development goals %K public health %K nutrition %K question-based learning %K open learning initiative %K Rwanda %K Ethiopia %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development. Objective: This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda. Methods: A web-based program—OneLearns (Online Education for Leaders in Nutrition and Sustainability)—uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021. Results: Of the 70 applicants, 25 (36%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80%, 95% CI 64%-96%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68%, 95% CI 50%-86%) and 18 (72%, 95% CI 54%-90%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively. Conclusions: Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda. %M 36469416 %R 10.2196/36585 %U https://formative.jmir.org/2022/12/e36585 %U https://doi.org/10.2196/36585 %U http://www.ncbi.nlm.nih.gov/pubmed/36469416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39443 %T Learning the Treatment Process in Radiotherapy Using an Artificial Intelligence–Assisted Chatbot: Development Study %A Rebelo,Nathanael %A Sanders,Leslie %A Li,Kay %A Chow,James C L %+ Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Ave, 7/F, Room 7-606, Toronto, ON, M5G 1X6, Canada, 1 416 946 4501 ext 5089, james.chow@rmp.uhn.ca %K chatbot %K artificial intelligence %K machine learning %K radiotherapy chain %K radiation treatment process %K communication %K diagnosis %K cancer therapy %K internet of things %K radiation oncology %K medical physics %K health care %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In knowledge transfer for educational purposes, most cancer hospital or center websites have existing information on cancer health. However, such information is usually a list of topics that are neither interactive nor customized to offer any personal touches to people facing dire health crisis and to attempt to understand the concerns of the users. Patients with cancer, their families, and the general public accessing the information are often in challenging, stressful situations, wanting to access accurate information as efficiently as possible. In addition, there is seldom any comprehensive information specifically on radiotherapy, despite the large number of older patients with cancer, to go through the treatment process. Therefore, having someone with professional knowledge who can listen to them and provide the medical information with good will and encouragement would help patients and families struggling with critical illness, particularly during the lingering pandemic. Objective: This study created a novel virtual assistant, a chatbot that can explain the radiation treatment process to stakeholders comprehensively and accurately, in the absence of any similar software. This chatbot was created using the IBM Watson Assistant with artificial intelligence and machine learning features. The chatbot or bot was incorporated into a resource that can be easily accessed by the general public. Methods: The radiation treatment process in a cancer hospital or center was described by the radiotherapy process: patient diagnosis, consultation, and prescription; patient positioning, immobilization, and simulation; 3D-imaging for treatment planning; target and organ contouring; radiation treatment planning; patient setup and plan verification; and treatment delivery. The bot was created using IBM Watson (IBM Corp) assistant. The natural language processing feature in the Watson platform allowed the bot to flow through a given conversation structure and recognize how the user responds based on recognition of similar given examples, referred to as intents during development. Therefore, the bot can be trained using the responses received, by recognizing similar responses from the user and analyzing using Watson natural language processing. Results: The bot is hosted on a website by the Watson application programming interface. It is capable of guiding the user through the conversation structure and can respond to simple questions and provide resources for requests for information that was not directly programmed into the bot. The bot was tested by potential users, and the overall averages of the identified metrics are excellent. The bot can also acquire users’ feedback for further improvements in the routine update. Conclusions: An artificial intelligence–assisted chatbot was created for knowledge transfer regarding radiation treatment process to the patients with cancer, their families, and the general public. The bot that is supported by machine learning was tested, and it was found that the bot can provide information about radiotherapy effectively. %M 36327383 %R 10.2196/39443 %U https://formative.jmir.org/2022/12/e39443 %U https://doi.org/10.2196/39443 %U http://www.ncbi.nlm.nih.gov/pubmed/36327383 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38003 %T Spotlighting Disability in a Major Electronic Health Record: Michigan Medicine’s Disability and Accommodations Tab %A Halkides,Heather %A James,Tyler G %A McKee,Michael M %A Meade,Michelle A %A Moran,Christa %A Park,Sophia %+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 734 998 7120, jamesty@med.umich.edu %K patients with disabilities %K disability accommodations %K electronic health records %K patient-centered care %K Affordable Care Act %K Americans with Disabilities Act %K disability %K disabilities %K affordable care %K EHR %K accommodation %K minority %K equity %K accessibility %K accessible %K inclusive %K inclusivity %K health care %K health service %K environment %K accommodate %K reporting %K data collection %K barrier %D 2022 %7 2.12.2022 %9 Viewpoint %J JMIR Form Res %G English %X People with disabilities represent the largest minority group in the United States and a priority population for health services research. Despite federal civil rights law, people with disabilities face inaccessible health care environments that fail to accommodate their disability. We present Michigan Medicine’s Disability and Accommodations Tab. This patient-facing questionnaire and shared data field in the electronic health record enables the collection and reporting of patient disability-related accommodations. The Disability Tab seeks to address provider- and clinic staff–reported barriers to providing accommodations and fosters an opportunity to redesign health care to meet the needs of people with disabilities. %M 36459406 %R 10.2196/38003 %U https://formative.jmir.org/2022/12/e38003 %U https://doi.org/10.2196/38003 %U http://www.ncbi.nlm.nih.gov/pubmed/36459406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37609 %T Using Social Media to Engage Justice-Involved Young Adults in Digital Health Interventions for Substance Use: Pilot Feasibility Survey Study %A Harrison,Anna %A Folk,Johanna %A Rodriguez,Christopher %A Wallace,Amanda %A Tolou-Shams,Marina %+ Mental Health Service, San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, United States, 1 415 221 4810, anna.harrison@ucsf.edu %K substance use %K young adult %K social media %K digital health technology %K mobile phone %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults involved in the justice system have high rates of substance use disorders and low rates of treatment engagement. Most justice-involved young adults are supervised in the community—not incarcerated in jail or prison—where they have ongoing access to substances and experience significant barriers to care. When they do engage in treatment, they tend to have worse outcomes than justice-involved adolescents and older adults. Despite the need to develop targeted treatments, there are unique challenges in recruiting this population into clinical research. Digital health technology offers many novel avenues for recruiting justice-involved young adults into clinical research studies and disseminating substance use disorder treatments to justice-involved young adults. Because the vast majority of young adults regularly use one or more social media platforms, social media may offer a cost-effective and efficient way to achieve these goals. Objective: This study aimed to describe the process and feasibility of using social media platforms (Facebook and Reddit) to recruit justice-involved young adults into clinical research. Justice-involved young adults recruited from these platforms completed a survey assessing the acceptability of digital health interventions to address substance use in this population. Methods: Justice-involved young adults (aged 18-24 years) were recruited through paid advertisements placed on Facebook and Reddit. Participants responded to a web-based survey focused on their substance use, treatment use history, and acceptability of various digital health interventions focused on substance use. Results: A national sample of justice-involved young adults were successfully enrolled and completed the survey (N=131). Participants were racially diverse (8/131, 6.1% American Indian individuals; 27/131, 20.6% Asian individuals; 23/131, 17.6% Black individuals; 26/131, 19.8% Latinx individuals; 8/131, 6.1% Pacific Islander individuals; 49/131, 37.4% White individuals; and 2/131, 1.5% individuals who identified as “other” race and ethnicity). Advertisements were cost-effective (US $0.66 per click on Facebook and US $0.47 per click on Reddit). More than half (72/131, 54.9%) of the participants were on probation or parole in the past year and reported hazardous alcohol (54/131, 51.9%) or drug (66/131, 57.4%) use. Most of the participants (103/131, 78.6%) were not currently participating in substance use treatment. Nearly two-third (82/131, 62.6%) of the participants were willing to participate in one or more hypothetical digital health interventions. Conclusions: Social media is a feasible and cost-effective method for reaching justice-involved young adults to participate in substance use research trials. With limited budgets, researchers can reach a broad audience, many of whom could benefit from treatment but are not currently engaged in care. Proposed digital health interventions focusing on reducing substance use, such as private Facebook groups, SMS text message–based appointment reminders, and coaching, had high acceptability. Future work will build on these findings to develop substance use treatment interventions for this population. %M 36459404 %R 10.2196/37609 %U https://formative.jmir.org/2022/12/e37609 %U https://doi.org/10.2196/37609 %U http://www.ncbi.nlm.nih.gov/pubmed/36459404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42538 %T Perceptions and Aspirations Toward Peer Mentoring in Social Media–Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study %A Lyu,Joanne Chen %A Afolabi,Aliyyat %A White,Justin S %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K peer mentoring %K electronic nicotine delivery systems %K cessation %K social media %K adolescents and young adults %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges. Objective: The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media–based peer mentoring interventions for e-cigarette cessation among AYAs. Methods: Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media–based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach. Results: Overall, participants were receptive to peer mentoring in social media–based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors’ time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media–based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional. Conclusions: This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program. %M 36454628 %R 10.2196/42538 %U https://formative.jmir.org/2022/12/e42538 %U https://doi.org/10.2196/42538 %U http://www.ncbi.nlm.nih.gov/pubmed/36454628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e29130 %T Job Disengagement Among Physical Education Teachers: Insights From a Cross-sectional Web-Based Survey With Path Modeling Analysis %A Chalghaf,Nasr %A Chen,Wen %A Tannoubi,Amayra %A Guelmami,Noomen %A Puce,Luca %A Ben Said,Noureddine %A Ben Khalifa,Maher %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, bragazzi@yorku.ca %K Work Disengagement Scale %K work %K job %K job satisfaction %K family–work conflict %K perceived stress %K physical education %K PLS-SEM %K SmartPLS %K teacher %K engagement %K Arab %K stress %K primary school %K secondary school %K development %K measurement %K scale %K tool %K fitness %K teacher %K educator %K school %K satisfaction %K digital tool %K mental health %K family %K cross-sectional %K survey %K modelling %K psychology %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical education teachers often experience stress and job disengagement. Objective: This study’s aims were as follows: (1) to adapt in the Arabic language and test the reliability and the validity of the work–family conflict (WFC) and family–work conflict (FWC) scales, (2) to develop and assess the psychometric properties of work disengagement among physical education teachers, and (3) to evaluate an explanatory model by presenting the mediating role of perceived stress as a major influencing factor in work disengagement and job satisfaction. Methods: A total of 303 primary and secondary school physical education teachers, comprising 165 (54.5%) men and 138 (45.5%) women participated voluntarily in our study. The measuring instruments are the Work Disengagement Scale, the Perceived Stress Scale, the WFC scale, the FWC scale, and the 9-item Teacher of Physical Education Job Satisfaction Inventory. Results: The Arabic language versions of the WFC and FWC scales had reasonably adequate psychometric properties, which were justified by confirmatory factor analyses and by the measurement of reliability, convergent, and discriminant validity through the measurement model using SmartPLS software. Similarly, the structural model established with SmartPLS confirmed strong links of the concepts of FWC, WFC, the job satisfaction questionnaire, and perceived stress with work disengagement among teachers of physical education. Conclusions: There is a growing interest in helping teachers cope with the daily pressures of work and family. A positive organizational context is a context with clear values regarding work priorities, which constitutes the basis of a feeling of shared responsibility and professional support. Good conditions can act as protective factors reducing work stress and positively influencing personal well-being, work attitudes, work commitment, and professional efficiency. Additional research on teachers is needed to examine the relationship between perceived work stress and the role of families, along with the extent to which this association can have a significant impact on teachers’ commitment to work. %M 36084318 %R 10.2196/29130 %U https://formative.jmir.org/2022/12/e29130 %U https://doi.org/10.2196/29130 %U http://www.ncbi.nlm.nih.gov/pubmed/36084318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39501 %T The Relationship Between the Big Five Personality Traits and the Theory of Planned Behavior in Using Mindfulness Mobile Apps: Cross-sectional Survey %A Kim,Sunghak %A Park,Jin Young %A Chung,Kyungmi %+ Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 10 4234 3442, chungkyungmi@yuhs.ac %K personality traits %K Theory of Planned Behavior %K mindfulness %K mobile apps %K mental health %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness has emerged as a promising approach toward improving mental health. Interest in mindfulness mobile app services has also increased in recent years. Understanding the determinants of mindfulness behavior is essential to predict people’s utilization of mindfulness mobile apps and beneficial for developing and implementing relevant intervention strategies. Nevertheless, little has been done to determine the predictors of mindfulness behavior. Objective: This study investigates the association between the Big Five personality traits and the Theory of Planned Behavior (TPB) variables in the context of using mindfulness mobile apps to explore the potential indirect effects of conscientiousness and neuroticism on people’s behavioral intention for mindfulness, mediated by their attitude toward mindfulness, subjective norm about mindfulness, and perceived behavior control over mindfulness. Methods: The authors conducted an online, cross-sectional survey in December 2021. Structural equation modeling was conducted to evaluate the overall model fit and test possible linkages among conscientiousness, neuroticism, attitude toward mindfulness, subjective norm about mindfulness, perceived behavior control over mindfulness, and behavioral intention for mindfulness. Bootstrapping mediation analyses were also conducted to test the potential mediating effect in the model. Results: A total of 297 Korean participants’ responses (153 males and 144 females) were analyzed. The proposed model had a good fit. Conscientiousness was correlated with attitude toward mindfulness (β=.384, P<.001), subjective norm about mindfulness (β=.249, P<.001), and perceived behavior control over mindfulness (β=.443, P<.001). Neuroticism was not correlated with attitude toward mindfulness (β=−.072, P=.28), but was correlated with subjective norm about mindfulness (β=.217, P=.003) and perceived behavior control over mindfulness (β=−.235, P<.001). Attitude toward mindfulness (β=.508, P<.001), subjective norm about mindfulness (β=.132, P=.01), and perceived behavior control over mindfulness (β=.540, P<.001) were separately correlated with behavioral intention for mindfulness. Conscientiousness was not directly correlated with behavioral intention for mindfulness (β=−.082, P=.27), whereas neuroticism was directly correlated with behavioral intention for mindfulness (β=.194, P=.001). Conscientiousness was indirectly linked with behavioral intention for mindfulness through attitude toward mindfulness (B=0.171, 95% CI 0.103-0.251) and perceived behavior control over mindfulness (B=0.198, 95% CI 0.132-0.273) but not through subjective norm about mindfulness (B=0.023, 95% CI −0.002 to 0.060). Neuroticism was indirectly linked with behavioral intention for mindfulness via perceived behavior control over mindfulness (B=−0.138, 95% CI −0.197 to −0.088) but not via subjective norm about mindfulness (B=0.021, 95% CI −0.002 to 0.059). Conclusions: The results show that the integration of the Big Five personality traits and TPB constructs is useful in predicting the use of mindfulness mobile apps. Focusing on conscientiousness and neuroticism in developing information dissemination and implementation strategies for enhancing mindfulness behavior using mobile apps may lead to the successful promotion of mindfulness mobile apps and adherence to mindfulness techniques. %M 36449344 %R 10.2196/39501 %U https://www.jmir.org/2022/11/e39501 %U https://doi.org/10.2196/39501 %U http://www.ncbi.nlm.nih.gov/pubmed/36449344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42126 %T Web-Based Health Information–Seeking Methods and Time Since Provider Engagement: Cross-sectional Study %A Shaveet,Eden %A Urquhart,Catherine %A Gallegos,Marissa %A Dammann,Olaf %A Corlin,Laura %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 7000, eden.shaveet@tufts.edu %K internet %K social media %K information-seeking behavior %K consumer health information %K physician-patient relations %K trust %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of web-based methods to seek health information is increasing in popularity. As web-based health information (WHI)–seeking affects health-related decision support and chronic symptom self-management, WHI-seeking from online sources may impact health care decisions and outcomes, including care-seeking decisions. Patients who are routinely connected to physicians are more likely to receive better and more consistent care. Little is known about whether WHI-seeking impacts the frequency at which patients engage with health care providers. Objective: Our primary objective was to describe the associations between the use of web-based methods to seek information about one’s own health and the time since last engaging with a health care provider about one’s own health. Additionally, we aimed to assess participants’ trust in health care organizations to contextualize our findings. Methods: We analyzed data from US adults participating in the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Survey (N=1034). Bivariate associations between demographic characteristics and health information–seeking methods were assessed with Pearson chi-squared tests. Bivariate associations of Medical Mistrust Index (MMI) scores with each health information–seeking method and time since provider engagement were assessed with F tests and adjusted Wald tests. We fit a multivariable logistic regression model to assess the association between WHI-seeking within the 12 months prior to survey (alone or in combination with provider-based methods versus provider only) and engagement with a provider more than 1 year prior to the time of survey, adjusting for age, race and ethnicity, sex, education, insurance coverage, and MMI. Results: Age, race and ethnicity, educational attainment, health insurance source, MMI, and time since provider engagement were each significantly associated with the health information–seeking method in bivariate analyses. Compared to using only provider-based health information seeking methods, WHI-based methods alone or in combination with provider-based methods were associated with a 51% lower likelihood (odds ratio 0.49, 95% CI 0.27-0.87) of engaging with a provider within the previous year. Participants who used WHI-seeking methods alone and those who had not engaged with a health care provider within the previous year demonstrated a higher mean MMI score; however, MMI was not a significant predictor of time since engagement with a provider in the multivariable analysis. Conclusions: Our findings from a nationally representative survey suggest that for those who use WHI-seeking methods (alone or in combination with provider-based information-seeking methods), there is a statistically significant lower likelihood of engaging with a provider in a year compared to those who only use provider-based methods. Future research should consider the intent of a person’s visit with a provider, trust in health care systems, methods of provider engagement, and specific web-based platforms for health information. %M 36449328 %R 10.2196/42126 %U https://formative.jmir.org/2022/11/e42126 %U https://doi.org/10.2196/42126 %U http://www.ncbi.nlm.nih.gov/pubmed/36449328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40339 %T The Passive Monitoring of Depression and Anxiety Among Workers Using Digital Biomarkers Based on Their Physical Activity and Working Conditions: 2-Week Longitudinal Study %A Watanabe,Kazuhiro %A Tsutsumi,Akizumi %+ Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, 252-0374, Japan, 81 42 778 9352, kzwatanabe-tky@umin.ac.jp %K digital biomarkers %K mobile health %K mental health %K psychological distress %K depression %K anxiety %K physical activity %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital data on physical activity are useful for self-monitoring and preventing depression and anxiety. Although previous studies have reported machine or deep learning models that use physical activity for passive monitoring of depression and anxiety, there are no models for workers. The working population has different physical activity patterns from other populations, which is based on commuting, holiday patterns, physical demands, occupations, and industries. These working conditions are useful in optimizing the model used in predicting depression and anxiety. Further, recurrent neural networks increase predictive accuracy by using previous inputs on physical activity, depression, and anxiety. Objective: This study evaluated the performance of a deep learning model optimized for predicting depression and anxiety in workers. Psychological distress was considered a depression and anxiety indicator. Methods: A 2-week longitudinal study was conducted with workers in urban areas in Japan. Absent workers were excluded. In a daily survey, psychological distress was measured using a self-reported questionnaire. As features, activity time by intensity was determined using the Google Fit application. Additionally, we measured age, gender, occupations, employment status, work shift types, working hours, and whether the response date was a working or nonworking day. A deep learning model, using long short-term memory, was developed and validated to predict psychological distress the next day, using features of the previous day. Further, a 5-fold cross-validation method was used to evaluate the performance of the aforementioned model. As the primary indicator of performance, classification accuracy for the severity of the psychological distress (light, subthreshold, and severe) was considered. Results: A total of 1661 days of supervised data were obtained from 236 workers, who were aged between 20 and 69 years. The overall classification accuracy for psychological distress was 76.3% (SD 0.04%). The classification accuracy for severe-, subthreshold-, and light-level psychological distress was 51.1% (SD 0.05%), 60.6% (SD 0.05%), and 81.6% (SD 0.04%), respectively. The model predicted a light-level psychological distress the next day after the participants had been involved in 3 peaks of activity (in the morning, noon, and evening) on the previous day. Lower activity levels were predicted as subthreshold- and severe-level psychological distress. Different predictive results were observed on the basis of occupations and whether the previous day was a working or nonworking day. Conclusions: The developed deep learning model showed a similar performance as in previous studies and, in particular, high accuracy for light-level psychological distress. Working conditions and long short-term memory were useful in maintaining the model performance for monitoring depression and anxiety, using digitally recorded physical activity in workers. The developed model can be implemented in mobile apps and may further be practically used by workers to self-monitor and maintain their mental health state. %M 36449342 %R 10.2196/40339 %U https://formative.jmir.org/2022/11/e40339 %U https://doi.org/10.2196/40339 %U http://www.ncbi.nlm.nih.gov/pubmed/36449342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39199 %T End Users’ and Other Stakeholders’ Needs and Requirements in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People With Dementia or Parkinson Disease: Mixed Methods Study %A Ahmed,Mona %A Marín,Mayca %A How,Daniella %A Judica,Elda %A Tropea,Peppino %A Bentlage,Ellen %A J Ferreira,Joaquim %A Bouça-Machado,Raquel %A Brach,Michael %+ Institute of Sport and Exercise Sciences, Münster University, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 25183 ext 34812, mona.ahmad@uni-muenster.de %K neurodegenerative %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K integrated care %K information and communication technology %K ICT %K user-centered design %K mobile phone %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With what has been known as the “triple-win effect”, introducing information and communication technologies (ICTs) in the health care of neurodegenerative diseases is beneficial in delaying the need for institutional care, reducing the associated health care costs, reducing the caregiving burden, and improving individuals’ quality of life. Nevertheless, the mismatch between the users’ expectations and their actual needs remains one of the main challenges that can reduce the usability of technology solutions. Therefore, the European project Personalized Integrated Care Promoting Quality of Life for Older People (PROCare4Life), which aimed to develop an ICT-based platform for all parties involved in the health care of neurodegenerative diseases, adopted a user-centered design approach, where all users are involved from the inception and throughout the platform development and implementation to integrate their needs and requirements in the proposed platform. Objective: This paper presents the results of a study on the needs and requirements of the potential end users (older people with neurodegenerative diseases, caregivers, and health care professionals) and other key stakeholders in the development of the PROCare4Life platform. Methods: A mixed qualitative and quantitative study design was used, including 2 web-based surveys, 40 interviews, and 4 workshops. The study was conducted between April and September 2020 in 5 European countries: Germany, Italy, Portugal, Romania, and Spain. Both data types were analyzed separately and then merged and interpreted, with greater priority placed on qualitative research. Results: A total of 217 participants were recruited; 157 (72.4%) of them completed the web-based surveys (n=85, 54.1% patients and n=72, 45.9% caregivers), and 60 (27.6%) individuals participated in the qualitative research (20/60, 33% health care professionals; 5/60, 8% patients; 5/60, 8% caregivers; and 30/60, 50% key stakeholders). We identified 3 main themes (T): (T1) experiences associated with illness, (T2) thoughts about the platform technology, and (T3) desired properties. Alerts for adverse events, communication tools, reminders, and monitoring are constantly needed functionalities, whereas ease of use, personalization, and user-friendliness are foreseen as necessary features. Conclusions: This paper identified the key personal, social, and health factors that influence the daily lives of the potential end users and reflected on their needs and expectations regarding the design of the proposed PROCare4Life platform. The collected data were useful for the development of the PROCare4Life platform. Although the combination and collection of features for diverse user groups are typical for integrated care platforms, it results in exponential complexity for designers, developers, and users. Contradicting opinions and several concerns in this study demonstrate that an ICT-integrated care platform should not promise too much for too many. Instead, selection, focus, and, sometimes, restriction to essentials are necessary. Users and other stakeholders should be involved in these decisions. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 36449340 %R 10.2196/39199 %U https://formative.jmir.org/2022/11/e39199 %U https://doi.org/10.2196/39199 %U http://www.ncbi.nlm.nih.gov/pubmed/36449340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38357 %T Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis %A Pullyblank,Kristin %A Atav,Serdar %+ Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, United States, 1 6075476711, kristin.pullyblank@bassett.org %K self-management programs %K self management %K internet-based intervention %K health promotion %K COVID-19 %K health equity %K socioeconomic status %K remote healthcare %K health delivery %K virtual care %K remote care %K remote delivery %K videoconference %K videoconferencing %K adherence %K attrition %K completion %K virtual health %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity. %M 36413622 %R 10.2196/38357 %U https://formative.jmir.org/2022/11/e38357 %U https://doi.org/10.2196/38357 %U http://www.ncbi.nlm.nih.gov/pubmed/36413622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e27421 %T Using Magnetic Resonance Imaging During Childbirth to Demonstrate Fetal Head Moldability and Brain Compression: Prospective Cohort Study %A Ami,Olivier %A Maran,Jean-Christophe %A Musset,Dominique %A Dubray,Claude %A Mage,Gérard %A Boyer,Louis %+ Clinique de la Muette - Ramsay Santé, 46 rue Nicolo, Paris, 75116, France, 33 661143924, olivier.ami@birthimaging.com %K parturition %K magnetic resonance imaging %K obstetrics %K fetus %K cephalopelvic disproportion %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. %M 36322921 %R 10.2196/27421 %U https://formative.jmir.org/2022/11/e27421 %U https://doi.org/10.2196/27421 %U http://www.ncbi.nlm.nih.gov/pubmed/36322921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33952 %T Fitbits for Monitoring Depressive Symptoms in Older Aged Persons: Qualitative Feasibility Study %A Mughal,Fiza %A Raffe,William %A Stubbs,Peter %A Kneebone,Ian %A Garcia,Jaime %+ Faculty of Engineering and IT, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, 2007, Australia, 61 4 5262 7824, fiza.mughal@uts.edu.au %K digital mental health %K Fitbit %K smartwatch %K smart wearable %K geriatric %K aging %K health informatics %K feasibility %K usability %K older aged %D 2022 %7 29.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2022, an estimated 1.105 billion people used smart wearables and 31 million used Fitbit devices worldwide. Although there is growing evidence for the use of smart wearables to benefit physical health, more research is required on the feasibility of using these devices for mental health and well-being. In studies focusing on emotion recognition, emotions are often inferred and dependent on external cues, which may not be representative of true emotional states. Objective: The aim of this study was to evaluate the feasibility and acceptability of using consumer-grade activity trackers for apps in the remote mental health monitoring of older aged people. Methods: Older adults were recruited using criterion sampling. Participants were provided an activity tracker (Fitbit Alta HR) and completed weekly online questionnaires, including the Geriatric Depression Scale, for 4 weeks. Before and after the study period, semistructured qualitative interviews were conducted to provide insight into the acceptance and feasibility of performing the protocol over a 4-week period. Interview transcripts were analyzed using a hybrid inductive-deductive thematic analysis. Results: In total, 12 participants enrolled in the study, and 9 returned for interviews after the study period. Participants had positive attitudes toward being remotely monitored, with 78% (7/9) of participants experiencing no inconvenience throughout the study period. Moreover, 67% (6/9) were interested in trialing our prototype when it is implemented. Participants stated they would feel more comfortable if mental well-being was being monitored by carers remotely. Conclusions: Fitbit-like devices were an unobtrusive and convenient tool to collect physiological user data. Future research should integrate physiological user inputs to differentiate and predict depressive tendencies in users. %M 36268552 %R 10.2196/33952 %U https://formative.jmir.org/2022/11/e33952 %U https://doi.org/10.2196/33952 %U http://www.ncbi.nlm.nih.gov/pubmed/36268552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42343 %T Feasibility of a Reinforcement Learning–Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study %A Bucher,Amy %A Blazek,E Susanne %A West,Ashley B %+ Lirio, 320 Corporate Drive, NW, Knoxville, TN, 37923, United States, 1 865 839 6158, abucher@lirio.com %K artificial intelligence %K reinforcement learning %K feasibility studies %K mammograms %K nudging %K behavioral intervention %K digital health %K email %K health equity %K cancer screening %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). Objective: The aim of this study was to establish the feasibility of a reinforcement learning–enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention’s reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. Methods: The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system’s existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science–based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. Results: In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. Conclusions: The reinforcement learning–enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact. %M 36441579 %R 10.2196/42343 %U https://formative.jmir.org/2022/11/e42343 %U https://doi.org/10.2196/42343 %U http://www.ncbi.nlm.nih.gov/pubmed/36441579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41489 %T How to Use the Six-Step Digital Ethnography Framework to Develop Buyer Personas: The Case of Fan Fit %A Fenton,Alex %A Heinze,Aleksej %A Osborne,McVal %A Ahmed,Wasim %+ Management School, University of Stirling, Stirling, FK9 4LA, United Kingdom, 44 1786 467, Wasim.Ahmed@Stirling.ac.uk %K health tracking %K digital %K ethnography %K apps %K mobile app %K customer %K physical activity %D 2022 %7 25.11.2022 %9 Viewpoint %J JMIR Form Res %G English %X Background: One of the key features of digital marketing is customer centricity, which can be applied to the domain of health. This is expressed through the ability to target specific customer segments with relevant content using appropriate channels and having data to track and understand each interaction. In order to do this, marketers create buyer personas based on a wide spectrum of quantitative and qualitative data. Digital ethnography is another established method for studying web-based communities. However, for practitioners, the complexity, rigor, and time associated with ethnographical work are sometimes out of reach. Objective: This paper responds to the gaps in the practically focused method of using social media for digital ethnography to develop buyer personas. This paper aims to demonstrate how digital ethnography can be used as a way to create and refine buyer personas. Methods: Using a case study of the Fan Fit smartphone app, which aimed to increase physical activity, a digital ethnography was applied to create a better understanding of customers and to create and refine buyer personas. Results: We propose two buyer personas, and we develop a 6-step digital ethnography framework designed for the development of buyer personas. Conclusions: The key contribution of this work is the proposal of a 6-step digital ethnography framework designed for the development of buyer personas. We highlight that the 6-step digital ethnography could be a robust tool for practitioners and academicians to analyze digital communications for the process of creating and updating data-driven buyer personas to create deeper insights into digital and health marketing efforts. %M 36427232 %R 10.2196/41489 %U https://formative.jmir.org/2022/11/e41489 %U https://doi.org/10.2196/41489 %U http://www.ncbi.nlm.nih.gov/pubmed/36427232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39322 %T Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries %A Kanning,Martina %A Bollenbach,Lukas %A Schmitz,Julian %A Niermann,Christina %A Fina,Stefan %+ Department of Sport Science, University of Konstanz, Universitätsstraße 10, Konstanz, 78464, Germany, 49 7531 883651, martina.kanning@uni-konstanz.de %K ecological momentary assessment %K active transport %K socio-ecological model %K subjective well-being %K mental health %K urban health %K GEMA %K geographically explicit ecological momentary assessment %K behaviour change %K walking %K experience %K environment %K monitoring %K activity %K tracking %K e-diary %K assessment %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints. Objective: This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies. Methods: The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary. Results: Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations). Conclusions: Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy. %M 36427231 %R 10.2196/39322 %U https://formative.jmir.org/2022/11/e39322 %U https://doi.org/10.2196/39322 %U http://www.ncbi.nlm.nih.gov/pubmed/36427231 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30285 %T Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: Randomized Technology-Supported Trial %A Kaseva,Kaisa %A Tervaniemi,Mari %A Heikura,Enni %A Kostilainen,Kaisamari %A Pöyhönen-Alho,Maritta %A Shoemaker,J Kevin %A Petrella,Robert J %A Peltonen,Juha E %+ Department of Sport and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Alppikatu 2, Helsinki, 00530, Finland, 358 443077737, kaisa.kaseva@helsinki.fi %K randomized trial %K physical activity %K lifestyles %K personality %K psychological well-being %K study attrition %K mental health %K lifestyle interventions %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Data attrition has been a common problem in longitudinal lifestyle interventions. The contributors to attrition in technology-supported physical activity interventions have not been thoroughly studied. Objective: The present study examined the roles of personality characteristics and indicators of psychological well-being in data attrition within a technology-supported, longitudinal intervention study with overweight adults. Methods: Participants (N=89) were adults from the Motivation Makes the Move! intervention study. Data attrition was studied after a 3-month follow-up. Participants’ personality characteristics were studied using the Short Five self-report questionnaire. Psychological well-being indicators were assessed with the RAND 36-item health survey, Positive and Negative Affect Schedule, and Beck Depression Inventory. Logistic regression analyses were conducted to assess the risk of discontinuing the study. The analyses were adjusted for sex, age, study group, and educational status. Results: At the 3-month follow-up, 65 of 89 participants (73% of the initial sample) had continued in the study. Participants’ personality characteristics and indicators of psychological well-being were not associated with the risk of dropping out of the study (all P values >.05). The results remained the same after covariate controls. Conclusions: Participant attrition was not attributable to personality characteristics or psychological well-being in the Motivation Makes the Move! study conducted with overweight adults. As attrition remains a challenge within longitudinal, technology-supported lifestyle interventions, attention should be paid to the potentially dynamic natures of personality and psychological well-being, as well as other elements beyond these. Trial Registration: ClinicalTrials.gov NCT02686502; https://clinicaltrials.gov/ct2/show/NCT02686502 %M 36427239 %R 10.2196/30285 %U https://formative.jmir.org/2022/11/e30285 %U https://doi.org/10.2196/30285 %U http://www.ncbi.nlm.nih.gov/pubmed/36427239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39185 %T Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation %A Pech,Marion %A Gbessemehlan,Antoine %A Dupuy,Lucile %A Sauzéon,Hélène %A Lafitte,Stéphane %A Bachelet,Philippe %A Amieva,Hélène %A Pérès,Karine %+ Bordeaux Population Health Research Center, Inserm, UMR 1219, University of Bordeaux, 146 rue Léo Saignat, Bordeaux, 33076, France, 33 667455145, marion.pech@u-bordeaux.fr %K voice assistance %K social isolation %K healthy aging %K living in place %K acceptability %K technologies %K digital divide %K older adults %K aging %K elderly population %K voice assistant %K COVID-19 %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4%) left the experimentation before its end and 69 (63.3%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75%) considered BeeVA as a reassuring presence, and few persons (15/69, 22%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82%) and useful (n=53, 77%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. %M 36355629 %R 10.2196/39185 %U https://formative.jmir.org/2022/11/e39185 %U https://doi.org/10.2196/39185 %U http://www.ncbi.nlm.nih.gov/pubmed/36355629 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40242 %T Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study %A Nicol,Ginger %A Wang,Ruoyun %A Graham,Sharon %A Dodd,Sherry %A Garbutt,Jane %+ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Washington University School of Medicine, 600 S Taylor Ave, Suite 121, St Louis, MO, 63110, United States, 1 3143625939, nicolg@wustl.edu %K COVID-19 %K adolescent depression %K mobile health %K cognitive behavioral therapy %K chatbot %K relational conversational agent %K depression %K anxiety %K suicide %K self-harm %K pandemic %K pediatric %K youth %K adolescent %K adolescence %K psychiatry %K conversational agent %K CBT %K clinic %K data %K acceptability %K feasibility %K usability %K primary care %K intervention %K mental health %K digital health %K technology mediated %K computer mediated %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053 %M 36413390 %R 10.2196/40242 %U https://formative.jmir.org/2022/11/e40242 %U https://doi.org/10.2196/40242 %U http://www.ncbi.nlm.nih.gov/pubmed/36413390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e26925 %T Patients’ and Health Care Providers’ Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study %A Khusial,Rishi %A van Koppen,Sophia %A Honkoop,Persijn %A Rijssenbeek-Nouwens,Lucia %A Fieten,Karin Berthine %A Keij,Sascha %A Drijver-Messelink,Marieke %A Sont,Jacob %+ Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, Netherlands, 31 7152 64574, r.j.khusial@lumc.nl %K eHealth %K mobile health %K mHealth %K asthma %K self-management %K home monitoring %K mobile phone %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. Objective: In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. Methods: In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. Results: In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients). Conclusions: Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users. %M 36413384 %R 10.2196/26925 %U https://formative.jmir.org/2022/11/e26925 %U https://doi.org/10.2196/26925 %U http://www.ncbi.nlm.nih.gov/pubmed/36413384 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39357 %T A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study %A Fee,Connie %A Fuller,Julia %A Guss,Carly E %A Woods,Elizabeth R %A Cooper,Ellen R %A Bhaumik,Urmi %A Graham,Dionne %A Burchett,Sandra K %A Dumont,Olivia %A Martey,Emily B %A Narvaez,Maria %A Haberer,Jessica E %A Swendeman,Dallas %A Mulvaney,Shelagh A %A Kumar,Vikram S %A Jackson,Jonathan L %A Ho,Y Xian %+ Dimagi, Inc, 585 Massachusetts Ave., Suite 3, Cambridge, MA, 02139-4075, United States, 1 617 649 2214 ext 63, yho@dimagi.com %K HIV %K case management %K youth %K young adult %K mobile health %K mHealth %K digital health %K mobile phone %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods: We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Conclusions: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial Registration: ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066 %M 36409541 %R 10.2196/39357 %U https://formative.jmir.org/2022/11/e39357 %U https://doi.org/10.2196/39357 %U http://www.ncbi.nlm.nih.gov/pubmed/36409541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40996 %T Regular Testing of HIV and Sexually Transmitted Infections With Self-Collected Samples From Multiple Anatomic Sites to Monitor Sexual Health in Men Who Have Sex With Men: Longitudinal Study %A Wong,Ngai Sze %A Kwan,Tsz Ho %A Chan,Denise P C %A Lui,Grace C Y %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China, 86 22528812, sslee@cuhk.edu.hk %K HIV testing %K STI testing %K self-sampling %K internet-based testing %K men who have sex with men %K HIV %K monitoring %K sex %K infection %K prevention %K community %K engagement %K cohort study %K testing %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular HIV and sexually transmitted infection (STI) testing for men who have sex with men (MSM) is an important means of infection prevention, the adoption of which remains suboptimal in the community. Objective: On the hypothesis that engagement plays an important role in sexual health monitoring, this study aimed to pilot-test internet-based HIV and STI testing with self-sampling to enhance engagement of MSM with regular testing. Methods: This 1-year cohort study was conducted on HIV-negative MSM aged 18 years or older. A designated website was set up to enable participants to make appointments for baseline and follow-up visits at 3-monthly intervals. On-site blood sampling was performed for HIV and syphilis tests, along with self-collection of pharyngeal swabs, rectal swabs, and urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Full engagement, as defined by having made at least 3 visits over a 6-12 months’ follow-up period, was compared with partial engagement in the bivariable logistic regression model. Results: Between August 2019 and October 2020, 204 MSM were recruited, after the exclusion of 2 baseline HIV-positive MSM. The majority (189/204, 92.7%) were Chinese, the median age was 31 (IQR 26-39) years, and 58.0% (116/200) had experience with pre-exposure prophylaxis (PrEP) at baseline. Full engagement (146/204, 71.6%) was associated with incident STI during the follow-ups (odds ratio [OR] 4.23, 95% CI 1.63-10.94), seeking a medical referral after STI detection (OR 10.25, 95% CI 3.25-29.79), and a synchronized schedule of HIV and STI testing with PrEP visits (OR 51.85, 95% CI 19.30-139.34). No incident HIV was detected in the follow-up period. At baseline, the overall STI (CT, NG, or syphilis) prevalence was 30%, with CT at 18%, NG at 13%, and syphilis at 5%. During follow-up, the incidences were 59.08/100 person-years (py) for any STI, 33.05/100 py for CT, 29.86/100 py for NG, and 10.4/100 py for syphilis. The detection rates of CT and NG in urine samples were lower than with pharyngeal swabs and rectal swabs. The scores for convenience, confidence of correct sampling, and accuracy of self-sampling were high (7 to 8 out of 10). Conclusions: Both baseline prevalence and incidence of STI were high among MSM engaged in regular testing. A high degree of engagement in regular STI and HIV testing was positively associated with incident STI, history of health-seeking behaviors, and perceived convenience of self-sampling. Self-sampling could be introduced as a means of enhancing engagement in regular HIV and STI testing. %M 36399372 %R 10.2196/40996 %U https://formative.jmir.org/2022/11/e40996 %U https://doi.org/10.2196/40996 %U http://www.ncbi.nlm.nih.gov/pubmed/36399372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38677 %T Extraction and Quantification of Words Representing Degrees of Diseases: Combining the Fuzzy C-Means Method and Gaussian Membership %A Han,Feng %A Zhang,ZiHeng %A Zhang,Hongjian %A Nakaya,Jun %A Kudo,Kohsuke %A Ogasawara,Katsuhiko %+ Graduate School of Health Sciences, Medical Management and Informatics, Hokkaido University, N12 W5, Sapporo, 060-0812, Japan, 81 011 706 3409, oga@hs.hokudai.ac.jp %K medical text %K fuzzy c-means %K cluster %K algorithm %K machine learning %K word quantification %K fuzzification %K Gauss %K radiology %K medical report %K documentation %K text mining %K data mining %K extraction %K unstructured %K free text %K quantification %K fuzzy %K diagnosis %K diagnostic %K EHR %K support system %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the development of medical data, a large amount of clinical data has been generated. These unstructured data contain substantial information. Extracting useful knowledge from this data and making scientific decisions for diagnosing and treating diseases have become increasingly necessary. Unstructured data, such as in the Marketplace for Medical Information in Intensive Care III (MIMIC-III) data set, contain several ambiguous words that demonstrate the subjectivity of doctors, such as descriptions of patient symptoms. These data could be used to further improve the accuracy of medical diagnostic system assessments. To the best of our knowledge, there is currently no method for extracting subjective words that express the extent of these symptoms (hereinafter, “degree words”). Objective: Therefore, we propose using the fuzzy c-means (FCM) method and Gaussian membership to quantify the degree words in the clinical medical data set MIMIC-III. Methods: First, we preprocessed the 381,091 radiology reports collected in MIMIC-III, and then we used the FCM method to extract degree words from unstructured text. Thereafter, we used the Gaussian membership method to quantify the extracted degree words, which transform the fuzzy words extracted from the medical text into computer-recognizable numbers. Results: The results showed that the digitization of ambiguous words in medical texts is feasible. The words representing each degree of each disease had a range of corresponding values. Examples of membership medians were 2.971 (atelectasis), 3.121 (pneumonia), 2.899 (pneumothorax), 3.051 (pulmonary edema), and 2.435 (pulmonary embolus). Additionally, all extracted words contained the same subjective words (low, high, etc), which allows for an objective evaluation method. Furthermore, we will verify the specific impact of the quantification results of ambiguous words such as symptom words and degree words on the use of medical texts in subsequent studies. These same ambiguous words may be used as a new set of feature values to represent the disorders. Conclusions: This study proposes an innovative method for handling subjective words. We used the FCM method to extract the subjective degree words in the English-interpreted report of the MIMIC-III and then used the Gaussian functions to quantify the subjective degree words. In this method, words containing subjectivity in unstructured texts can be automatically processed and transformed into numerical ranges by digital processing. It was concluded that the digitization of ambiguous words in medical texts is feasible. %M 36399376 %R 10.2196/38677 %U https://formative.jmir.org/2022/11/e38677 %U https://doi.org/10.2196/38677 %U http://www.ncbi.nlm.nih.gov/pubmed/36399376 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42955 %T Postpartum Migraine Headache Coding in Electronic Health Records of a Large Integrated Health Care System: Validation Study %A Shi,Jiaxiao %A Fassett,Michael J %A Chiu,Vicki Y %A Avila,Chantal C %A Khadka,Nehaa %A Brown,Brittany %A Patel,Pooja %A Mensah,Nana %A Xie,Fagen %A Peltier,Morgan R %A Getahun,Darios %+ Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Avenue, Pasadena, CA, 91101, United States, 1 626 564 5658, Darios.T.Getahun@kp.org %K migraine headache %K validation %K diagnosis %K pharmacy %K postpartum %K medical record %K health plan %K electronic health record %K coding %K pharmacy record %K diagnostic code %K EHR system %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Migraine is a common neurological disorder characterized by repeated headaches of varying intensity. The prevalence and severity of migraine headaches disproportionally affects women, particularly during the postpartum period. Moreover, migraines during pregnancy have been associated with adverse maternal outcomes, including preeclampsia and postpartum stroke. However, due to the lack of a validated instrument for uniform case ascertainment on postpartum migraine headache, there is uncertainty in the reported prevalence in the literature. Objective: The aim of this study was to evaluate the completeness and accuracy of reporting postpartum migraine headache coding in a large integrated health care system’s electronic health records (EHRs) and to compare the coding quality before and after the implementation of the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes and pharmacy records in EHRs. Methods: Medical records of 200 deliveries in all 15 Kaiser Permanente Southern California hospitals during 2 time periods, that is, January 1, 2012 through December 31, 2014 (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] coding period) and January 1, 2017 through December 31, 2019 (ICD-10-CM coding period), were randomly selected from EHRs for chart review. Two trained research associates reviewed the EHRs for all 200 women for postpartum migraine headache cases documented within 1 year after delivery. Women were considered to have postpartum migraine headache if either a mention of migraine headache (yes for diagnosis) or a prescription for treatment of migraine headache (yes for pharmacy records) was noted in the electronic chart. Results from the chart abstraction served as the gold standard and were compared with corresponding diagnosis and pharmacy prescription utilization records for both ICD-9-CM and ICD-10-CM coding periods through comparisons of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), as well as the summary statistics of F-score and Youden J statistic (J). The kappa statistic (κ) for interrater reliability was calculated. Results: The overall agreement between the identification of migraine headache using diagnosis codes and pharmacy records compared to the medical record review was strong. Diagnosis coding (F-score=87.8%; J=82.5%) did better than pharmacy records (F-score=72.7%; J=57.5%) when identifying cases, but combining both of these sources of data produced much greater accuracy in the identification of postpartum migraine cases (F-score=96.9%; J=99.7%) with sensitivity, specificity, PPV, and NPV of 100%, 99.7%, 93.9%, and 100%, respectively. Results were similar across the ICD-9-CM (F-score=98.7%, J=99.9%) and ICD-10-CM coding periods (F-score=94.9%; J=99.6%). The interrater reliability between the 2 research associates for postpartum migraine headache was 100%. Conclusions: Neither diagnostic codes nor pharmacy records alone are sufficient for identifying postpartum migraine cases reliably, but when used together, they are quite reliable. The completeness of the data remained similar after the implementation of the ICD-10-CM coding in the EHR system. %M 36394937 %R 10.2196/42955 %U https://formative.jmir.org/2022/11/e42955 %U https://doi.org/10.2196/42955 %U http://www.ncbi.nlm.nih.gov/pubmed/36394937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38780 %T Acceptability to and Engagement With a Virtual Sickle Cell Trait Education Program (SCTaware): Single-Center Prospective Study %A Beeman,Chase M %A Abrams,Mary Ann %A Zajo,Kristin N %A Stanek,Joseph %A O'Brien,Sarah H %A Chan,Peter %A Shen,Yvette %A McCorkle,Ben %A Johnson,Latrice %A Chisolm,Deena %A Barnard-Kirk,Toyetta %A Mahan,John D %A Martinez-Mendez,Alexandra %A Phillips,Whitney L %A Creary,Susan E %+ Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, The Ohio State University, 700 Children’s Dr, Columbus, OH, 43205, United States, 1 614 722 3569, susan.creary@nationwidechildrens.org %K virtual education %K remote education %K internet-based %K health education %K hematology %K patient education %K sickle cell %K genetic %K child %K parenting %K sickle cell trait %K public health education %K acceptability %K Hemoglobin S-trait %K screening %K newborn %K eHealth %K digital health %K telemedicine %K telehealth %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Public health programs are tasked with educating the community on health topics, but it is unclear whether these programs are acceptable to learners. Currently, these programs are delivered via a variety of platforms including in-person, virtually, and over the telephone. Sickle cell trait (SCT) education for parents of children with this trait is one of many education programs provided by the Ohio Department of Health. The novel SCTaware videoconference education program was developed by a research team after central Ohio’s standard program transitioned from in-person to telephone-only education during the COVID-19 pandemic. Objective: Our objectives were to investigate the acceptability of the format and engagement with the SCTaware education and assess parental worry about having a child with SCT before and after receiving SCTaware. Methods: This was a single-center, prospective study of English-speaking parents of children <3 years of age identified to have hemoglobin S trait by newborn screening. Parents who previously received SCT education by telephone, were able to be contacted, and had access to an electronic device capable of videoconferencing were eligible to complete surveys after receiving the virtual SCTaware education program. The SCTaware educator also completed a survey to assess participant engagement. Data were summarized descriptively and a McNemar test was used to compare parental worry before and after receiving SCTaware. Results: In total, 55 participants completed follow-up surveys after receiving standard SCT telephone education and then completing SCTaware. Most (n=51) participants reported that the SCTaware content and visuals were very easy to understand (n=47) and facilitated conversation with the educator (n=42). All of them said the visuals were respectful and trustworthy, helped them understand content better, and that their questions were addressed. Nearly two-thirds (62%, n=34) reported that the pictures appeared very personal and applied to them. The educator noted most participants (n=45) were engaged and asked questions despite having to manage distractions during their education sessions. Many participants (n=33) reported some level of worry following telephone-only education; this was significantly reduced after receiving SCTaware (P<.001). Conclusions: Our results suggest that SCTaware is acceptable and engaging to parents. While telephone education may make SCT education more accessible, these findings suggest that many parents experience significant worry about their child with SCT after these sessions. A study to evaluate SCTaware’s effectiveness at closing parents’ SCT knowledge gaps is ongoing. %M 36394943 %R 10.2196/38780 %U https://formative.jmir.org/2022/11/e38780 %U https://doi.org/10.2196/38780 %U http://www.ncbi.nlm.nih.gov/pubmed/36394943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36340 %T Measurement of Vital Signs Using Lifelight Remote Photoplethysmography: Results of the VISION-D and VISION-V Observational Studies %A Heiden,Emily %A Jones,Tom %A Brogaard Maczka,Annika %A Kapoor,Melissa %A Chauhan,Milan %A Wiffen,Laura %A Barham,Helen %A Holland,Jeremy %A Saxena,Manish %A Wegerif,Simon %A Brown,Thomas %A Lomax,Mitch %A Massey,Heather %A Rostami,Shahin %A Pearce,Laurence %A Chauhan,Anoop %+ Mind Over Matter Medtech Ltd, Kemp House, London, EC1V 2NX, United Kingdom, 44 7881 927063, melissa@mind-medtech.com %K general practice %K vital signs/methods %K vital signs/standards %K photoplethysmography %K remote photoplethysmography %K remote photoplethysmography %K Lifelight %K contactless %K software %K algorithm development %K algorithm %K blood pressure %K health monitoring %K health technology %K remote monitoring %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The detection of early changes in vital signs (VSs) enables timely intervention; however, the measurement of VSs requires hands-on technical expertise and is often time-consuming. The contactless measurement of VSs is beneficial to prevent infection, such as during the COVID-19 pandemic. Lifelight is a novel software being developed to measure VSs by remote photoplethysmography based on video captures of the face via the integral camera on mobile phones and tablets. We report two early studies in the development of Lifelight. Objective: The objective of the Vital Sign Comparison Between Lifelight and Standard of Care: Development (VISION-D) study (NCT04763746) was to measure respiratory rate (RR), pulse rate (PR), and blood pressure (BP) simultaneously by using the current standard of care manual methods and the Lifelight software to iteratively refine the software algorithms. The objective of the Vital Sign Comparison Between Lifelight and Standard of Care: Validation (VISION-V) study (NCT03998098) was to validate the use of Lifelight software to accurately measure VSs. Methods: BP, PR, and RR were measured simultaneously using Lifelight, a sphygmomanometer (BP and PR), and the manual counting of RR. Accuracy performance targets for each VS were defined from a systematic literature review of the performance of state-of-the-art VSs technologies. Results: The VISION-D data set (17,233 measurements from 8585 participants) met the accuracy targets for RR (mean error 0.3, SD 3.6 vs target mean error 2.3, SD 5.0; n=7462), PR (mean error 0.3, SD 4.0 vs mean error 2.2, SD 9.2; n=10,214), and diastolic BP (mean error −0.4, SD 8.5 vs mean error 5.5, SD 8.9; n=8951); for systolic BP, the mean error target was met but not the SD (mean error 3.5, SD 16.8 vs mean error 6.7, SD 15.3; n=9233). Fitzpatrick skin type did not affect accuracy. The VISION-V data set (679 measurements from 127 participants) met all the standards: mean error −0.1, SD 3.4 for RR; mean error 1.4, SD 3.8 for PR; mean error 2.8, SD 14.5 for systolic BP; and mean error −0.3, SD 7.0 for diastolic BP. Conclusions: At this early stage in development, Lifelight demonstrates sufficient accuracy in the measurement of VSs to support certification for a Level 1 Conformité Européenne mark. As the use of Lifelight does not require specific training or equipment, the software is potentially useful for the contactless measurement of VSs by nonclinical staff in residential and home care settings. Work is continuing to enhance data collection and processing to achieve the robustness and accuracy required for routine clinical use. International Registered Report Identifier (IRRID): RR2-10.2196/14326 %M 36374541 %R 10.2196/36340 %U https://formative.jmir.org/2022/11/e36340 %U https://doi.org/10.2196/36340 %U http://www.ncbi.nlm.nih.gov/pubmed/36374541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40765 %T Recruitment and Retention in Remote Research: Learnings From a Large, Decentralized Real-world Study %A Li,Sophia Xueying %A Halabi,Ramzi %A Selvarajan,Rahavi %A Woerner,Molly %A Fillipo,Isabell Griffith %A Banerjee,Sreya %A Mosser,Brittany %A Jain,Felipe %A Areán,Patricia %A Pratap,Abhishek %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College Street, 12th floor, Toronto, ON, M5T 1R8, Canada, 1 416 535 8501, Abhishek.Pratap@camh.ca %K participant recruitment %K participant retention %K decentralized studies %K active and passive data collection %K retention %K adherence %K compliance %K engagement %K smartphone %K mobile health %K mHealth %K sensor data %K clinical research %K data sharing %K recruitment %K mobile phone %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones are increasingly used in health research. They provide a continuous connection between participants and researchers to monitor long-term health trajectories of large populations at a fraction of the cost of traditional research studies. However, despite the potential of using smartphones in remote research, there is an urgent need to develop effective strategies to reach, recruit, and retain the target populations in a representative and equitable manner. Objective: We aimed to investigate the impact of combining different recruitment and incentive distribution approaches used in remote research on cohort characteristics and long-term retention. The real-world factors significantly impacting active and passive data collection were also evaluated. Methods: We conducted a secondary data analysis of participant recruitment and retention using data from a large remote observation study aimed at understanding real-world factors linked to cold, influenza, and the impact of traumatic brain injury on daily functioning. We conducted recruitment in 2 phases between March 15, 2020, and January 4, 2022. Over 10,000 smartphone owners in the United States were recruited to provide 12 weeks of daily surveys and smartphone-based passive-sensing data. Using multivariate statistics, we investigated the potential impact of different recruitment and incentive distribution approaches on cohort characteristics. Survival analysis was used to assess the effects of sociodemographic characteristics on participant retention across the 2 recruitment phases. Associations between passive data-sharing patterns and demographic characteristics of the cohort were evaluated using logistic regression. Results: We analyzed over 330,000 days of engagement data collected from 10,000 participants. Our key findings are as follows: first, the overall characteristics of participants recruited using digital advertisements on social media and news media differed significantly from those of participants recruited using crowdsourcing platforms (Prolific and Amazon Mechanical Turk; P<.001). Second, participant retention in the study varied significantly across study phases, recruitment sources, and socioeconomic and demographic factors (P<.001). Third, notable differences in passive data collection were associated with device type (Android vs iOS) and participants’ sociodemographic characteristics. Black or African American participants were significantly less likely to share passive sensor data streams than non-Hispanic White participants (odds ratio 0.44-0.49, 95% CI 0.35-0.61; P<.001). Fourth, participants were more likely to adhere to baseline surveys if the surveys were administered immediately after enrollment. Fifth, technical glitches could significantly impact real-world data collection in remote settings, which can severely impact generation of reliable evidence. Conclusions: Our findings highlight several factors, such as recruitment platforms, incentive distribution frequency, the timing of baseline surveys, device heterogeneity, and technical glitches in data collection infrastructure, that could impact remote long-term data collection. Combined together, these empirical findings could help inform best practices for monitoring anomalies during real-world data collection and for recruiting and retaining target populations in a representative and equitable manner. %M 36374539 %R 10.2196/40765 %U https://formative.jmir.org/2022/11/e40765 %U https://doi.org/10.2196/40765 %U http://www.ncbi.nlm.nih.gov/pubmed/36374539 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37797 %T Lessons Learned From Transition of an In-Person to a Virtual Randomized Controlled Trial for Weight and Fitness Concerns in Active-Duty Service Members: Survey Study %A Afari,Niloofar %A Yarish,Natalie M %A Wooldridge,Jennalee S %A Materna,Karla %A Hernandez,Jeffrey %A Blanco,Brian H %A Camodeca,Angela L %A Peters,Joshua J %A Herbert,Matthew S %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, United States, 1 858 642 3387, nafari@ucsd.edu %K virtualization %K weight-loss intervention %K lessons learned %K military personnel %K acceptance and commitment therapy %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: This paper describes and discusses the transition of and modifications to a weight management randomized controlled trial among active-duty military personnel from an in-person to a virtual format as a result of the COVID-19 pandemic. The original pragmatic cohort-randomized controlled trial was designed to compare the effectiveness of an 8-week group weight management program, ShipShape, to a version of ShipShape enhanced with acceptance and commitment therapy. Objective: The objective of our study was to assess potential differences between in-person and virtual participation in participants’ demographics, motivation, confidence, credibility, expectations, and satisfaction with the interventions; we also examined the pragmatics of the technology and participants’ experiences in virtual-format intervention groups. Methods: A total of 178 active-duty personnel who had failed or were at risk of failing their physical fitness assessment or were overweight or obese were enrolled in the study. In-person (n=149) and virtual (n=29) participants reported demographics, motivation, confidence, credibility, expectations, and satisfaction. Interventionists recorded attendance and participation in the group sessions. Independent-sample 2-tailed t tests and chi-square tests were used to compare the characteristics of the in-person and virtual participants. Pragmatics of the technology and participants’ experiences in the virtual format were assessed through surveys and open-ended questions. Results: Participants were 29.7 (SD 6.9) years old on average, 61.8% (110/178) female, and 59.6% (106/178) White and had an average BMI of 33.1 (SD 3.9) kg/m2. Participants were highly motivated to participate and confident in their ability to complete a weight management program. A total of 82.6% (147/178) of all participants attended 5 of the 8 sessions, and participation was rated as “excellent” by interventionists in both formats. The interventions were found to be credible and to have adequate expectations for effectiveness and high satisfaction in both formats. There were no differences between in-person and virtual participants in any of these metrics, other than interventionist-rated participation, for which virtual participants had significantly higher ratings (P<.001). Technical satisfaction with the virtual sessions was rated as “good” to “very good,” and participants were satisfied with the content of the virtual sessions. A word cloud of responses identified “mindfulness,” “helpful,” “different,” “food,” “binder,” and “class” as concepts the virtual participants found most useful about the program. Conclusions: Modifications made in response to the COVID-19 pandemic were successful, given the recruitment of active-duty personnel with similar demographic characteristics, attendance levels, and indicators of credibility, expectancy, and satisfaction in the virtual format and the in-person format. This successful transition provides support for the use of virtual or digital weight management interventions to increase accessibility and reach among highly mobile active-duty personnel. Trial Registration: ClinicalTrials.gov NCT03029507; https://clinicaltrials.gov/ct2/show/NCT03029507 %M 36201851 %R 10.2196/37797 %U https://www.jmir.org/2022/11/e37797 %U https://doi.org/10.2196/37797 %U http://www.ncbi.nlm.nih.gov/pubmed/36201851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41721 %T Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis %A Gliske,Kate %A Berry,Katie R %A Ballard,Jaime %A Evans-Chase,Michelle %A Solomon,Phyllis L %A Fenkel,Caroline %+ Charlie Health, 233 E Main St., Suite 401, Bozeman, MT, 59715, United States, 1 952 334 1411, kate.gliske@charliehealth.com %K telehealth %K telepsychiatry %K telemedicine %K intensive outpatient %K remote outpatient %K mental health %K quality improvement %K routine outcome monitoring %K mental health treatment %K patient outcome %K outpatient program %K youth %K young adult %K depression %K suicidal ideation %K health outcome %K outcome monitoring %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective: This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results: Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions: Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes. %M 36355428 %R 10.2196/41721 %U https://formative.jmir.org/2022/11/e41721 %U https://doi.org/10.2196/41721 %U http://www.ncbi.nlm.nih.gov/pubmed/36355428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40507 %T A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design %A Magee,Michael R %A Gholamrezaei,Ali %A McNeilage,Amy G %A Sim,Alison %A Dwyer,Leah %A Ferreira,Manuela L %A Darnall,Beth D %A Glare,Paul %A Ashton-James,Claire E %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Douglas Building, Royal North Shore Hospital, Reserve Rd, Sydney, St Leonards 2065, Australia, 61 2 9463 1526, mmag9080@uni.sydney.edu.au %K chronic pain %K deprescribing %K tapering %K dose reduction %K opioids %K mHealth %K mobile health %K SMS %K text messaging %K digital health %K behavior change %K self-efficacy %K consumer engagement %K co-design %K coproduction %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ≥8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians’ ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. %M 36355415 %R 10.2196/40507 %U https://formative.jmir.org/2022/11/e40507 %U https://doi.org/10.2196/40507 %U http://www.ncbi.nlm.nih.gov/pubmed/36355415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33676 %T Digital Technology in Psychiatry: Survey Study of Clinicians %A Sterling,William Andrew %A Sobolev,Michael %A Van Meter,Anna %A Guinart,Daniel %A Birnbaum,Michael L %A Rubio,Jose M %A Kane,John M %+ Institute of Behavioral Science, Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 718 470 8005, daniguinart@gmail.com %K digital psychiatry %K passive monitoring technology %K digital phenotype %K psychiatry %K mental health %K clinicians %K clinician perspectives %K digital health %K physicians %K psychiatrists %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technology has the potential to transform psychiatry, but its adoption has been limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to effective implementation and patient benefit. Objective: Our objective was to elicit clinician perspectives on emerging digital technology. Methods: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients’ attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. Results: In total, 139 clinicians completed the survey—they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5%). Overall, 83.4% (n=116) of them stated that digital data could improve their practice, and 23.0% (n=32) of responders reported that they had viewed patients’ profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7%) as well as clinical intervention support (n=90, 64.7%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5%) and whether digital data would be actionable (n=107, 77%). Furthermore, 95.0% (n=132) of clinicians expected their patients to share digital data. Conclusions: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians’ self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake. %M 36355414 %R 10.2196/33676 %U https://formative.jmir.org/2022/11/e33676 %U https://doi.org/10.2196/33676 %U http://www.ncbi.nlm.nih.gov/pubmed/36355414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35447 %T Shared Autonomy to Reduce Sedentary Behavior Among Sit-Stand Desk Users in the United States and India: Web-Based Study %A Kim,Lawrence H %A Saha,Gourab %A Leon,Annel Amelia %A King,Abby C %A Mauriello,Matthew Louis %A Paredes,Pablo E %+ Department of Computer Science, University of Maryland, 8125 Paint Branch Drive, College Park, MD, 20742, United States, 1 650 723 4000, paredes@umd.edu %K shared autonomy %K automation %K sedentary behavior %K sit-stand desk %K nonvolitional behavior change %K culture %D 2022 %7 9.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Fitness technologies such as wearables and sit-stand desks are increasingly being used to fight sedentary lifestyles by encouraging physical activity. However, adherence to such technologies decreases over time because of apathy and increased dismissal of behavioral nudges. Objective: To address this problem, we introduced shared autonomy in the context of sit-stand desks, where user input is integrated with robot autonomy to control the desk and reduce sedentary behavior and investigated user reactions and preferences for levels of automation with a sit-stand desk. As demographics affect user acceptance of robotic technology, we also studied how perceptions of nonvolitional behavior change differ across cultures (United States and India), sex, familiarity, dispositional factors, and health priming messages. Methods: We conducted a web-based vignette study in the United States and India where a total of 279 participants watched video vignettes of a person interacting with sit-stand desks of various levels of automation and answered questions about their perceptions of the desks such as ranking of the different levels of automation. Results: Participants generally preferred either manual or semiautonomous desks over the fully autonomous option (P<.001). However, participants in India were generally more amenable to the idea of nonvolitional interventions from the desk than participants in the United States (P<.001). Male participants had a stronger desire for having control over the desk than female participants (P=.01). Participants who were more familiar with sit-stand desks were more likely to adopt autonomous sit-stand desks (P=.001). No effects of health priming messages were observed. We estimated the projected health outcome by combining ranking data and hazard ratios from previous work and found that the semiautonomous desk led to the highest projected health outcome. Conclusions: These results suggest that the shared autonomy desk is the optimal level of automation in terms of both user preferences and estimated projected health outcomes. Demographics such as culture and sex had significant effects on how receptive users were to autonomous intervention. As familiarity improves the likelihood of adoption, we propose a gradual behavior change intervention to increase acceptance and adherence, especially for populations with a high desire for control. %M 36350687 %R 10.2196/35447 %U https://formative.jmir.org/2022/11/e35447 %U https://doi.org/10.2196/35447 %U http://www.ncbi.nlm.nih.gov/pubmed/36350687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37865 %T Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach %A Dauber,Sarah %A Hammond,Cori %A Hogue,Aaron %A Henderson,Craig %A Nugent,Jessica %A Ford,Veronica %A Brown,Jill %A Scott,Lenore %A Ondersma,Steven %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 212 841 5270, sdauber@toendaddiction.org %K pregnant women %K postpartum women %K home visiting %K substance use %K computerized intervention %K mobile health %K mobile phone %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e–SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective: This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e–SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e–SBI-HV prototype and describe the e–SBI-HV prototype. Methods: Adaptation of the original e-SBI into the e–SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e–SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results: The e–SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor–client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e–SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. Conclusions: This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e–SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e–SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e–SBI-HV. %M 36346648 %R 10.2196/37865 %U https://formative.jmir.org/2022/11/e37865 %U https://doi.org/10.2196/37865 %U http://www.ncbi.nlm.nih.gov/pubmed/36346648 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33638 %T The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study %A Bulzacchelli,Maria T %A Bellantoni,Jenna M %A McCue,Leigh %A Dzugan,Jerry %+ Krieger School of Arts and Sciences, Johns Hopkins University, 3505 North Charles Street, Room 202, Baltimore, MD, 21218, United States, 1 410 516 8340, mbulzac1@jhu.edu %K mobile app %K mobile device %K mobile phone %K smartphone %K safety %K workplace safety %K occupational safety %K mobile health %K mHealth %K commercial fishing %K cross-sectional study %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59%) and Android phones (n=24, 39%). Most participants (n=53, 87%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85%). Over half of the participants reported that they had either safety-related apps (n=17, 28%) or apps that help them with their work (n=35, 57%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. %M 36346649 %R 10.2196/33638 %U https://formative.jmir.org/2022/11/e33638 %U https://doi.org/10.2196/33638 %U http://www.ncbi.nlm.nih.gov/pubmed/36346649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40907 %T Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study %A Nagawa,Catherine S %A Lane,Ian A %A McKay,Colleen E %A Kamberi,Ariana %A Shenette,Lisa L %A Kelly,Megan M %A Davis,Maryann %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 8999, cnagawa@mgh.harvard.edu %K serious mental illness %K mental disorder %K psychiatric disorder %K tobacco use %K smoking cessation %K text messaging %K intervention %K smoking %K mental health %K virtual %K COVID-19 %K pandemic %K symptom %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the “interplay between smoking and having a serious mental illness” theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the “social contextual factors of smoking in adults with serious mental illness” theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the “smoking and quitting behaviors similar to the general population” theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. %M 36342765 %R 10.2196/40907 %U https://formative.jmir.org/2022/11/e40907 %U https://doi.org/10.2196/40907 %U http://www.ncbi.nlm.nih.gov/pubmed/36342765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39511 %T A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial %A Paetzold,Isabell %A Schick,Anita %A Rauschenberg,Christian %A Hirjak,Dusan %A Banaschewski,Tobias %A Meyer-Lindenberg,Andreas %A Butz,Sebastian %A Floesser,Chiara %A Schueltke,Leonie %A Boehnke,Jan Rasmus %A Boecking,Benjamin %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5 1, Mannheim, 68159, Germany, 49 62117031930, ulrich.reininghaus@zi-mannheim.de %K mobile health intervention %K mHealth intervention %K digital intervention %K just-in-time adaptive intervention %K JITAI %K blended care %K public mental health %K inclusiveness %K transdiagnostic %K clinical staging %K intervention manual %K mobile phone %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people are a target population for mental health–related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective: This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants’ baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants’ sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants’ sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods: We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study’s manual, a scoping review of existing literature and manuals, exchange with experts, the team’s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results: A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI −0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=−2.83, 95% CI −5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions: The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration: German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): RR2-10.2196/27462 %M 36331526 %R 10.2196/39511 %U https://formative.jmir.org/2022/11/e39511 %U https://doi.org/10.2196/39511 %U http://www.ncbi.nlm.nih.gov/pubmed/36331526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38164 %T HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study %A Darville-Sanders,Gabrielle %A Reinoso,Humberto %A MacInnes,Jann %A Corluyan,Emilie %A Munroe,Dominique %A Mathis,Mary W %A Madden,Suzie Lamarca %A Hamrick,Johnathan %A Dickerson,Lisa %A Gaddis,Cheryl %+ Department of Public Health, Mercer University, 3001 Mercer University Drive, Atlanta, GA, 30341, United States, 1 678 547 6492, darville-sanders_gc@mercer.edu %K human papillomavirus %K HPV %K HPV vaccine %K provider communication %K medical trainees %K immunization %K vaccine %K communication %K student %K sexually transmitted infection %K STI %K United States of America %K USA %K young adult %K teen %K patient %K parent %K immunization %K mobile phone %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. Objective: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. Methods: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. Results: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach α indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport (α=.796), patient respect or empathy (α=.737), provider interview or intake (α=.9), patient counseling or education (α=.935), provider communication closure (α=.896), and provider knowledge (α=.824). Conclusions: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee’s individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates. %M 36331545 %R 10.2196/38164 %U https://formative.jmir.org/2022/11/e38164 %U https://doi.org/10.2196/38164 %U http://www.ncbi.nlm.nih.gov/pubmed/36331545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37280 %T Atrial Fibrillation Detection With an Analog Smartwatch: Prospective Clinical Study and Algorithm Validation %A Campo,David %A Elie,Valery %A de Gallard,Tristan %A Bartet,Pierre %A Morichau-Beauchant,Tristan %A Genain,Nicolas %A Fayol,Antoine %A Fouassier,David %A Pasteur-Rousseau,Adrien %A Puymirat,Etienne %A Nahum,Julien %+ Withings, 2 rue Maurice Hartmann, Issy Les Moulineaux, 92130, France, 33 637430705, valery.elie@withings.com %K atrial fibrillation %K mobile health %K mHealth %K diagnosis %K electrocardiogram %K ECG %K smartwatch %K smart technology %K wearable %K cardiology %K cardiac %K heart failure %K heart disease %K cardiovascular %K morbidity %K automatic detection %K algorithm %K physician %K sensor %K digital health %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Atrial fibrillation affects approximately 4% of the world’s population and is one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. It can be difficult to diagnose when asymptomatic or in the paroxysmal stage, and its natural history is not well understood. New wearables and connected devices offer an opportunity to improve on this situation. Objective: We aimed to validate an algorithm for the automatic detection of atrial fibrillation from a single-lead electrocardiogram taken with a smartwatch. Methods: Eligible patients were recruited from 4 sites in Paris, France. Electrocardiograms (12-lead reference and single lead) were captured simultaneously. The electrocardiograms were reviewed by independent, blinded board-certified cardiologists. The sensitivity and specificity of the algorithm to detect atrial fibrillation and normal sinus rhythm were calculated. The quality of single-lead electrocardiograms (visibility and polarity of waves, interval durations, heart rate) was assessed in comparison with the gold standard (12-lead electrocardiogram). Results: A total of 262 patients (atrial fibrillation: n=100, age: mean 74.3 years, SD 12.3; normal sinus rhythm: n=113, age: 61.8 years, SD 14.3; other arrhythmia: n=45, 66.9 years, SD 15.2; unreadable electrocardiograms: n=4) were included in the final analysis; 6.9% (18/262) were classified as Noise by the algorithm. Excluding other arrhythmias and Noise, the sensitivity for atrial fibrillation detection was 0.963 (95% CI lower bound 0.894), and the specificity was 1.000 (95% CI lower bound 0.967). Visibility and polarity accuracies were similar (1-lead electrocardiogram: P waves: 96.9%, QRS complexes: 99.2%, T waves: 91.2%; 12-lead electrocardiogram: P waves: 100%, QRS complexes: 98.8%, T waves: 99.5%). P-wave visibility accuracy was 99% (99/100) for patients with atrial fibrillation and 95.7% (155/162) for patients with normal sinus rhythm, other arrhythmias, and unreadable electrocardiograms. The absolute values of the mean differences in PR duration and QRS width were <3 ms, and more than 97% were <40 ms. The mean difference between the heart rates from the 1-lead electrocardiogram calculated by the algorithm and those calculated by cardiologists was 0.55 bpm. Conclusions: The algorithm demonstrated great diagnostic performance for atrial fibrillation detection. The smartwatch’s single-lead electrocardiogram also demonstrated good quality for physician use in daily routine care. Trial Registration: ClinicalTrials.gov NCT04351386; http://clinicaltrials.gov/ct2/show/NCT04351386 %M 35481559 %R 10.2196/37280 %U https://formative.jmir.org/2022/11/e37280 %U https://doi.org/10.2196/37280 %U http://www.ncbi.nlm.nih.gov/pubmed/35481559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35864 %T Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study %A Hunter,Inga %A Lockhart,Caroline %A Rao,Vasudha %A Tootell,Beth %A Wong,Samuel %+ School of Management, Massey Business School, Massey University, BSC, 3rd floor, Tennent Drive, Palmerston North, 4410, New Zealand, 64 6 356 9099 ext 84913, I.Hunter@massey.ac.nz %K access %K choice %K trust %K telehealth %K rural %K barriers %K enablers %K underserved populations %K underserved %K equity %K elder %K older adult %K eHealth %K telemedicine %K barrier %K enabler %K facilitator %K focus group %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. Objective: This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. Methods: In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ≥55 years participated. The participants were asked whether they had used telehealth, how they saw their community’s health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. Results: The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes—trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes—health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non–health-related services such as internet banking. Conclusions: Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities. %M 36331533 %R 10.2196/35864 %U https://formative.jmir.org/2022/11/e35864 %U https://doi.org/10.2196/35864 %U http://www.ncbi.nlm.nih.gov/pubmed/36331533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39637 %T Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics %A Timmers,Thomas %A van der Weegen,Walter %A Janssen,Loes %A Kremer,Jan %A Kool,Rudolf Bertijn %+ IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 746446069, thomas@interactivestudios.nl %K eHealth %K qualitative research %K qualitative %K focus group %K knee %K surgery %K feedback %K user need %K patient need %K user centered %K content codevelopment %K patient involvement %K co-design %K participatory %K app design %K mobile health %K mHealth %K health app %K orthopedic %K mobile phone %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 %M 36326799 %R 10.2196/39637 %U https://formative.jmir.org/2022/11/e39637 %U https://doi.org/10.2196/39637 %U http://www.ncbi.nlm.nih.gov/pubmed/36326799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36949 %T Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study %A Jarvis,Tamika %A Mah,Allison M L %A Wang,Rosalie H %A Wilson,Michael G %+ McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, MML-417, Canada, 1 905 525 9140 ext 22121, wilsom2@mcmaster.ca %K assistive technology %K program funding %K usability testing %K internet %K web-based database %K health services %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Assistive technology (AT) can contribute to how individuals participate and engage in everyday activities, such as communication and mobility, and facilitates access to the services they require. Navigating Canada’s AT system has been described as fragmented and complex, presenting barriers for individuals who require AT, caregivers, and health service providers. AccessATCanada was developed as a centralized web-based resource to help support access to AT by providing information about the existing jurisdictional funding programs and services. Objective: This study aimed to evaluate the usability of AccessATCanada by gathering feedback about its features, functionality, and areas of strength and opportunity from potential end users. Methods: A usability testing study using a think-aloud approach and semistructured interviews was conducted to measure the effectiveness and efficiency of and user satisfaction with AccessATCanada and to identify issues with the interface during end-user interaction. A qualitative thematic analysis was used to generate insights into and core themes about user experiences. User feedback was used to inform subsequent updates of the database with the goal of enhancing website friendliness and functionality before its official launch. Results: A total of 10 participants (6 consumers, 1 caregiver, and 3 providers) participated in the usability testing study. The usability performance and scores tended to improve between the 2 testing cycles. Most participants were able to successfully complete all the tasks independently. The efficiency scores tended to improve as the users continued to engage with the interface. The website received an overall System Usability Score of 62.22, which was ranked as “OK/fair to good.” The users provided an overall positive evaluation of the beta version of the web-based resource tested over 2 cycles and helped to identify areas for improvement. They commented on the functionality and added value of the website, discovery of new programs and resources, and design aesthetics. Most usability issues were reported as minor challenges related to presentation, functionality, and language, and feedback was adopted into later iterations of the website. Conclusions: This study provides reflections on the value of usability testing and elements that are key to the creation of user-centered resources, such as the inclusion of participants with various abilities and considerations regarding website design and accessibility in an increasingly web-based world. AccessATCanada is now part of a growing global response to expand the reach of AT programs and services, improve the equity of access to AT, and reduce the complexity of navigating AT systems. %M 36326813 %R 10.2196/36949 %U https://formative.jmir.org/2022/11/e36949 %U https://doi.org/10.2196/36949 %U http://www.ncbi.nlm.nih.gov/pubmed/36326813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30327 %T Internet-Based Intervention Compared to Brief Intervention for Smoking Cessation in Brazil: Pilot Study %A Machado,Nathalia Munck %A Gomide,Henrique Pinto %A Bernardino,Heder Soares %A Ronzani,Telmo Mota %+ Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 8163287381, nmachado@kumc.edu %K smoking cessation %K internet-based intervention %K digital intervention %K mobile health %K mHealth %K tobacco %K addiction %K public health %K digital intervention %K substance use %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop. Objective: This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians. Methods: Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated. Results: A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups. Conclusions: The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size. %M 36326817 %R 10.2196/30327 %U https://formative.jmir.org/2022/11/e30327 %U https://doi.org/10.2196/30327 %U http://www.ncbi.nlm.nih.gov/pubmed/36326817 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38387 %T Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches %A Jarman,Hannah K %A McLean,Siân A %A Rodgers,Rachel %A Fuller-Tyszkiewicz,Matthew %A Paxton,Susan %A O'Gorman,Beth %A Harris,Emily %A Shatte,Adrian %A Bishop,Katie %A Baumann,Tahlia %A Mahoney,Danielle %A Daugelat,Melissa-Claire %A Yager,Zali %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9251 7777, h.jarman@deakin.edu.au %K eating disorders %K app-based intervention %K lived experience %K design thinking %K interviews %K young women %K co-design %K mobile health %K mHealth %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. %M 36315225 %R 10.2196/38387 %U https://formative.jmir.org/2022/10/e38387 %U https://doi.org/10.2196/38387 %U http://www.ncbi.nlm.nih.gov/pubmed/36315225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39998 %T Screening for Generalized Anxiety Disorder From Acoustic and Linguistic Features of Impromptu Speech: Prediction Model Evaluation Study %A Teferra,Bazen Gashaw %A Borwein,Sophie %A DeSouza,Danielle D %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, 10 King’s College Road, Toronto, ON, M5S 3G4, Canada, 1 4169786992, bazen.teferra@mail.utoronto.ca %K mental health %K generalized anxiety disorder %K impromptu speech %K acoustic features %K linguistic features %K anxiety prediction %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Frequent interaction with mental health professionals is required to screen, diagnose, and track mental health disorders. However, high costs and insufficient access can make frequent interactions difficult. The ability to assess a mental health disorder passively and at frequent intervals could be a useful complement to the conventional treatment. It may be possible to passively assess clinical symptoms with high frequency by characterizing speech alterations collected using personal smartphones or other wearable devices. The association between speech features and mental health disorders can be leveraged as an objective screening tool. Objective: This study aimed to evaluate the performance of a model that predicts the presence of generalized anxiety disorder (GAD) from acoustic and linguistic features of impromptu speech on a larger and more generalizable scale than prior studies did. Methods: A total of 2000 participants were recruited, and they participated in a single web-based session. They completed the Generalized Anxiety Disorder-7 item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. We used the linguistic and acoustic features that were found to be associated with anxiety disorders in previous studies along with demographic information to predict whether participants fell above or below the screening threshold for GAD based on the Generalized Anxiety Disorder-7 item scale threshold of 10. Separate models for each sex were also evaluated. We reported the mean area under the receiver operating characteristic (AUROC) from a repeated 5-fold cross-validation to evaluate the performance of the models. Results: A logistic regression model using only acoustic and linguistic speech features achieved a significantly greater prediction accuracy than a random model did (mean AUROC 0.57, SD 0.03; P<.001). When separately assessing samples from female participants, we observed a mean AUROC of 0.55 (SD 0.05; P=.01). The model constructed from the samples from male participants achieved a mean AUROC of 0.57 (SD 0.07; P=.002). The mean AUROC increased to 0.62 (SD 0.03; P<.001) on the all-sample data set when demographic information (age, sex, and income) was included, indicating the importance of demographics when screening for anxiety disorders. The performance also increased for the female sample to a mean of 0.62 (SD 0.04; P<.001) when using demographic information (age and income). An increase in performance was not observed when demographic information was added to the model constructed from the male samples. Conclusions: A logistic regression model using acoustic and linguistic speech features, which have been suggested to be associated with anxiety disorders in prior studies, can achieve above-random accuracy for predicting GAD. Importantly, the addition of basic demographic variables further improves model performance, suggesting a role for speech and demographic information to be used as automated, objective screeners of GAD. %M 36306165 %R 10.2196/39998 %U https://formative.jmir.org/2022/10/e39998 %U https://doi.org/10.2196/39998 %U http://www.ncbi.nlm.nih.gov/pubmed/36306165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38480 %T A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation %A Pape,Magdalena %A Färber,Tanja %A Seiferth,Caroline %A Roth,Tanja %A Schroeder,Stefanie %A Wolstein,Joerg %A Herpertz,Stephan %A Steins-Loeber,Sabine %+ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital of the Ruhr-University Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany, 49 0234 509 ext 59039, magdalena.pape@rub.de %K mobile health %K mHealth %K eHealth %K tailoring %K gender %K weight loss intervention %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions. Objective: This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features. Methods: Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed. Results: Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention. Conclusions: We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention. %M 36301614 %R 10.2196/38480 %U https://formative.jmir.org/2022/10/e38480 %U https://doi.org/10.2196/38480 %U http://www.ncbi.nlm.nih.gov/pubmed/36301614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38215 %T Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App–Based Hypertension Care Program: Observational Study %A Branch,OraLee H %A Rikhy,Mohit %A Auster-Gussman,Lisa A %A Lockwood,Kimberly G %A Graham,Sarah A %+ Lark Technologies, Inc, 2570 El Camino Real, Mountain View, CA, 94040, United States, 1 650 300 1755, sarah.graham@lark.com %K high blood pressure %K obesity %K weight loss %K conversational artificial intelligence %K lifestyle coaching %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective: This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods: Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results: By month 3, there was a significant drop of –5.4 mm Hg (95% CI –6.5 to –4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss. %M 36301618 %R 10.2196/38215 %U https://formative.jmir.org/2022/10/e38215 %U https://doi.org/10.2196/38215 %U http://www.ncbi.nlm.nih.gov/pubmed/36301618 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e34923 %T Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study %A McCue,Maggie %A Blair,Christopher %A Fehnert,Ben %A King,James %A Cormack,Francesca %A Sarkey,Sara %A Eramo,Anna %A Kabir,Christopher %A Khatib,Rasha %A Kemp,David %+ Takeda Pharmaceuticals USA, Inc, 95 Hayden Ave, Lexington, MA, 02421, United States, 1 224 554 2820, Maggie.McCue@takeda.com %K depression %K major depressive disorder %K depression management %K patient engagement %K patient satisfaction %K mobile app %K patient-reported outcomes %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). Objective: We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). Methods: In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire–Depression). Results: All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). Conclusions: Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. Trial Registration: ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213 %M 36301599 %R 10.2196/34923 %U https://formative.jmir.org/2022/10/e34923 %U https://doi.org/10.2196/34923 %U http://www.ncbi.nlm.nih.gov/pubmed/36301599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40316 %T A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study %A Long,Zhiwen %A Huang,Shan %A Zhang,Jie %A Zhang,Deng %A Yin,Jun %A He,Chengyuan %A Zhang,Qinqiu %A Xu,Huilin %A He,Huimin %A Sun,Ho Ching %A Xie,Ke %+ Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Number 32, West 2nd Section, First Ring Road, Qingyang District, Chengdu, 610072, China, 86 18981838382, xieke@med.uestc.edu.cn %K digital tool %K nutritional risk screening %K dietary assessment %K validity %K cancer patients %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective: This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods: We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results: A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions: The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528 %M 36287601 %R 10.2196/40316 %U https://formative.jmir.org/2022/10/e40316 %U https://doi.org/10.2196/40316 %U http://www.ncbi.nlm.nih.gov/pubmed/36287601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e17838 %T Colocating Teleophthalmology Within Primary Care Settings to Improve Access to Diabetic Retinopathy Screening: Retrospective Descriptive Evaluation %A Wandy,Tiffany %A Rayaz,Shuja %A Brager,Jenna Ashly Levenson %A Kiritsy,Michael %A Offermann,Elizabeth %A Durand,Daniel %+ LifeBridge Health, 2401 West Belvedere Avenue, Baltimore, MD, 21215, United States, 1 410 601 4388, shuja.rayaz@gmail.com %K diabetic retinopathy %K screening %K telemedicine %K teleretinopathy %K population health %K value-based care %K quality measure performance %K accountable care organization %K ACO performance %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual retinal exams for patients with diabetes are critical as diabetic retinopathy is the number one cause of preventable blindness in working-age adults in the United States. Currently, most patients with diabetes in the United States receive a referral from their primary care provider to see an ophthalmologist for their annual dilated eye exam, which can be an added inconvenience and expense. As such, there is a need for alternative screening strategies within an outpatient network. The use of a telemedicine platform in a primary care setting serves as a novel strategy to increase diabetic retinopathy screening rates. In order to provide better access to diabetic retinopathy screening for our patients, cameras were placed in 3 primary care practices in October 2017 as part of an 8-month pilot program. Specialized cameras from Intelligent Retinal Imaging Systems (IRIS) were used to acquire images that could be interpreted remotely by ophthalmologists within the LifeBridge Health network for the diagnosis of diabetic retinopathy and the detection of other types of pathology (eg, macular edema). Objective: The aim of this retrospective descriptive study was to examine whether a telemedicine platform can be used as a cost-effective way to increase diabetic retinopathy screening rates in the primary care setting. Methods: Aggregate screening volume and diagnostic data were collected for each of the 3 practice locations for the 8-month pilot period (October 30, 2017, through June 30, 2018). Additionally, payor reimbursement data and equipment cost data were used to determine the payback period for each of the 3 practice locations. Results: The pilot program proved the business case that implementation of the IRIS camera in 3 practice locations could result in enough patients being screened to pay for the cost of the camera within a maximum of 2 years. The 3 practices showed increased diabetic retinopathy screening rates of 1%, 6%, and 24%, respectively, and were all able to screen enough patients to be on track to pay off the cost of the camera within 2 years of implementation. Aggregate data from the pilot period showed that of the 1213 patients who were screened, approximately 17.1% (n=207) were diagnosed with diabetic retinopathy and an additional 17.7% (n=215) were suspected of having some other form of pathology. Of note, 10.1% (n=123) were also identified as being “IRIS saves,” defined as having pathology identified that was severe enough to be considered an imminent threat to their vision. Conclusions: This retrospective descriptive study suggests that a telemedicine platform can be used to improve diabetic retinopathy screening rates in the primary care setting within a large health care system in a cost-effective way that allows for the cost of the equipment to be recouped through billing within a maximum of 2 years. %M 36287608 %R 10.2196/17838 %U https://formative.jmir.org/2022/10/e17838 %U https://doi.org/10.2196/17838 %U http://www.ncbi.nlm.nih.gov/pubmed/36287608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41418 %T Changes in Food Insecurity Among Individuals Using a Telehealth and Nutrition Platform: Longitudinal Study %A Bakre,Shivani %A Shea,Benjamin %A Ortega,Kaylee %A Scharen,Jared %A Langheier,Jason %A Hu,Emily %+ Foodsmart, 595 Pacific Ave. Fl. 4, San Francisco, CA, 94133, United States, 1 650 823 9022, ben.shea@foodsmart.com %K food insecurity %K tele-nutrition %K telehealth %K meal planning %K SNAP %K diet %K nutrition %K COVID-19 %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity is a complex public health problem affecting many individuals in the United States. Digital health interventions that promote behavior change and provide access to affordable and healthy food may help to alleviate food insecurity. Objective: The aim of this study was to characterize food-insecure users of Foodsmart, a telehealth and nutrition platform with meal planning, food ordering, nutrition education, budgeting, and grocery discount features, and to evaluate changes in diet and food insecurity. Methods: We retrospectively analyzed data collected from 4595 adults who used the Foodsmart platform between February and October 2021. Participants self-reported their diet, demographics, biometrics, and food insecurity status in a 56-item questionnaire. Participants were reported to be food insecure if they answered “sometimes” or “often” to the question “How often does the food you buy not last and you don't have money to get more?” from the United States Department of Agriculture’s Household Food Security survey. We examined baseline characteristics of participants by food insecurity status, associations between characteristics and baseline food insecurity, and changes in diet quality and food insecurity status. To evaluate potential causes of reversing food insecurity, the use of 6 Foodsmart features was compared between food-insecure participants who achieved food security versus food-insecure participants who remained food insecure, based on their last response to the food insecurity question. Results: We found that 16% (742/4595) of participants were food insecure at baseline. Participants who were food insecure at baseline were more likely to be obese, to have at least one chronic condition, to have a lower diet quality, to cook less frequently at home, to think healthy food is too expensive, and less likely to order takeout or eat at a restaurant. Among participants who were food insecure at baseline, 61% (451/742) improved their nutrition and 29% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the “deals” (28.6% higher), “CookItNow” (36.4% higher), and “telenutrition” (27.5% higher) features compared to those who remained food insecure. Conclusions: This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security. %M 36282563 %R 10.2196/41418 %U https://formative.jmir.org/2022/10/e41418 %U https://doi.org/10.2196/41418 %U http://www.ncbi.nlm.nih.gov/pubmed/36282563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39954 %T Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study %A Bendig,Jonas %A Spanz,Anja %A Leidig,Jana %A Frank,Anika %A Stahr,Marcus %A Reichmann,Heinz %A Loewenbrück,Kai F %A Falkenburger,Björn H %+ Department of Neurology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, Dresden, 01307, Germany, 49 351 458 19675, Jonas.Bendig@uniklinikum-dresden.de %K eHealth %K usability %K Parkinson disease %K telehealth and telemonitoring %K older adults %K aging %K older population %K neurodegenerative disease %K digital solution %K wearable sensor %K mobile health %K system usability %K eHealth solution %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Parkinson disease (PD) is a neurodegenerative disorder with a variety of motor and nonmotor symptoms. Many of these symptoms can be monitored by eHealth solutions, including smartphone apps, wearable sensors, and camera systems. The usability of such systems is a key factor in long-term use, but not much is known about the predictors of successful use and preferable methods to assess usability in patients with PD. Objective: This study tested methods to assess usability and determined prerequisites for successful use in patients with PD. Methods: We performed comprehensive usability assessments with 18 patients with PD using a mixed methods usability battery containing the System Usability Scale, a rater-based evaluation of device-specific tasks, and qualitative interviews. Each patient performed the usability battery with 2 of 3 randomly assigned devices: a tablet app, wearable sensors, and a camera system. The usability battery was administered at the beginning and at the end of a 4-day testing period. Between usability batteries, the systems were used by the patients during 3 sessions of motor assessments (wearable sensors and camera system) and at the movement disorder ward (tablet app). Results: In this study, the rater-based evaluation of tasks discriminated the best between the 3 eHealth solutions, whereas subjective modalities such as the System Usability Scale were not able to distinguish between the systems. Successful use was associated with different clinical characteristics for each system: eHealth literacy and cognitive function predicted successful use of the tablet app, and better motor function and lower age correlated with the independent use of the camera system. The successful use of the wearable sensors was independent of clinical characteristics. Unfortunately, patients who were not able to use the devices well provided few improvement suggestions in qualitative interviews. Conclusions: eHealth solutions should be developed with a specific set of patients in mind and subsequently tested in this cohort. For a complete picture, usability assessments should include a rater-based evaluation of task performance, and there is a need to develop strategies to circumvent the underrepresentation of poorly performing patients in qualitative usability research. %M 36282558 %R 10.2196/39954 %U https://formative.jmir.org/2022/10/e39954 %U https://doi.org/10.2196/39954 %U http://www.ncbi.nlm.nih.gov/pubmed/36282558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36782 %T The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study %A Kenjrawi,Yazan %A Dashash,Mayssoon %+ Medical Education Program, Syrian Virtual University, Omar Bin Abdulaziz Street, Damascus, Syrian Arab Republic, 963 948379097, yazankenjrawi@gmail.com %K evidence-based medicine %K continuous medical education %K web-based learning %K Syria %K medical graduates %K medical education %K web-based course %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. Objective: This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. Methods: A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. Results: Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants’ EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. Conclusions: In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners’ skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM. %M 36282556 %R 10.2196/36782 %U https://formative.jmir.org/2022/10/e36782 %U https://doi.org/10.2196/36782 %U http://www.ncbi.nlm.nih.gov/pubmed/36282556 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35538 %T User Behavior of a Publicly Available, Free-to-Use, Self-guided mHealth App for Depression: Observational Study in a Global Sample %A Su,Langting %A Anderson,Page Lyn %+ Department of Psychology, Georgia State University, Psychology Department, Urban Life Building, 140 Decatur Street, Atlanta, GA, 30033, United States, 1 404 822 7009, panderson@gsu.edu %K mHealth %K depression %K smartphone %K mobile app %K digital health %K global mental health %K MoodTools %K mobile health %K mental health %K mobile phone %K low- and middle-income countries %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reducing the burden of depression is a global health concern. Self-guided mobile health (mHealth) apps are one approach to address this problem. However, there is little research on self-guided mHealth apps in a global sample or on how they are used in the real world. These gaps in our knowledge must be addressed to bring the promise of mHealth apps for reducing the global burden of depression closer to reality. Objective: The purpose of this study is to examine the naturalistic user behavior of MoodTools, a publicly available, free-to-use, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. Methods: Mobile analytics data were collected from all unique downloads of the Android version of MoodTools between March 1, 2016, and February 28, 2018. Due to the deidentification and data aggregation process, no demographic or personal identifying information was tied to individual user data. All information was stored in aggregated, anonymized data files on Google Analytics’ storage database. Google’s software development kit was used to securely capture data about the number of downloads, location of downloads, number of app sessions, frequency and duration of app sessions, time between app sessions, and user retention, allowing for examination of which app’s tools were viewed and for how long, including Information (psychoeducation), Test (self-monitoring using the Patient Health Questionnaire [PHQ-9]), Thought Diary (targeting negative cognitions), Activities (behavioral activation), Videos (curated from YouTube), and Safety Plan (safety plan development and links to quickly access crisis management resources). Results: MoodTools was used by 158,930 people from 198 countries, including countries where English was not the primary language and in low- and middle-income countries. After the initial download, 51.14% (n=81,277) of users returned to the app after the initial download, and retention rates decreased with each subsequent app session. The typical person used the app for 3 sessions for a total of 12 minutes over 90 days. The most frequently visited tools were Test and Thought Diary (n=393,549, 24.32%). On average, users completed and reviewed the results of the PHQ-9 for 49 seconds and 53 seconds, respectively, and spent 3 minutes and 5 seconds on Thought Diary. Conclusions: Self-guided mHealth apps could be one approach (among the many needed) to reduce the burden of depression. Observational data collected in this study show a global interest in MoodTools, including in low- and middle-income countries and countries where English is not the primary language. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms, and if so, what “dosage” provides a meaningful benefit. %M 36282559 %R 10.2196/35538 %U https://formative.jmir.org/2022/10/e35538 %U https://doi.org/10.2196/35538 %U http://www.ncbi.nlm.nih.gov/pubmed/36282559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e31136 %T An Automated Surveillance System (SurCeGGID) for the French Sexually Transmitted Infection Clinics: Epidemiological Monitoring Study %A Ndeikoundam Ngangro,Ndeindo %A Pioche,Corinne %A Vaux,Sophie %A Viriot,Delphine %A Durand,Julien %A Berat,Bénédicte %A Hamdaoui,Mohammed %A Lot,Florence %+ Infectious Diseases Department, Sante publique France, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France, 33 (0)141796804, ndeindo.ndeikoundam@santepubliquefrance.fr %K HIV %K hepatitis B %K hepatitis C %K STI %K sexual health %K epidemiology %K surveillance %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Viral and bacterial sexually transmitted infections (STIs) are public health concerns worldwide, but surveillance systems are not comprehensive enough to design and monitor accurately STI control strategies in most countries. In 2016, 320 STI clinics (CeGIDDs in French) were implemented in France, primarily targeting most exposed populations, although access is free of charge for anybody. Objective: This article describes the mandatory surveillance system (SurCeGIDD) based on CeGIDD’s individual data aiming to better guide STI prevention. Methods: A decree ensured the use of software to manage consultations in CeGIDDs and to transfer surveillance data. A web service was implemented to secure data transfer from CeGIDDs’ software to a centralized database. CeGIDDs can also transfer data in CSV format via a secured data-sharing platform. Then, data are automatically checked before integration. Data on sociodemographic variables, sexual exposure, blood exposure, symptoms, STI tests, STI diagnoses, and sexual health services delivery were collected for the previous year (n–1). Preliminary and descriptive analyses of 2017-2018 data transmitted in 2018 and 2019, respectively, were performed using numbers and proportions for qualitative variables. Results: In 2017, 54/320 (16.9%) CeGIDDs transmitted their data. In 2018, this number of participants increased to 143/320 (44.7%) CeGIDDs. The corresponding volume of records increased from 2414 in 2017 to 382,890 in 2018. In 2018, most attendances were hospital based (263,480/382,890, 68.81%). In 2018, attendees were mostly men 227,326/379,921 (59.84%), while 151,963/379,921 (40%) were women 632/379,921 (0.17%) transgenders. The median age was 27 years for men, 23 years for women, and 30 years for transgender. Half of the attendees (81,964/174,932, 46.85%) were heterosexual men, 69,016/174,932 (39.45%) heterosexual women, 20,764/174,932 (11.87%) men who have sex with men, and 3188/174,932 (1.82%) women who have sex with women. A majority of them were born in France (227,698/286,289, 79.53%) and unemployed 115,913/211,707 (54.75%). The positivity rates were 0.37% for 205,348 HIV serologies, 1.31% for 131,551 hepatitis B virus serologies, 7.16% for 161,241 Chlamydia trachomatis PCR, 2.83% for 146,649 gonorrhea PCR, 1.04% for the syphilis combination of treponema and nontreponema serologies, and 5.96% for 13,313 Mycoplasma genitalium PCR. Conclusions: Despite challenges, the effectiveness of the SurCeGIDD surveillance based on routine patients’ records was demonstrated. The wide range of information, including socioeconomic determinants, might help to better guide and evaluate the prevention policies and services delivery. However, the growing volumes of information will require adapted tools and algorithms for the data management and analyses. %M 36282557 %R 10.2196/31136 %U https://formative.jmir.org/2022/10/e31136 %U https://doi.org/10.2196/31136 %U http://www.ncbi.nlm.nih.gov/pubmed/36282557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37385 %T The Development and Evaluation of “Life Age”—a Primary Prevention and Population-Focused Risk Communication Tool: Feasibility Study With a Single-Arm Repeated Measures Design %A Olusan,Adeogo Akinwale %A Barr,Suzanne %A Cobain,Mark %A Whelan,Holly %+ Department of Cardiology, Belfast Health and Social Care (HSC) Trust, 274 Grosvenor Road,, Belfast, BT12 6BA, United Kingdom, 44 7423161441, aakinwale@yahoo.co.uk %K Life Age %K Heart Age %K cardiovascular risk %K lifestyle change %K psychosocial well-being %K population focused risk communication tool %K health promotion %K risk perception %K premature mortality %K risk communication %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Communicating cardiovascular risk to the general population requires forms of communication that can enhance risk perception and stimulate lifestyle changes associated with reduced cardiovascular risk. Objective: The aim of this study was to evaluate the motivational potential of a novel lifestyle risk assessment (“Life Age”) based on factors predictive of both premature mortality and psychosocial well-being. Methods: A feasibility study with a single-arm repeated measures design was conducted to evaluate the potential efficacy of Life Age on motivating lifestyle changes. Participants were recruited via social media, completed a web-based version of the Life Age questionnaire at baseline and at follow-up (8 weeks), and received 23 e-newsletters based on their Life Age results along with a mobile tracker. Participants’ estimated Life Age scores were analyzed for evidence of lifestyle changes made. Quantitative feedback of participants was also assessed. Results: In total, 18 of 27 participants completed the two Life Age tests. The median baseline Life Age was 1 year older than chronological age, which was reduced to –1.9 years at follow-up, representing an improvement of 2.9 years (P=.02). There were also accompanying improvements in Mediterranean diet score (P=.001), life satisfaction (P=.003), and sleep (P=.05). Quantitative feedback assessment indicated that the Life Age tool was easy to understand, helpful, and motivating. Conclusions: This study demonstrated the potential benefit of a novel Life Age tool in generating a broad set of lifestyle changes known to be associated with clinical risk factors, similar to “Heart Age.” This was achieved without the recourse to expensive biomarker tests. However, the results from this study suggest that the motivated lifestyle changes improved both healthy lifestyle risks and psychosocial well-being, consistent with the approach of Life Age in merging the importance of a healthy lifestyle and psychosocial well-being. Further evaluation using a larger randomized controlled trial is required to fully evaluate the impact of the Life Age tool on lifestyle changes, cardiovascular disease prevention, and overall psychosocial well-being. %M 36279163 %R 10.2196/37385 %U https://formative.jmir.org/2022/10/e37385 %U https://doi.org/10.2196/37385 %U http://www.ncbi.nlm.nih.gov/pubmed/36279163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40452 %T The Family Level Assessment of Screen Use–Mobile Approach: Development of an Approach to Measure Children’s Mobile Device Use %A Perez,Oriana %A Kumar Vadathya,Anil %A Beltran,Alicia %A Barnett,R Matthew %A Hindera,Olivia %A Garza,Tatyana %A Musaad,Salma M %A Baranowski,Tom %A Hughes,Sheryl O %A Mendoza,Jason A %A Sabharwal,Ashutosh %A Veeraraghavan,Ashok %A O'Connor,Teresia M %+ United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, United States, 1 713 798 6782, teresiao@bcm.edu %K screen time %K mobile media apps %K children %K mobile phone use %K tablet use %K mobile phone %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children’s screen time has been the most common method of measuring screen time, which may be imprecise or biased. Objective: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)–mobile approach, an innovative method that leverages the existing features of the Android platform. Methods: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. Results: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child’s mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. Conclusions: The FLASH-mobile approach offers an important new research approach to measure children’s use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children. %M 36269651 %R 10.2196/40452 %U https://formative.jmir.org/2022/10/e40452 %U https://doi.org/10.2196/40452 %U http://www.ncbi.nlm.nih.gov/pubmed/36269651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37137 %T Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study %A Kenter,Robin Maria Francisca %A Schønning,Adrian %A Inal,Yavuz %+ Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Christies gate 12, Bergen, 5015, Norway, 47 48464314, robken@helse-bergen.no %K usability testing %K user evaluation %K attention-deficit/hyperactivity disorder %K self-guided intervention %K internet-delivered %K self-help %K adults with attention-deficit/hyperactivity disorder %K intervention %K usability study %K care needs %K usability %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although effective pharmacological treatment exists, many adults with attention-deficit/hyperactivity disorder (ADHD) prefer a nonpharmacological option for managing their symptoms. Internet-delivered self-help interventions have the potential to address this unmet supportive care need reported by adults with ADHD, at relatively low costs. However, if the intervention does not offer optimal functions, content, and layout, it could decrease adherence and engagement and potentially compromise the effectiveness of such interventions. Thus, there is a need for examining the usability and factors that enhance and impair the usability of internet-delivered self-help interventions. Objective: This study evaluates the usability of an internet-delivered self-help intervention for adults with ADHD (MyADHD). The main goals were to (1) collect qualitative and quantitative data on usability and (2) identify usability problems. Methods: Individual think-aloud interviews and staged usability testing (N=5) were conducted to evaluate the usability of the MyADHD intervention in terms of function, content, and design. MyADHD end users provided iterative feedback to maximize engagement and usability. They performed tasks involved in operating the intervention and provided “think-aloud” commentary and postsession usability ratings. The interviews were recorded, transcribed verbatim, and analyzed. Results: Participants were satisfied with the overall usability of the program. The average perceived usability score out of 100 was 70 for the first round of testing and improved to 77.5 after applying modifications, with a mean score of 75.5 (SD 5.9) for all rounds of usability testing. The analysis of the interviews revealed 3 central themes: functionality, content, and layout. Conclusions: Optimizing the usability of internet-delivered self-guided interventions is a critical step in the design and development process. The usability testing in this study provided valuable information from users’ perspectives on the content and platform of the intervention. Analysis revealed the need for intervention enhancement with regard to design, functionality, and content from the perspective of potential end users. Overall, participants saw value in the MyADHD intervention and were confident that they could use it for the self-management of symptoms and expressed the desire to use the entire intervention when it becomes available. Through this development process, we produced an intervention that is likely to be used successfully and is ready for deployment in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 %M 36269662 %R 10.2196/37137 %U https://formative.jmir.org/2022/10/e37137 %U https://doi.org/10.2196/37137 %U http://www.ncbi.nlm.nih.gov/pubmed/36269662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39373 %T Mental Illness Concordance Between Hospital Clinical Records and Mentions in Domestic Violence Police Narratives: Data Linkage Study %A Karystianis,George %A Cabral,Rina Carines %A Adily,Armita %A Lukmanjaya,Wilson %A Schofield,Peter %A Buchan,Iain %A Nenadic,Goran %A Butler,Tony %+ School of Population Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Kensington Campus, Sydney, 2052, Australia, 61 93852517, g.karystianis@unsw.edu.au %K data linkage %K mental health %K domestic violence %K police records %K hospital records %K text mining %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To better understand domestic violence, data sources from multiple sectors such as police, justice, health, and welfare are needed. Linking police data to data collections from other agencies could provide unique insights and promote an all-of-government response to domestic violence. The New South Wales Police Force attends domestic violence events and records information in the form of both structured data and a free-text narrative, with the latter shown to be a rich source of information on the mental health status of persons of interest (POIs) and victims, abuse types, and sustained injuries. Objective: This study aims to examine the concordance (ie, matching) between mental illness mentions extracted from the police’s event narratives and mental health diagnoses from hospital and emergency department records. Methods: We applied a rule-based text mining method on 416,441 domestic violence police event narratives between December 2005 and January 2016 to identify mental illness mentions for POIs and victims. Using different window periods (1, 3, 6, and 12 months) before and after a domestic violence event, we linked the extracted mental illness mentions of victims and POIs to clinical records from the Emergency Department Data Collection and the Admitted Patient Data Collection in New South Wales, Australia using a unique identifier for each individual in the same cohort. Results: Using a 2-year window period (ie, 12 months before and after the domestic violence event), less than 1% (3020/416,441, 0.73%) of events had a mental illness mention and also a corresponding hospital record. About 16% of domestic violence events for both POIs (382/2395, 15.95%) and victims (101/631, 16.01%) had an agreement between hospital records and police narrative mentions of mental illness. A total of 51,025/416,441 (12.25%) events for POIs and 14,802/416,441 (3.55%) events for victims had mental illness mentions in their narratives but no hospital record. Only 841 events for POIs and 919 events for victims had a documented hospital record within 48 hours of the domestic violence event. Conclusions: Our findings suggest that current surveillance systems used to report on domestic violence may be enhanced by accessing rich information (ie, mental illness) contained in police text narratives, made available for both POIs and victims through the application of text mining. Additional insights can be gained by linkage to other health and welfare data collections. %M 36264613 %R 10.2196/39373 %U https://formative.jmir.org/2022/10/e39373 %U https://doi.org/10.2196/39373 %U http://www.ncbi.nlm.nih.gov/pubmed/36264613 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37982 %T Social Media Communication and Network Correlates of HIV Infection and Transmission Risks Among Black Sexual Minority Men: Cross-sectional Digital Epidemiology Study %A Young,Lindsay E %A Tang,Jack Lipei %A Nan,Yuanfeixue %+ Annenberg School for Communication and Journalism, University of Southern California, 3502 Watt Way, Los Angeles, CA, 90089, United States, 1 610 331 1930, lindsay.young@usc.edu %K HIV surveillance %K HIV prevention %K digital epidemiology %K social media %K social networks %K sexual minority men %K men who have sex with men %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, HIV disproportionately affects Black cisgender sexual minority men (BSMM). Although epidemiological and behavioral surveillance are integral to identifying BSMM at risk of HIV infection and transmission, overreliance on self-reported data, inability to observe social contexts, and neglect of populations with limited engagement in health care systems limits their effectiveness. Digital epidemiological approaches drawing on social media data offer an opportunity to overcome these limitations by passively observing in organic settings activities, beliefs, behaviors, and moods that indicate health risks but are otherwise challenging to capture. Objective: The primary aim of this study was to determine whether features of Facebook communication and networks were associated with biological, behavioral, and psychological indicators of HIV infection and transmission risk. Methods: Facebook and survey data were collected from BSMM aged 18 to 35 years living in Chicago (N=310). Participants’ Facebook posts were characterized using 4 culturally tailored topic dictionaries related to aspects of HIV protection and risk among BSMM (sexual health; substance use; sex behavior; and ballroom culture, a salient subculture in lesbian, gay, bisexual, transgender, and queer communities of color). Social network methods were used to capture structural features of BSMM’s Facebook friendships (centrality, brokerage, and local clustering) and Facebook group affiliations. Multivariable regressions revealed relationships between these Facebook features and 5 ground truth indicators of HIV infection and transmission risk (sexually transmitted infection incidence, condomless sex, sex drug use, biomedical prevention, and depression). Results: Although analysis of participants’ Facebook posts revealed that HIV-related topics occupied a small portion of the total messages posted by each participant, significant associations were found between the following HIV risk indicators and Facebook features: Condomless sex, including communication about sexual health (odds ratio [OR] 1.58, 95% CI 1.09-2.29), ballroom culture (OR 0.76, 95% CI 0.63-0.93), and friendship centrality (OR 0.69, 95% CI 0.52-0.92); Sex drug use, including communication about substance use (OR 1.81, 95% CI 1.17-2.79) and friendship centrality (OR 0.73, 95% CI 0.55-0.96) and brokerage (OR 0.71, 95% CI 0.51-0.99); Biomedical prevention, including communication about ballroom culture (OR 0.06, 95% CI 0.01-0.71); and Depression, including communication about sexual health (β=–0.72, 95% CI −1.42 to −0.02), ballroom culture (β=.80, 95% CI 0.27-1.34), friendship centrality (β=−0.90, 95% CI −1.60 to −0.21), and Facebook group affiliations (β=.84, 95% CI 0.25-1.43). Facebook features provided no significant explanatory value for sexually transmitted infection incidence. Conclusions: Finding innovative strategies to detect BSMM at risk of contracting or transmitting HIV is critical to eliminating HIV disparities in this community. The findings suggest that social media data enable passive observance of social and communicative contexts that would otherwise go undetected using traditional HIV surveillance methods. As such, social media data are promising complements to more traditional data sources. %M 36264617 %R 10.2196/37982 %U https://formative.jmir.org/2022/10/e37982 %U https://doi.org/10.2196/37982 %U http://www.ncbi.nlm.nih.gov/pubmed/36264617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37877 %T A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study %A Goonesekera,Yenushka %A Donkin,Liesje %+ Department of Psychology and Neuroscience, Auckland University of Technology, 55 Wellesley Street East, Private Bag 92006, Auckland, 1010, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K health anxiety %K conversational agent %K illness anxiety disorder %K COVID-19 %K iCBT %K user experience %K anthropomorphism %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies. Objective: The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic. Methods: Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed. Results: The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis. Conclusions: Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety. %M 36150049 %R 10.2196/37877 %U https://formative.jmir.org/2022/10/e37877 %U https://doi.org/10.2196/37877 %U http://www.ncbi.nlm.nih.gov/pubmed/36150049 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40018 %T Shared Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction %A Gomez Lumbreras,Ainhoa %A Reese,Thomas J %A Del Fiol,Guilherme %A Tan,Malinda S %A Butler,Jorie M %A Hurwitz,Jason T %A Brown,Mary %A Kawamoto,Kensaku %A Thiess,Henrik %A Wright,Maria %A Malone,Daniel C %+ Department of Pharmacotherapy, Skaggs College of Pharmacy, University of Utah, 30 S 2000 East, Room 4922, Salt Lake City, UT, 84112, United States, 1 801 581 8054, dan.malone@utah.edu %K decision making, shared %K decision support systems, clinical %K decision making %K decision support %K user-centered design %K patient-centered care %K risk management %K drug interaction %K pharmacotherapy %K pharmacy %K pharmaceutical %K warfarin %K unified theory of acceptance and use of technology %K UTAUT %K NSAID %K anti-inflammatory %K non-steroidal %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Warnings about drug-drug interactions (DDIs) between warfarin and nonsteroidal anti-inflammatory drugs (NSAIDs) within electronic health records indicate potential harm but fail to account for contextual factors and preferences. We developed a tool called DDInteract to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. DDInteract was designed to be integrated into electronic health records using interoperability standards. Objective: The purpose of this study was to conduct a formative evaluation of a DDInteract that incorporates patient and product contextual factors to estimate the risk of bleeding. Methods: A randomized formative evaluation was conducted to compare DDInteract to usual care (UC) using physician-patient dyads. Using case vignettes, physicians and patients on warfarin participated in simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Dyads were randomized to either DDInteract or UC. Participants completed a postsession interview and survey of the SDM process. This included the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). They also were interviewed after the session to obtain perceptions on DDInteract and UC resources for DDIs. Results: Twelve dyad encounters were performed using virtual software. Most (n=11, 91.7%) patients were over 50 years of age, and 9 (75%) had been taking warfarin for more than 2 years (75%). Regarding scores on the SDM-Q-9, participants rated DDInteract higher than UC for questions pertaining to helping patients clarify the decision (P=.03), involving patients in the decision (P=.01), displaying treatment options (P<.001), identifying advantages and disadvantages (P=.01), and facilitating patient understanding (P=.01) and discussion of preferences (P=.01). Five of the 8 UTAUT constructs showed differences between the 2 groups, favoring DDInteract (P<.05). Usability ratings from the SUS were significantly higher (P<.05) for physicians using DDInteract compared to those in the UC group but showed no differences from the patient’s perspective. No differences in patient responses were observed between groups using the DCS. During the session debrief, physicians indicated little concern for the additional time or workload entailed by DDInteract use. Both clinicians and patients indicated that the tool was beneficial in simulated encounters to understand and mitigate the risk of harm from this DDI. Conclusions: Overall, DDInteract may improve encounters where there is a risk of bleeding due to a potential drug-drug interaction involving anticoagulants. Participants rated DDInteract as logical and useful for enhancing SDM. They reported that they would be willing to use the tool for an interaction involving warfarin and NSAIDs. %M 36260377 %R 10.2196/40018 %U https://formative.jmir.org/2022/10/e40018 %U https://doi.org/10.2196/40018 %U http://www.ncbi.nlm.nih.gov/pubmed/36260377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39759 %T Long-term Follow-up of Patients With Hernia Using the Hernia-Specific Quality-of-Life Mobile App: Feasibility Questionnaire Study %A Huang,Ching-Shui %A Tai,Feng-Chuan %A Lien,Heng-Hui %A Wong,Jia-Uei %A Huang,Chi-Cheng %+ Department of Surgery, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei, 106, Taiwan, 886 2 28757808, chishenh74@gmail.com %K hernia %K mobile app %K quality of life %K Hernia-Specific Quality-of-Life (HERQL) %K mobile health %K mHealth %K app %K self-management %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hernia repair is one of the most common surgical procedures; however, the long-term outcomes are seldom reported due to incomplete follow-up. Objective: The aim of this study was to examine the use of a mobile app for the long-term follow-up of hernia recurrence, complication, and quality-of-life perception. Methods: A cloud-based corroborative system drove a mobile app with the HERQL (Hernia-Specific Quality-of-Life) questionnaire built in. Patients who underwent hernia repair were identified from medical records, and an invitation to participate in this study was sent through the post. Results: The response rate was 11.89% (311/2615) during the 1-year study period, whereas the recurrence rate was 1.0% (3/311). Causal relationships between symptomatic and functional domains of the HERQL questionnaire were indicated by satisfactory model fit indices and significant regression coefficients derived from structural equational modeling. Regarding patients’ last hernia surgeries, 88.7% (276/311) of the patients reported them to be satisfactory or very satisfactory, 68.5% (213/311) of patients reported no discomfort, and 61.1% (190/311) of patients never experienced mesh foreign body sensation. Subgroup analysis for the most commonly used mesh repairs found that mesh plug repair inevitably resulted in worse symptoms and quality-of-life perception from the group with groin hernias. Conclusions: The mobile app has the potential to enhance the quality of care for patients with hernia and facilitate outcomes research with more complete follow-up. %M 36260390 %R 10.2196/39759 %U https://formative.jmir.org/2022/10/e39759 %U https://doi.org/10.2196/39759 %U http://www.ncbi.nlm.nih.gov/pubmed/36260390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35926 %T A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial %A Abrantes,Ana M %A Meshesha,Lidia Z %A E Blevins,Claire %A Battle,Cynthia L %A Lindsay,Clifford %A Marsh,Eliza %A Feltus,Sage %A Buman,Matthew %A Agu,Emmanuel %A Stein,Michael %+ Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, United States, 1 4014556440, Ana_Abrantes@Brown.edu %K alcohol use disorder %K AUD %K physical activity %K smartphone app %K Fitbit %K feasibility study %K mobile phone %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions: The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 %M 36260381 %R 10.2196/35926 %U https://formative.jmir.org/2022/10/e35926 %U https://doi.org/10.2196/35926 %U http://www.ncbi.nlm.nih.gov/pubmed/36260381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40726 %T Understanding Mental Health Apps for Youth: Focus Group Study With Latinx Youth %A Agapie,Elena %A Chang,Katherine %A Patrachari,Sneha %A Neary,Martha %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 3850, s.schueller@uci.edu %K mental health %K mental health apps %K youth %K child %K teenager %K focus group %K human-centered design %K mobile health %K mHealth %K health app %K cognitive behavioral therapy %K CBT %K perspective %K qualitative %K mindfulness %K health app %K digital health tool %K Latino %K Latinx %K mobile phone %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of mental health apps (MHapps) are being developed for youth. In addition, youth are high users of both technologies and MHapps. However, little is known about their perspectives on MHapps. MHapps might be particularly well suited to reach the youth underserved by traditional mental health resources, and incorporating their perspectives is especially critical to ensure such tools are useful to them. Objective: The goal of this study was to develop and pilot a process for eliciting youth perspectives on MHapps in a structured and collaborative way. We also sought to generate learnings on the perspectives of Latinx youth on MHapps and their use in ways that might facilitate discovery, activation, or engagement in MHapps, especially in Latinx populations. Methods: We created a series of focus groups consisting of 5 sessions. The groups introduced different categories of MHapps (cognitive behavioral therapy apps, mindfulness apps, and miscellaneous apps). Within each category, we selected 4 MHapps that participants chose to use for a week and provided feedback through both between-session and in-session activities. We recruited 5 youths ranging in age from 15 to 21 (mean 18, SD 2.2) years. All the participants identified as Hispanic or Latinx. After completing all 5 focus groups, the participants completed a brief questionnaire to gather their impressions of the apps they had used. Results: Our focus group methodology collected detailed and diverse information about youth perspectives on MHapps. However, we did identify some aspects of our methods that were less successful at engaging the youth, such as our between-session activities. The Latinx youth in our study wanted apps that were accessible, relatable, youth centric, and simple and could be integrated with their offline lives. We also found that the mindfulness apps were viewed most favorably but that the miscellaneous and cognitive behavioral therapy apps were viewed as more impactful. Conclusions: Eliciting youth feedback on MHapps is critical if these apps are going to serve a role in supporting their mental health and well-being. We refined a process for collecting feedback from the youth and identified factors that were important to a set of Latinx youth. Future work could be broader, that is, recruit larger samples of more diverse youth, or deeper, that is, collect more information from each youth around interests, needs, barriers, or facilitators or better understand the various impacts of MHapps by using qualitative and quantitative measures. Nevertheless, this study advances the formative understanding of how the youth, particularly Latinx youth, might be viewing these tools. %M 36256835 %R 10.2196/40726 %U https://formative.jmir.org/2022/10/e40726 %U https://doi.org/10.2196/40726 %U http://www.ncbi.nlm.nih.gov/pubmed/36256835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35426 %T Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study %A Herbert,Carly %A Broach,John %A Heetderks,William %A Qashu,Felicia %A Gibson,Laura %A Pretz,Caitlin %A Woods,Kelsey %A Kheterpal,Vik %A Suvarna,Thejas %A Nowak,Christopher %A Lazar,Peter %A Ayturk,Didem %A Barton,Bruce %A Achenbach,Chad %A Murphy,Robert %A McManus,David %A Soni,Apurv %+ Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 4047180676, carly.herbert@umassmed.edu %K COVID-19 %K SARS-CoV-2 %K rapid tests %K MyDataHelps smartphone app %K mHealth %K mobile health %K serial self-testing %K digital health %K pandemic %K self test %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals’ use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team’s interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7%) and 159 (77.2%) completed testing and follow-up surveys, respectively. In total, 51.3% (97/189) of study participants were women, the average age was 40.7 years, 34.4% (65/189) were non-White, and 82% (155/189) had a bachelor’s degree or higher. Most (n=133/206, 64.6%) participants showed high testing adherence, meaning they completed over 75% of the assigned tests. Participants’ interpretations of test results demonstrated high agreement (2106/2130, 98.9%) with the study verified results, with a κ score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants’ high adherence to the recommended testing schedule, significant reliability between participants and study staff’s test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. %M 36041004 %R 10.2196/35426 %U https://formative.jmir.org/2022/10/e35426 %U https://doi.org/10.2196/35426 %U http://www.ncbi.nlm.nih.gov/pubmed/36041004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e33769 %T Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study %A Kalańska-Łukasik,Barbara %A Gładyś,Aleksandra %A Jadczyk,Tomasz %A Gruz-Kwapisz,Monika %A Wojakowski,Wojciech %A Kowalska,Malgorzata %+ Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 47, Katowice, 40-635, Poland, 1 32 359 86 90, b.kalanska.lukasik@gmail.com %K telemedicine %K readiness %K patient-cardiologist contact %K telehealth %K acceptance %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients’ readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users’ expectations. Objective: This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases. Methods: We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants. Results: Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication. Conclusions: During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions. %M 36256834 %R 10.2196/33769 %U https://formative.jmir.org/2022/10/e33769 %U https://doi.org/10.2196/33769 %U http://www.ncbi.nlm.nih.gov/pubmed/36256834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e29920 %T RWD-Cockpit: Application for Quality Assessment of Real-world Data %A Babrak,Lmar Marie %A Smakaj,Erand %A Agac,Teyfik %A Asprion,Petra Maria %A Grimberg,Frank %A der Werf,Daan Van %A van Ginkel,Erwin Willem %A Tosoni,Deniz David %A Clay,Ieuan %A Degen,Markus %A Brodbeck,Dominique %A Natali,Eriberto Noel %A Schkommodau,Erik %A Miho,Enkelejda %+ University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences, Hofackerstrasse 30, Muttenz, 4132, Switzerland, 41 0612285847, enkelejda.miho@fhnw.ch %K real-world data %K real-world evidence %K quality assessment %K application %K mobile phone %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technologies are transforming the health care system. A large part of information is generated as real-world data (RWD). Data from electronic health records and digital biomarkers have the potential to reveal associations between the benefits and adverse events of medicines, establish new patient-stratification principles, expose unknown disease correlations, and inform on preventive measures. The impact for health care payers and providers, the biopharmaceutical industry, and governments is massive in terms of health outcomes, quality of care, and cost. However, a framework to assess the preliminary quality of RWD is missing, thus hindering the conduct of population-based observational studies to support regulatory decision-making and real-world evidence. Objective: To address the need to qualify RWD, we aimed to build a web application as a tool to translate characterization of some quality parameters of RWD into a metric and propose a standard framework for evaluating the quality of the RWD. Methods: The RWD-Cockpit systematically scores data sets based on proposed quality metrics and customizable variables chosen by the user. Sleep RWD generated de novo and publicly available data sets were used to validate the usability and applicability of the web application. The RWD quality score is based on the evaluation of 7 variables: manageability specifies access and publication status; complexity defines univariate, multivariate, and longitudinal data; sample size indicates the size of the sample or samples; privacy and liability stipulates privacy rules; accessibility specifies how the data set can be accessed and to what granularity; periodicity specifies how often the data set is updated; and standardization specifies whether the data set adheres to any specific technical or metadata standard. These variables are associated with several descriptors that define specific characteristics of the data set. Results: To address the need to qualify RWD, we built the RWD-Cockpit web application, which proposes a framework and applies a common standard for a preliminary evaluation of RWD quality across data sets—molecular, phenotypical, and social—and proposes a standard that can be further personalized by the community retaining an internal standard. Applied to 2 different case studies—de novo–generated sleep data and publicly available data sets—the RWD-Cockpit could identify and provide researchers with variables that might increase quality. Conclusions: The results from the application of the framework of RWD metrics implemented in the RWD-Cockpit application suggests that multiple data sets can be preliminarily evaluated in terms of quality using the proposed metrics. The output scores—quality identifiers—provide a first quality assessment for the use of RWD. Although extensive challenges remain to be addressed to set RWD quality standards, our proposal can serve as an initial blueprint for community efforts in the characterization of RWD quality for regulated settings. %M 35266872 %R 10.2196/29920 %U https://formative.jmir.org/2022/10/e29920 %U https://doi.org/10.2196/29920 %U http://www.ncbi.nlm.nih.gov/pubmed/35266872 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e34055 %T An Accessible Communication System for Population-Based Genetic Testing: Development and Usability Study %A Coffin,Tara %A Bowen,Deborah %A Swisher,Elizabeth %A Lu,Karen %A Rayes,Nadine %A Norquist,Barbara %A Blank,Stephanie %A Levine,Douglas %A Bakkum-Gamez,Jamie %A Fleming,Gini %A Olopade,Olufunmilayo %A D’Andrea,Alan %A Nebgen,Denise %A Peterson,Christine %A Munsell,Mark %A Gavin,Kathleen %A Lechner,Rebecca %A Crase,Jamie %A Polinsky,Deborah %A Romero,Iris %+ University of Washington, 1400 NE Campus Parkway, Seattle, WA, 98195-4550, United States, 1 206 543 2100, tbcoffin@uw.edu %K genetic testing %K internet %K social media %K accessibility %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Genetic testing uptake is low, despite the well-established connection between pathogenic variants in certain cancer-linked susceptibility genes and ovarian cancer risk. Given that most major insurers cover genetic testing for those with a family history suggestive of hereditary cancer, the issue may lie in access to genetic testing. Remotely accessible web-based communication systems may improve awareness, and uptake, of genetic testing services. Objective: This study aims to present the development and formative evaluation of the multistep web-based communication system required to support the implementation of, and access to, genetic testing. Methods: While designing the multistep web-based communication system, we considered various barriers and facilitators to genetic testing, guided by dimensions of accessibility. In addition to conducting usability testing, we performed ongoing assessments focusing on the function of the web-based system and participant response rates, with the goal of continuing to make modifications to the web-based communication system as it is in use. Results: The combined approach of usability testing and expert user experience consultation resulted in several modifications to the multistep web-based communication system, including changes that related to imagery and content, web accessibility, and general organization of the web-based system. All recommendations were made with the goal of improving the overall accessibility of the web-based communication system. Conclusions: A multistep web-based communication system appears to be an effective way to address many potential barriers to access, which may otherwise make genetic testing difficult for at-risk individuals to participate in. Importantly, some dimensions of access were easy to assess before study recruitment, but other aspects of the communication system required ongoing assessment during the implementation process of the Making Genetic Testing Accessible study. %M 36251350 %R 10.2196/34055 %U https://formative.jmir.org/2022/10/e34055 %U https://doi.org/10.2196/34055 %U http://www.ncbi.nlm.nih.gov/pubmed/36251350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41415 %T Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study %A Badawy,Sherif M %A DiMartino,Lisa %A Brambilla,Donald %A Klesges,Lisa %A Baumann,Ana %A Burns,Ebony %A DeMartino,Terri %A Jacobs,Sara %A Khan,Hamda %A Nwosu,Chinonyelum %A Shah,Nirmish %A Hankins,Jane S %A , %+ Department of Hematology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 800, Memphis, TN, 38105, United States, 1 901 5954153, jane.hankins@stjude.org %K sickle cell anemia %K implementation science %K adherence %K hydroxycarbamide %K self-efficacy %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hydroxyurea therapy is effective for reducing complications related to sickle cell disease (SCD) and is recommended by National Health Lung and Blood Institute care guidelines. However, hydroxyurea is underutilized, and adherence is suboptimal. We wanted to test a multilevel mobile health (mHealth) intervention to increase hydroxyurea adherence among patients and improve prescribing among providers in a multicenter clinical trial. In the first 2 study sites, participants were exposed to the early phases of the COVID-19 pandemic, which included disruption to their regular SCD care. Objective: We aimed to describe the impact of the COVID-19 pandemic on the implementation of an mHealth behavioral intervention for improving hydroxyurea adherence among patients with SCD. Methods: The first 2 sites initiated enrollment 3 months prior to the start of the pandemic (November 2019 to March 2020). During implementation, site A clinics shut down for 2 months and site B clinics shut down for 9 months. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the implementation and effectiveness of the intervention. mHealth implementation was assessed based on patients’ daily app use. Adherence to hydroxyurea was calculated as the proportion of days covered (PDC) from prescription records over the first 12 and 24 weeks after implementation. A linear model examined the relationship between app usage and PDC change, adjusting for baseline PDC, lockdown duration, and site. We conducted semistructured interviews with patients, health care providers, administrators, and research staff to identify factors associated with mHealth implementation and effectiveness. We used a mixed methods approach to investigate the convergence of qualitative and quantitative findings. Results: The percentage of patients accessing the app decreased after March 15, 2020 from 86% (n=55) to 70% (n=45). The overall mean PDC increase from baseline to week 12 was 4.5% (P=.32) and to week 24 was 1.5% (P=.70). The mean PDC change was greater at site A (12 weeks: 20.9%; P=.003; 24 weeks: 16.7%; P=.01) than site B (12 weeks: −8.2%; P=.14; 24 weeks: −10.3%; P=.02). After adjustment, PDC change was 13.8% greater in those with increased app use after March 15, 2020. Interview findings indicated that site B’s closure during COVID-19 had a greater impact, but almost all patients reported that the InCharge Health app helped support more consistent medication use. Conclusions: We found significant impacts of the early clinic lockdowns, which reduced implementation of the mHealth intervention and led to reduced patient adherence to hydroxyurea. However, disruptions were lower among participants who experienced shorter clinic lockdowns and were associated with higher hydroxyurea adherence. Investigation of added strategies to mitigate the effects of care interruptions during major emergencies (eg, patient coaching and health navigation) may “insulate” the implementation of interventions to increase medication adherence. Trial Registration: ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167 International Registered Report Identifier (IRRID): RR2-10.2196/16319 %M 36240004 %R 10.2196/41415 %U https://formative.jmir.org/2022/10/e41415 %U https://doi.org/10.2196/41415 %U http://www.ncbi.nlm.nih.gov/pubmed/36240004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38661 %T Evidence for Telemedicine’s Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational Study %A Mandal,Soumik %A Wiesenfeld,Batia M %A Mann,Devin %A Lawrence,Katharine %A Chunara,Rumi %A Testa,Paul %A Nov,Oded %+ Department of Population Health, New York University Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013442, mandal.soumik@gmail.com %K digital health %K telemedicine %K urgent care %K COVID-19 %K health care delivery %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods: Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results: The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions: The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience. %M 36103553 %R 10.2196/38661 %U https://formative.jmir.org/2022/10/e38661 %U https://doi.org/10.2196/38661 %U http://www.ncbi.nlm.nih.gov/pubmed/36103553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36260 %T Developing Population Health Surveillance Using mHealth in Low-Resource Settings: Qualitative Assessment and Pilot Evaluation %A Benda,Natalie C %A Zawtha,Sakie %A Anderson,Kyrie %A Sharma,Mohit Manoj %A Lin,Phoe Be %A Zawtha,Beichotha %A Masterson Creber,Ruth %+ Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61st Street, Suite 301, New York, NY, 10065, United States, 1 5635432222, ncb4001@med.cornell.edu %K mobile health %K mHealth %K low- and middle-income countries %K population health surveillance %K user-centered design %K mobile phone %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Population surveillance data are essential for understanding population needs and evaluating health programs. Governmental and nongovernmental organizations in western Myanmar did not previous have means for conducting robust, electronic population health surveillance. Objective: This study involved developing mobile health (mHealth)–based population health surveillance in a rural, low-resource setting with minimal cellular infrastructure in western Myanmar. This was an early formative study in which our goal was to establish the initial feasibility of conducting mHealth population health surveillance, optimizing procedures, and building capacity for future work. Methods: We used an iterative design process to develop mHealth-based population health surveillance focused on general demographics (eg, total census, age category, sex, births, and deaths). Interviews were conducted with international consultants (nurse midwives) and local clinicians (nurses and physicians) in Myanmar. Our analytic approach was informed by the Systems Engineering Initiative for Patient Safety work systems model to capture the multilevel user needs for developing health interventions, which was used to create a prototype data collection tool. The prototype was then pilot-tested in 33 villages to establish an initial proof of concept. Results: We conducted 7 interviews with 5 participants who provided feedback regarding the domains of the work system, including environmental, organizational, sociocultural, technological, informational, and task- and people-based considerations, for adapting an mHealth tool. Environmental considerations included managing limited electricity and internet service. Organizational needs involved developing agreements to work within existing government infrastructure as well as leveraging the communal nature of societies to describe the importance of surveillance data collection and gain buy-in. Linguistic diversity and lack of experience with technology were both cited as people- and technology-based aspects to inform prototype design. The use of mobile tools was also viewed as a means to improve the quality of the data collected and as a feasible option for working in settings with limited internet access. Following the prototype design based on the findings of initial interviews, the mHealth tool was piloted in 33 villages, allowing our team to collect census data from 11,945 people for an initial proof of concept. We also detected areas of potentially missing data, which will need to be further investigated and mitigated in future studies. Conclusions: Previous studies have not focused heavily on the early stages of developing population health surveillance capacity in low- and middle-income countries. Findings related to key design considerations using a work systems lens may be informative to others developing technology-based solutions in extremely low-resource settings. Future work will involve collecting additional health-related data and further evaluating the quality of the data collected. Our team established an initial proof of concept for using an mHealth tool to collect census-related information in a low-resource, extremely rural, and low-literacy environment. %M 36239997 %R 10.2196/36260 %U https://formative.jmir.org/2022/10/e36260 %U https://doi.org/10.2196/36260 %U http://www.ncbi.nlm.nih.gov/pubmed/36239997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40869 %T An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study %A Browne,Jonathan D %A Vaninetti,Michael %A Giard,David %A Kostas,Konstantinos %A Dave,Ankur %+ Ascension Illinois, Alexian Brothers Medical Center, Eberle Building, Suite 610, 800 Biesterfield Rd, Elk Grove Village, IL, 60007, United States, 1 630 379 9815, ankur.dave@ascension.org %K back pain %K chronic pain %K mobile %K app %K multidisciplinary care %K biopsychosocial %K self-management %K mHealth %K mobile health %K mobile app %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group–based pain program—Pain Rehabilitation Outpatient-Camp. Objective: This was a prospective pilot clinical trial that evaluated the PainNavigator platform’s utility in low back pain management to inform future trial development. Methods: A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items—Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results: The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions: These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials. %M 36227637 %R 10.2196/40869 %U https://formative.jmir.org/2022/10/e40869 %U https://doi.org/10.2196/40869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39869 %T mHealth Technologies for Managing Problematic Pornography Use: Content Analysis %A Henry,Nathan %A Donkin,Liesje %A Williams,Matt %A Pedersen,Mangor %+ Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland, 1010, New Zealand, 64 9 921 9666 ext 7304, nathan.henry@aut.ac.nz %K pornography %K compulsive sexual behavior disorder %K CSBD %K mobile health %K mHealth %K problematic pornography use %K PPU %K mobile intervention %K just-in-time adaptive intervention %K smartphone-based therapy %K addiction %K internet addiction %K behavioral addiction %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps. Objective: This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction. Methods: The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis. Results: In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety. Conclusions: There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption. %M 36227634 %R 10.2196/39869 %U https://formative.jmir.org/2022/10/e39869 %U https://doi.org/10.2196/39869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227634 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39764 %T Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study %A Gudmundsson,G Haukur %A Mészáros,Judit %A Björnsdóttir,Ágústa E %A Ámundadóttir,María L %A Thorvardardottir,Gudrun E %A Magnusdottir,Erna %A Helgadottir,Halla %A Oddsson,Saemundur %+ Medical and Research Department, Sidekick Health, Oberwallstraße 6, Berlin, 10117, Germany, 49 1744789708, judit@sidekickhealth.com %K cancer %K lifestyle %K quality of life %K mobile app %K digital therapeutics %K self-management %K physical activity %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. %M 36227639 %R 10.2196/39764 %U https://formative.jmir.org/2022/10/e39764 %U https://doi.org/10.2196/39764 %U http://www.ncbi.nlm.nih.gov/pubmed/36227639 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37687 %T Online Health Information Seeking and eHealth Literacy Among Spanish Language–Dominant Latino Adults Receiving Care in a Community Clinic: Secondary Analysis of Pilot Randomized Controlled Trial Data %A Chavarria,Enmanuel A %A Christy,Shannon M %A Feng,Han %A Miao,Hongyu %A Abdulla,Rania %A Gutierrez,Liliana %A Lopez,Diana %A Sanchez,Julian %A Gwede,Clement K %A Meade,Cathy D %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, United States, 1 4047278741, enmanuel.chavarria@emory.edu %K eHealth literacy %K online health information seeking %K medically underserved %K Hispanic %K Latino %K Spanish language–dominant %K health communications %K colorectal cancer screening %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. Objective: This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. Methods: Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants’ sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy—among those seeking OHI—assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. Results: A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (β=1.20, 95% CI 0.14-2.26; P=.02). Conclusions: Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. Trial Registration: ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361 %M 35238785 %R 10.2196/37687 %U https://formative.jmir.org/2022/10/e37687 %U https://doi.org/10.2196/37687 %U http://www.ncbi.nlm.nih.gov/pubmed/35238785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38977 %T The Triage Capability of Laypersons: Retrospective Exploratory Analysis %A Kopka,Marvin %A Feufel,Markus A %A Balzer,Felix %A Schmieding,Malte L %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 581 052, marvin.kopka@charite.de %K digital health %K triage %K self-triage %K urgency assessment %K patient-centered care %K care navigation %K decision support %K symptom checker %K care %K support %K medical %K health professional %K patient %K self-assessment %K decision %K accuracy %K error %K sensitivity %K emergency %K female %K male %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health–related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient’s health. Recently, patient-facing decision support systems, commonly known as symptom checkers, have been developed to assist laypersons in these decisions. Objective: The purpose of this study is to identify factors influencing laypersons’ ability to self-triage and their risk averseness in self-triage decisions. Methods: We analyzed publicly available data on 91 laypersons appraising 45 short fictitious patient descriptions (case vignettes; N=4095 appraisals). Using signal detection theory and descriptive and inferential statistics, we explored whether the type of medical decision laypersons face, their confidence in their decision, and sociodemographic factors influence their triage accuracy and the type of errors they make. We distinguished between 2 decisions: whether emergency care was required (decision 1) and whether self-care was sufficient (decision 2). Results: The accuracy of detecting emergencies (decision 1) was higher (mean 82.2%, SD 5.9%) than that of deciding whether any type of medical care is required (decision 2, mean 75.9%, SD 5.25%; t>90=8.4; P<.001; Cohen d=0.9). Sensitivity for decision 1 was lower (mean 67.5%, SD 16.4%) than its specificity (mean 89.6%, SD 8.6%) whereas sensitivity for decision 2 was higher (mean 90.5%, SD 8.3%) than its specificity (mean 46.7%, SD 15.95%). Female participants were more risk averse and overtriaged more often than male participants, but age and level of education showed no association with participants’ risk averseness. Participants’ triage accuracy was higher when they were certain about their appraisal (2114/3381, 62.5%) than when being uncertain (378/714, 52.9%). However, most errors occurred when participants were certain of their decision (1267/1603, 79%). Participants were more commonly certain of their overtriage errors (mean 80.9%, SD 23.8%) than their undertriage errors (mean 72.5%, SD 30.9%; t>89=3.7; P<.001; d=0.39). Conclusions: Our study suggests that laypersons are overcautious in deciding whether they require medical care at all, but they miss identifying a considerable portion of emergencies. Our results further indicate that women are more risk averse than men in both types of decisions. Layperson participants made most triage errors when they were certain of their own appraisal. Thus, they might not follow or even seek advice (eg, from symptom checkers) in most instances where advice would be useful. %M 36222793 %R 10.2196/38977 %U https://formative.jmir.org/2022/10/e38977 %U https://doi.org/10.2196/38977 %U http://www.ncbi.nlm.nih.gov/pubmed/36222793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35923 %T Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service–Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study %A Yang,Shanyin %A Huang,Jiegang %A Ye,Li %A Lin,Jianyan %A Xie,Zhiman %A Guo,Baodong %A Li,Yanjun %A Liang,Bingyu %A Zheng,Zhigang %A Lunze,Karsten %A Abdullah,Abu S %A Liang,Hao %A Quintiliani,Lisa M %+ Department of Medicine, Boston Univeristy School of Medicine, 72 E Concord St, Boston, MA, 02118, United States, 1 617 638 2777, lisa.quintiliani@bmc.org %K mobile health %K mHealth %K China %K smoking %K smoking cessation %K HIV %K qualitative research %K SMS text messages %K WeChat %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective: This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages. Methods: We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results: A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions: We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China. %M 36222795 %R 10.2196/35923 %U https://formative.jmir.org/2022/10/e35923 %U https://doi.org/10.2196/35923 %U http://www.ncbi.nlm.nih.gov/pubmed/36222795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37866 %T Information Resources Among Flemish Pregnant Women: Cross-sectional Study %A Lanssens,Dorien %A Thijs,Inge M %A Dreesen,Pauline %A Van Hecke,Ann %A Coorevits,Pascal %A Gaethofs,Gitte %A Derycke,Joyce %A Tency,Inge %+ Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, University of Hasselt, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K pregnancy app %K mobile app %K questionnaire %K pregnancy %K pregnant %K mHealth %K mobile health %K cross-sectional %K user need %K user expectation %K survey %K maternal %K maternity %K user experience %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. %M 36222794 %R 10.2196/37866 %U https://formative.jmir.org/2022/10/e37866 %U https://doi.org/10.2196/37866 %U http://www.ncbi.nlm.nih.gov/pubmed/36222794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35176 %T From Real-world Individuals’ Data to National Health Indicators: Multiphase Pilot Study in Gabon %A Koumamba,Aimé Patrice %A Ngoungou,Edgard Brice %A Engohang-Ndong,Jean %A Ibinga,Euloge %A Ondzigue Mbenga,Raymond %A Diallo,Gayo %+ Centre de recherche sur la santé des populations de Bordeaux, Institut national de la santé et de la recherche médicale 1219, Université de Bordeaux, 146 Rue Léo Saignat 11, Bordeaux, 33076, France, 33 77921571, aime-patrice.koumamba@u-bordeaux.fr %K health data quality %K decision support information system %K low- and middle-income countries %K LMICs %K mobile phone %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. Objective: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. Methods: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. Results: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93% vs 12%, P<.001; 96% vs 18%, P<.001; and 100% vs 18%, P<.001; respectively). Conclusions: The proposed model contributes significantly to the improvement of health data quality in Gabon. %M 36206045 %R 10.2196/35176 %U https://formative.jmir.org/2022/10/e35176 %U https://doi.org/10.2196/35176 %U http://www.ncbi.nlm.nih.gov/pubmed/36206045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e42055 %T Formative Evaluation of the Acceptance of HIV Prevention Artificial Intelligence Chatbots By Men Who Have Sex With Men in Malaysia: Focus Group Study %A Peng,Mary L %A Wickersham,Jeffrey A %A Altice,Frederick L %A Shrestha,Roman %A Azwa,Iskandar %A Zhou,Xin %A Halim,Mohd Akbar Ab %A Ikhtiaruddin,Wan Mohd %A Tee,Vincent %A Kamarulzaman,Adeeba %A Ni,Zhao %+ School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, 06477, United States, 1 203 737 3039, zhao.ni@yale.edu %K artificial intelligence %K chatbot %K HIV prevention %K implementation science %K men who have sex with men %K MSM %K mobile health design %K mHealth design %K unified theory of acceptance and use of technology %K mobile phone %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile technologies are being increasingly developed to support the practice of medicine, nursing, and public health, including HIV testing and prevention. Chatbots using artificial intelligence (AI) are novel mobile health strategies that can promote HIV testing and prevention among men who have sex with men (MSM) in Malaysia, a hard-to-reach population at elevated risk of HIV, yet little is known about the features that are important to this key population. Objective: The aim of this study was to identify the barriers to and facilitators of Malaysian MSM’s acceptance of an AI chatbot designed to assist in HIV testing and prevention in relation to its perceived benefits, limitations, and preferred features among potential users. Methods: We conducted 5 structured web-based focus group interviews with 31 MSM in Malaysia between July 2021 and September 2021. The interviews were first recorded, transcribed, coded, and thematically analyzed using NVivo (version 9; QSR International). Subsequently, the unified theory of acceptance and use of technology was used to guide data analysis to map emerging themes related to the barriers to and facilitators of chatbot acceptance onto its 4 domains: performance expectancy, effort expectancy, facilitating conditions, and social influence. Results: Multiple barriers and facilitators influencing MSM’s acceptance of an AI chatbot were identified for each domain. Performance expectancy (ie, the perceived usefulness of the AI chatbot) was influenced by MSM’s concerns about the AI chatbot’s ability to deliver accurate information, its effectiveness in information dissemination and problem-solving, and its ability to provide emotional support and raise health awareness. Convenience, cost, and technical errors influenced the AI chatbot’s effort expectancy (ie, the perceived ease of use). Efficient linkage to health care professionals and HIV self-testing was reported as a facilitating condition of MSM’s receptiveness to using an AI chatbot to access HIV testing. Participants stated that social influence (ie, sociopolitical climate) factors influencing the acceptance of mobile technology that addressed HIV in Malaysia included privacy concerns, pervasive stigma against homosexuality, and the criminalization of same-sex sexual behaviors. Key design strategies that could enhance MSM’s acceptance of an HIV prevention AI chatbot included an anonymous user setting; embedding the chatbot in MSM-friendly web-based platforms; and providing user-guiding questions and options related to HIV testing, prevention, and treatment. Conclusions: This study provides important insights into key features and potential implementation strategies central to designing an AI chatbot as a culturally sensitive digital health tool to prevent stigmatized health conditions in vulnerable and systematically marginalized populations. Such features not only are crucial to designing effective user-centered and culturally situated mobile health interventions for MSM in Malaysia but also illuminate the importance of incorporating social stigma considerations into health technology implementation strategies. %M 36201390 %R 10.2196/42055 %U https://formative.jmir.org/2022/10/e42055 %U https://doi.org/10.2196/42055 %U http://www.ncbi.nlm.nih.gov/pubmed/36201390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e32666 %T Bolstering the Business Case for Adoption of Shared Decision-Making Systems in Primary Care: Randomized Controlled Trial %A Sperl-Hillen,JoAnn M %A Anderson,Jeffrey P %A Margolis,Karen L %A Rossom,Rebecca C %A Kopski,Kristen M %A Averbeck,Beth M %A Rosner,Jeanine A %A Ekstrom,Heidi L %A Dehmer,Steven P %A O’Connor,Patrick J %+ Research Department, HealthPartners Center for Chronic Care Innovation, 8170 33rd Ave S, Bloomington, MN, 55425, United States, 1 952 967 5009, JoAnn.M.SperlHillen@HealthPartners.Com %K clinical decision support %K primary care %K ICD-10 diagnostic coding %K CPT levels of service %K shared decision-making %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited budgets may often constrain the ability of health care delivery systems to adopt shared decision-making (SDM) systems designed to improve clinical encounters with patients and quality of care. Objective: This study aimed to assess the impact of an SDM system shown to improve diabetes and cardiovascular patient outcomes on factors affecting revenue generation in primary care clinics. Methods: As part of a large multisite clinic randomized controlled trial (RCT), we explored the differences in 1 care system between clinics randomized to use an SDM intervention (n=8) versus control clinics (n=9) regarding the (1) likelihood of diagnostic coding for cardiometabolic conditions using the 10th Revision of the International Classification of Diseases (ICD-10) and (2) current procedural terminology (CPT) billing codes. Results: At all 24,138 encounters with care gaps targeted by the SDM system, the proportion assigned high-complexity CPT codes for level of service 5 was significantly higher at the intervention clinics (6.1%) compared to that in the control clinics (2.9%), with P<.001 and adjusted odds ratio (OR) 1.64 (95% CI 1.02-2.61). This was consistently observed across the following specific care gaps: diabetes with glycated hemoglobin A1c (HbA1c)>8% (n=8463), 7.2% vs 3.4%, P<.001, and adjusted OR 1.93 (95% CI 1.01-3.67); blood pressure above goal (n=8515), 6.5% vs 3.7%, P<.001, and adjusted OR 1.42 (95% CI 0.72-2.79); suboptimal statin management (n=17,765), 5.8% vs 3%, P<.001, and adjusted OR 1.41 (95% CI 0.76-2.61); tobacco dependency (n=7449), 7.5% vs. 3.4%, P<.001, and adjusted OR 2.14 (95% CI 1.31-3.51); BMI >30 kg/m2 (n=19,838), 6.2% vs 2.9%, P<.001, and adjusted OR 1.45 (95% CI 0.75-2.8). Compared to control clinics, intervention clinics assigned ICD-10 diagnosis codes more often for observed cardiometabolic conditions with care gaps, although the difference did not reach statistical significance. Conclusions: In this randomized study, use of a clinically effective SDM system at encounters with care gaps significantly increased the proportion of encounters assigned high-complexity (level 5) CPT codes, and it was associated with a nonsignificant increase in assigning ICD-10 codes for observed cardiometabolic conditions. Trial Registration: ClinicalTrials.gov NCT 02451670; https://clinicaltrials.gov/ct2/show/NCT 02451670 %M 36201392 %R 10.2196/32666 %U https://formative.jmir.org/2022/10/e32666 %U https://doi.org/10.2196/32666 %U http://www.ncbi.nlm.nih.gov/pubmed/36201392 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37474 %T Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study %A Proctor,Steven L %A Rigg,Khary K %A Tien,Allen Y %+ Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, United States, 1 305 858 3335, sproctor@thrivingmind.org %K opioids %K contingency management %K mHealth %K digital health %K mobile app %K innovation %K opioid use disorder %K recovery %K acceptability %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. %M 36197705 %R 10.2196/37474 %U https://formative.jmir.org/2022/10/e37474 %U https://doi.org/10.2196/37474 %U http://www.ncbi.nlm.nih.gov/pubmed/36197705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36353 %T Adapting Child Health Knowledge Translation Tools for Use by Indigenous Communities: Qualitative Study Exploring Health Care Providers’ Perspectives %A Elliott,Sarah A %A Kreutz,Jason %A Wright,Kelsey S %A Di Lallo,Sherri %A Scott,Shannon D %A Hartling,Lisa %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, ECHA 4-472, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 1241, se2@ualberta.ca %K knowledge translation %K culture %K Indigenous culture %K child health %K adaptation %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Our research groups have developed a number of parental knowledge translation (KT) tools to help families understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency health care services. It is unclear whether the videos in their current form and language are useful for a wider range of populations, including Indigenous groups. Objective: The purpose of this study was to explore whether and understand how our KT tools could be adapted for use with Indigenous communities. Methods: Health care providers (HCPs) serving Indigenous families in Alberta, Canada, were asked to review 2 of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semistructured interview. HCPs were asked to reflect on the usability of the KT tools within their practice and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. Results: A total of 18 HCPs (n=15, 83% women and n=3, 17% men) from various health professions (eg, physician, registered nurse, and licensed practical nurse) were interviewed. Of these 18 HCPs, 7 (39%) self-identified as Indigenous. Four overarching themes were identified as important when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility affects the types of KT tools that can be obtained or used by various individuals and communities and the extent to which they can implement recommendations given in those KT tools. In addition, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase the relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. Conclusions: These findings serve to cultivate a greater understanding of the various components that HCPs consider important when developing or culturally adapting KT tools for use by Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users (health care consumers) when developing KT tools. %M 36197711 %R 10.2196/36353 %U https://formative.jmir.org/2022/10/e36353 %U https://doi.org/10.2196/36353 %U http://www.ncbi.nlm.nih.gov/pubmed/36197711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37406 %T Mining the Gems of a Web-Based Mindfulness Intervention: Qualitative Analysis of Factors Aiding Completion and Implementation %A Yadav,Muskan %A Neate,Sandra %A Hassed,Craig %A Chambers,Richard %A Connaughton,Sherelle %A Nag,Nupur %+ Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Melbourne, 3010, Australia, 61 383447944, nnag@unimelb.edu.au %K digital intervention %K health education %K mindfulness %K online learning %K behavior change %K mental health %K mental well-being %K physical well-being %K meditation %K health promotion %K digital health %K eHealth %K thematic analysis %K attrition %K participation %K involvement %K engagement %K attitude %K perspective %K patient education %K e-learning %K user feedback %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions provide a cost effective and accessible means for positive behavior change. However, high participant attrition is common and facilitators for implementation of behaviors are not well understood. Objective: The goal of the research was to identify elements of a digital mindfulness course that aided in course completion and implementation of teachings. Methods: Inductive thematic analysis was used to assess participant comments regarding positive aspects of the online mindfulness course Mindfulness for Well-being and Peak Performance. Participants were aged 18 years and older who had self-selected to register and voluntarily completed at least 90% the course. The course comprised educator-guided lessons and discussion forums for participant reflection and feedback. Participant comments from the final discussion forum were analyzed to identify common themes pertaining to elements of the course that aided in course completion and implementation of teachings. Results: Of 3355 course completers, 283 participants provided comments related to the research question. Key themes were (1) benefits from the virtual community, (2) appeal of content, (3) enablers to participation and implementation, and (4) benefits noted in oneself. Of subthemes identified, some, such as community support, variety of easily implementable content, and free content access, align with that reported previously in the literature, while other subthemes, including growing together, repeating the course, evidence-based teaching, and immediate benefits on physical and mental well-being, were novel findings. Conclusions: Themes identified as key elements for aiding participant completion of a mindfulness digital health intervention and the implementation of teachings may inform the effective design of future digital health interventions to drive positive health behaviors. Future research should focus on understanding motivations for participation, identification of effective methods for participant retention, and behavior change techniques to motivate long-term adherence to healthy behaviors. %M 36197709 %R 10.2196/37406 %U https://formative.jmir.org/2022/10/e37406 %U https://doi.org/10.2196/37406 %U http://www.ncbi.nlm.nih.gov/pubmed/36197709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36275 %T Using Personalized Avatars as an Adjunct to an Adult Weight Loss Management Program: Randomized Controlled Feasibility Study %A Horne,Maria %A Hardy,Maryann %A Murrells,Trevor %A Ugail,Hassan %A Hill,Andrew John %+ Faculty of Medicine and Health, School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, United Kingdom, 44 113 343 ext 1230, M.Horne@leeds.ac.uk %K avatar %K feasibility %K obesity %K weight loss %K weight management %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a global public health concern. Interventions rely predominantly on managing dietary intake and increasing physical activity; however, sustained adherence to behavioral regimens is often poor. The lack of sustained motivation, self-efficacy, and poor adherence to behavioral regimens are recognized barriers to successful weight loss. Avatar-based interventions achieve better patient outcomes in the management of chronic conditions by promoting more active engagement. Virtual representations of self can affect real-world behavior, acting as a catalyst for sustained weight loss behavior. Objective: We evaluated whether a personalized avatar, offered as an adjunct to an established weight loss program, can increase participant motivation, sustain engagement, optimize service delivery, and improve participant health outcomes. Methods: A feasibility randomized design was used to determine the case for future development and evaluation of avatar-based technology in a randomized controlled trial. Participants were recruited from general practitioner referrals to a 12-week National Health Service weight improvement program. The main outcome measure was weight loss. Secondary outcome measures were quality-of-life and self-efficacy. Quantitative data were subjected to descriptive statistical tests and exploratory comparison between intervention and control arms. Feasibility and acceptability were assessed through interviews and analyzed using framework approach. Health Research Authority ethics approval was granted. Results: Overall, 10 men (n=7, 70% for routine care and avatar and n=3, 30% for routine care) and 33 women (n=23, 70% for intervention and n=10, 30% for routine care) were recruited. Participants’ initial mean weight was greater in the intervention arm than in the routine care arm (126.3 kg vs 122.9 kg); pattern of weight loss was similar across both arms of the study in T0 to T1 period but accelerated in T1 to T2 period for intervention participants, suggesting that access to the self-resembling avatar may promote greater engagement with weight loss initiatives in the short-to-medium term. Mean change in participants’ weight from T0 to T2 was 4.5 kg (95% CI 2.7-6.3) in the routine care arm and 5.3 kg (95% CI 3.9-6.8) in the intervention arm. Quality-of-life and self-efficacy measures demonstrated greater improvement in the intervention arm at both T1 (105.5 for routine care arm and 99.7 for intervention arm) and T2 (100.1 for routine care arm and 81.2 for intervention arm). Overall, 13 participants (n=11, 85% women and n=2, 15% men) and two health care professionals were interviewed about their experience of using the avatar program. Conclusions: Participants found using the personalized avatar acceptable, and feedback reiterated that seeing a future self helped to reinforce motivation to change behavior. This feasibility study demonstrated that avatar-based technology may successfully promote engagement and motivation in weight loss programs, enabling participants to achieve greater weight loss gains and build self-confidence. Trial Registration: ISRCTN Registry 17953876; https://doi.org/10.1186/ISRCTN17953876 %M 36197703 %R 10.2196/36275 %U https://formative.jmir.org/2022/10/e36275 %U https://doi.org/10.2196/36275 %U http://www.ncbi.nlm.nih.gov/pubmed/36197703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37746 %T Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study %A O'Callaghan,Erin %A Mahrer,Nicole %A Belanger,Heather G %A Sullivan,Scott %A Lee,Christine %A Gupta,Carina T %A Winsberg,Mirène %+ Brightside Health Inc, 2471 Peralta St, Unit A, Oakland, CA, 94607, United States, 1 813 786 7685, heather.belanger@brightside.com %K telemedicine %K telehealth %K psychiatry %K mental health %K suicidal ideation %K depression %K anxiety %K suicide %K depressive disorder %K digital health %K eHealth %K psychiatric medication %K demographic %K psychiatric care %K decision-making %K decision support %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective: This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods: Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results: Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions: The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed. %M 36178727 %R 10.2196/37746 %U https://formative.jmir.org/2022/9/e37746 %U https://doi.org/10.2196/37746 %U http://www.ncbi.nlm.nih.gov/pubmed/36178727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e30113 %T Thinking Aloud or Screaming Inside: Exploratory Study of Sentiment Around Work %A Hoque Tania,Marzia %A Hossain,Md Razon %A Jahanara,Nuzhat %A Andreev,Ilya %A Clifton,David A %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, CHI Lab, Old Road Research Campus, Oxford, OX3 7DQ, United Kingdom, 44 1865617670, marzia.hoquetania@eng.ox.ac.uk %K work-related mental health %K sentiment analysis %K natural language processing %K occupational health %K Bayesian inference %K machine learning %K artificial intelligence %K mobile phone %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Millions of workers experience work-related ill health every year. The loss of working days often accounts for poor well-being because of discomfort and stress caused by the workplace. The ongoing pandemic and postpandemic shift in socioeconomic and work culture can continue to contribute to adverse work-related sentiments. Critically investigating state-of-the-art technologies, this study identifies the research gaps in recognizing workers’ need for well-being support, and we aspire to understand how such evidence can be collected to transform the workforce and workplace. Objective: Building on recent advances in sentiment analysis, this study aims to closely examine the potential of social media as a tool to assess workers’ emotions toward the workplace. Methods: This study collected a large Twitter data set comprising both pandemic and prepandemic tweets facilitated through a human-in-the-loop approach in combination with unsupervised learning and meta-heuristic optimization algorithms. The raw data preprocessed through natural language processing techniques were assessed using a generative statistical model and a lexicon-assisted rule-based model, mapping lexical features to emotion intensities. This study also assigned human annotations and performed work-related sentiment analysis. Results: A mixed methods approach, including topic modeling using latent Dirichlet allocation, identified the top topics from the corpus to understand how Twitter users engage with discussions on work-related sentiments. The sorted aspects were portrayed through overlapped clusters and low intertopic distances. However, further analysis comprising the Valence Aware Dictionary for Sentiment Reasoner suggested a smaller number of negative polarities among diverse subjects. By contrast, the human-annotated data set created for this study contained more negative sentiments. In this study, sentimental juxtaposition revealed through the labeled data set was supported by the n-gram analysis as well. Conclusions: The developed data set demonstrates that work-related sentiments are projected onto social media, which offers an opportunity to better support workers. The infrastructure of the workplace, the nature of the work, the culture within the industry and the particular organization, employers, colleagues, person-specific habits, and upbringing all play a part in the health and well-being of any working adult who contributes to the productivity of the organization. Therefore, understanding the origin and influence of the complex underlying factors both qualitatively and quantitatively can inform the next generation of workplaces to drive positive change by relying on empirically grounded evidence. Therefore, this study outlines a comprehensive approach to capture deeper insights into work-related health. %M 36178712 %R 10.2196/30113 %U https://formative.jmir.org/2022/9/e30113 %U https://doi.org/10.2196/30113 %U http://www.ncbi.nlm.nih.gov/pubmed/36178712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e41241 %T Comparison Between QT and Corrected QT Interval Assessment by an Apple Watch With the AccurBeat Platform and by a 12‑Lead Electrocardiogram With Manual Annotation: Prospective Observational Study %A Chokshi,Sara %A Tologonova,Gulzhan %A Calixte,Rose %A Yadav,Vandana %A Razvi,Naveed %A Lazar,Jason %A Kachnowski,Stan %+ Healthcare Innovation and Technology Lab, 3960 Broadway, New York, NY, 10032, United States, 1 212 543 0100, schokshi@hitlab.org %K artificial intelligence ECG %K AI ECG %K AI wearables %K big data %K cardiovascular medicine %K digital health %K machine learning %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Abnormal prolongation or shortening of the QT interval is associated with increased risk for ventricular arrhythmias and sudden cardiac death. For continuous monitoring, widespread use, and prevention of cardiac events, advanced wearable technologies are emerging as promising surrogates for conventional 12‑lead electrocardiogram (ECG) QT interval assessment. Previous studies have shown a good agreement between QT and corrected QT (QTc) intervals measured on a smartwatch ECG and a 12-lead ECG, but the clinical accuracy of computerized algorithms for QT and QTc interval measurement from smartwatch ECGs is unclear. Objective: The prospective observational study compared the smartwatch-recorded QT and QTc assessed using AccurKardia’s AccurBeat platform with the conventional 12‑lead ECG annotated manually by a cardiologist. Methods: ECGs were collected from healthy participants (without any known cardiovascular disease) aged >22 years. Two consecutive 30-second ECG readings followed by (within 15 minutes) a 10-second standard 12-lead ECG were recorded for each participant. Characteristics of the participants were compared by sex using a 2-sample t test and Wilcoxon rank sum test. Statistical comparisons of heart rate (HR), QT interval, and QTc interval between the platform and the 12-lead ECG, ECG lead I, and ECG lead II were done using the Wilcoxon sign rank test. Linear regression was used to predict QTc and QT intervals from the ECG based on the platform’s QTc/QT intervals with adjustment for age, sex, and difference in HR measurement. The Bland-Altman method was used to check agreement between various QT and QTc interval measurements. Results: A total of 50 participants (32 female, mean age 46 years, SD 1 year) were included in the study. The result of the regression model using the platform measurements to predict the 12-lead ECG measurements indicated that, in univariate analysis, QT/QTc intervals from the platform significantly predicted QT/QTc intervals from the 12-lead ECG, ECG lead I, and ECG lead II, and this remained significant after adjustment for sex, age, and change in HR. The Bland-Altman plot results found that 96% of the average QTc interval measurements between the platform and QTc intervals from the 12-lead ECG were within the 95% confidence limit of the average difference between the two measurements, with a mean difference of –10.5 (95% limits of agreement –71.43, 50.43). A total of 94% of the average QT interval measurements between the platform and the 12-lead ECG were within the 95% CI of the average difference between the two measurements, with a mean difference of –6.3 (95% limits of agreement –54.54, 41.94). Conclusions: QT and QTc intervals obtained by a smartwatch coupled with the platform’s assessment were comparable to those from a 12-lead ECG. Accordingly, with further refinements, remote monitoring using this technology holds promise for the identification of QT interval prolongation. %M 36169999 %R 10.2196/41241 %U https://formative.jmir.org/2022/9/e41241 %U https://doi.org/10.2196/41241 %U http://www.ncbi.nlm.nih.gov/pubmed/36169999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40001 %T Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study %A Tuot,Delphine S %A Crowley,Susan T %A Katz,Lois A %A Leung,Joseph %A Alcantara-Cadillo,Delly K %A Ruser,Christopher %A Talbot-Montgomery,Elizabeth %A Vassalotti,Joseph A %+ University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 628 206 3784, Delphine.tuot@ucsf.edu %K chronic kidney disease %K CKD %K awareness %K usability %K kidney %K renal %K think aloud %K self-management %K patient education %K health education %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient awareness of chronic kidney disease (CKD) is low in part due to suboptimal testing for CKD among those at risk and lack of discussions about kidney disease between patients and clinicians. To bridge these gaps, the National Kidney Foundation developed the Kidney Score Platform, which is a web-based series of tools that includes resources for health care professionals as well as an interactive, dynamic patient-facing component that includes a brief questionnaire about risk factors for kidney disease, individualized assessment of risk for developing CKD, and self-management tools to manage one’s kidney disease. Objective: The aim of this study is to perform usability testing of the patient component of the Kidney Score platform among veterans with and at risk for kidney disease and among clinicians working as primary care providers in Veterans Affairs administration. Methods: Think-aloud exercises were conducted, during which participants (veterans and clinicians) engaged with the platform while verbalizing their thoughts and making their perceptions, reasonings, and decision points explicit. A usability facilitator observed participants’ behaviors and probed selectively to clarify their comprehension of the tool’s instructions, content, and overall functionality. Thematic analysis on the audio-recording transcripts was performed, focusing on positive attributes, negative comments, and areas that required facilitator involvement. Results: Veterans (N=18) were 78% (14/18) male with a mean age of 58.1 years. Two-thirds (12/18) were of non-White race/ethnicity, 28% (5/18) had laboratory evidence of CKD without a formal diagnosis, and 50% (9/18) carried a diagnosis of hypertension or diabetes. Clinicians (N=19) were 29% (5/17) male, 30% (5/17) of non-White race/ethnicity, and had a mean of 17 (range 4-32) years of experience. Veterans and clinicians easily navigated the online tool and appreciated the personalized results page as well as the inclusion of infographics to deliver key educational messages. Three major themes related to content and communication about risk for CKD emerged from the think-aloud exercises: (1) tension between lay and medical terminology when discussing kidney disease and diagnostic tests, (2) importance of linking general information to concrete self-management actions, and (3) usefulness of the tool as an adjunct to the office visit to prepare for patient-clinician communication. Importantly, these themes were consistent among interviews involving both veterans and clinicians. Conclusions: Veterans and clinicians both thought that the Kidney Score Platform would successfully promote communication and discussion about kidney disease in primary care settings. Tension between using medical terminology that is used regularly by clinicians versus lay terminology to promote CKD awareness was a key challenge, and knowledge of this can inform the development of future CKD educational materials. %M 36170008 %R 10.2196/40001 %U https://formative.jmir.org/2022/9/e40001 %U https://doi.org/10.2196/40001 %U http://www.ncbi.nlm.nih.gov/pubmed/36170008 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36714 %T Comparing Transactional eHealth Literacy of Individuals With Cancer and Surrogate Information Seekers: Mixed Methods Study %A Vasquez,Taylor S %A Bylund,Carma L %A Alpert,Jordan %A Close,Julia %A Le,Tien %A Markham,Merry Jennifer %A Taylor,Greenberry B %A Paige,Samantha R %+ College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL, 32608, United States, 1 3215370306, tsthelander@ufl.edu %K eHealth literacy %K cancer communication %K individuals with cancer %K surrogate seekers %K web-based information credibility appraisal %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships with one another. One role that a member of a support network may enact is that of a surrogate seeker, who seeks information in an informal capacity on behalf of others. Individuals with cancer and surrogate seekers often use the internet to learn about cancer, but differences in their skills and strategies have received little empirical attention. Objective: This study aimed to examine the eHealth literacy of individuals with cancer and surrogate information seekers, including an investigation of how each group evaluates the credibility of web-based cancer information. As a secondary aim, we sought to explore the differences that exist between individuals with cancer and surrogate seekers pertaining to eHealth literacies and sociodemographic contexts. Methods: Between October 2019 and January 2020, we conducted a web-based survey of 282 individuals with cancer (n=185) and surrogate seekers (n=97). We used hierarchical linear regression analyses to explore differences in functional, communicative, critical, and translational eHealth literacy between individuals with cancer and surrogate seekers using the Transactional eHealth Literacy Instrument. Using a convergent, parallel mixed methods design, we also conducted a thematic content analysis of an open-ended survey response to qualitatively examine how each group evaluates web-based cancer information. Results: eHealth literacy scores did not differ between individuals with cancer and surrogate seekers, even after adjusting for sociodemographic variables. Individuals with cancer and surrogate seekers consider the credibility of web-based cancer information based on its channel (eg, National Institutes of Health). However, in evaluating web-based information, surrogate seekers were more likely than individuals with cancer to consider the presence and quality of scientific references supporting the information. Individuals with cancer were more likely than surrogate seekers to cross-reference other websites and web-based sources to establish consensus. Conclusions: Web-based cancer information accessibility and evaluation procedures differ among individuals with cancer and surrogate seekers and should be considered in future efforts to design web-based cancer education interventions. Future studies may also benefit from more stratified recruitment approaches and account for additional contextual factors to better understand the unique circumstances experienced within this population. %M 36170007 %R 10.2196/36714 %U https://formative.jmir.org/2022/9/e36714 %U https://doi.org/10.2196/36714 %U http://www.ncbi.nlm.nih.gov/pubmed/36170007 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36118 %T Detection of Depression Severity Using Bengali Social Media Posts on Mental Health: Study Using Natural Language Processing Techniques %A Kabir,Muhammad Khubayeeb %A Islam,Maisha %A Kabir,Anika Nahian Binte %A Haque,Adiba %A Rhaman,Md Khalilur %+ Department of Computer Science, Brac University, 66 Mohakhali, Dhaka, 1212, Bangladesh, 880 1708812609, muhammad.khubayeeb.kabir@g.bracu.ac.bd %K mental health forums %K natural language processing %K severity %K major depressive disorder %K deep learning %K machine learning %K multiclass text classification %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are a myriad of language cues that indicate depression in written texts, and natural language processing (NLP) researchers have proven the ability of machine learning and deep learning approaches to detect these cues. However, to date, these approaches bridging NLP and the domain of mental health for Bengali literature are not comprehensive. The Bengali-speaking population can express emotions in their native language in greater detail. Objective: Our goal is to detect the severity of depression using Bengali texts by generating a novel Bengali corpus of depressive posts. We collaborated with mental health experts to generate a clinically sound labeling scheme and an annotated corpus to train machine learning and deep learning models. Methods: We conducted a study using Bengali text-based data from blogs and open source platforms. We constructed a procedure for annotated corpus generation and extraction of textual information from Bengali literature for predictive analysis. We developed our own structured data set and designed a clinically sound labeling scheme with the help of mental health professionals, adhering to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) during the process. We used 5 machine learning models for detecting the severity of depression: kernel support vector machine (SVM), random forest, logistic regression K-nearest neighbor (KNN), and complement naive Bayes (NB). For the deep learning approach, we used long short-term memory (LSTM) units and gated recurrent units (GRUs) coupled with convolutional blocks or self-attention layers. Finally, we aimed for enhanced outcomes by using state-of-the-art pretrained language models. Results: The independent recurrent neural network (RNN) models yielded the highest accuracies and weighted F1 scores. GRUs, in particular, produced 81% accuracy. The hybrid architectures could not surpass the RNNs in terms of performance. Kernel SVM with term frequency–inverse document frequency (TF-IDF) embeddings generated 78% accuracy on test data. We used validation and training loss curves to observe and report the performance of our architectures. Overall, the number of available data remained the limitation of our experiment. Conclusions: The findings from our experimental setup indicate that machine learning and deep learning models are fairly capable of assessing the severity of mental health issues from texts. For the future, we suggest more research endeavors to increase the volume of Bengali text data, in particular, so that modern architectures reach improved generalization capability. %M 36169989 %R 10.2196/36118 %U https://formative.jmir.org/2022/9/e36118 %U https://doi.org/10.2196/36118 %U http://www.ncbi.nlm.nih.gov/pubmed/36169989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35114 %T Exploring Socioeconomic Status as a Global Determinant of COVID-19 Prevalence, Using Exploratory Data Analytic and Supervised Machine Learning Techniques: Algorithm Development and Validation Study %A Winston,Luke %A McCann,Michael %A Onofrei,George %+ Department of Computing, Atlantic Technological University, Port Road, Letterkenny, F92 FC93, Ireland, 353 862435617, L00162644@student.lyit.ie %K COVID-19 %K machine learning %K data analysis %K epidemiology %K human development index %D 2022 %7 27.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic represents the most unprecedented global challenge in recent times. As the global community attempts to manage the pandemic in the long term, it is pivotal to understand what factors drive prevalence rates and to predict the future trajectory of the virus. Objective: This study had 2 objectives. First, it tested the statistical relationship between socioeconomic status and COVID-19 prevalence. Second, it used machine learning techniques to predict cumulative COVID-19 cases in a multicountry sample of 182 countries. Taken together, these objectives will shed light on socioeconomic status as a global risk factor of the COVID-19 pandemic. Methods: This research used exploratory data analysis and supervised machine learning methods. Exploratory analysis included variable distribution, variable correlations, and outlier detection. Following this, the following 3 supervised regression techniques were applied: linear regression, random forest, and adaptive boosting (AdaBoost). Results were evaluated using k-fold cross-validation and subsequently compared to analyze algorithmic suitability. The analysis involved 2 models. First, the algorithms were trained to predict 2021 COVID-19 prevalence using only 2020 reported case data. Following this, socioeconomic indicators were added as features and the algorithms were trained again. The Human Development Index (HDI) metrics of life expectancy, mean years of schooling, expected years of schooling, and gross national income were used to approximate socioeconomic status. Results: All variables correlated positively with the 2021 COVID-19 prevalence, with R2 values ranging from 0.55 to 0.85. Using socioeconomic indicators, COVID-19 prevalence was predicted with a reasonable degree of accuracy. Using 2020 reported case rates as a lone predictor to predict 2021 prevalence rates, the average predictive accuracy of the algorithms was low (R2=0.543). When socioeconomic indicators were added alongside 2020 prevalence rates as features, the average predictive performance improved considerably (R2=0.721) and all error statistics decreased. Thus, adding socioeconomic indicators alongside 2020 reported case data optimized the prediction of COVID-19 prevalence to a considerable degree. Linear regression was the strongest learner with R2=0.693 on the first model and R2=0.763 on the second model, followed by random forest (0.481 and 0.722) and AdaBoost (0.454 and 0.679). Following this, the second model was retrained using a selection of additional COVID-19 risk factors (population density, median age, and vaccination uptake) instead of the HDI metrics. However, average accuracy dropped to 0.649, which highlights the value of socioeconomic status as a predictor of COVID-19 cases in the chosen sample. Conclusions: The results show that socioeconomic status is an important variable to consider in future epidemiological modeling, and highlights the reality of the COVID-19 pandemic as a social phenomenon and a health care phenomenon. This paper also puts forward new considerations about the application of statistical and machine learning techniques to understand and combat the COVID-19 pandemic. %M 36001798 %R 10.2196/35114 %U https://formative.jmir.org/2022/9/e35114 %U https://doi.org/10.2196/35114 %U http://www.ncbi.nlm.nih.gov/pubmed/36001798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37745 %T An Economic Impact Model for Estimating the Value to Health Systems of a Digital Intervention for Diabetes Primary Care: Development and Usefulness Study %A Powers,Brenton %A Bucher,Amy %+ Lirio, 320 Corporate Drive, NW, Knoxville, TN, 37923, United States, 1 865 839 6158, abucher@lirio.com %K return on investment %K value %K payment model %K cost %K economic impact %K digital health %K eHealth %K diabetes %K primary care %K email %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is associated with significant long-term costs for both patients and health systems. Regular primary care visits aligned with American Diabetes Association guidelines could help mitigate those costs while generating near-term revenue for health systems. Digital interventions prompting primary care visits among unengaged patients could provide significant economic value back to the health system as well as individual patients, but only few economic models have been put forth to understand this value. Objective: Our objective is to establish a data-based method to estimate the economic impact to a health system of interventions promoting primary care visits for people with diabetes who have been historically unengaged with their care. The model was built with a focus on a specific digital health intervention, Precision Nudging, but can be used to quantify the value of other interventions driving primary care usage among patients with diabetes. Methods: We developed an economic model to estimate the financial value of a primary care visit of a patient with diabetes to the health system. This model requires segmenting patients with diabetes according to their level of blood sugar control as measured by their most recent hemoglobin A1c value to understand how frequently they should be visiting a primary care provider. The model also accounts for the payer mix among the population with diabetes, documenting the percentage of insurance coverage through a commercial plan, Medicare, or Medicaid, as these influence the reimbursement rates for the services. Then, the model takes into consideration the population base rates of comorbid conditions for patients with diabetes and the associated current procedural terminology codes to understand what a provider can bill as well as the expected inpatient revenue from a subset of patients likely to require hospitalization based on the national hospitalization rates for people with diabetes. Physician reimbursement is subtracted from the total. Finally, the model also accounts for the level of patient engagement with the intervention to ensure a realistic estimate of the impact. Results: We present a model to prospectively estimate the economic impact of a digital health intervention to encourage patients with documented diabetes diagnoses to attend primary care visits. The model leverages both publicly available and health system data to calculate the per appointment value (revenue) to the health system. The model offers a method to understand and test the financial impact of Precision Nudging or other primary care–focused diabetes interventions inclusive of costs driven by comorbid conditions. Conclusions: The proposed economic model can help health systems understand and evaluate the estimated economic benefits of interventions focused on primary care and prevention for patients with diabetes as well as help intervention developers determine pricing for their product. %M 36155985 %R 10.2196/37745 %U https://formative.jmir.org/2022/9/e37745 %U https://doi.org/10.2196/37745 %U http://www.ncbi.nlm.nih.gov/pubmed/36155985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35035 %T Using Social Media to Facilitate Communication About Women’s Testing: Tool Validation Study %A Coffin,Tara %A Bowen,Deborah %A Lu,Karen %A Swisher,Elizabeth M %A Rayes,Nadine %A Norquist,Barbara %A Blank,Stephanie V %A Levine,Douglas A %A Bakkum-Gamez,Jamie Nadine %A Fleming,Gini F %A I Olopade,Olufunmilayo %A Romero,Iris %A D'Andrea,Alan %A Nebgen,Denise R %A Peterson,Christine %A Munsell,Mark F %A Gavin,Kathleen %A Crase,Jamie %A Polinsky,Deborah %A Lechner,Rebecca %+ University of Washington, 1400 NE Campus Parkway, Seattle, WA, 98195-4550, United States, 1 (206) 543 2100, tbcoffin@uw.edu %K ovarian cancer %K hereditary cancer %K genetic testing %K online social media recruitment %K Facebook %K social media %K mobile phone %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Strong participant recruitment practices are critical to public health research but are difficult to achieve. Traditional recruitment practices are often time consuming, costly, and fail to adequately target difficult-to-reach populations. Social media platforms such as Facebook are well-positioned to address this area of need, enabling researchers to leverage existing social networks and deliver targeted information. The MAGENTA (Making Genetic Testing Accessible) study aimed to improve the availability of genetic testing for hereditary cancer susceptibility in at-risk individuals through the use of a web-based communication system along with social media advertisements to improve reach. Objective: This paper is aimed to evaluate the effectiveness of Facebook as an outreach tool for targeting women aged ≥30 years for recruitment in the MAGENTA study. Methods: We designed and implemented paid and unpaid social media posts with ongoing assessment as a primary means of research participant recruitment in collaboration with patient advocates. Facebook analytics were used to assess the effectiveness of paid and unpaid outreach efforts. Results: Over the course of the reported recruitment period, Facebook materials had a reach of 407,769 people and 57,248 (14.04%) instances of engagement, indicating that approximately 14.04% of people who saw information about the study on Facebook engaged with the content. Paid advertisements had a total reach of 373,682. Among those reached, just <15% (54,117/373,682, 14.48%) engaged with the page content. Unpaid posts published on the MAGENTA Facebook page resulted in a total of 34,087 reach and 3131 instances of engagement, indicating that around 9.19% (3131/34,087) of people who saw unpaid posts engaged. Women aged ≥65 years reported the best response rate, with approximately 43.95% (15,124/34,410) of reaches translating to engagement. Among the participants who completed the eligibility questionnaire, 27.44% (3837/13,983) had heard about the study through social media or another webpage. Conclusions: Facebook is a useful way of enhancing clinical trial recruitment of women aged ≥30 years who have a potentially increased risk for ovarian cancer by promoting news stories over social media, collaborating with patient advocacy groups, and running paid and unpaid campaigns. Trial Registration: ClinicalTrials.gov NCT02993068; https://clinicaltrials.gov/ct2/show/NCT02993068 %M 36155347 %R 10.2196/35035 %U https://formative.jmir.org/2022/9/e35035 %U https://doi.org/10.2196/35035 %U http://www.ncbi.nlm.nih.gov/pubmed/36155347 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39813 %T Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study %A Hudson,Georgie %A Negbenose,Esther %A Neary,Martha %A Jansli,Sonja M %A Schueller,Stephen M %A Wykes,Til %A Jilka,Sagar %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7AL, United Kingdom, 44 7708715627, sagar.jilka@warwick.ac.uk %K well-being %K apps %K patient and public involvement %K coproduction %K mental health %K service user %K technology %K mobile health %K mHealth %K digital %K mobile phone %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective: This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods: A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results: We found low agreement between the participants’ and professionals’ ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants’ star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions: As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps. %M 36149733 %R 10.2196/39813 %U https://formative.jmir.org/2022/9/e39813 %U https://doi.org/10.2196/39813 %U http://www.ncbi.nlm.nih.gov/pubmed/36149733 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35648 %T Relative Effectiveness of Social Media, Dating Apps, and Information Search Sites in Promoting HIV Self-testing: Observational Cohort Study %A Stafylis,Chrysovalantis %A Vavala,Gabriella %A Wang,Qiao %A McLeman,Bethany %A Lemley,Shea M %A Young,Sean D %A Xie,Haiyi %A Matthews,Abigail G %A Oden,Neal %A Revoredo,Leslie %A Shmueli-Blumberg,Dikla %A Hichborn,Emily G %A McKelle,Erin %A Moran,Landhing M %A Jacobs,Petra %A Marsch,Lisa A %A Klausner,Jeffrey D %+ Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, United States, 1 626 757 8602, chrstafylis@outlook.com %K HIV prevention %K PrEP %K home HIV test %K social media %K dating apps %K search engines %K HIV %K human immunodeficiency virus %K self-testing %K infection %K digital health %K health promotion %K MSM %K pre-exposure prophylaxis %K medical information %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media sites, dating apps, and information search sites have been used to reach individuals at high risk for HIV infection. However, it is not clear which platform is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different characteristics that impact their readiness for HIV testing. Objective: This study aimed to compare the relative effectiveness of social media sites, dating apps, and information search sites in promoting HIV self-testing among minority men who have sex with men (MSM) at an increased risk of HIV infection. Test kit order rates were used as a proxy to evaluate promotion effectiveness. In addition, we assessed differences in characteristics between participants who ordered and did not order an HIV test kit. Methods: Culturally appropriate advertisements were placed on popular sites of three different platforms: social media sites (Facebook, Instagram), dating apps (Grindr, Jack’D), and information search sites (Google, Bing). Advertisements targeted young (18-30 years old) and minority (Black or Latinx) MSM at risk of HIV exposure. Recruitment occurred in 2 waves, with each wave running advertisements on 1 platform of each type over the same period. Participants completed a baseline survey assessing sexual or injection use behavior, substance use including alcohol, psychological readiness to test, attitudes toward HIV testing and treatment, and HIV-related stigma. Participants received an electronic code to order a free home-based HIV self-test kit. Follow-up assessments were conducted to assess HIV self-test kit use and uptake of pre-exposure prophylaxis (PrEP) at 14 and 60 days post enrollment. Results: In total, 271 participants were enrolled, and 254 were included in the final analysis. Among these 254 participants, 177 (69.7%) ordered a home HIV self-test kit. Most of the self-test kits were ordered by participants enrolled from dating apps. Due to waves with low enrollment, between wave statistical comparisons were not feasible. Within wave comparison revealed that Jack’D showed higher order rates (3.29 kits/day) compared to Instagram (0.34 kits/day) and Bing (0 kits/day). There were no associations among self-test kit ordering and HIV-related stigma, perceptions about HIV testing and treatment, and mistrust of medical organizations. Conclusions: Our findings show that using popular dating apps might be an efficient way to promote HIV self-testing. Stigma, perceptions about HIV testing and treatment, or mistrust of medical organizations may not affect order rates of HIV test kits promoted on the internet. Trial Registration: ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID): RR2-10.2196/20417 %M 36149729 %R 10.2196/35648 %U https://formative.jmir.org/2022/9/e35648 %U https://doi.org/10.2196/35648 %U http://www.ncbi.nlm.nih.gov/pubmed/36149729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39013 %T Resilience in Web-Based Mental Health Communities: Building a Resilience Dictionary With Semiautomatic Text Analysis %A Kang,Yong-Bin %A McCosker,Anthony %A Kamstra,Peter %A Farmer,Jane %+ Australian Research Council (ARC) Centre of Excellence for Automated Decision-Making and Society (ADM+S), Swinburne University of Technology, John St, Hawthorn, Victoria, 3122, Australia, 61 3 9214 5904, ykang@swin.edu.au %K resilience dictionary %K mental health %K peer-support forum %K topic modeling %K text analysis %K content moderation %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Resilience is an accepted strengths-based concept that responds to change, adversity, and crises. This concept underpins both personal and community-based preventive approaches to mental health issues and shapes digital interventions. Online mental health peer-support forums have played a prominent role in enhancing resilience by providing accessible places for sharing lived experiences of mental issues and finding support. However, little research has been conducted on whether and how resilience is realized, hindering service providers’ ability to optimize resilience outcomes. Objective: This study aimed to create a resilience dictionary that reflects the characteristics and realization of resilience within online mental health peer-support forums. The findings can be used to guide further analysis and improve resilience outcomes in mental health forums through targeted moderation and management. Methods: A semiautomatic approach to creating a resilience dictionary was proposed using topic modeling and qualitative content analysis. We present a systematic 4-phase analysis pipeline that preprocesses raw forum posts, discovers core themes, conceptualizes resilience indicators, and generates a resilience dictionary. Our approach was applied to a mental health forum run by SANE (Schizophrenia: A National Emergency) Australia, with 70,179 forum posts between 2018 and 2020 by 2357 users being analyzed. Results: The resilience dictionary and taxonomy developed in this study, reveal how resilience indicators (ie, “social capital,” “belonging,” “learning,” “adaptive capacity,” and “self-efficacy”) are characterized by themes commonly discussed in the forums; each theme’s top 10 most relevant descriptive terms and their synonyms; and the relatedness of resilience, reflecting a taxonomy of indicators that are more comprehensive (or compound) and more likely to facilitate the realization of others. The study showed that the resilience indicators “learning,” “belonging,” and “social capital” were more commonly realized, and “belonging” and “learning” served as foundations for “social capital” and “adaptive capacity” across the 2-year study period. Conclusions: This study presents a resilience dictionary that improves our understanding of how aspects of resilience are realized in web-based mental health forums. The dictionary provides novel guidance on how to improve training to support and enhance automated systems for moderating mental health forum discussions. %M 36136394 %R 10.2196/39013 %U https://formative.jmir.org/2022/9/e39013 %U https://doi.org/10.2196/39013 %U http://www.ncbi.nlm.nih.gov/pubmed/36136394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39497 %T Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study %A Oh,Kyue Taek %A Ko,Jisu %A Shin,Jaemyung %A Ko,Minsam %+ Department of Human-Computer Interaction, Hanyang University, Ansan, Republic of Korea, 82 314001071, minsam@hanyang.ac.kr %K health app design %K morning behavior change %K wake-up task %K mobile alarm %K productivity %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person’s motivation and available time for productive morning behavior. Objective: This study explores a design for morning behavior change using a wake-up task, a simple assignment the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) exploring key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app and (2) understanding the general practice of affecting morning behavior change by implementing wake-up tasks. Methods: We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercises. We recruited 36 participants to perform squat exercises in the early morning using the wake-up tasks for 2 weeks. First, we conducted a generalized estimating equation (GEE) analysis for the first research objective. Next, we conducted a thematic analysis of the postsurvey answers to identify key themes about morning behavior change with the wake-up tasks for the second objective. Results: The use of wake-up tasks was significantly associated with both the completion of the target behavior (math task: P=.005; picture task: P<.001) and the elapsed time (picture task: P=.08); the time to alarm dismissal was significantly related to the elapsed time to completion (P<.001). Moreover, the theory of planned behavior (TPB) variables, common factors for behavior change, were significant, but their magnitudes and directions differed slightly from the other domains. Furthermore, the survey results reveal how the participants used the wake-up tasks and why they were effective for morning behavior performance. Conclusions: The results reveal the effectiveness of wake-up tasks in accomplishing the target morning behavior and address key factors for morning behavior change, such as (1) waking up on time, (2) escaping from sleep inertia, and (3) quickly starting the desired target behavior. %M 36129742 %R 10.2196/39497 %U https://formative.jmir.org/2022/9/e39497 %U https://doi.org/10.2196/39497 %U http://www.ncbi.nlm.nih.gov/pubmed/36129742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40703 %T Postoperative Outcomes of a Digital Rehabilitation Program After Total Knee Arthroplasty: Retrospective, Observational Feasibility Study %A Hong,Mindy %A Loeb,Joey %A Yang,Manshu %A Bailey,Jeannie F %+ Hinge Health, Inc., 455 Market Street, Suite 700, San Francisco, CA, 94105, United States, 1 615 498 8308, mindy.hong@hingehealth.com %K total knee arthroplasty %K surgical %K digital intervention %K musculoskeletal %K telemedicine %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Surgery can sometimes be the best solution for chronic musculoskeletal pain, but presurgical preparation and postsurgical rehabilitation are often required to achieve the maximum benefits. A digital musculoskeletal surgical care program was developed to support the population of patients undergoing total knee arthroplasty. Objective: We aimed to demonstrate safety, engagement, and acceptability and explore clinical outcomes, health care use, and satisfaction among participants of a digital musculoskeletal surgical care program who were undergoing total knee arthroplasty. Methods: A retrospective, observational feasibility study comparing digital musculoskeletal surgical care program participants to a comparison group was conducted. The intervention group registered for a digital musculoskeletal surgical care program, which included health coaches, physical therapists, and tailored exercises and educational articles to provide preoperative and postoperative support to patients who had recently undergone total knee arthroplasty. Comparison group members received standard-of-care treatment. Engagement (number of exercise therapy sessions and educational articles accessed per week) and acceptability (Net Promoter Score) were examined among intervention group participants. Descriptive statistics for postoperative outcomes, including safety (postoperative complications), clinical improvement (pain, function, anxiety, and depression), and health care use and experiences (length of hospital stay, surgery satisfaction, and physical therapy adherence), were reported for both groups. Differences among postoperative results were compared by using the independent samples 2-tailed t test or Mann-Whitney test for continuous outcomes and the Fisher exact test or chi-square test for categorical outcomes. Results: Of the 53 participants (intervention group: n=22; comparison group: n=31) who were included in this study, 35 (66%) were female and 25 (47%) were aged from 45 to 60 years. On average, the intervention group completed 23 exercise sessions, read 2.7 educational articles, sent 45.5 texts to their health coaches, and were actively engaged for 6 weeks after their operation. Among 21 participants, 14 (67%) self-reported as promoters on the Net Promoter Score scale. Intervention group members reported fewer postoperative complications (6/22, 27%) than the comparison group (15/31, 48%), and they experienced better outcomes with regard to function (Knee Injury and Osteoarthritis Outcome Score–Physical Function Short Form—intervention group: mean 23.0; comparison group: mean 32.5), depression (Patient Health Questionnaire 2-Item—intervention group: mean 0.4; comparison group: mean 1.6), anxiety (General Anxiety Disorder 2-Item—intervention group: mean 0.6; comparison group: mean 1.5), and impressions of change (Patient Global Impression of Change—intervention group: median 7.0; comparison group: median 6.0). Intervention group participants also reported less health care use, better adherence to their physical therapy exercises, and higher surgery satisfaction. Conclusions: Our digital musculoskeletal surgical care program shows promising levels of engagement and acceptability among those who recently underwent total knee arthroplasty. The surgical care program may also help with improving postsurgical complications and clinical outcomes and lowering health care use. %M 36121690 %R 10.2196/40703 %U https://formative.jmir.org/2022/9/e40703 %U https://doi.org/10.2196/40703 %U http://www.ncbi.nlm.nih.gov/pubmed/36121690 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39476 %T A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study %A Geerling,Bart %A Kelders,Saskia M %A Stevens,Anja W M M %A Kupka,Ralph W %A Bohlmeijer,Ernst T %+ Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0622274351, b.geerling@dimence.nl %K bipolar disorder %K positive psychology %K cocreation %K mobile health %K mHealth %K web-based %K psychology %K bipolar %K intervention %K quality of life %K mental illness %K pilot %K self-esteem %K acceptance %K social isolation %K manic episode %K manic %K self-help %K positive %K mobile phone %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD. Objective: This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD. Methods: The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app. Results: Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms. Conclusions: With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD. %M 35946327 %R 10.2196/39476 %U https://formative.jmir.org/2022/9/e39476 %U https://doi.org/10.2196/39476 %U http://www.ncbi.nlm.nih.gov/pubmed/35946327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36805 %T Influence of 2 Digital Exercise Modules of a Multimodular System on Balance and Leg Strength Under Consideration of Use Adherence: Prospective Cohort Study %A Venek,Verena %A Kranzinger,Christina %A Jungreitmayr,Sonja %A Ring-Dimitriou,Susanne %A Schwameder,Hermann %A Stöggl,Thomas %+ Salzburg Research Forschungsgesellschaft mbH, Jakob Haringer Straße 5/3, Salzburg, 5020, Austria, 43 6622288 ext 415, v.venek@fh-kaernten.at %K active and assisted living %K functional fitness training %K information and communication technology %K use adherence %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To empower healthy aging, digital solutions embed multiple modules for physical activity, cognitive health promotion, and social engagement. Integrating new empowering technologies such as digital exercise monitoring requires assessment measures and analysis procedures, considering variable compliance of users with different modules. Objective: This study aims to assess the influence of a tablet-based and a feedback system–based exercise module on balance and leg strength by considering use adherence instead of the use of the entire multimodular system. Methods: In the prospective cohort study within the fit4AAL project, 83 users (n=67, 81% women; n=16, 19% men; mean age 66.2, SD 2.3 years) used the 2 digital exercise modules of a multimodular physical activity promotion system for >18 weeks. A data-driven clustering method based on the average use frequency of the exercise modules determined the number of user types that met the World Health Organization–recommended training frequency of at least twice per week. On the basis of this use adherence, statistical analysis was performed with features of functional performance tests (unipedal stance, 30-second chair rise, Y-balance, and hurdle step tests). The tests were conducted 6 months before the intervention, immediately before the intervention, and after the intervention, comparing the baseline phase with the 3 feedback use groups of the study (using only the tablet, the tablet and the feedback system, or only the feedback system). Results: Of the 83 users, 43 (52%) met the World Health Organization–recommended frequency of muscle-strengthening activities. Overall, the feedback use groups achieved, on average, more chair rises in 30 seconds than the baseline group (P=.01; moderate effect size of 0.07). Of the 43 users, 26 (60%) additionally used the feedback system–based exercise module. They improved in balance compared with the users using either the tablet or the feedback system (P=.02). In addition, they improved their leg strength within the group (P=.04) and compared with the baseline (P=.01). Conclusions: The additional use of a feedback system showed a tendency to positively maintain and influence the already exceptionally high functional performance of older adults. Considering use adherence in future multimodular system studies is crucial to assess the influence of single and combined use of exercise modules on functional performance. %M 36121691 %R 10.2196/36805 %U https://formative.jmir.org/2022/9/e36805 %U https://doi.org/10.2196/36805 %U http://www.ncbi.nlm.nih.gov/pubmed/36121691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39787 %T Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study %A Peipert,Allison %A Krendl,Anne C %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 812 855 2012, lolorenz@indiana.edu %K psychotherapy %K CBT %K cognitive behavioral therapy %K behavior therapy %K digital mental health %K self-help %K support group %K mental health %K digital health %K eHealth %K low-intensity intervention %K survey %K waiting list %K health system %K health care delivery %K health care professional %K care provider %K bibliotherapy %K attitude %K perception %K digital intervention %K web-based intervention %K depression %K anxiety %K mental disorder %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. Objective: The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers’ attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers’ willingness to use digital and nondigital LITs and their decisions to learn about them. Methods: We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. Results: Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. Conclusions: Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists. %M 36112400 %R 10.2196/39787 %U https://formative.jmir.org/2022/9/e39787 %U https://doi.org/10.2196/39787 %U http://www.ncbi.nlm.nih.gov/pubmed/36112400 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36517 %T Acceptability and Impact of an Educational App (iCare) for Informal Carers Looking After People at Risk of Pressure Ulceration: Mixed Methods Pilot Study %A McKeown,Eamonn %A McGraw,Caroline %A Holder,Pru %A Shand,Jenny %A Hirani,Shashivadan P %+ School of Health & Psychological Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 70405917, eamonn.mckeown.1@city.ac.uk %K pressure ulcers %K informal carers %K smartphone apps %K mobile health %K mHealth %K educational technology %K health education %K mobile phone %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden. Objective: This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role. Methods: In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a “think aloud” interview in week 1 and semistructured interviews at the end of weeks 2 and 6. Results: Of the 32 participants, 23 (72%) participants completed the week 2 and 16 (50%) completed the week 6 questionnaires; 66% (21/32) of carers participated in qualitative “think aloud” interviews, and 18 (56%) also participated in semistructured interviews at week 2, and 13 (41%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme “I’m more careful now and would react to signs of redness” captured participants’ reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: “When you’re not used to these things, they take time to get the hang of” and “It’s not a fun app but it is informative.” All participants (n=32, 100%) liked the microlearning approach. Conclusions: The iCare app offers a promising way to improve informal carers’ pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences. %M 36112413 %R 10.2196/36517 %U https://formative.jmir.org/2022/9/e36517 %U https://doi.org/10.2196/36517 %U http://www.ncbi.nlm.nih.gov/pubmed/36112413 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32453 %T The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study %A Frechette,Mikaela %A Fanning,Jason %A Hsieh,Katherine %A Rice,Laura %A Sosnoff,Jacob %+ Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66103, United States, 1 913 588 5235, jsosnoff@kumc.edu %K usability testing %K mobile health %K wheeled device user %K fall risk %K telehealth %K mHealth %K mobile device %K smartphone %K health applications %K older adults %K elderly population %K device usability %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. %M 36112405 %R 10.2196/32453 %U https://formative.jmir.org/2022/9/e32453 %U https://doi.org/10.2196/32453 %U http://www.ncbi.nlm.nih.gov/pubmed/36112405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37503 %T Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study %A MacKinnon,Madison %A Moloney,Max %A Bullock,Emma %A Morra,Alison %A To,Teresa %A Lemiere,Catherine %A Lougheed,M Diane %+ Asthma Research Unit, Kingston Health Sciences Centre, 72 Stuart St, Kingston, ON, K7L2V7, Canada, 1 647 808 5346, 13mm190@queensu.ca %K work-related asthma %K asthma %K dissemination %K implementation %K e-tools %K barriers %K limitations %K electronic medical records %K EMRs %K knowledge translation %K mobile phone %D 2022 %7 15.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun. Objective: This study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L). Methods: This study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities. Results: A total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee. Conclusions: Stakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation. %M 35964327 %R 10.2196/37503 %U https://formative.jmir.org/2022/9/e37503 %U https://doi.org/10.2196/37503 %U http://www.ncbi.nlm.nih.gov/pubmed/35964327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40739 %T Agreement Between Clinically Measured Weight and Self-reported Weight Among Patients With Type 2 Diabetes Through an mHealth Lifestyle Coaching Program in Denmark: Secondary Analysis of a Randomized Controlled Trial %A Imeraj,Albi %A Olesen,Thomas Bastholm %A Laursen,Ditte Hjorth %A Søndergaard,Jens %A Brandt,Carl Joakim %+ Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J B Winsløws Vej 9A, Odense, 5000, Denmark, 45 31390187, aimeraj@health.sdu.dk %K telemedicine %K digital behavioral coaching %K lifestyle change %K mobile intervention %K obesity %K diabetes %K patient engagement %K validation %K self-report %K body weight %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are increasingly used to handle and promote positive health behaviors. Clinical measures are often used, and a certain precision is essential for digital health interventions to have an effect. Only few studies have compared clinically measured weights with self-reported weights. No study has examined the validity of self-reported weight from a mobile app used in a tailored weight loss intervention. Objective: The aim of this study was to analyze the agreement between clinically measured weight and self-reported weight collected from a mobile health lifestyle coaching program during a 12-month weight loss intervention for obese patients with and without type 2 diabetes. The secondary aim was to investigate the determinants for possible discrepancies between clinically measured and self-reported weights of these patients with different demographic and lifestyle characteristics and achievements of weight loss goals. Methods: Weight registrations were collected from participants (N=104) in a Danish randomized controlled trial examining the effect of a digital lifestyle intervention on weight loss among obese patients with and without type 2 diabetes. Data were collected at baseline and after 6 and 12 months. Self-reported weight was measured at home and registered in the app. Results: Self-reported body weight was lower than the weight measured in the clinic after 6 months by 1.03 kg (95% CI 1.01-1.05; P<.001) and after 12 months also by 1.03 kg (95% CI 0.99-1.04; P<.001). After 6 months, baseline weight and BMI were associated with a discrepancy of 0.03 kg (95% CI 0.01-0.04; P=.01) and 0.09 kg (95% CI 0.02-0.17; P=.02) per increment of 1 kg and 1 kg/m2, respectively, between clinically measured weight and self-reported weight. Weight change during the first 6 months was also associated with a difference of 0.1 kg (95% CI 0.04-0.01; P<.001) per kilogram of difference in weight between clinically measured weight and self-reported weight. Participants who did not achieve the 5% weight loss goal underestimated their weight by 0.79 kg (95% CI 0.34-1.23) at 6 months. After 12 months, only baseline weight was associated with a discrepancy of 0.03 kg (95% CI 0.01-0.05; P=.02) per increment of kilogram between clinically measured weight and self-reported weight. None of the other factors showed any significant discrepancy after 12 months. Conclusions: Self-reported weight obtained from mobile health is a valid method for collecting anthropometric measurements. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 %M 36047606 %R 10.2196/40739 %U https://formative.jmir.org/2022/9/e40739 %U https://doi.org/10.2196/40739 %U http://www.ncbi.nlm.nih.gov/pubmed/36047606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39046 %T Digital Global Recruitment for Women’s Health Research: Cross-sectional Study %A Rodriguez,Erika %A Peer,Komal %A Fruh,Victoria %A James,Kaitlyn %A Williams,Anna %A de Figueiredo Veiga,Alexis %A Winter,Michael R %A Shea,Amanda %A Aschengrau,Ann %A Lane,Kevin J %A Mahalingaiah,Shruthi %+ Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States, 1 6174147305, shruthi@hsph.harvard.edu %K digital recruitment %K internet %K menstrual tracking app %K menstrual %K menstruation %K reproductive health %K reproduction %K mobile health %K menstrual health %K mHealth %K women's health %K Facebook %K social media %K epidemiology research %K in-app message %K tracking app %K health application %K health app %K eHealth %K digital health %K health technology %K ovulation %K recruit %K attrition %K research subject %K participation %K participant %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the increased popularity of mobile menstrual tracking apps and boosted Facebook posts, there is a unique opportunity to recruit research study participants from across the globe via these modalities to evaluate women’s health. However, no studies to date have assessed the feasibility of using these recruitment sources for epidemiological research on ovulation and menstruation. Objective: The objective of this study was to assess the feasibility of recruiting a diverse sample of women to an epidemiological study of ovulation and menstruation (OM) health (OM Global Health Study) using digital recruitment sources. The feasibility and diversity were assessed via click and participation rates, geographic location, BMI, smoking status, and other demographic information. Methods: Participants were actively recruited via in-app messages using the menstrual tracking app Clue (BioWink GmbH) and a boosted Facebook post by DivaCup (Diva International Inc.). Other passive recruitment methods also took place throughout the recruitment period (eg, email communications, blogs, other social media). The proportion of participants who visited the study website after viewing and clicking the hypertext link (click rates) in the in-app messages and boosted Facebook post and the proportion of participants who completed the surveys per the number of completed consent and eligibility screeners (participation rates) were used to quantify the success of recruiting participants to the study website and study survey completion, respectively. Survey completion was defined as finishing the pregnancy and birth history section of the OM Global Health Study questionnaire. Results: The recruitment period was from February 27, 2018, through January 24, 2020. In-app messages and the boosted Facebook post were seen by 104,000 and 21,400 people, respectively. Overall, 215 participants started the OM Global Health Study survey, of which 140 (65.1%), 39 (18.1%), and 36 (16.8%) participants were recruited via the app, the boosted Facebook post, and other passive recruitment methods, respectively. The click rate via the app was 18.9% (19,700 clicks/104,000 ad views) and 1.6% via the boosted Facebook post (340 clicks/21,400 ad views.) The overall participation rate was 44.6% (198/444), and the average participant age was 21.8 (SD 6.1) years. In terms of geographic and racial/ethnic diversity, 91 (44.2%) of the participants resided outside the United States and 147 (70.7%) identified as non-Hispanic White. In-app recruitment produced the most geographically diverse stream, with 44 (32.8%) of the 134 participants in Europe, 77 (57.5%) in North America, and 13 (9.8%) in other parts of the world. Both human error and nonhuman procedural breakdowns occurred during the recruitment process, including a computer programming error related to age eligibility and a hacking attempt by an internet bot. Conclusions: In-app messages using the menstrual tracking app Clue were the most successful method for recruiting participants from many geographic regions and producing the greatest numbers of started and completed surveys. This study demonstrates the utility of digital recruitment to enroll participants from diverse geographic locations and provides some lessons to avoid technical recruitment errors in future digital recruitment strategies for epidemiological research. %M 35969168 %R 10.2196/39046 %U https://formative.jmir.org/2022/9/e39046 %U https://doi.org/10.2196/39046 %U http://www.ncbi.nlm.nih.gov/pubmed/35969168 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e33606 %T Personalized Energy Expenditure Estimation: Visual Sensing Approach With Deep Learning %A Perrett,Toby %A Masullo,Alessandro %A Damen,Dima %A Burghardt,Tilo %A Craddock,Ian %A Mirmehdi,Majid %+ University of Bristol, Digital Health, First Floor, 1 Cathedral Square, Bristol, BS1 5DD, United Kingdom, 44 117 45 50375, toby.perrett@bristol.ac.uk %K energy expenditure %K calories, calorimetry %K deep learning %K computer vision %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Calorimetry is both expensive and obtrusive but provides the only way to accurately measure energy expenditure in daily living activities of any specific person, as different people can use different amounts of energy despite performing the same actions in the same manner. Deep learning video analysis techniques have traditionally required a lot of data to train; however, recent advances in few-shot learning, where only a few training examples are necessary, have made developing personalized models without a calorimeter a possibility. Objective: The primary aim of this study is to determine which activities are most well suited to calibrate a vision-based personalized deep learning calorie estimation system for daily living activities. Methods: The SPHERE (Sensor Platform for Healthcare in a Residential Environment) Calorie data set is used, which features 10 participants performing 11 daily living activities totaling 4.5 hours of footage. Calorimeter and video data are available for all recordings. A deep learning method is used to regress calorie predictions from video. Results: Models are personalized with 32 seconds from all 11 actions in the data set, and mean square error (MSE) is taken against a calorimeter ground truth. The best single action for calibration is wipe (1.40 MSE). The best pair of actions are sweep and sit (1.09 MSE). This compares favorably to using a whole 30-minute sequence containing 11 actions to calibrate (1.06 MSE). Conclusions: A vision-based deep learning energy expenditure estimation system for a wide range of daily living activities can be calibrated to a specific person with footage and calorimeter data from 32 seconds of sweeping and 32 seconds of sitting. %M 36103223 %R 10.2196/33606 %U https://formative.jmir.org/2022/9/e33606 %U https://doi.org/10.2196/33606 %U http://www.ncbi.nlm.nih.gov/pubmed/36103223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39718 %T Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study %A Saeidnia,Hamid Reza %A Kozak,Marcin %A Ausloos,Marcel %A Herteliu,Claudiu %A Mohammadzadeh,Zahra %A Ghorbi,Ali %A Karajizadeh,Mehrdad %A Hassanzadeh,Mohammad %+ Department of Knowledge and Information Science, Tarbiat Modares University, Tehran-Ashrafi Esfahani Highway- After Paul Hemmat, Tehran, 6931753865, Iran, 98 09394464224, hamidrezasaednia@gmail.com %K self-care %K mobile app %K ADDIE model %K COVID-19 %K underdeveloped countries %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care—one of the most effective ways to prevent illness—can be improved through mobile health apps. Objective: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. Methods: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app’s usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. Results: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the “interface and satisfaction,” “ease of use,” and “usefulness” components. Conclusions: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries—often lacking other tools—can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government. %M 36054441 %R 10.2196/39718 %U https://formative.jmir.org/2022/9/e39718 %U https://doi.org/10.2196/39718 %U http://www.ncbi.nlm.nih.gov/pubmed/36054441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37287 %T Motive-Oriented, Personalized, Internet-Based Interventions for Depression: Nonclinical Experimental Study %A Bücker,Lara %A Berger,Thomas %A Bruhns,Alina %A Westermann,Stefan %+ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany, 49 040 7410 55868, l.buecker@uke.de %K internet-based interventions %K depression %K adherence %K motive orientation %K personalization %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The low level of adherence in internet-based self-help interventions for depression suggests that in many existing programs, the motivational fit between the program and the user is unsatisfactory (eg, the user seeks autonomy, but the program provides directive guidance). Personalized, motive-oriented, self-help interventions could enable participants who interact with a program and its contents to have more engaging and less aversive experiences and thus increase adherence. Objective: In an experimental study with a nonclinical analogue sample, we aimed to test the hypotheses that a better motivational person-program fit is linked with higher anticipated adherence, working alliance, and satisfaction with the program. Methods: Motivational person-program fit was examined with respect to the 2 contrasting motives being autonomous and being supported. The hypotheses were tested by specifically varying the motivational person-program fit in a nonclinical sample (N=55), where participants were asked to work on, and subsequently evaluate, a limited set of individual pages of a self-help program with guidance (in the form of text messages) for depression. The sections of the self-help program were redesigned to either particularly address the autonomy motive or the support motive. For the quasi-experimental variation of the motivational person-program characteristics, we divided the 55 participants into 2 groups (autonomy group: n=27, 49%; support group: n=28, 51%) by screening method (using the Inventory of Approach and Avoidance Motivation), corresponding to the 2 motives. Both groups evaluated (in randomized order) 2 excerpts of the program—one that matched their motive (fit) and one that was contrary to it (no fit). Immediately after the evaluation of each excerpt, anticipated adherence, working alliance, and treatment satisfaction were assessed. Results: Regarding being supported, the satisfaction with or violation of this motive had an impact on (optimal) anticipated adherence as well as working alliance and satisfaction with the intervention; a congruent person-program fit resulted in significantly higher anticipated adherence (t27=3.00; P=.006), working alliance (t27=3.20; P=.003), and satisfaction (t27=2.86; P=.008) than a noncongruent fit. However, a similar impact could not be found for the motive being autonomous. Several correlations were found that supported our hypotheses (eg, for the congruent person-program fit autonomy motive and autonomy group, support satisfaction negatively correlated with optimal anticipated adherence). Conclusions: This first experimental study gives reason to assume that motive orientation may have a positive influence on adherence, working alliance, and satisfaction in internet-based self-help interventions for depression and other mental disorders. Future studies should conduct randomized controlled trials with clinical samples and assess clinical outcomes. %M 36098989 %R 10.2196/37287 %U https://formative.jmir.org/2022/9/e37287 %U https://doi.org/10.2196/37287 %U http://www.ncbi.nlm.nih.gov/pubmed/36098989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40046 %T Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study %A Du,Yan %A Patel,Neela %A Hernandez,Arthur %A Zamudio-Samano,Maria %A Li,Shiyu %A Zhang,Tianou %A Fernandez,Roman %A Choi,Byeong Yeob %A Land,William M %A Ullevig,Sarah %A Estrada Coats,Vanessa %A Moussavou,Jessh Mondesir Mavoungou %A Parra-Medina,Deborah %A Yin,Zenong %+ Center on Smart and Connected Health Technology, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 5044931202, duy@uthscsa.edu %K qigong %K mind-body exercise %K Five Animal Frolics %K health technology %K older adults %K Hispanics %K Latinos %K low-income %K healthy aging %K aging in place %K independent living %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living. Objective: This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living. Methods: This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis. Results: The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes. Conclusions: The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder. %M 35997685 %R 10.2196/40046 %U https://formative.jmir.org/2022/9/e40046 %U https://doi.org/10.2196/40046 %U http://www.ncbi.nlm.nih.gov/pubmed/35997685 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36130 %T Predicting Depression in Patients With Knee Osteoarthritis Using Machine Learning: Model Development and Validation Study %A Nowinka,Zuzanna %A Alagha,M Abdulhadi %A Mahmoud,Khadija %A Jones,Gareth G %+ MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, h.alagha@imperial.ac.uk %K knee osteoarthritis %K depression %K machine learning %K predictive modeling %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Knee osteoarthritis (OA) is the most common form of OA and a leading cause of disability worldwide. Chronic pain and functional loss secondary to knee OA put patients at risk of developing depression, which can also impair their treatment response. However, no tools exist to assist clinicians in identifying patients at risk. Machine learning (ML) predictive models may offer a solution. We investigated whether ML models could predict the development of depression in patients with knee OA and examined which features are the most predictive. Objective: The primary aim of this study was to develop and test an ML model to predict depression in patients with knee OA at 2 years and to validate the models using an external data set. The secondary aim was to identify the most important predictive features used by the ML algorithms. Methods: Osteoarthritis Initiative Study (OAI) data were used for model development and external validation was performed using Multicenter Osteoarthritis Study (MOST) data. Forty-two features were selected, which denoted routinely collected demographic and clinical data such as patient demographics, past medical history, knee OA history, baseline examination findings, and patient-reported outcome measures. Six different ML classification models were trained (logistic regression, least absolute shrinkage and selection operator [LASSO], ridge regression, decision tree, random forest, and gradient boosting machine). The primary outcome was to predict depression at 2 years following study enrollment. The presence of depression was defined using the Center for Epidemiological Studies Depression Scale. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score. The most important features were extracted from the best-performing model on external validation. Results: A total of 5947 patients were included in this study, with 2969 in the training set, 742 in the test set, and 2236 in the external validation set. For the test set, the AUC ranged from 0.673 (95% CI 0.604-0.742) to 0.869 (95% CI 0.824-0.913), with an F1 score of 0.435 to 0.490. On external validation, the AUC varied from 0.720 (95% CI 0.685-0.755) to 0.876 (95% CI 0.853-0.899), with an F1 score of 0.456 to 0.563. LASSO modeling offered the highest predictive performance. Blood pressure, baseline depression score, knee pain and stiffness, and quality of life were the most predictive features. Conclusions: To our knowledge, this is the first study to apply ML classification models to predict depression in patients with knee OA. Our study showed that ML models can deliver a clinically acceptable level of performance (AUC>0.7) in predicting the development of depression using routinely available demographic and clinical data. Further work is required to address the class imbalance in the training data and to evaluate the clinical utility of the models in facilitating early intervention and improved outcomes. %M 36099008 %R 10.2196/36130 %U https://formative.jmir.org/2022/9/e36130 %U https://doi.org/10.2196/36130 %U http://www.ncbi.nlm.nih.gov/pubmed/36099008 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34450 %T Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial %A Marin,Anna %A DeCaro,Renée %A Schiloski,Kylie %A Elshaar,Ala’a %A Dwyer,Brigid %A Vives-Rodriguez,Ana %A Palumbo,Rocco %A Turk,Katherine %A Budson,Andrew %+ Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130-4817, United States, 1 8573646184, amarin@bu.edu %K cognitive training %K Alzheimer disease dementia %K technology %D 2022 %7 12.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear. Objective: We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period. Methods: Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to AD or mild AD dementia. Participants were randomly assigned to either the Constant Therapy (n=10) or active control (n=9) group. The Constant Therapy group completed a tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The active control group completed paper-and-pencil games during the first 24 weeks and were invited to complete an optional Constant Therapy training during the second 24 weeks. Every 6 weeks, the participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The participants independently accessed Constant Therapy using an Apple iPad. Our primary feasibility outcomes were the rate of adherence and daily use of Constant Therapy over 24 weeks. Our secondary outcomes were Constant Therapy performance over 24 weeks and change in RBANS scores between the 2 experimental groups. Results: Feasibility analyses were computed for participants who completed 24 weeks of Constant Therapy. We found that long-term use of the Constant Therapy program was feasible in patients with AD over 24 weeks (adherence 80%; program use 121/168 days, for 32 minutes daily). These participants showed an overall improvement in accuracy and latency (P=.005) in the Constant Therapy scores, as well as specific improvements in visual and auditory memory, attention, and arithmetic tasks. The Constant Therapy group showed improvement in the RBANS coding subtest. No unexpected problems or adverse events were observed. Conclusions: Long-term (eg, 24 weeks) computerized cognitive training using Constant Therapy is feasible in patients with AD in the mild cognitive impairment and mild dementia stages. Patients adhered more to Constant Therapy than to the paper-and-pencil training over 24 weeks and improved their performance over time. These findings support the development of future randomized controlled trials that will investigate the efficacy of Constant Therapy to sustain cognitive function in patients with AD. Trial Registration: ClinicalTrials.gov NCT02521558; https://clinicaltrials.gov/ct2/show/NCT02521558 %M 36094804 %R 10.2196/34450 %U https://formative.jmir.org/2022/9/e34450 %U https://doi.org/10.2196/34450 %U http://www.ncbi.nlm.nih.gov/pubmed/36094804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36177 %T Quality of Late-Life Depression Information on the Internet: Website Evaluation Study %A Pryor,Teaghan A M %A Reynolds,Kristin A %A Kirby,Paige L %A Bernstein,Matthew T %+ Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada, 1 2044749528, kristin.reynolds@umanitoba.ca %K late-life %K depression %K older adults %K internet %K websites %K information quality %K usability %K readability %D 2022 %7 12.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet can increase the accessibility of mental health information and improve the mental health literacy of older adults. The quality of mental health information on the internet can be inaccurate or biased, leading to misinformation. Objective: This study aims to evaluate the quality, usability, and readability of websites providing information concerning depression in later life. Methods: Websites were identified through a Google search and evaluated by assessing quality (DISCERN), usability (Patient Education Materials Assessment Tool), and readability (Simple Measure of Gobbledygook). Results: The overall quality of late-life depression websites (N=19) was adequate, and the usability and readability were poor. No significant relationship was found between the quality and readability of the websites. Conclusions: The websites can be improved by enhancing information quality, usability, and readability related to late-life depression. The use of high-quality websites may improve mental health literacy and shared treatment decision-making for older adults. %M 36094802 %R 10.2196/36177 %U https://formative.jmir.org/2022/9/e36177 %U https://doi.org/10.2196/36177 %U http://www.ncbi.nlm.nih.gov/pubmed/36094802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36432 %T The Helpfulness of Web-Based Mental Health and Well-being Forums for Providing Peer Support for Young People: Cross-sectional Exploration %A Banwell,Emily %A Hanley,Terry %A De Ossorno Garcia,Santiago %A Mindel,Charlotte %A Kayll,Thomas %A Sefi,Aaron %+ Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M15 6JA, United Kingdom, emily.banwell@manchester.ac.uk %K adolescent mental health %K peer support %K web-based forums %K web-based mental health %D 2022 %7 9.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people are increasingly seeking out web-based support for their mental health and well-being. Peer support forums are popular with this age group, with young individuals valuing the fact that the forums are available 24/7, providing a safe and anonymous space for exploration. Currently, little systematic evaluation of the helpfulness of such forums in providing support has been conducted. Objective: This study examined the helpfulness of the support offered within web-based mental health and well-being peer support forums for young people. It specifically investigated the self-reported user ratings of helpfulness reported through the completion of a developing experience measure. The ratings will be used to consider further development of the measure and reflect upon the overall helpfulness of the forums as indicated by the reported scores. Methods: The study used routinely collected practice-based outcome data from web-based mental health forums for young people. These forums are hosted by the UK-based web-based therapy and support service, Kooth. A cross-sectional design was used to explore—using a range of inferential statistical measures—the outcomes reported by those accessing the forums using a Peer Online Community Experience Measure (POCEM). To consider the helpfulness in general, 23,443 POCEMs completed in 2020 were used. A second data set of 17,137 completed POCEMs from the same year was used to consider whether various engagement indicators had an impact upon the helpfulness rating. Results: Female users aged between 11 and 16 years predominantly completed the POCEM. This is in keeping with the majority of those using the service. In total, 74.6% (8240/11,045) of the scores on the POCEM indicated that the individuals found the posts helpful. An ANOVA indicated that male users were more likely to report obtaining intrapersonal support, whereas female users obtained interpersonal support. Furthermore, the POCEM scores reflected the internal consistency of the measure and provided an insight into the way that young people made use of the peer support resource; for instance, posts that were rated more helpful were correlated with spending longer time reading them, and the topics discussed varied throughout the day with more mental health issues being discussed later at night. Conclusions: The results seem to demonstrate that, overall, the young people involved in this study found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed. However, limitations were noted, suggesting that caution is needed when interpreting the results of this study. Although such services are incredibly well used, they have received little research attention to date. As such, further investigation into what constitutes helpful and unhelpful peer support is needed. %M 36083629 %R 10.2196/36432 %U https://formative.jmir.org/2022/9/e36432 %U https://doi.org/10.2196/36432 %U http://www.ncbi.nlm.nih.gov/pubmed/36083629 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38354 %T Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing %A Hightow-Weidman,Lisa B %A Muessig,Kathryn %A Soberano,Zach %A Rosso,Matthew T %A Currie,Andrew %A Adams Larsen,Margo %A Knudtson,Kelly %A Vecchio,Alyssa %+ Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, United States, 1 919 843 0033, lisa_hightow@med.unc.edu %K HIV %K virtual reality %K status disclosure %K prevention %K young men who have sex with men %K artificial intelligence %K medication adherence %K transmission %K viral load %K men %K sex %K development %K usability %K testing %K virtual simulation %K young men %K United States %K behavior %K social determinants %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior. Objective: To address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing. Methods: Building on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview. Results: TT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI. Conclusions: TT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression. Trial Registration: ClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372 %M 36074551 %R 10.2196/38354 %U https://formative.jmir.org/2022/9/e38354 %U https://doi.org/10.2196/38354 %U http://www.ncbi.nlm.nih.gov/pubmed/36074551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34902 %T Understanding Gender Biases and Differences in Web-Based Reviews of Sanctioned Physicians Through a Machine Learning Approach: Mixed Methods Study %A Barnett,Julia %A Bjarnadóttir,Margrét Vilborg %A Anderson,David %A Chen,Chong %+ Technology and Social Behavior, Northwestern University, 2240 Campus Drive, Room 2-168 (Attention: Dept of Comm Studies), Evanston, IL, 60208, United States, 1 847 491 7530, JuliaBarnett@u.northwestern.edu %K gender %K natural language processing %K web-based reviews %K physician ratings by customer %K text mining %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have highlighted gender differences in web-based physician reviews; however, so far, no study has linked web-based ratings with quality of care. Objective: We compared a consumer-generated measure of physician quality (web-based ratings) with a clinical quality outcome (sanctions for malpractice or improper behavior) to understand how patients’ perceptions and evaluations of physicians differ based on the physician’s gender. Methods: We used data from a large web-based physician review website and the Federation of State Medical Boards. We implemented paragraph vector methods to identify words that are specific to and indicative of separate groups of physicians. Then, we enriched these findings by using the National Research Council Canada word-emotion association lexicon to assign emotional scores to reviews for different subpopulations according to gender, gender and sanction, and gender and rating. Results: We found statistically significant differences in the sentiment and emotion of reviews between male and female physicians. Numerical ratings are lower and sentiment in text reviews is more negative for women who will be sanctioned than for men who will be sanctioned; sanctioned male physicians are still associated with positive reviews. Conclusions: Given the growing impact of web-based reviews on demand for physician services, understanding the different dynamics of reviews for male and female physicians is important for consumers and platform architects who may revisit their platform design. %M 36074543 %R 10.2196/34902 %U https://formative.jmir.org/2022/9/e34902 %U https://doi.org/10.2196/34902 %U http://www.ncbi.nlm.nih.gov/pubmed/36074543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34471 %T An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients’ Experiences and Perspectives %A Obro,Louise Faurholt %A Osther,Palle Jörn Sloth %A Ammentorp,Jette %A Pihl,Gitte Thybo %A Heiselberg,Kasper Kvols %A Krogh,Peter Gall %A Handberg,Charlotte %+ Urological Research Center, Vejle Hospital (Lillebaelt Hospital), University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark, 45 24994502, louise.faurholt.obro@rsyd.dk %K mobile phone %K mobile health %K mHealth %K prostate cancer %K self-management %K health coaching %K coaching %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients’ self-management of health behaviors and improve well-being. Objective: This study aims to explore patients’ experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients’ self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients’ individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. %M 35925751 %R 10.2196/34471 %U https://formative.jmir.org/2022/9/e34471 %U https://doi.org/10.2196/34471 %U http://www.ncbi.nlm.nih.gov/pubmed/35925751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32795 %T Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study %A Ma,Tony %A Chang,Katie %A Alyusuf,Amal %A Bajracharya,Elina %A Washio,Yukiko %A Kelly,Patricia J %A Bellad,Roopa M %A Mahantashetti,Niranjana S %A Charantimath,Umesh %A Short,Vanessa L %A Lalakia,Parth %A Jaeger,Frances %A Goudar,Shivaprasad %A Derman,Richard %+ Benten Technologies, Inc, 9408 Grant Avenue, Suite 206, Manassas, VA, 20110-1816, United States, 1 703 662 5858 ext 143, tonyma@bententech.com %K mobile health %K mHealth %K peer counselors %K breastfeeding %K rural %K usability %K low- and middle-income countries %K agile %K task shifting %K user-centered design %K mobile phone %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group’s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 %M 36074546 %R 10.2196/32795 %U https://formative.jmir.org/2022/9/e32795 %U https://doi.org/10.2196/32795 %U http://www.ncbi.nlm.nih.gov/pubmed/36074546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38262 %T A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial %A Miller,Hailey N %A Voils,Corrine I %A Cronin,Kate A %A Jeanes,Elizabeth %A Hawley,Jeffrey %A Porter,Laura S %A Adler,Rachel R %A Sharp,Whitney %A Pabich,Samantha %A Gavin,Kara L %A Lewis,Megan A %A Johnson,Heather M %A Yancy Jr,William S %A Gray,Kristen E %A Shaw,Ryan J %+ School of Nursing, Duke University, 307 Trent Drive, North Carolina, NC, 27710, United States, 1 919 684 9434, ryan.shaw@duke.edu %K text message %K weight management %K automation %K clinical trial %K engagement %K digital technology %K electronic data capture %K REDCap %K automated text message %K digital health intervention %K health intervention %K health database %K digital health %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies and software allows for new opportunities to communicate and engage with research participants over time. When software is coupled with automation, we can engage with research participants in a reliable and affordable manner. Research Electronic Data Capture (REDCap), a browser-based software, has the capability to send automated text messages. This feature can be used to automate delivery of tailored intervention content to research participants in interventions, offering the potential to reduce costs and improve accessibility and scalability. Objective: This study aimed to describe the development and use of 2 REDCap databases to deliver automated intervention content and communication to index participants and their partners (dyads) in a 2-arm, 24-month weight management trial, Partner2Lose. Methods: Partner2Lose randomized individuals with overweight or obesity and cohabitating with a partner to a weight management intervention alone or with their partner. Two databases were developed to correspond to 2 study phases: one for weight loss initiation and one for weight loss maintenance and reminders. The weight loss initiation database was programmed to send participants (in both arms) and their partners (partner-assisted arm) tailored text messages during months 1-6 of the intervention to reinforce class content and support goal achievement. The weight maintenance and reminder database was programmed to send maintenance-related text messages to each participant (both arms) and their partners (partner-assisted arm) during months 7-18. It was also programmed to send text messages to all participants and partners over the course of the 24-month trial to remind them of group classes, dietary recall and physical activity tracking for assessments, and measurement visits. All text messages were delivered via Twilio and were unidirectional. Results: Five cohorts, comprising 231 couples, were consented and randomized in the Partner2Lose trial. The databases will send 53,518 automated, tailored text messages during the trial, significantly reducing the need for staff to send and manage intervention content over 24 months. The cost of text messaging will be approximately US $450. Thus far, there is a 0.004% known error rate in text message delivery. Conclusions: Our trial automated the delivery of tailored intervention content and communication using REDCap. The approach described provides a framework that can be used in future behavioral health interventions to create an accessible, reliable, and affordable method for intervention delivery and engagement that requires minimal trial-specific resources and personnel time. Trial Registration: ClinicalTrials.gov NCT03801174; https://clinicaltrials.gov/ct2/show/NCT03801174?term=NCT03801174 %M 36066936 %R 10.2196/38262 %U https://formative.jmir.org/2022/9/e38262 %U https://doi.org/10.2196/38262 %U http://www.ncbi.nlm.nih.gov/pubmed/36066936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37216 %T Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Symptoms of Postpartum Anxiety and Depression: Feasibility Randomized Controlled Trial %A Suchan,Victoria %A Peynenburg,Vanessa %A Thiessen,David %A Nugent,Marcie %A Dear,Blake %A Titov,Nickolai %A Hadjistavropoulos,Heather %+ Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, hadjista@uregina.ca %K postpartum depression %K postpartum anxiety %K internet-delivered cognitive behavioral therapy %K transdiagnostic %K therapist assistance %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and are associated with significant personal and economic costs. Fewer than half of the mothers experiencing PPD or PPA symptoms receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behavioral therapy (ICBT). Objective: This pilot study aimed to examine the impact of a therapist-assisted, transdiagnostic ICBT program on symptoms of PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population, which did not include therapist assistance. Methods: Clients endorsing the symptoms of PPD or PPA (N=63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment as usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction, as well as measures of treatment satisfaction and therapeutic alliance, before treatment, after treatment, and at the 1-month follow-up. Outcome measures were also completed at the 6-month follow-up for clients who completed the ICBT course. Results: Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements after treatment and at the 1-month follow-up on more measures than the TAU group, with medium between-group Cohen d effects on primary outcome measures for anxiety (Cohen d=0.65, 95% CI 0.13-1.17), PPD (Cohen d=0.52, 95% CI 0.01-1.04), and depression (Cohen d=0.56, 95% CI 0.05-1.08), and on secondary outcome measures of overall distress (Cohen d=0.69, 95% CI 0.17-1.21), anxiety (Cohen d=0.59, 95% CI 0.07-1.11), and stress (Cohen d=0.76, 95% CI 0.23-1.28). Time-by-group interactions for proportional reductions between groups over time were only significant after treatment and at the 1-month follow-up for the primary anxiety measure (P=.006). This study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible, and 95% (21/22) of the clients were satisfied with the treatment content and therapist support. Conclusions: Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD and PPA symptoms to improve access to psychological treatments. Trial Registration: ClinicalTrials.gov NCT04012580; https://clinicaltrials.gov/ct2/show/NCT04012580 %M 36066958 %R 10.2196/37216 %U https://formative.jmir.org/2022/9/e37216 %U https://doi.org/10.2196/37216 %U http://www.ncbi.nlm.nih.gov/pubmed/36066958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34212 %T The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %K exposure %K behavior %K effect %K design %K adoption %K use %K case study %K effectiveness %K user interface %K mobile phone %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%. %M 35580138 %R 10.2196/34212 %U https://formative.jmir.org/2022/9/e34212 %U https://doi.org/10.2196/34212 %U http://www.ncbi.nlm.nih.gov/pubmed/35580138 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34159 %T The Use of Smartphone Serious Gaming Apps in the Treatment of Substance Use Disorders: Observational Study on Feasibility and Acceptability %A Schilt,Thelma %A Ruijter,Elvira Sharine %A Godeschalk,Nikky %A van Haaster,Marit %A Goudriaan,Anna E %+ Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Jacob Obrechtstraat 92, Amsterdam, 1071 KR, Netherlands, 31 88 505 1220, thelma.schilt@jellinek.nl %K addiction care %K mobile phone %K cognitive training %K neurocognition %K mental health %K mobile health %K digital applications %K health applications %K smartphone %K cognitive assessment %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Addiction is a worldwide problem with major health complications. Despite intensive treatment, relapse rates remain high. The prevalence of cognitive impairment is high in patients with substance use disorders (SUDs) and is associated with treatment dropout and relapse. Evidence indicates that cognitive function training in persons with SUDs may support treatment. Therefore, the use of web-based tools to test and train cognitive functions is of increasing interest. Objective: The goal of this study was to determine the feasibility and acceptability of a serious gaming smartphone app to test and train cognitive functions in addition to the treatment of SUDs. Methods: A prospective observational study was conducted with 229 patients seeking addiction treatment. The patients were offered 2 smartphone apps in addition to regular care: MyCognition Quotient (MyCQ) assessed cognitive functions and AquaSnap trained these functions. The feasibility was determined based on acceptance rates. The acceptability of the smartphone apps was qualitatively analyzed based on the answers to a questionnaire. Patient characteristics were compared between patients who played and did not play smartphone games. Explorative correlation analyses were performed between the playing time and cognitive assessment scores. Results: Of the 229 patients who were offered the apps, 110 completed the MyCQ assessment, and 59 started playing AquaSnap, yielding acceptance rates of 48.0% and 25.8%, respectively. The group that completed the MyCQ assessment was significantly more educated than the group that did not download the apps (χ22=7.3; P=.03). The education level did not differ significantly between the group that played AquaSnap and the group that did not (P=.06). There were relatively more women in the AquaSnap playing group than in the nonplaying group (χ21=6.5; P=.01). The groups did not differ in terms of age, substance use, treatment setting, mood, or quality of life. With respect to acceptability, 83% (38/46) of the patients who filled out the questionnaire enjoyed taking the MyCQ measurement, whereas 41% (14/34) enjoyed playing the AquaSnap game. Furthermore, 76% (35/46) and 68% (23/34) rated the apps MyCQ and AquaSnap, respectively, as easy. More playing minutes was associated with decreased working memory reaction time and executive functioning accuracy. Conclusions: Our study showed that the use of a smartphone app for cognitive assessment in patients with SUDs who are interested and highly educated is feasible and acceptable for the subgroup that was asked to fill out a perception questionnaire. However, the use of a smartphone app for cognitive training was less feasible for this group of patients. Improvement of the training application and enhancement of the motivation of clients are needed. Despite these limitations, the present results provide support for future research investigating the use of smartphone apps for cognitive assessment and training in relation to the treatment of SUDs. %M 36066923 %R 10.2196/34159 %U https://formative.jmir.org/2022/9/e34159 %U https://doi.org/10.2196/34159 %U http://www.ncbi.nlm.nih.gov/pubmed/36066923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32460 %T Attention-Based Models for Classifying Small Data Sets Using Community-Engaged Research Protocols: Classification System Development and Validation Pilot Study %A Ferrell,Brian J %A Raskin,Sarah E %A Zimmerman,Emily B %A Timberline,David H %A McInnes,Bridget T %A Krist,Alex H %+ Center for Community Engagement and Impact, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA, 23284, United States, 1 8043505426, ferrellbj@vcu.edu %K data augmentation %K BERT %K transformer-based models %K text classification %K community engagement %K prototype %K IRB research %K community-engaged research %K participatory research %K deep learning %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Community-engaged research (CEnR) is a research approach in which scholars partner with community organizations or individuals with whom they share an interest in the study topic, typically with the goal of supporting that community’s well-being. CEnR is well-established in numerous disciplines including the clinical and social sciences. However, universities experience challenges reporting comprehensive CEnR metrics, limiting the development of appropriate CEnR infrastructure and the advancement of relationships with communities, funders, and stakeholders. Objective: We propose a novel approach to identifying and categorizing community-engaged studies by applying attention-based deep learning models to human participants protocols that have been submitted to the university’s institutional review board (IRB). Methods: We manually classified a sample of 280 protocols submitted to the IRB using a 3- and 6-level CEnR heuristic. We then trained an attention-based bidirectional long short-term memory unit (Bi-LSTM) on the classified protocols and compared it to transformer models such as Bidirectional Encoder Representations From Transformers (BERT), Bio + Clinical BERT, and Cross-lingual Language Model–Robustly Optimized BERT Pre-training Approach (XLM-RoBERTa). We applied the best-performing models to the full sample of unlabeled IRB protocols submitted in the years 2013-2019 (n>6000). Results: Although transfer learning is superior, receiving a 0.9952 evaluation F1 score for all transformer models implemented compared to the attention-based Bi-LSTM (between 48%-80%), there were key issues with overfitting. This finding is consistent across several methodological adjustments: an augmented data set with and without cross-validation, an unaugmented data set with and without cross-validation, a 6-class CEnR spectrum, and a 3-class one. Conclusions: Transfer learning is a more viable method than the attention-based bidirectional-LSTM for differentiating small data sets characterized by the idiosyncrasies and variability of CEnR descriptions used by principal investigators in research protocols. Despite these issues involving overfitting, BERT and the other transformer models remarkably showed an understanding of our data unlike the attention-based Bi-LSTM model, promising a more realistic path toward solving this real-world application. %M 36066925 %R 10.2196/32460 %U https://formative.jmir.org/2022/9/e32460 %U https://doi.org/10.2196/32460 %U http://www.ncbi.nlm.nih.gov/pubmed/36066925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38520 %T The Impact of Smartphone Apps Designed to Reduce Food Waste on Improving Healthy Eating, Financial Expenses and Personal Food Waste: Crossover Pilot Intervention Trial Studying Students’ User Experiences %A Mathisen,Therese Fostervold %A Johansen,Frode Ramstad %+ Faculty of Health, Welfare and Organisation, Østfold University College, Høgskolen i Østfold, PO Box 700, Halden, No-1757, Norway, 47 69 60 80 00, therese.f.mathisen@hiof.no %K smartphone app %K food waste %K healthy eating %K diet %K automatic %K registration %K global sustainability %K financial expenses %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Global sustainability and individual health need coordinated attention. While individuals are recommended a healthy diet to reduce the burden of noncommunicable diseases, global attention to natural resource conservation is also needed. The latter specifically means effective measures to reduce food waste. Objective: This pilot study evaluates the experiences of students and effect from using smartphone apps designed to reduce food waste on personal healthy eating, financial expenses, and food waste. Methods: A total of 6 students from different study programs (mean age 24.7, SD 2.9) were recruited to evaluate 2 different apps designed to reduce food waste and to register food consumption, food waste, and financial food expenses before and after the app trials. The apps evaluated were the commercially available TotalCtrl Home and Too-Good-To-Go. Results were analyzed by mixed methods, comprising statistical analyses for quantifiable data and thematic analyses for qualitative data. The apps were used separately in random order, each for 1 month. Primary outcome was user expectations to and experiences from the use of the apps, which were obtained by semistructured interviews. Secondary outcomes were changes in food waste volume, financial food expenses, and healthy eating. While information on food waste and food expenses was obtained by weighing food waste and registering food costs for 2 weeks before and after app trials, scores for consuming healthy diets were calculated from registered food records by scoring criteria matched to national recommendations for healthy eating. Results: Awareness on food waste increased after app trials, but experiences with apps pointed toward several potential for technical and content improvements. The students reported that there were too many manual operations in the apps to induce permanent use (TotalCtrl Home), that services seemed more concerned about the producers’ interests than the individual’s needs (Too-Good-To-Go), and that they missed a composite app that included functions to promote healthy eating and overview of budget and expenses as well as of food waste (both apps). Use of apps designed to reduce food waste and personal costs and to improve healthy eating did not result in any measurable effects, that is, no change in food waste (mean change 0.81, SD 1.5 kg; P=.13), healthy eating (mean change –0.24, SD 0.43; P=.24), or personal food expenses (mean change 47.5 NOK or US $4.8, SD 416.9 NOK or US $42.5; P=.39). Conclusions: Apps may aid in increased awareness of food waste at the producer and consumer levels. Large-scale studies with longer duration are needed to see if apps may induce measurable changes in food waste, healthy eating, and financial expenses. %M 36053667 %R 10.2196/38520 %U https://formative.jmir.org/2022/9/e38520 %U https://doi.org/10.2196/38520 %U http://www.ncbi.nlm.nih.gov/pubmed/36053667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36919 %T Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging %A Kathuria,Hasmeena %A Shankar,Divya %A Cobb,Vinson %A Newman,Julia %A Bulekova,Katia %A Werntz,Scott %A Borrelli,Belinda %+ The Pulmonary Center, Boston University School of Medicine, 72 E Concord St, R304, Boston, MA, 02118, United States, 1 6176384860, hasmeena@bu.edu %K text message %K smoking cessation %K opioid use disorder %K tobacco dependence %K tobacco treatment interventions %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective: This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods: From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results: The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions: SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit. %M 36048509 %R 10.2196/36919 %U https://formative.jmir.org/2022/9/e36919 %U https://doi.org/10.2196/36919 %U http://www.ncbi.nlm.nih.gov/pubmed/36048509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35015 %T Digital Health Screening in People With HIV in Uganda to Increase Alcohol Use Reporting: Qualitative Study on the Development and Testing of the Self-administered Digital Screener for Health %A Emenyonu,Nneka %A Kekibiina,Allen %A Woolf-King,Sarah %A Kyampire,Catherine %A Fatch,Robin %A Dawson-Rose,Carol %A Muyindike,Winnie %A Hahn,Judith %+ Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, 550 16th Street, UCSF Mission Hall, 3rd Floor, San Francisco, CA, 94158, United States, 1 6505751465, nneka.emenyonu@ucsf.edu %K unhealthy alcohol use %K HIV %K digital screening %K Uganda %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting. Objective: This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy. Methods: We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy. Results: A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener. Conclusions: We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions. %M 36048519 %R 10.2196/35015 %U https://formative.jmir.org/2022/9/e35015 %U https://doi.org/10.2196/35015 %U http://www.ncbi.nlm.nih.gov/pubmed/36048519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34280 %T Measurement of Heart Rate Using the Withings ScanWatch Device During Free-living Activities: Validation Study %A Giggins,Oonagh M %A Doyle,Julie %A Smith,Suzanne %A Crabtree,Daniel R %A Fraser,Matthew %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370200 ext 2114, oonagh.giggins@dkit.ie %K heart rate %K photoplethysmography %K PPG %K wearable electronic device %K wrist-worn device %K validation study %K heart %K activity %K physical activity %K free-living activity %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wrist-worn devices that incorporate photoplethysmography (PPG) sensing represent an exciting means of measuring heart rate (HR). A number of studies have evaluated the accuracy of HR measurements produced by these devices in controlled laboratory environments. However, it is also important to establish the accuracy of measurements produced by these devices outside the laboratory, in real-world, consumer use conditions. Objective: This study sought to examine the accuracy of HR measurements produced by the Withings ScanWatch during free-living activities. Methods: A sample of convenience of 7 participants volunteered (3 male and 4 female; mean age 64, SD 10 years; mean height 164, SD 4 cm; mean weight 77, SD 16 kg) to take part in this real-world validation study. Participants were instructed to wear the ScanWatch for a 12-hour period on their nondominant wrist as they went about their day-to-day activities. A Polar H10 heart rate sensor was used as the criterion measure of HR. Participants used a study diary to document activities undertaken during the 12-hour study period. These activities were classified according to the 11 following domains: desk work, eat or drink, exercise, gardening, household activities, self-care, shopping, sitting, sleep, travel, and walking. Validity was assessed using the Bland-Altman analysis, concordance correlation coefficient (CCC), and mean absolute percentage error (MAPE). Results: Across all activity domains, the ScanWatch measured HR with MAPE values <10%, except for the shopping activity domain (MAPE=10.8%). The activity domains that were more sedentary in nature (eg, desk work, eat or drink, and sitting) produced the most accurate HR measurements with a small mean bias and MAPE values <5%. Moderate to strong correlations (CCC=0.526-0.783) were observed between devices for all activity domains, except during the walking activity domain, which demonstrated a weak correlation (CCC=0.164) between devices. Conclusions: The results of this study show that the ScanWatch measures HR with a degree of accuracy that is acceptable for general consumer use; however, it would not be suitable in circumstances where more accurate measurements of HR are required, such as in health care or in clinical trials. Overall, the ScanWatch was less accurate at measuring HR during ambulatory activities (eg, walking, gardening, and household activities) compared to more sedentary activities (eg, desk work, eat or drink, and sitting). Further larger-scale studies examining this device in different populations and during different activities are required. %M 36048505 %R 10.2196/34280 %U https://formative.jmir.org/2022/9/e34280 %U https://doi.org/10.2196/34280 %U http://www.ncbi.nlm.nih.gov/pubmed/36048505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38716 %T Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study %A Williams,Kofoworola D A %A Wijaya,Clarisa %A Stamatis,Caitlin A %A Abbott,Gabriel %A Lattie,Emily G %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th floor, Chicago, IL, 60611, United States, 1 (312) 503 2922, kofoworola.williams@northwestern.edu %K Black or African American men %K college %K mental health %K social media %K mobile apps %K mobile phone %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. Objective: The aim of this study was to identify and understand college-attending Black men’s needs and preferences for using digital health technologies and social media for stress and mental health symptom management. Methods: Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. Results: Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media–based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. Conclusions: The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men. %M 36044261 %R 10.2196/38716 %U https://formative.jmir.org/2022/8/e38716 %U https://doi.org/10.2196/38716 %U http://www.ncbi.nlm.nih.gov/pubmed/36044261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35743 %T Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program %A Fioratti,Iuri %A Miyamoto,Gisela Cristiane %A Fandim,Junior Vitorino %A Ribeiro,Camila Pereira Pontes %A Batista,Geovana Domingues %A Freitas,Gabriella Evangelista %A Palomo,Andressa Santos %A Reis,Felipe José Jandré dos %A Costa,Leonardo Oliveira Pena %A Maher,Christopher G %A Saragiotto,Bruno Tirotti %+ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galero, 448, Tatuapé, São Paulo, 03071-000, Brazil, 55 11 970127143, iurifioratti@gmail.com %K telerehabilitation %K musculoskeletal pain %K implementation science %K feasibility study %K chronic pain %K pain %K pilot study %K eHealth %K exercise %K telehealth %K self-management %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective: This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods: The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients’ perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results: In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions: We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users’ implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration: ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439 %M 35776863 %R 10.2196/35743 %U https://formative.jmir.org/2022/8/e35743 %U https://doi.org/10.2196/35743 %U http://www.ncbi.nlm.nih.gov/pubmed/35776863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37061 %T Digital Content-Free Speech Analysis Tool to Measure Affective Distress in Mental Health: Evaluation Study %A Tonn,Peter %A Seule,Lea %A Degani,Yoav %A Herzinger,Shani %A Klein,Amit %A Schulze,Nina %+ Neuropsychiatric Center of Hamburg, Stresemannstr 23, Hamburg, 22769, Germany, 49 40 5330738, tonn@npz-hamburg.de %K mobile health %K mHealth %K depression %K assessment %K voice analysis %K evaluation %K speech %K speech analysis %K tool %K distress %K mental health %K mood %K diagnosis %K measurement %K questionnaire %K mobile phone %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mood disorders and depression are pervasive and significant problems worldwide. These represent severe health and emotional impairments for individuals and a considerable economic and social burden. Therefore, fast and reliable diagnosis and appropriate treatment are of great importance. Verbal communication can clarify the speaker’s mental state—regardless of the content, via speech melody, intonation, and so on. In both everyday life and clinical conditions, a listener with appropriate previous knowledge or a trained specialist can grasp helpful knowledge about the speaker's psychological state. Using automated speech analysis for the assessment and tracking of patients with mental health issues opens up the possibility of remote, automatic, and ongoing evaluation when used with patients’ smartphones, as part of the current trends toward the increasing use of digital and mobile health tools. Objective: The primary aim of this study is to evaluate the measurements of the presence or absence of depressive mood in participants by comparing the analysis of noncontentual speech parameters with the results of the Patient Health Questionnaire-9. Methods: This proof-of-concept study included participants in different affective phases (with and without depression). The inclusion criteria included a neurological or psychiatric diagnosis made by a specialist and fluent use of the German language. The measuring instrument was the VoiceSense digital voice analysis tool, which enables the analysis of 200 specific speech parameters based on machine learning and the assessment of the findings using Patient Health Questionnaire-9. Results: A total of 292 psychiatric and voice assessments were performed with 163 participants (males: n=47, 28.8%) aged 15 to 82 years. Of the 163 participants, 87 (53.3%) were not depressed at the time of assessment, and 88 (53.9%) participants had clinically mild to moderate depressive phases. Of the 163 participants, 98 (32.5%) showed subsyndromal symptoms, and 19 (11.7%) participants were severely depressed. In the speech analysis, a clear differentiation between the individual depressive levels, as seen in the Patient Health Questionnaire-9, was also shown, especially the clear differentiation between nondepressed and depressed participants. The study showed a Pearson correlation of 0.41 between clinical assessment and noncontentual speech analysis (P<.001). Conclusions: The use of speech analysis shows a high level of accuracy, not only in terms of the general recognition of a clinically relevant depressive state in the participants. Instead, there is a high degree of agreement regarding the extent of depressive impairment with the assessment of experienced clinical practitioners. From our point of view, the application of the noncontentual analysis system in everyday clinical practice makes sense, especially with the idea of a quick and unproblematic assessment of the state of mind, which can even be carried out without personal contact. Trial Registration: ClinicalTrials.gov NCT03700008; https://clinicaltrials.gov/ct2/show/NCT03700008 %M 36040767 %R 10.2196/37061 %U https://formative.jmir.org/2022/8/e37061 %U https://doi.org/10.2196/37061 %U http://www.ncbi.nlm.nih.gov/pubmed/36040767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39387 %T Predicting Psychological Symptoms When Facebook’s Digital Well-being Features Are Used: Cross-sectional Survey Study %A Barsova,Tamara %A Cheong,Zi Gi %A Mak,Ann R %A Liu,Jean CJ %+ Yale-NUS College, 28 College Avenue West, #01-501, Singapore, 138533, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K digital well-being %K depression %K anxiety %K stress %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior research has linked social media usage to poorer mental health. To address these concerns, social media platforms have introduced digital well-being tools to help users monitor their engagement. Nonetheless, little is known about the effectiveness of these tools. Objective: In this study, we focused on Facebook to assess users’ awareness and usage of the following six Facebook well-being tools: the Unfollow, Snooze, Off-Facebook Activity, Your Time on Facebook, Set Daily Reminders, and Notification Settings features. Additionally, we examined whether the use of these tools was associated with better mental health outcomes. Methods: We conducted a cross-sectional survey of 598 Facebook users. The survey comprised questions about (1) baseline Facebook use, (2) the adoption of Facebook’s digital well-being tools, and (3) participant demographics. These were used to predict the primary outcome measure—scores on the 21-item Depression, Anxiety, and Stress Scale. Results: Most participants (580/598, 97%) knew about Facebook’s digital well-being tools, but each tool was used by only 17.4% (104/598) to 55.5% (332/598) of participants. In turn, the use of two tools was associated with better well-being; although participants who spent more time on Facebook reported higher levels of depression, anxiety, and stress, those who managed their feed content or notifications by using the Unfollow or Notification Settings features had lower scores on each of these measures. However, the use of the Snooze, Off-Facebook Activity, Your Time on Facebook, or Set Time Reminder features was not associated with lower depression, anxiety, or stress scores. Conclusions: Of the 6 Facebook digital well-being tools, only 2 were associated with better mental health among users. This underscores the complexity of designing social media platforms to promote user welfare. Consequently, we urge further research into understanding the efficacy of various digital well-being tools. Trial Registration: ClinicalTrials.gov NCT04967846; https://clinicaltrials.gov/ct2/show/study/NCT04967846 %M 36036971 %R 10.2196/39387 %U https://formative.jmir.org/2022/8/e39387 %U https://doi.org/10.2196/39387 %U http://www.ncbi.nlm.nih.gov/pubmed/36036971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38664 %T Development of a Noninvasive Blood Glucose Monitoring System Prototype: Pilot Study %A Valero,Maria %A Pola,Priyanka %A Falaiye,Oluwaseyi %A Ingram,Katherine H %A Zhao,Liang %A Shahriar,Hossain %A Ahamed,Sheikh Iqbal %+ Department of Information Technology, Kennesaw State University, 680 Arntson Drive, Suite J312, Marietta, GA, 30060, United States, 1 470 578 4552, mvalero2@kennesaw.edu %K diabetes %K deep learning %K machine learning %K glucose concentration %K noninvasive monitoring %K optical sensors %K glucose monitoring %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes mellitus is a severe disease characterized by high blood glucose levels resulting from dysregulation of the hormone insulin. Diabetes is managed through physical activity and dietary modification and requires careful monitoring of blood glucose concentration. Blood glucose concentration is typically monitored throughout the day by analyzing a sample of blood drawn from a finger prick using a commercially available glucometer. However, this process is invasive and painful, and leads to a risk of infection. Therefore, there is an urgent need for noninvasive, inexpensive, novel platforms for continuous blood sugar monitoring. Objective: Our study aimed to describe a pilot test to test the accuracy of a noninvasive glucose monitoring prototype that uses laser technology based on near-infrared spectroscopy. Methods: Our system is based on Raspberry Pi, a portable camera (Raspberry Pi camera), and a visible light laser. The Raspberry Pi camera captures a set of images when a visible light laser passes through skin tissue. The glucose concentration is estimated by an artificial neural network model using the absorption and scattering of light in the skin tissue. This prototype was developed using TensorFlow, Keras, and Python code. A pilot study was run with 8 volunteers that used the prototype on their fingers and ears. Blood glucose values obtained by the prototype were compared with commercially available glucometers to estimate accuracy. Results: When using images from the finger, the accuracy of the prototype is 79%. Taken from the ear, the accuracy is attenuated to 62%. Though the current data set is limited, these results are encouraging. However, three main limitations need to be addressed in future studies of the prototype: (1) increase the size of the database to improve the robustness of the artificial neural network model; (2) analyze the impact of external factors such as skin color, skin thickness, and ambient temperature in the current prototype; and (3) improve the prototype enclosure to make it suitable for easy finger and ear placement. Conclusions: Our pilot study demonstrates that blood glucose concentration can be estimated using a small hardware prototype that uses infrared images of human tissue. Although more studies need to be conducted to overcome limitations, this pilot study shows that an affordable device can be used to avoid the use of blood and multiple finger pricks for blood glucose monitoring in the diabetic population. %M 36018623 %R 10.2196/38664 %U https://formative.jmir.org/2022/8/e38664 %U https://doi.org/10.2196/38664 %U http://www.ncbi.nlm.nih.gov/pubmed/36018623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37994 %T Heart Rate Variability Biofeedback to Treat Anxiety in Young People With Autism Spectrum Disorder: Findings From a Home-Based Pilot Study %A Coulter,Helen %A Donnelly,Mark %A Mallett,John %A Kernohan,W George %+ Ulster University, Shore Road, Newtownabbey, BT370QB, United Kingdom, 44 2895365135, mp.donnelly@ulster.ac.uk %K autism %K anxiety %K biofeedback %K remote intervention %K mobile phone %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings. Objective: This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population. Methods: We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device. Results: Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t6=2.55; P=.04; Cohen d=0.99) as well as adults (t7=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD. Conclusions: HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD. Trial Registration: ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093 %M 36018712 %R 10.2196/37994 %U https://formative.jmir.org/2022/8/e37994 %U https://doi.org/10.2196/37994 %U http://www.ncbi.nlm.nih.gov/pubmed/36018712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34786 %T Effects and Processes of an mHealth Intervention for the Management of Chronic Diseases: Prospective Observational Study %A Breckner,Amanda %A Litke,Nicola %A Göbl,Linda %A Wiezorreck,Lars %A Miksch,Antje %A Szecsenyi,Joachim %A Wensing,Michel %A Weis,Aline %+ Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 34646, amanda.breckner@med.uni-heidelberg.de %K telemedicine %K multimorbidity %K primary health care %K symptom assessment %K chronic disease %K mobile phone %D 2022 %7 25.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for self-management are a promising way to meet the needs of patients with chronic diseases in primary care practices. Therefore, an mHealth intervention, TelePraCMan, was developed and evaluated for patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, high blood pressure, or heart failure in a German primary care setting. TelePraCMan entails a symptom diary, an appointment manager, a manager to document goals, and a warning system. The app should foster the self-management of participating patients. Objective: We aimed to examine the effects of TelePraCMan on patient activation and quality of life and explored the underlying contextual factors, impacts, and degree of implementation. Methods: In a prospective observational study design, we collected data by using interviews and written questionnaires from participating patients (intervention and control groups) and primary care workers (physicians and practice assistants). The primary outcomes of interest were patient-reported quality of life (12-Item Short Form Survey) and patient activation (patient activation measure). The quantitative analysis focused on differences between patients in the intervention and control groups, as well as before (T0) and after (T1) the intervention. Interviews were analyzed by using qualitative content analysis via MAXQDA (VERBI GmbH). Results: At baseline, 25 patients and 24 primary care workers completed the questionnaire, and 18 patients and 21 primary care workers completed the follow-up survey. The patients were predominantly male and, on average, aged 64 (SD 11) years (T0). The primary care workers were mostly female (62%) and, on average, aged 47 (SD 10) years (T0). No differences were observed in the outcomes before and after the intervention or between the intervention and control groups. In the additional interviews, 4 patients and 11 primary care workers were included. The interviewees perceived that the intervention was useful for some patients. However, contextual factors and problems with implementation activities negatively affected the use of the app with patients. The main reasons for the low participation were the COVID-19 pandemic and the target group, which seemed to have less interest in mHealth; the interviewees attributed this to the older age of patients. However, the respondents felt that the app would be better accepted in 5 or 10 years. Conclusions: Although the TelePraCMan app was rated as very good and important by the participants, few patients used it. The digital intervention was hardly implemented and had limited impact in the current setting of German primary care. Trial Registration: German Clinical Trials Register DRKS00017320; https://tinyurl.com/4uwrzu85 %M 36006666 %R 10.2196/34786 %U https://formative.jmir.org/2022/8/e34786 %U https://doi.org/10.2196/34786 %U http://www.ncbi.nlm.nih.gov/pubmed/36006666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39508 %T Willingness to Use Internet-Based Versus Bibliotherapy Interventions in a Representative US Sample: Cross-sectional Survey Study %A De Jesús-Romero,Robinson %A Wasil,Akash %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K psychotherapy %K digital mental health %K digital health %K eHealth %K adoption %K preference %K self-help %K bibliotherapy %K iCBT %K CBT %K internet-based intervention %K self-guided intervention %K mental health %K print media %K cognitive behavioral therapy %K digital health intervention %K patient education %K psychoeducation %K health resource %K health information %K health education %K education material %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-help interventions have the potential to increase access to evidence-based mental health care. Self-help can be delivered via different formats, including print media or digital mental health interventions (DMHIs). However, we do not know which delivery format is more likely to result in higher engagement. Objective: The aims of this study were to identify if there is a preference for engaging in print media versus DMHIs and whether there are individual differences in relative preferences. Methods: Participants were 423 adults between the ages of 18 and 82 years (201/423, 47.5% female) recruited on Prolific as a nationally representative sample of the US population, including non-Hispanic White (293/423, 69.2%), non-Hispanic Black (52/423, 12%), Asian (31/423, 7%), Hispanic (25/423, 6%), and other individuals (22/423, 5%). We provided individuals with psychoeducation in different self-help formats and measured their willingness to use print media versus DMHIs. We also assessed participants’ demographics, personality, and perception of each format’s availability and helpfulness and used these to predict individual differences in the relative preferences. Results: Participants reported being more willing to engage with print media than with DMHIs (B=0.41, SE 0.08; t422=4.91; P<.001; d=0.24, 95% CI 0.05-0.43). This preference appeared to be influenced by education level (B=0.22, SE 0.09; t413=2.41; P=.02; d=0.13, 95% CI –0.06 to 0.32), perceived helpfulness (B=0.78, SE 0.06; t411=13.66; P<.001; d=0.46, 95% CI 0.27-0.66), and perceived availability (B=0.20, SE 0.58; t411=3.25; P=.001; d=0.12, 95% CI 0.07-0.30) of the self-help format. Conclusions: This study suggests an overall preference for print media over DMHIs. Future work should investigate whether receiving mental health treatment via participants’ preferred delivery format can lead to higher engagement. %M 36001373 %R 10.2196/39508 %U https://formative.jmir.org/2022/8/e39508 %U https://doi.org/10.2196/39508 %U http://www.ncbi.nlm.nih.gov/pubmed/36001373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36972 %T Passively Captured Interpersonal Social Interactions and Motion From Smartphones for Predicting Decompensation in Heart Failure: Observational Cohort Study %A Cakmak,Ayse S %A Perez Alday,Erick A %A Densen,Samuel %A Najarro,Gabriel %A Rout,Pratik %A Rozell,Christopher J %A Inan,Omer T %A Shah,Amit J %A Clifford,Gari D %+ Department of Biomedical Informatics, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 6123, erick@dbmi.emory.edu %K heart failure %K mobile device %K social interaction %K heart disease %K mobile health %K hospitalization %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a major cause of frequent hospitalization and death. Early detection of HF symptoms using smartphone-based monitoring may reduce adverse events in a low-cost, scalable way. Objective: We examined the relationship of HF decompensation events with smartphone-based features derived from passively and actively acquired data. Methods: This was a prospective cohort study in which we monitored HF participants’ social and movement activities using a smartphone app and followed them for clinical events via phone and chart review and classified the encounters as compensated or decompensated by reviewing the provider notes in detail. We extracted motion, location, and social interaction passive features and self-reported quality of life weekly (active) with the short Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey. We developed and validated an algorithm for classifying decompensated versus compensated clinical encounters (hospitalizations or clinic visits). We evaluated models based on single modality as well as early and late fusion approaches combining patient-reported outcomes and passive smartphone data. We used Shapley additive explanation values to quantify the contribution and impact of each feature to the model. Results: We evaluated 28 participants with a mean age of 67 years (SD 8), among whom 11% (3/28) were female and 46% (13/28) were Black. We identified 62 compensated and 48 decompensated clinical events from 24 and 22 participants, respectively. The highest area under the precision-recall curve (AUCPr) for classifying decompensation was with a late fusion approach combining KCCQ-12, motion, and social contact features using leave-one-subject-out cross-validation for a 2-day prediction window. It had an AUCPr of 0.80, with an area under the receiver operator curve (AUC) of 0.83, a positive predictive value (PPV) of 0.73, a sensitivity of 0.77, and a specificity of 0.88 for a 2-day prediction window. Similarly, the 4-day window model had an AUC of 0.82, an AUCPr of 0.69, a PPV of 0.62, a sensitivity of 0.68, and a specificity of 0.87. Passive social data provided some of the most informative features, with fewer calls of longer duration associating with a higher probability of future HF decompensation. Conclusions: Smartphone-based data that includes both passive monitoring and actively collected surveys may provide important behavioral and functional health information on HF status in advance of clinical visits. This proof-of-concept study, although small, offers important insight into the social and behavioral determinants of health and the feasibility of using smartphone-based monitoring in this population. Our strong results are comparable to those of more active and expensive monitoring approaches, and underscore the need for larger studies to understand the clinical significance of this monitoring method. %M 36001367 %R 10.2196/36972 %U https://formative.jmir.org/2022/8/e36972 %U https://doi.org/10.2196/36972 %U http://www.ncbi.nlm.nih.gov/pubmed/36001367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38475 %T Reliability and Validity of Electronic Patient-Reported Outcomes Using the Smartphone App AllerSearch for Hay Fever: Prospective Observational Study %A Akasaki,Yasutsugu %A Inomata,Takenori %A Sung,Jaemyoung %A Okumura,Yuichi %A Fujio,Kenta %A Miura,Maria %A Hirosawa,Kunihiko %A Iwagami,Masao %A Nakamura,Masahiro %A Ebihara,Nobuyuki %A Nakamura,Masahiro %A Ide,Takuma %A Nagino,Ken %A Murakami,Akira %+ Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 338133111, tinoma@juntendo.ac.jp %K hay fever %K AllerSearch %K smartphone app %K mobile health %K mHealth %K patient-reported outcome %K reliability %K validity %K Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire %K JACQLQ %K questionnaire %K allergic conjunctivitis %D 2022 %7 23.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hay fever is a highly prevalent, heterogenous, and multifactorial disease. Patients may benefit from longitudinal assessments using mobile health (mHealth) principles. We have previously attempted to establish an effective mHealth platform for patients with hay fever through AllerSearch, our in-house smartphone app that assesses electronic patient-reported outcomes through a questionnaire on hay fever and provides evidence-based advice. To be used by the public, an investigation on its reliability and validity is necessary. Objective: The aim of this paper is to assess the reliability and validity of subjective symptom data on hay fever collected through our app, AllerSearch. Methods: This study used a prospective observational design. The participants were patients aged ≥20 years recruited from a single university hospital between June 2, 2021, and January 26, 2022. We excluded patients who could not use smartphones as well as those with incomplete data records and outlier data. All participants answered the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (JACQLQ), first in the paper-and-pencil format and subsequently on AllerSearch on the same day. The JACQLQ comprises the following three domains: Domain I, with 9 items on ocular or nasal symptoms; Domain II, with 17 items on daily activity and psychological well-being; and Domain III, with 3 items on overall condition by face score. The concordance rate of each domain between the 2 platforms was calculated. The internal consistency of Domains I and II of the 2 platforms was assessed using Cronbach alpha coefficients, the concurrent validity of Domains I and II was assessed by calculating Pearson correlation coefficients, and the mean differences between the 2 platforms were assessed using Bland-Altman analysis. Results: In total, 22 participants were recruited; the data of 20 (91%) participants were analyzed. The average age was 65.4 (SD 12.8) years, and 80% (16/20) of the participants were women. The concordance rate of Domains I, II, and III between the paper-based and app-based JACQLQ was 0.78, 0.85, and 0.90, respectively. The internal consistency of Domains I and II between the 2 platforms was satisfactory (Cronbach alpha of .964 and .919, respectively). Pearson correlation analysis yielded a significant positive correlation between Domains I and II across the 2 platforms (r=0.920 and r=0.968, respectively). The mean difference in Domains I and II between the 2 platforms was 3.35 units (95% limits of agreement: –6.51 to 13.2). Conclusions: Our findings indicate that AllerSearch is a valid and reliable tool for the collection of electronic patient-reported outcomes to assess hay fever, contributing to the advantages of the mHealth platform. %M 35998022 %R 10.2196/38475 %U https://formative.jmir.org/2022/8/e38475 %U https://doi.org/10.2196/38475 %U http://www.ncbi.nlm.nih.gov/pubmed/35998022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35631 %T Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study %A Adong,Julian %A Fatch,Robin %A Emenyonu,Nneka %A Muyindike,Winnie %A Ngabirano,Christine %A Cheng,Debbie %A Hahn,Judith %+ Faculty of Medicine, Mbarara University of Science and Technology, Plot 8-18, Kabale Road, P.O.Box 1410, Mbarara, +256, Uganda, 256 755553595, adongjulian@gmail.com %K cell phone use %K phone usage %K cell phone %K mHealth %K HIV %K low resource setting %K low resource %K mobile health %K antiretroviral %K Uganda %K Africa %K alcohol %K text message %K text messaging %K cellphone %K mobile health %K low income %K LMIC %K TB %K tuberculosis %K viral infection %K infectious disease %K sexually transmitted %K STD %D 2022 %7 23.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone–delivered services for medical and public health practice. Objective: Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods: We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use—a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. Results: A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions: There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. %M 35998023 %R 10.2196/35631 %U https://formative.jmir.org/2022/8/e35631 %U https://doi.org/10.2196/35631 %U http://www.ncbi.nlm.nih.gov/pubmed/35998023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36912 %T Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies %A Woulfe,Fionn %A Fadahunsi,Kayode Philip %A O'Grady,Michael %A Chirambo,Griphin Baxter %A Mawkin,Mala %A Majeed,Azeem %A Smith,Simon %A Henn,Patrick %A O'Donoghue,John %+ Department of Primary Care and Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 20 7589 5111, k.fadahunsi14@imperial.ac.uk %K evaluation tool %K mobile health %K mHealth %K smartphone app %K app %K international mHealth %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use. Objective: This study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice. Methods: A two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis. Results: The final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES. Conclusions: The Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries. %M 35984688 %R 10.2196/36912 %U https://formative.jmir.org/2022/8/e36912 %U https://doi.org/10.2196/36912 %U http://www.ncbi.nlm.nih.gov/pubmed/35984688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34303 %T mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes %A Lawrason,Sarah Victoria Clewes %A Brown-Ganzert,Lynda %A Campeau,Lysa %A MacInnes,Megan %A Wilkins,C J %A Martin Ginis,Kathleen Anne %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Rd, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9187, svcl11@mail.ubc.ca %K exercise %K stakeholder participation %K spinal cord injuries %K telemedicine %K mobile apps %K mobile phone %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences. Objective: This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods: Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results: Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions: Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration: ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617 %M 35984695 %R 10.2196/34303 %U https://formative.jmir.org/2022/8/e34303 %U https://doi.org/10.2196/34303 %U http://www.ncbi.nlm.nih.gov/pubmed/35984695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37285 %T Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity Through a Parent-Reported Survey in the Time of COVID-19: Exploratory Study %A Grodberg,David %A Bridgewater,Jesse %A Loo,Theoren %A Bravata,Dena %+ Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06520, United States, 1 2037852513, david.grodberg@yale.edu %K adolescent %K child, family health %K mental health %K behavioral health %K stress %K protective factors %K productivity %K COVID-19 %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families’ behavioral health needs. Objective: The aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents’ reports of workplace productivity. Methods: A clinical research team at Brightline—a virtual, pediatric behavioral health solution—drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents’ reports of workplace productivity. Results: Participants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children’s behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents’ workplace productivity. Conclusions: This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child’s behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers. %M 35616439 %R 10.2196/37285 %U https://formative.jmir.org/2022/8/e37285 %U https://doi.org/10.2196/37285 %U http://www.ncbi.nlm.nih.gov/pubmed/35616439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39519 %T Social Media Use and Well-being With Bipolar Disorder During the COVID-19 Pandemic: Path Analysis %A Pollock Star,Ariel %A Bachner,Yaacov G %A Cohen,Bar %A Haglili,Ophir %A O'Rourke,Norm %+ Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, P.O. Box 653, Be'er Sheva, Israel, 972 08 647 7301, ORourke@bgu.ac.il %K bipolar disorder %K COVID-19 %K life satisfaction %K loneliness %K social media use %K social media %K Facebook %K social support %K mental health %K mental illness %K mental disorder %K social media advertising %K advertising %K advertisement %K mania %K hypo/mania %K manic %K depressive %K depression %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reliable and consistent social support is associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (eg, shelter in place) reduced access to regular social contacts, while social media use (SMU) increased concomitantly. Little is currently known about associations between the well-being of adults with BD and different types of SMU (eg, passive and active). Objective: For this study, we had two goals. First, we report descriptive information regarding SMU by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and SMU. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic. Methods: Over 8 weeks, we obtained responses from an international sample of 102 adults with BD using the Qualtrics online platform. Most had previously participated in the BADAS (Bipolar Affective Disorders and older Adults) Study (n=89, 87.3%); the remainder were recruited specifically for this research (n=13, 2.7%). The subsamples did not differ in age (t100=1.64; P=.10), gender (χ22=0.2; P=.90), socioeconomic status (χ26=9.9; P=.13), or time since BD diagnosis (t97=1.27; P=.21). Both were recruited using social media advertising micro-targeted to adults with BD. On average, participants were 53.96 (SD 13.22, range 20-77) years of age, they had completed 15.4 (SD 4.28) years of education, and were diagnosed with BD 19.6 (SD 10.31) years ago. Path analyses were performed to develop and test our hypothesized model. Results: Almost all participants (n=95, 93.1%) reported having both Facebook and LinkedIn accounts; 91.2% (n=93) reported regular use of either or both. During the pandemic, most (n=62, 60.8%) reported accessing social media several times a day; 36.3% (n=37) reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and, inversely, social support and life satisfaction. Social support predicts social Facebook use, whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support. Conclusions: Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively associated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, SMU, and well-being over time. %M 35980726 %R 10.2196/39519 %U https://formative.jmir.org/2022/8/e39519 %U https://doi.org/10.2196/39519 %U http://www.ncbi.nlm.nih.gov/pubmed/35980726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38737 %T A “No-Code” App Design Platform for Mobile Health Research: Development and Usability Study %A Liu,Sam %A La,Henry %A Willms,Amanda %A Rhodes,Ryan E %+ School of Exercise Science, Physical and Health Education, University of Victoria, McKinnon Building 124, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, samliu@uvic.ca %K app development %K behavior change technique %K health promotion %K mobile health %K mobile application %K application development %K design platform %K platform development %K no-code mHealth app %K no-code app %K no-code %K end user %K participatory research %K Pathverse %K agile %K hybrid-agile %K software design %K software development %K software developer %K computer science %K BCT %K behavior change %K research tool %K research instrument %K digital platform %K mHealth %K mobile app %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of “no-code” software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps. Objective: We aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform. Methods: The study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process. Results: Our team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat. Conclusions: To our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform. %M 35980740 %R 10.2196/38737 %U https://formative.jmir.org/2022/8/e38737 %U https://doi.org/10.2196/38737 %U http://www.ncbi.nlm.nih.gov/pubmed/35980740 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37309 %T Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa %A Soepnel,Larske M %A McKinley,Michelle C %A Klingberg,Sonja %A Draper,Catherine E %A Prioreschi,Alessandra %A Norris,Shane A %A Ware,Lisa J %+ SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa, 27 010 447 3721, larske.soepnel@gmail.com %K preconception health %K micronutrient supplements %K adherence %K behavioral %K SMS text messaging intervention %K mobile health %K mHealth %K radio serial %K mobile phone %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff %M 35980731 %R 10.2196/37309 %U https://formative.jmir.org/2022/8/e37309 %U https://doi.org/10.2196/37309 %U http://www.ncbi.nlm.nih.gov/pubmed/35980731 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e28626 %T A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study %A Schnall,Rebecca %A Liu,Jianfang %A Alvarez,Gabriella %A Porras,Tiffany %A Ganzhorn,Sarah %A Boerner,Samantha %A Huang,Ming-Chun %A Trujillo,Paul %A Cioe,Patricia %+ Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, United States, 1 212 342 6886, rb897@columbia.edu %K HIV %K mHealth %K smoking cessation %K intervention %K smoking %K persons with HIV %K pilot %K pilot test %K mobile app %K smartwatch %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. Objective: We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. Methods: A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. Results: Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). Conclusions: Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. Trial Registration: ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609 %M 35980739 %R 10.2196/28626 %U https://formative.jmir.org/2022/8/e28626 %U https://doi.org/10.2196/28626 %U http://www.ncbi.nlm.nih.gov/pubmed/35980739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37682 %T Determining the Influencing Factors on Acceptance of eHealth Pain Management Interventions Among Patients With Chronic Pain Using the Unified Theory of Acceptance and Use of Technology: Cross-sectional Study %A Stoppok,Paula %A Teufel,Martin %A Jahre,Lisa %A Rometsch,Caroline %A Müßgens,Diana %A Bingel,Ulrike %A Skoda,Eva-Maria %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, Germany, 49 201 43 87 55 20, alexander.baeuerle@uni-due.de %K eHealth %K eHealth interventions %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K chronic pain %K pain management %K acceptance %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is a complex disease with high prevalence rates, and many individuals who are affected do not receive adequate treatment. As a complement to conventional therapies, eHealth interventions could provide many benefits to a multimodal treatment approach for patients with chronic pain, whereby future use is associated with the acceptance of these interventions. Objective: This study aims to assess the acceptance of eHealth pain management interventions among patients with chronic pain and identify the influencing factors on acceptance. A further objective of the study is to evaluate the viability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and compare it with its extended version in terms of explained variance of acceptance. Methods: We performed a cross-sectional web-based study. In total, 307 participants with chronic pain, as defined according to the International Association for the Study of Pain criteria, were recruited through flyers, posters, and web-based inquiries between December 2020 and July 2021. In addition to sociodemographic and medical data, the assessment included validated psychometric instruments and an extended version of the well-established UTAUT model. For statistical analyses, group comparisons and multiple hierarchical regression analyses were performed. Results: The acceptance of eHealth pain management interventions among patients with chronic pain was overall moderate to high (mean 3.67, SD 0.89). There was significant difference in acceptance among age groups (W=9674.0; r=0.156; P=.04). Effort expectancy (β=.37; P<.001), performance expectancy (β=.33; P<.001), and social influence (β=.34; P<.001) proved to be the most important predictors of acceptance. The extended UTAUT (including the original UTAUT factors as well as sociodemographic, medical, and eHealth-related factors) model explained 66.4% of the variance in acceptance, thus supporting the viability of the model. Compared with the original UTAUT model (performance expectancy, effort expectancy, and social influence), the extended model explained significantly more variance (F25,278=1.74; P=.02). Conclusions: Given the association between acceptance and future use, the knowledge of the influencing factors on acceptance should be used in the development and promotion of eHealth pain management interventions. Overall, the acceptance of eHealth pain management interventions was moderate to high. In total, 8 predictors proved to be significant predictors of acceptance. The UTAUT model is a valuable instrument for determining acceptance as well as the factors that influence acceptance of eHealth pain management interventions among patients with chronic pain. The extended UTAUT model provided the greatest predictive value for acceptance. %M 35976199 %R 10.2196/37682 %U https://formative.jmir.org/2022/8/e37682 %U https://doi.org/10.2196/37682 %U http://www.ncbi.nlm.nih.gov/pubmed/35976199 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39846 %T A Comparison Between Clinical Guidelines and Real-World Treatment Data in Examining the Use of Session Summaries: Retrospective Study %A Sadeh-Sharvit,Shiri %A Rego,Simon A %A Jefroykin,Samuel %A Peretz,Gal %A Kupershmidt,Tomer %+ Eleos Health, 260 Charles St, Waltham, MA, 02453, United States, 1 5109848132, shiri@eleos.health %K Empirically based practices %K natural language processing %K psychotherapy %K behavioral therapy %K adherence %K treatment fidelity %K clinical training %K real-world data %K real-world study %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although behavioral interventions have been found to be efficacious and effective in randomized clinical trials for most mental illnesses, the quality and efficacy of mental health care delivery remains inadequate in real-world settings, partly owing to suboptimal treatment fidelity. This “therapist drift” is an ongoing issue that ultimately reduces the effectiveness of treatments; however, until recently, there have been limited opportunities to assess adherence beyond large randomized controlled trials. Objective: This study explored therapists’ use of a standard component that is pertinent across most behavioral treatments—prompting clients to summarize their treatment session as a means for consolidating and augmenting their understanding of the session and the treatment plan. Methods: The data set for this study comprised 17,607 behavioral treatment sessions administered by 322 therapists to 3519 patients in 37 behavioral health care programs across the United States. Sessions were captured by a therapy-specific artificial intelligence (AI) platform, and an automatic speech recognition system transcribed the treatment meeting and separated the data to the therapist and client utterances. A search for possible session summary prompts was then conducted, with 2 psychologists validating the text that emerged. Results: We found that despite clinical recommendations, only 54 (0.30%) sessions included a summary. Exploratory analyses indicated that session summaries mostly addressed relationships (n=27), work (n=20), change (n=6), and alcohol (n=5). Sessions with meeting summaries were also characterized by greater therapist interventions and included greater use of validation, complex reflections, and proactive problem-solving techniques. Conclusions: To the best of our knowledge, this is the first study to assess a large, diverse data set of real-world treatment practices. Our findings provide evidence that fidelity with the core components of empirically designed psychological interventions is a challenge in real-world settings. The results of this study can inform the development of machine learning and AI algorithms and offer nuanced, timely feedback to providers, thereby improving the delivery of evidence-based practices and quality of mental health care services and facilitating better clinical outcomes in real-world settings. %M 35972782 %R 10.2196/39846 %U https://formative.jmir.org/2022/8/e39846 %U https://doi.org/10.2196/39846 %U http://www.ncbi.nlm.nih.gov/pubmed/35972782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34737 %T Predictors of the Acceptance of an Electronic Coach Targeting Self-management of Patients With Type 2 Diabetes: Web-Based Survey %A Harakeh,Zeena %A Van Keulen,Hilde %A Hogenelst,Koen %A Otten,Wilma %A De Hoogh,Iris M %A Van Empelen,Pepijn %+ Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands, 31 6 11615907, zeena.harakeh@tno.nl %K mobile health %K type 2 diabetes %K self-management %K eCoach %K Technology Acceptance Model %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes (T2D) is a lifestyle-related disease whose prevalence increases with age. Diabetes self-management through mobile health (mHealth) apps enables patients with T2D to improve their health. According to the Technology Acceptance Model (TAM), technology acceptance (ie, intended use) is necessary to ensure mHealth can be implemented successfully. Therefore, the specific acceptance requirements of patients with T2D should be considered. Objective: This cross-sectional study aims to examine the extent to which different TAM predictors are associated with the acceptance of a diabetes app including an electronic coach (eCoach; Iris app) among patients with T2D. Methods: Using a web-based survey, data on 92 patients with T2D (mean age 62.76 years, SD 8.29 years) were collected. Acceptance of the Iris app with the TAM predictors (ie, perceived usefulness, perceived ease of use, social influence, perceived self-efficacy, perceived security, prior usage experience, perceived health, and propensity of data/information sharing) was assessed. Further, control variables (ie, gender, age, education, ethnicity, household, BMI, amount of years with diabetes, diabetes-related complaints, and medication use) were assessed. Results: Multiple linear regression analyses showed that acceptance of the Iris app was positively associated with perceived usefulness (β=.57, P<.001), social influence (subjective norm; β=.20, P=.004), and willingness to share data (β=.25, P<.001). In addition, acceptance regarding the Iris app was higher among patients with T2D with overweight (β=.23, P=.01) or obese BMI (β=.21, P=.01). The model explained 75.8% of the variance in the acceptance of the Iris app by patients with T2D. In addition, perceived usefulness of the Iris app was positively related to perceived ease of use (β=.32, P<.001), subjective norm (β=.26, P=.004), perceived control (β=.19, P=.03), willingness to share data (β=.20, P=.01) regarding the Iris app, and perceived security regarding general use of apps/smartphone/internet (β=.15, P=.04). The model explained 58.2% of the variance in patients’ perceived usefulness about the Iris app. Conclusions: Among patients with T2D, the belief that the use of the Iris app is helpful/beneficial, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the acceptance of this app. In addition, the belief that the use of (health) apps is reliable and secure, the belief that the use of the Iris app is easy to use, a higher perceived capability and personal control with using this app, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the perceived usefulness of such an app. These TAM predictors explained a high variance in acceptance and perceived usefulness of the Iris app. Implications for practice are addressed. %M 35972769 %R 10.2196/34737 %U https://formative.jmir.org/2022/8/e34737 %U https://doi.org/10.2196/34737 %U http://www.ncbi.nlm.nih.gov/pubmed/35972769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37054 %T Feasibility of Conducting Long-term Health and Behaviors Follow-up in Adolescents: Longitudinal Observational Study %A Cucchiaro,Giovanni %A Ahumada,Luis %A Gray,Geoffrey %A Fierstein,Jamie %A Yates,Hannah %A Householder,Kym %A Frye,William %A Rehman,Mohamed %+ Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, 33701, United States, 1 6266168290, gcucchi1@jhmi.edu %K Fitbit %K wearables %K health tracker %K survey %K adolescents %K psychosocial %K long term %K follow-up %K feasibility %K artificial intelligence %K machine learning %K posterior spine fusion %K operation %K surgery %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning uses algorithms that improve automatically through experience. This statistical learning approach is a natural extension of traditional statistical methods and can offer potential advantages for certain problems. The feasibility of using machine learning techniques in health care is predicated on access to a sufficient volume of data in a problem space. Objective: This study aimed to assess the feasibility of data collection from an adolescent population before and after a posterior spine fusion operation. Methods: Both physical and psychosocial data were collected. Adolescents scheduled for a posterior spine fusion operation were approached when they were scheduled for the surgery. The study collected repeated measures of patient data, including at least 2 weeks prior to the operation and 6 months after the patients were discharged from the hospital. Patients were provided with a Fitbit Charge 4 (consumer-grade health tracker) and instructed to wear it as often as possible. A third-party web-based portal was used to collect and store the Fitbit data, and patients were trained on how to download and sync their personal device data on step counts, sleep time, and heart rate onto the web-based portal. Demographic and physiologic data recorded in the electronic medical record were retrieved from the hospital data warehouse. We evaluated changes in the patients’ psychological profile over time using several validated questionnaires (ie, Pain Catastrophizing Scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Pediatric Quality of Life Inventory). Questionnaires were administered to patients using Qualtrics software. Patients received the questionnaire prior to and during the hospitalization and again at 3 and 6 months postsurgery. We administered paper-based questionnaires for the self-report of daily pain scores and the use of analgesic medications. Results: There were several challenges to data collection from the study population. Only 38% (32/84) of the patients we approached met eligibility criteria, and 50% (16/32) of the enrolled patients dropped out during the follow-up period—on average 17.6 weeks into the study. Of those who completed the study, 69% (9/13) reliably wore the Fitbit and downloaded data into the web-based portal. These patients also had a high response rate to the psychosocial surveys. However, none of the patients who finished the study completed the paper-based pain diary. There were no difficulties accessing the demographic and clinical data stored in the hospital data warehouse. Conclusions: This study identifies several challenges to long-term medical follow-up in adolescents, including willingness to participate in these types of studies and compliance with the various data collection approaches. Several of these challenges—insufficient incentives and personal contact between researchers and patients—should be addressed in future studies. %M 35969442 %R 10.2196/37054 %U https://formative.jmir.org/2022/8/e37054 %U https://doi.org/10.2196/37054 %U http://www.ncbi.nlm.nih.gov/pubmed/35969442 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e32768 %T Exploring Factors Associated With Mobile Phone Behaviors and Attitudes Toward Technology Among Adults With Alcohol Use Disorder and Implications for mHealth Interventions: Exploratory Study %A Sillice,Marie Aline %A Stein,Michael %A Battle,Cynthia L %A Meshesha,Lidia Z %A Lindsay,Clifford %A Agu,Emmanuel %A Abrantes,Ana M %+ City University of New York School of Public Health & Health Policies, Center for Systems and Community Design, 55 W 125th St, New York, NY, 10027, United States, 1 646 364 0281, marie.sillice@sph.cuny.edu %K mobile phone use patterns %K substance use %K alcohol %K technological attitude %K alcohol use disorder %K demographic differences %K anxiety %K depression %K mobile phone %K patient attitude %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is associated with severe chronic medical conditions and premature mortality. Expanding the reach or access to effective evidence-based treatments to help persons with AUD is a public health objective. Mobile phone or smartphone technology has the potential to increase the dissemination of clinical and behavioral interventions (mobile health interventions) that increase the initiation and maintenance of sobriety among individuals with AUD. Studies about how this group uses their mobile phone and their attitudes toward technology may have meaningful implications for participant engagement with these interventions. Objective: This exploratory study examined the potential relationships among demographic characteristics (race, gender, age, marital status, and income), substance use characteristics (frequency of alcohol and cannabis use), and clinical variables (anxiety and depression symptoms) with indicators of mobile phone use behaviors and attitudes toward technology. Methods: A sample of 71 adults with AUD (mean age 42.9, SD 10.9 years) engaged in an alcohol partial hospitalization program completed 4 subscales from the Media Technology Usage and Attitudes assessment: Smartphone Usage measures various mobile phone behaviors and activities, Positive Attitudes and Negative Attitudes measure attitudes toward technology, and the Technological Anxiety/Dependence measure assesses level of anxiety when individuals are separated from their phone and dependence on this device. Participants also provided demographic information and completed the Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. Lastly, participants reported their frequency of alcohol use over the past 3 months using the Drug Use Frequency Scale. Results: Results for the demographic factors showed a significant main effect for age, Smartphone Usage (P=.003; ηp2=0.14), and Positive Attitudes (P=.01; ηp2=0.07). Marital status (P=.03; ηp2=0.13) and income (P=.03; ηp2=0.14) were associated only with the Technological Anxiety and Dependence subscale. Moreover, a significant trend was found for alcohol use and the Technological Anxiety/Dependence subscale (P=.06; R2=0.02). Lastly, CES-D scores (P=.03; R2=0.08) and GAD symptoms (P=.004; R2=0.13) were significant predictors only of the Technological Anxiety/Dependence subscale. Conclusions: Findings indicate differences in mobile phone use patterns and attitudes toward technology across demographic, substance use, and clinical measures among patients with AUD. These results may help inform the development of future mHealth interventions among this population. %M 35969449 %R 10.2196/32768 %U https://formative.jmir.org/2022/8/e32768 %U https://doi.org/10.2196/32768 %U http://www.ncbi.nlm.nih.gov/pubmed/35969449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37163 %T Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study %A O'Connor,Cara %A Leyritana,Katerina %A Doyle,Aoife M %A Birdthistle,Isolde %A Lewis,James J %A Gill,Randeep %A Salvaña,Edsel Maurice %+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com %K mobile health %K mHealth %K adherence %K HIV %K antiretroviral therapy %K process evaluation %K Philippines %K men who have sex with men %K MSM %K mobile phone %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Philippines HIV epidemic is one of the fastest growing epidemics globally, and infections among men who have sex with men are increasing at an alarming rate. Connect for Life Philippines is a mobile health (mHealth) intervention that supports antiretroviral therapy (ART) adherence in this key population through individualized voice calls and SMS text messages. Objective: The objective of this process evaluation is to assess the intervention reach, dose delivered and received, fidelity, and acceptability and to describe contextual factors affecting the implementation of an mHealth adherence support intervention for patients on ART in a clinic in Metro Manila, Philippines. Methods: A mixed methods process evaluation approach was used in an observational cohort study. Quantitative data sources for the process evaluation were call and SMS text message logs obtained from the mHealth platform and questionnaires collected at 12-, 24-, and 48-week study visits. Qualitative data were collected from process reports and through a series of focus group discussions conducted with a subset of participants during the intervention development phase, after an initial 8-week pilot phase, and at the end of the study. Results: The 462 study participants received 31,095 interactive voice calls and 8234 SMS text messages during the study. Owing to technical issues, intervention fidelity was low, with only 22.1% (102/462) of the participants receiving reminders via voice calls and others (360/462, 77.9%) receiving only SMS text messages during the intervention. After 48 weeks in the study, 63.5% (293/462) of the participants reported that they would be quite likely or very likely to recommend the program to a friend, and 53.8% (249/462) of the participants reported that they benefited quite a bit or very much from the intervention. Participants who were on ART for <6 months at the beginning of the study and those who received the daily or weekly pill reminders were more likely to report that they benefited from the intervention (P=.02 and P=.01, respectively). Conclusions: The Connect for Life intervention had high participant satisfaction and acceptability, especially among those who received high dose of the intervention. However, poor reliability of local telecommunication networks had a large impact on the intervention’s usability, fidelity, and dose received. %M 35969425 %R 10.2196/37163 %U https://formative.jmir.org/2022/8/e37163 %U https://doi.org/10.2196/37163 %U http://www.ncbi.nlm.nih.gov/pubmed/35969425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38092 %T Design and Formative Evaluation of a Virtual Voice-Based Coach for Problem-solving Treatment: Observational Study %A Kannampallil,Thomas %A Ronneberg,Corina R %A Wittels,Nancy E %A Kumar,Vikas %A Lv,Nan %A Smyth,Joshua M %A Gerber,Ben S %A Kringle,Emily A %A Johnson,Jillian A %A Yu,Philip %A Steinman,Lesley E %A Ajilore,Olu A %A Ma,Jun %+ University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 466 (MC 275), Chicago, IL, 60608, United States, 1 (312) 413 9830, maj2015@uic.edu %K voice assistants %K behavioral therapy %K problem-solving therapy %K mental health %K artificial intelligence %K user evaluation %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence has provided new opportunities for human interactions with technology for the practice of medicine. Among the recent artificial intelligence innovations, personal voice assistants have been broadly adopted. This highlights their potential for health care–related applications such as behavioral counseling to promote healthy lifestyle habits and emotional well-being. However, the use of voice-based applications for behavioral therapy has not been previously evaluated. Objective: This study aimed to conduct a formative user evaluation of Lumen, a virtual voice-based coach developed as an Alexa skill that delivers evidence-based, problem-solving treatment for patients with mild to moderate depression and/or anxiety. Methods: A total of 26 participants completed 2 therapy sessions—an introductory (session 1) and a problem-solving (session 2)—with Lumen. Following each session with Lumen, participants completed user experience, task-related workload, and work alliance surveys. They also participated in semistructured interviews addressing the benefits, challenges and barriers to Lumen use, and design recommendations. We evaluated the differences in user experience, task load, and work alliance between sessions using 2-tailed paired t tests. Interview transcripts were coded using an inductive thematic analysis to characterize the participants’ perspectives regarding Lumen use. Results: Participants found Lumen to provide high pragmatic usability and favorable user experience, with marginal task load during interactions for both Lumen sessions. However, participants experienced a higher temporal workload during the problem-solving session, suggesting a feeling of being rushed during their communicative interactions. On the basis of the qualitative analysis, the following themes were identified: Lumen’s on-demand accessibility and the delivery of a complex problem-solving treatment task with a simplistic structure for achieving therapy goals; themes related to Lumen improvements included streamlining and improved personalization of conversations, slower pacing of conversations, and providing additional context during therapy sessions. Conclusions: On the basis of an in-depth formative evaluation, we found that Lumen supported the ability to conduct cognitively plausible interactions for the delivery of behavioral therapy. Several design suggestions identified from the study including reducing temporal and cognitive load during conversational interactions, developing more natural conversations, and expanding privacy and security features were incorporated in the revised version of Lumen. Although further research is needed, the promising findings from this study highlight the potential for using Lumen to deliver personalized and accessible mental health care, filling a gap in traditional mental health services. %M 35969431 %R 10.2196/38092 %U https://formative.jmir.org/2022/8/e38092 %U https://doi.org/10.2196/38092 %U http://www.ncbi.nlm.nih.gov/pubmed/35969431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34572 %T A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study %A Bird,Marissa %A Carter,Nancy %A Lim,Audrey %A Kazmie,Nadia %A Fajardo,Cindy %A Reaume,Shannon %A McGillion,Michael H %+ School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S1K4, Canada, 1 905 525 9140, birdm3@mcmaster.ca %K usability testing %K digital health %K children with medical complexities %K children %K chronic disease %K pediatrics %K health care %K parenting %K virtual health %K care provider %K youth %K family needs %K home care %K usability %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible. Objective: In this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers. Methods: Hospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews. Results: A total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58% to 100%; the average satisfaction rating across groups was ≥80%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5% to 89.5%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries. Conclusions: Usability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment. %M 35969456 %R 10.2196/34572 %U https://formative.jmir.org/2022/8/e34572 %U https://doi.org/10.2196/34572 %U http://www.ncbi.nlm.nih.gov/pubmed/35969456 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39129 %T The Effectiveness of Web-Based Psychotherapy to Treat and Prevent Burnout: Controlled Trial %A Michelsen,Clive %A Kjellgren,Anette %+ Science College, University of Karlstad, Bjuörgatan 32, Malmö, 21124, Sweden, 46 704065696, clive.michelsen@scienscollege.se %K risk for burnout %K effectivity of web-based therapy %K Proactive Occupational Health %K presenteeism %K work-related stress %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Burnout is a hidden productivity killer in organizations. Finding a solution to efficiently measure and proactively prevent or rehabilitate employees with burnout is a challenge. To meet this unabated demand, companies and caregivers can focus on proactive measures to prevent “Burnout as an Occupational Phenomenon.” Objective: We aimed to address effectiveness, reliability, and validity of the empowerment for participation (EFP) batch of assessments to measure burnout risk in relation to the efficacy of web-based interventions using cognitive behavioral therapy (CBT) and floating to improve mental health and well-being. We introduced three risk assessments: risk for burnout, risk of anxiety, and risk for depression. Methods: We used an interventional, empirical, and parallel design using raw EFP psychometric data to measure the effectiveness of web-based therapy to reduce the risk of burnout between a control group and web-based therapy group. A total of 50 participants were selected. The rehabilitation and control groups consisted of 25 normally distributed employees each. The rehabilitation group received therapy, whereas the control group had not yet received any form of therapy. IBM SPSS was used to analyze the data collected, and a repeated measures ANOVA, an analysis of covariance, a discriminant analysis, and a construct validity analysis were used to test for reliability and validity. The group was selected from a list of employees within the My-E-Health ecosystem who showed a moderate or high risk for burnout. All assessments and mixed-method CBT were web-based, and floating was conducted at designated locations. The complete EFP assessment was integrated into a digital ecosystem designed for this purpose and therapy, offering a secure and encrypted ecosystem. Results: There was a statistically significant difference between pre- and postassessment scores for burnout. The reliability of the burnout measure was good (Cronbach α=.858; mean 1.826, SD 3.008; Cohen d=0.607; P<.001) with a high validity of 0.9420. A paired samples 2-tailed test showed a good t score of 4.292 and P<.001, with a good effect size, Cohen d=0.607. Web-based therapy reduced the risk for burnout in participants compared with the control group. Tests of between-subject effects show F=16.964, a significant difference between the control group and the web-based therapy group: P<.001, with movement between the group variables of 0.261 or 26.1% for the dependent variable. Conclusions: This study suggests good reliability and validity of using web-based interventional mixed methods CBT to reduce the risk of burnout. The EFP batch of web-based assessments could reliably identify morbidity risk levels and successfully measure clinical interventions and rehabilitation with consistently reliable results to serve as both a diagnostic and therapeutic tool worthy of major research in the future. Trial Registration: ClinicalTrials.gov NCT05343208; https://clinicaltrials.gov/ct2/show/NCT05343208 %M 35802001 %R 10.2196/39129 %U https://formative.jmir.org/2022/8/e39129 %U https://doi.org/10.2196/39129 %U http://www.ncbi.nlm.nih.gov/pubmed/35802001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36969 %T Development of a Dynamically Tailored mHealth Intervention (What Do You Drink) to Reduce Excessive Drinking Among Dutch Lower-Educated Students: User-Centered Design Approach %A van Keulen,Hilde %A Voogt,Carmen %A Kleinjan,Marloes %A Kramer,Jeannet %A Andree,Rosa %A van Empelen,Pepijn %+ Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Schipholweg 77-79, Leiden, 2316 ZL, Netherlands, 31 652803631, hilde.vankeulen@tno.nl %K alcohol consumption %K excessive drinking %K lower-educated students %K adolescents %K young adults %K dynamic tailoring %K mobile health intervention %K intervention mapping %K health promotion %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse. Objective: This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch). Methods: We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6). Results: Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention. Conclusions: The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown. Trial Registration: Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619 %M 35969428 %R 10.2196/36969 %U https://formative.jmir.org/2022/8/e36969 %U https://doi.org/10.2196/36969 %U http://www.ncbi.nlm.nih.gov/pubmed/35969428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36443 %T Qualitative Evaluation of an Artificial Intelligence–Based Clinical Decision Support System to Guide Rhythm Management of Atrial Fibrillation: Survey Study %A Stacy,John %A Kim,Rachel %A Barrett,Christopher %A Sekar,Balaviknesh %A Simon,Steven %A Banaei-Kashani,Farnoush %A Rosenberg,Michael A %+ Department of Medicine, University of Colorado, 12631 E 17th Ave, Mailbox B177, Aurora, CO, 80045, United States, 1 303 724 1785, john.stacy@cuanschutz.edu %K Clinical decision support system %K machine learning %K supervised learning %K reinforcement learning %K atrial fibrillation %K rhythm strategy %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the numerous studies evaluating various rhythm control strategies for atrial fibrillation (AF), determination of the optimal strategy in a single patient is often based on trial and error, with no one-size-fits-all approach based on international guidelines/recommendations. The decision, therefore, remains personal and lends itself well to help from a clinical decision support system, specifically one guided by artificial intelligence (AI). QRhythm utilizes a 2-stage machine learning (ML) model to identify the optimal rhythm management strategy in a given patient based on a set of clinical factors, in which the model first uses supervised learning to predict the actions of an expert clinician and identifies the best strategy through reinforcement learning to obtain the best clinical outcome—a composite of symptomatic recurrence, hospitalization, and stroke. Objective: We qualitatively evaluated a novel, AI-based, clinical decision support system (CDSS) for AF rhythm management, called QRhythm, which uses both supervised and reinforcement learning to recommend either a rate control or one of 3 types of rhythm control strategies—external cardioversion, antiarrhythmic medication, or ablation—based on individual patient characteristics. Methods: Thirty-three clinicians, including cardiology attendings and fellows and internal medicine attendings and residents, performed an assessment of QRhythm, followed by a survey to assess relative comfort with automated CDSS in rhythm management and to examine areas for future development. Results: The 33 providers were surveyed with training levels ranging from resident to fellow to attending. Of the characteristics of the app surveyed, safety was most important to providers, with an average importance rating of 4.7 out of 5 (SD 0.72). This priority was followed by clinical integrity (a desire for the advice provided to make clinical sense; importance rating 4.5, SD 0.9), backward interpretability (transparency in the population used to create the algorithm; importance rating 4.3, SD 0.65), transparency of the algorithm (reasoning underlying the decisions made; importance rating 4.3, SD 0.88), and provider autonomy (the ability to challenge the decisions made by the model; importance rating 3.85, SD 0.83). Providers who used the app ranked the integrity of recommendations as their highest concern with ongoing clinical use of the model, followed by efficacy of the application and patient data security. Trust in the app varied; 1 (17%) provider responded that they somewhat disagreed with the statement, “I trust the recommendations provided by the QRhythm app,” 2 (33%) providers responded with neutrality to the statement, and 3 (50%) somewhat agreed with the statement. Conclusions: Safety of ML applications was the highest priority of the providers surveyed, and trust of such models remains varied. Widespread clinical acceptance of ML in health care is dependent on how much providers trust the algorithms. Building this trust involves ensuring transparency and interpretability of the model. %M 35969422 %R 10.2196/36443 %U https://formative.jmir.org/2022/8/e36443 %U https://doi.org/10.2196/36443 %U http://www.ncbi.nlm.nih.gov/pubmed/35969422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35482 %T Adding an App-Based Intervention to the Cognitive Behavioral Analysis System of Psychotherapy in Routine Outpatient Psychotherapy Treatment: Proof-of-Concept Study %A Netter,Anna-Lena %A Beintner,Ina %A Brakemeier,Eva-Lotta %+ Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenberg Strasse 18, Marburg, 32035, Germany, 49 64212823757, anna-lena.netter@uni-marburg.de %K Cognitive Behavioral Analysis System of Psychotherapy %K persistent depressive disorder %K blended therapy %K internet and mobile-based Interventions %K routine clinical care %K eHealth %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an empirically supported psychotherapeutic treatment developed specifically for persistent depressive disorder. However, given the high rates of nonresponse and relapse, there is a need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose via, for example, the continuous web-based application of therapy strategies between sessions. The strong emphasis in CBASP on the therapeutic relationship, combined with limited therapeutic availabilities, encourages the addition of web-based interventions to face-to-face therapy in terms of blended therapy. Objective: The aim of this study was to test an app-based intervention called CBASPath, which was designed to be used as a blended therapy tool. CBASPath offers 8 sequential modules with app-based exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. Methods: CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients were asked to report their use patterns and blended use (integrated use of the app as part of therapy sessions) at 3 assessment points over the 6-month test period and rate the usability and quality of and their satisfaction with CBASPath. Results: The results of the pilot trial showed that 93% (12/13) of participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favorable engagement with CBASPath; however, the frequency of use differed widely among the participants and assessment points. Situational analysis was used by all participants, and the number of completed modules ranged from 1 to 7. All participants reported blended use, although the frequency of integration in the face-to-face sessions varied widely. Conclusions: Our findings suggest that the digital augmentation of complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to high adherence and increase patient self-management. A few adjustments, such as saving entries directly in the app, could facilitate higher user engagement. A randomized controlled trial is now needed to investigate the efficacy and added value of this blended approach. In the long term, CBASPath could help optimize persistent depressive disorder treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app. %M 35943764 %R 10.2196/35482 %U https://formative.jmir.org/2022/8/e35482 %U https://doi.org/10.2196/35482 %U http://www.ncbi.nlm.nih.gov/pubmed/35943764 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e28851 %T A Psychological Support Intervention to Help Injured Athletes “Get Back in the Game”: Design and Development Study %A Ardern,Clare L %A Hooper,Nicholas %A O'Halloran,Paul %A Webster,Kate E %A Kvist,Joanna %+ Department of Family Practice, University of British Columbia, Robert H.N. Ho Research Centre (level 6), 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 6046752575, clare.ardern@liu.se %K sports %K medicine %K rehabilitation %K sports injury %K psychological support %K mental health %K postoperative medicine %K feasibility %K eHealth %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective: We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery. Methods: Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population–based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes’ experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases—(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31). Results: The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features. Conclusions: The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies. %M 35943769 %R 10.2196/28851 %U https://formative.jmir.org/2022/8/e28851 %U https://doi.org/10.2196/28851 %U http://www.ncbi.nlm.nih.gov/pubmed/35943769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35599 %T Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study %A Matthews,Stacey %A Atkins,Brooke %A Walton,Natalie %A Mitchell,Julie-Anne %A Jennings,Garry %A Buttery,Amanda K %+ National Heart Foundation of Australia, Level 2, 850 Collins street, Melbourne, 3008, Australia, 61 03 9321 1593, stacey.matthews@heartfoundation.org.au %K mHealth %K mobile heath %K apps %K app %K guideline %K cardiovascular disease %K atrial fibrillation %K heart failure %K heart %K cardiac %K cardiovascular %K acute coronary syndrome %K smartphone %K implementation %K digital health %K develop %K evaluate %K evaluation %K Australia %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users’ experience of the most and least useful components of the app is needed. %M 35930350 %R 10.2196/35599 %U https://formative.jmir.org/2022/8/e35599 %U https://doi.org/10.2196/35599 %U http://www.ncbi.nlm.nih.gov/pubmed/35930350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39280 %T Understanding Preconception Women’s Needs and Preferences for Digital Health Resources: Qualitative Study %A Walker,Ruth Elizabeth %A Quong,Sara %A Olivier,Patrick %A Wu,Ling %A Xie,Jue %A Boyle,Jacqueline %+ Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Australia, 61 437789800, ruth.walker@monash.edu %K digital health %K preconception %K health promotion %K behavior change %K women's health %K maternal health %K digital health resource %K healthy life style %K qualitative analysis %K online health information %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors. Objective: This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health. Methods: This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants’ lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants’ perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework. Results: In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women’s busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions. Conclusions: Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors. %M 35930344 %R 10.2196/39280 %U https://formative.jmir.org/2022/8/e39280 %U https://doi.org/10.2196/39280 %U http://www.ncbi.nlm.nih.gov/pubmed/35930344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38247 %T Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study %A Bachina,Preetham %A Lippincott,Christopher Kirk %A Perry,Allison %A Munk,Elizabeth %A Maltas,Gina %A Bohr,Rebecca %A Rock,Robert Bryan %A Shah,Maunank %+ Division of Infectious Diseases, Johns Hopkins School of Medicine, CRB-II, 1M-10, 1550 Orleans St, Baltimore, MD, 21287, United States, 1 4432870401, mshah28@jhmi.edu %K video directly observed therapy %K vDOT %K mobile health %K mHealth %K tuberculosis %K medication adherence %K telemedicine %K treatment %K telehealth %K observed therapy %K COVID-19 %K primary outcome %K treatment adherence %K technology adoption %K virtual health %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective: In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods: We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre–COVID-19 (before March 2020), and post–COVID-19 (after March 2020) periods; within the post–COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra–COVID-19 (after August 2020) periods. Results: Among 49 patients with TB (mean age 41, SD 19; n=27, 55% female and n=47, 96% non–US born), 18 (36.7%) received treatment during the post–COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81%, SD 17.4) compared to in-person DOT (mean 54.5%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35% (11/31) of patients with TB in the pre–COVID-19 period to 67% (12/18) in the post–COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56%, 67%, and 79%, P=.001 for the pre–, early, and intra–COVID-19 periods, respectively). Conclusions: vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. %M 35834671 %R 10.2196/38247 %U https://formative.jmir.org/2022/8/e38247 %U https://doi.org/10.2196/38247 %U http://www.ncbi.nlm.nih.gov/pubmed/35834671 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e38570 %T Prediction of VO2max From Submaximal Exercise Using the Smartphone Application Myworkout GO: Validation Study of a Digital Health Method %A Helgerud,Jan %A Haglo,Håvard %A Hoff,Jan %+ Medical Rehabilitation Clinic, Myworkout, Ingvald Ystgaards veg 23, Trondheim, 7047, Norway, 47 92621619, havard@treningsklinikken.no %K high-intensity interval training %K cardiovascular health %K physical inactivity %K endurance training %K measurement accuracy %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Physical inactivity remains the largest risk factor for the development of cardiovascular disease worldwide. Wearable devices have become a popular method of measuring activity-based outcomes and facilitating behavior change to increase cardiorespiratory fitness (CRF) or maximal oxygen consumption (VO2max) and reduce weight. However, it is critical to determine their accuracy in measuring these variables. Objective: This study aimed to determine the accuracy of using a smartphone and the application Myworkout GO for submaximal prediction of VO2max. Methods: Participants included 162 healthy volunteers: 58 women and 104 men (17-73 years old). The study consisted of 3 experimental tests randomized to 3 separate days. One-day VO2max was assessed with Metamax II, with the participant walking or running on the treadmill. On the 2 other days, the application Myworkout GO used standardized high aerobic intensity interval training (HIIT) on the treadmill to predict VO2max. Results: There were no significant differences between directly measured VO2max (mean 49, SD 14 mL/kg/min) compared with the VO2max predicted by Myworkout GO (mean 50, SD 14 mL/kg/min). The direct and predicted VO2max values were highly correlated, with an R2 of 0.97 (P<.001) and standard error of the estimate (SEE) of 2.2 mL/kg/min, with no sex differences. Conclusions: Myworkout GO accurately calculated VO2max, with an SEE of 4.5% in the total group. The submaximal HIIT session (4 x 4 minutes) incorporated in the application was tolerated well by the participants. We present health care providers and their patients with a more accurate and practical version of health risk estimation. This might increase physical activity and improve exercise habits in the general population. %M 35925653 %R 10.2196/38570 %U https://cardio.jmir.org/2022/2/e38570 %U https://doi.org/10.2196/38570 %U http://www.ncbi.nlm.nih.gov/pubmed/35925653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39277 %T Optimization of a Quality Improvement Tool for Cancer Diagnosis in Primary Care: Qualitative Study %A Chima,Sophie %A Martinez-Gutierrez,Javiera %A Hunter,Barbara %A Manski-Nankervis,Jo-Anne %A Emery,Jon %+ Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, 305 Grattan St, Parkville, Melbourne, 3010, Australia, 61 410 798 352, s.chima@unimelb.edu.au %K cancer %K primary health care %K diagnosis %K quality improvement %K clinical decision support tool %K general practice %K pilot %K feasibility %K Clinical Performance Feedback Intervention Theory %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common route to a diagnosis of cancer is through primary care. Delays in diagnosing cancer occur when an opportunity to make a timely diagnosis is missed and is evidenced by patients visiting the general practitioner (GP) on multiple occasions before referral to a specialist. Tools that minimize prolonged diagnostic intervals and reduce missed opportunities to investigate patients for cancer are therefore a priority. Objective: This study aims to explore the usefulness and feasibility of a novel quality improvement (QI) tool in which algorithms flag abnormal test results that may be indicative of undiagnosed cancer. This study allows for the optimization of the cancer recommendations before testing the efficacy in a randomized controlled trial. Methods: GPs, practice nurses, practice managers, and consumers were recruited to participate in individual interviews or focus groups. Participants were purposively sampled as part of a pilot and feasibility study, in which primary care practices were receiving recommendations relating to the follow-up of abnormal test results for prostate-specific antigen, thrombocytosis, and iron-deficiency anemia. The Clinical Performance Feedback Intervention Theory (CP-FIT) was applied to the analysis using a thematic approach. Results: A total of 17 interviews and 3 focus groups (n=18) were completed. Participant themes were mapped to CP-FIT across the constructs of context, recipient, and feedback variables. The key facilitators to use were alignment with workflow, recognized need, the perceived importance of the clinical topic, and the GPs’ perception that the recommendations were within their control. Barriers to use included competing priorities, usability and complexity of the recommendations, and knowledge of the clinical topic. There was consistency between consumer and practitioner perspectives, reporting language concerns associated with the word cancer, the need for more patient-facing resources, and time constraints of the consultation to address patients’ worries. Conclusions: There was a recognized need for the QI tool to support the diagnosis of cancer in primary care, but barriers were identified that hindered the usability and actionability of the recommendations in practice. In response, the tool has been refined and is currently being evaluated as part of a randomized controlled trial. Successful and effective implementation of this QI tool could support the detection of patients at risk of undiagnosed cancer in primary care and assist in preventing unnecessary delays. %M 35925656 %R 10.2196/39277 %U https://formative.jmir.org/2022/8/e39277 %U https://doi.org/10.2196/39277 %U http://www.ncbi.nlm.nih.gov/pubmed/35925656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e33309 %T Comparing Web-Based Venues to Recruit Gay, Bisexual, and Other Cisgender Men Who Have Sex With Men to a Large HIV Prevention Service in Brazil: Evaluation Study %A Bezerra,Daniel Rodrigues Barros %A Jalil,Cristina Moreira %A Jalil,Emilia Moreira %A Coelho,Lara Esteves %A Netto,Eduardo Carvalheira %A Freitas,Josias %A Monteiro,Laylla %A Santos,Toni %A Souza,Cleo %A Hoagland,Brenda %A Veloso,Valdilea Gonçalves %A Grinsztejn,Beatriz %A Cardoso,Sandra Wagner %A Torres,Thiago Silva %+ Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av Brasil 4365 Manguinhos, Rio de Janeiro, 21040360, Brazil, 55 2138659623, thiago.torres@ini.fiocruz.br %K social media %K web-based recruitment strategies %K men who have sex with men %K pre-exposure prophylaxis %K PrEP %K HIV prevention %K Brazil %K Latin America %K HIV %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet and mobile phones, widely available in Brazil, could be used to disseminate information about HIV prevention and to recruit gay, bisexual, and other cisgender men who have sex with men (MSM) to HIV prevention services. Data evaluating the characteristics of MSM recruited through different web-based strategies and estimating their cost and yield in the country are not available. Objective: We aimed to describe a web-based recruitment cascade, compare the characteristics of MSM recruited to a large HIV prevention service in Rio de Janeiro according to web-based venues, and estimate the cost per participant for each strategy. Methods: We promoted advertisements on geosocial networking (GSN) apps (Hornet and Grindr) and social media (Facebook and Instagram) from March 2018 to October 2019. The advertisements invited viewers to contact a peer educator to schedule a visit at the HIV prevention service. Performance of web-based recruitment cascade was based on how many MSM (1) were reached by the advertisement, (2) contacted the peer educator, and (3) attended the service. We used chi-square tests to compare MSM recruited through GSN apps and social media. The estimated advertisement cost to recruit a participant was calculated by dividing total advertisement costs by number of participants who attended the service or initiated preexposure prophylaxis (PrEP). Results: Advertisement reached 1,477,344 individuals; 1270 MSM contacted the peer educator (86 contacts per 100,000 views)—564 (44.4%), 401 (31.6%) and 305 (24.0%)—through social media, Grindr, and Hornet. Among the 1270 individuals who contacted the peer educator, 36.3% (n=461) attended the service with similar proportion for each web-based strategy (social media: 203/564, 36.0%; Grindr: 152/401, 37.9%; and Hornet: 107/305, 35.1%). MSM recruited through GSN apps were older (mean age 30 years vs 26 years; P<.001), more frequently self-reported as White (111/247, 44.9% vs 62/191, 32.5%; P=.03), and had higher schooling level (postsecondary: 157/254, 61.8% vs 94/194, 48.5%; P=.007) than MSM recruited through social media. GSN apps recruited MSM with higher HIV risk as measured by PrEP eligibility (207/239, 86.6% vs 133/185, 71.9%; P<.001) compared with social media, but there was no difference in PrEP uptake between the two strategies (P=.22). The estimated advertisement costs per participant attending the HIV prevention service were US $28.36 for GSN apps and US $12.17 for social media. The estimated advertisement costs per participant engaging on PrEP were US $58.77 for GSN apps and US $27.75 for social media. Conclusions: Social media and GSN app advertisements were useful to disseminate information on HIV prevention strategies and to recruit MSM to a large HIV prevention service in Brazil. Compared to GSN apps, social media advertisements were less expensive and reached more vulnerable and younger MSM. Digital marketing campaigns should use different and complementary web-based venues to reach a plurality of MSM. %M 35925658 %R 10.2196/33309 %U https://formative.jmir.org/2022/8/e33309 %U https://doi.org/10.2196/33309 %U http://www.ncbi.nlm.nih.gov/pubmed/35925658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38424 %T Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders’ Perspectives %A van de Vijver,Steven %A Hummel,Deirdre %A van Dijk,Annericht Hester %A Cox,Jan %A van Dijk,Oscar %A Van den Broek,Nicoline %A Metting,Esther %+ Amsterdam Health & Technology Institute, Amsterdam University Medical Center, Paasheuvelweg 25, Amsterdam, 1105 BP, Netherlands, 31 6 19053595, s.vandevijver@ahti.nl %K primary care %K chronic disease %K telemonitoring %K digital health %K self-management %K patient-centered care %K chronic care %K chronic care management %K illness %K healthcare %K healthcare professional %K user %K patient %K platform %K tool %K communication %K empowerment %K online %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. %M 35921145 %R 10.2196/38424 %U https://formative.jmir.org/2022/8/e38424 %U https://doi.org/10.2196/38424 %U http://www.ncbi.nlm.nih.gov/pubmed/35921145 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e40022 %T Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study %A Midgett,Aida %A Doumas,Diana M %A Buller,Mary K %+ Department of Counselor Education, Boise State University, 1910 University Drive, Boise, ID, 83725, United States, 1 2084261219, AidaMidgett@boisestate.edu %K teacher bullying interventions %K technology-based bullying intervention %K STAC %K middle school %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers’ attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. %M 35921129 %R 10.2196/40022 %U https://formative.jmir.org/2022/8/e40022 %U https://doi.org/10.2196/40022 %U http://www.ncbi.nlm.nih.gov/pubmed/35921129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35319 %T Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis %A Lobchuk,Michelle %A Bathi,Prachotan Reddy %A Ademeyo,Adedotun %A Livingston,Aislinn %+ College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Room 315 - 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada, 1 204 474 7135, Michelle.Lobchuk@umanitoba.ca %K web browser %K user-centered design %K qualitative research %K internet %K empathy %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations. Objective: The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application. Methods: This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner’s thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants’ experiences in the usability testing sessions. Results: We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel. Conclusions: This study’s findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management. %M 35921138 %R 10.2196/35319 %U https://formative.jmir.org/2022/8/e35319 %U https://doi.org/10.2196/35319 %U http://www.ncbi.nlm.nih.gov/pubmed/35921138 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35685 %T Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study %A Jerrott,Susan %A Clark,Sharon %A Chorney,Jill %A Coulombe,Aimee %A Wozney,Lori %+ Mental Health and Addictions Program, Nova Scotia Health, 300 Pleasant Street, EC Purdy Building, Dartmouth, NS, B2Y 3S3, Canada, 1 902 449 0603, lori.wozney@nshealth.ca %K text messaging %K youth %K mental health %K waiting list %K informatics %K health behavior %K self-care %K mental health literacy %K caregivers %K transdiagnostic %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective: To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods: A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results: A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions: Results are preliminary but show that brief, core skill–focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention. %M 35738559 %R 10.2196/35685 %U https://formative.jmir.org/2022/8/e35685 %U https://doi.org/10.2196/35685 %U http://www.ncbi.nlm.nih.gov/pubmed/35738559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e27990 %T A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study %A Román-Villarán,Esther %A Alvarez-Romero,Celia %A Martínez-García,Alicia %A Escobar-Rodríguez,German Antonio %A García-Lozano,María José %A Barón-Franco,Bosco %A Moreno-Gaviño,Lourdes %A Moreno-Conde,Jesús %A Rivas-González,José Antonio %A Parra-Calderón,Carlos Luis %+ Computational Health Informatics Group, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas, University of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain, 34 955 013 662, celia.alvarez@juntadeandalucia.es %K adherence %K ontology %K clinical decision support system %K CDSS %K complex chronic patients %K functional validation %K multimorbidity %K polypharmacy %K atrial fibrillation %K anticoagulants %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to an increase in life expectancy, the prevalence of chronic diseases is also on the rise. Clinical practice guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases, but a deficiency in the implementation of these CPGs has been identified. The PITeS-TiiSS (Telemedicine and eHealth Innovation Platform: Information Communications Technology for Research and Information Challenges in Health Services) tool, a personalized ontology-based clinical decision support system (CDSS), aims to reduce variability, prevent errors, and consider interactions between different CPG recommendations, among other benefits. Objective: The aim of this study is to design, develop, and validate an ontology-based CDSS that provides personalized recommendations related to drug prescription. The target population is older adult patients with chronic diseases and polypharmacy, and the goal is to reduce complications related to these types of conditions while offering integrated care. Methods: A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, including CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT; International Health Terminology Standards Development Organisation). Once the CDSS was developed, validation was carried out by using a retrospective case study. Results: This project was funded in January 2015 and approved by the Virgen del Rocio University Hospital ethics committee on November 24, 2015. Two different tasks were carried out to test the functioning of the tool. First, retrospective data from a real patient who met the inclusion criteria were used. Second, the analysis of an adoption model was performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results are favorable and allow the proposed research to continue to the next phase. Conclusions: An ontology-based CDSS was successfully designed, developed, and validated. However, in future work, validation in a real environment should be performed to ensure the tool is usable and reliable. %M 35916719 %R 10.2196/27990 %U https://formative.jmir.org/2022/8/e27990 %U https://doi.org/10.2196/27990 %U http://www.ncbi.nlm.nih.gov/pubmed/35916719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36405 %T Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration %A Petrovic,Milica %A Bonanno,Silvia %A Landoni,Marta %A Ionio,Chiara %A Hagedoorn,Mariët %A Gaggioli,Andrea %+ ExperienceLab, Università Cattolica del Sacro Cuore, Largo A Gemmeli 1, Milan, 20123, Italy, 39 3497366542, milica.petrovic@unicatt.it %K informal care %K story %K storytelling %K stories %K patient narrative %K digital narrative %K informal caregiver %K caregiver %K caregiving %K transformative storytelling technique %K audio stories %K audio story %K digital health %K eHealth %K empower %K fiction %K life narrative %K audio narrative %K self-help %K user-centered design %K human-centered design %K innovation in mental health %K mental health %K therapy %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transformative storytelling technique is an innovative top-down approach to narrative therapy that aims to provide building blocks for creating flourishing narratives for target groups or populations. This approach acts as a facilitator for implementing the human-centered design in developing digital self-help tools for larger samples or target groups. Objective: This study applied the transformative storytelling technique, as a new approach in mental health, to develop empowering audio narratives for informal caregivers. Methods: A narrative inquiry was conducted with 17 informal caregivers (16 women and 1 man) who completed a semistructured interview, “Caregiver Life Story,” acquiring information about the beginning of the role, rising action, and critical point of the role. The participants’ ages ranged from 41 to 84 years, with all participants providing care for at least a 6-month period. This inquiry was guided by the transformative storytelling technique, and aimed to collect data relevant to creating fictional stories based on real-life themes. Results: Twenty-five overall themes were distinguished across three a priori–set categories, providing narrative building blocks for the informal caregiver life stories. The final empowering caregiver life story was created as an example for this study, demonstrating the application of the transformative storytelling technique in an informal care context. Conclusions: The creation of empowering stories for populations or target groups in mental health care requires a unified and guided approach that will follow clear guidelines and storytelling principles. The transformative storytelling technique is a first of its kind in the mental health context, representing an initial step in enabling and supporting the creation of meaningful stories and the development of relatable, but productive, narratives. Such narratives have the potential to serve across media and digital platforms for supporting and improving well-being, and potentially triggering self-change in the target group or population. %M 35802492 %R 10.2196/36405 %U https://formative.jmir.org/2022/8/e36405 %U https://doi.org/10.2196/36405 %U http://www.ncbi.nlm.nih.gov/pubmed/35802492 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35396 %T Diagnosis of Atrial Fibrillation Using Machine Learning With Wearable Devices After Cardiac Surgery: Algorithm Development Study %A Hiraoka,Daisuke %A Inui,Tomohiko %A Kawakami,Eiryo %A Oya,Megumi %A Tsuji,Ayumu %A Honma,Koya %A Kawasaki,Yohei %A Ozawa,Yoshihito %A Shiko,Yuki %A Ueda,Hideki %A Kohno,Hiroki %A Matsuura,Kaoru %A Watanabe,Michiko %A Yakita,Yasunori %A Matsumiya,Goro %+ Department of Cardiovascular Surgery, University of Chiba, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan, 81 08041941178, d.the.lion.hearted@gmail.com %K wearable device %K atrial fibrillation %K photoplethysmography %K cardiology %K heart %K mHealth %K mobile health %K pulse %K development %K pilot study %K Apple Watch %K sensor %K algorithm %K detection %K diagnose %K cardiac surgery %K machine learning %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Some attempts have been made to detect atrial fibrillation (AF) with a wearable device equipped with photoelectric volumetric pulse wave technology, and it is expected to be applied under real clinical conditions. Objective: This study is the second part of a 2-phase study aimed at developing a method for immediate detection of paroxysmal AF, using a wearable device with built-in photoplethysmography (PPG). The objective of this study is to develop an algorithm to immediately diagnose AF by an Apple Watch equipped with a PPG sensor that is worn by patients undergoing cardiac surgery and to use machine learning on the pulse data output from the device. Methods: A total of 80 patients who underwent cardiac surgery at a single institution between June 2020 and March 2021 were monitored for postoperative AF, using a telemetry-monitored electrocardiogram (ECG) and an Apple Watch. AF was diagnosed by qualified physicians from telemetry-monitored ECGs and 12-lead ECGs; a diagnostic algorithm was developed using machine learning on the pulse rate data output from the Apple Watch. Results: One of the 80 patients was excluded from the analysis due to redness caused by wearing the Apple Watch. Of 79 patients, 27 (34.2%) developed AF, and 199 events of AF including brief AF were observed. Of them, 18 events of AF lasting longer than 1 hour were observed, and cross-correlation analysis showed that pulse rate measured by Apple Watch was strongly correlated (cross-correlation functions [CCF]: 0.6-0.8) with 8 events and very strongly correlated (CCF>0.8) with 3 events. The diagnostic accuracy by machine learning was 0.9416 (sensitivity 0.909 and specificity 0.838 at the point closest to the top left) for the area under the receiver operating characteristic curve. Conclusions: We were able to safely monitor pulse rate in patients who wore an Apple Watch after cardiac surgery. Although the pulse rate measured by the PPG sensor does not follow the heart rate recorded by telemetry-monitored ECGs in some parts, which may reduce the accuracy of AF diagnosis by machine learning, we have shown the possibility of clinical application of using only the pulse rate collected by the PPG sensor for the early detection of AF. %M 35916709 %R 10.2196/35396 %U https://formative.jmir.org/2022/8/e35396 %U https://doi.org/10.2196/35396 %U http://www.ncbi.nlm.nih.gov/pubmed/35916709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e30149 %T Data-Driven User-Type Clustering of a Physical Activity Promotion App: Usage Data Analysis Study %A Kranzinger,Christina %A Venek,Verena %A Rieser,Harald %A Jungreitmayr,Sonja %A Ring-Dimitriou,Susanne %+ Salzburg Research Forschungsgesellschaft mbH, Jakob-⁠Haringer-⁠Straße 5/⁠3, Salzburg, 5020, Austria, 43 6622288 ext 252, christina.kranzinger@salzburgresearch.at %K active and assisted living %K app usage %K cluster analysis %K Jenks natural breaks algorithm %K Partitioning Around Medoids algorithm %K physical activity promotion %K usage groups %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity remains a leading risk factor for mortality worldwide. Owing to increasing sedentary behavior (activities in a reclining, seated, or lying position with low-energy expenditures), vehicle-based transport, and insufficient physical workload, the prevalence of physical activity decreases significantly with age. To promote sufficient levels of participation in physical activities, the research prototype Fit-mit-ILSE was developed with the goal of making adults aged ≥55 years physically fit and fit for the use of assistive technologies. The system combines active and assisted living technologies and smart services in the ILSE app. Objective: The clustering of health and fitness app user types, especially in the context of active and assisted living projects, has been mainly defined by experts through 1D cluster thresholds based on app usage frequency. We aimed to investigate and present data-driven methods for clustering app user types and to identify usage patterns based on the ILSE app function Fit at home. Methods: During the 2 phases of the field trials, ILSE app log data were collected from 165 participants. Using this data set, 2 data-driven approaches were applied for clustering to group app users who were similar to each other. First, the common approach of user-type clustering based on expert-defined thresholds was replaced by a data-driven derivation of the cluster thresholds using the Jenks natural breaks algorithm. Second, a multidimensional clustering approach using the Partitioning Around Medoids algorithm was explored to consider the detailed app usage pattern data. Results: Applying the Jenks clustering algorithm to the mean usage per day and clustering the users into 4 groups showed that most of the users (63/165, 38.2%) used the Fit at home function between once a week and every second day. More men were in the low usage group than women. In addition, the younger users were more often identified as moderate or high users than the older users, who were mainly classified as low users; moreover, the regional differences between Vienna and Salzburg were identified. In addition, the multidimensional approach identified 4 different user groups that differed mainly in terms of time of use, gender, and region. Overall, the younger women living in Salzburg were the users with highest average app usage. Conclusions: The application of different clustering approaches showed that data-driven calculations of user groups can complement expert-based definitions, provide objective thresholds for the analysis of app usage data, and identify groups that can be targeted individually based on their specific group characteristics. %M 35916687 %R 10.2196/30149 %U https://formative.jmir.org/2022/8/e30149 %U https://doi.org/10.2196/30149 %U http://www.ncbi.nlm.nih.gov/pubmed/35916687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37169 %T Changes in Resilience Following Engagement With a Virtual Mental Health System: Real-world Observational Study %A Graziani,Grant %A Aylward,Brandon S %A Kunkle,Sarah %A Shih,Emily %+ Ginger, 116 New Montgomery St. Suite 500, San Francisco, CA, 94105, United States, 1 855 446 4374, ggraziani@ginger.io %K behavioral coaching %K psychological resilience %K mental health %K telehealth %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health services can serve as scalable solutions to address the growing demand for mental health care. However, more research is needed to better understand the association between engagement with care and improvements in subclinical outcomes. Objective: This study aims to fill this research gap by examining the relationship between members’ engagement with the Ginger platform and changes in their psychological resilience. Methods: We conducted a retrospective observational study of 3272 members who accessed Ginger, an on-demand mental health service, between January 2021 and November 2021. Each member completed the 10-item Connor-Davidson Resilience Scale questionnaire, a measure of psychological resilience, at baseline and again during a 6- to 16-week follow-up window. Depression and anxiety symptoms (9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder) were also measured. Linear regression was used to identify the association between engagement with Ginger’s multiple care modalities and changes in resilience. Moderator analysis was conducted to test whether clinical depression or anxiety at baseline moderated the relationship between engagement level and changes in resilience. Results: Of the 3272 members, 2683 (82%) reported low resilience at baseline. The mean change in resilience was 0.77 (SD 5.50) points. Linear regression models showed that age and census region did not predict changes in resilience; however, male members showed larger improvements (coefficient=0.58; P=.04). Baseline mental health outcomes, including resilience and depression and anxiety symptoms, were strong predictors of changes in resilience. Every point decrease in baseline resilience is associated with a 0.28-point increase in change in resilience (P<.001), and members with no or mild depression and anxiety at baseline saw changes in resilience that were 1.44 points (P<.001) larger than their clinical counterparts. Engagement with the Ginger system predicted changes in resilience. Members who engaged with Ginger coaching, clinical services, or both improved their resilience by 1.82, 1.55, and 1.40 points, respectively (P<.001), more than those who only engaged with Ginger content. Screening negative for moderate to severe depression and anxiety at baseline was associated with larger improvements in resilience (coefficient=1.30; P<.001); however, subclinical status was not shown to be a moderator for the association between level of engagement and changes in resilience. Conclusions: Engagement with Ginger services was associated with improvements in resilience. Members who engaged in coaching or clinical care had significantly larger improvements compared with those who only engaged in self-guided content, regardless of whether a member screened positive for clinical depression or anxiety at baseline. %M 35904875 %R 10.2196/37169 %U https://formative.jmir.org/2022/7/e37169 %U https://doi.org/10.2196/37169 %U http://www.ncbi.nlm.nih.gov/pubmed/35904875 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37108 %T Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study %A Zaslavsky,Oleg %A Kaneshiro,Jasmine %A Chu,Frances %A Teng,Andrew %A Domoto-Reilly,Kimiko %A Chen,Annie T %+ University of Washington, 1959 Pacific Street NE, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K dementia %K caregiver %K internet based %K digital health %K digital intervention %K eHealth %K feasibility %K web-based %K peer support %K didactic training %K caregiving %K informal care %K spousal care %K remote intervention %K Lewy body %K Lewy bodies %K discussion forum %K discussion platform %K online support %K distress %K stress reduction %K online discussion %K support group %K discussion group %K burden %K depression %K depressive symptom %K lonely %K loneliness %K mental health %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. Objective: We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. Methods: We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience–Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. Results: Participants’ baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them “a great deal” to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one’s abilities to provide care to the care recipient (4/12, 33%). Conclusions: The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency. %M 35904843 %R 10.2196/37108 %U https://formative.jmir.org/2022/7/e37108 %U https://doi.org/10.2196/37108 %U http://www.ncbi.nlm.nih.gov/pubmed/35904843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37832 %T Deployment of an End-to-End Remote, Digitalized Clinical Study Protocol in COVID-19: Process Evaluation %A Zahradka,Nicole %A Pugmire,Juliana %A Lever Taylor,Jessie %A Wolfberg,Adam %A Wilkes,Matt %+ Current Health Inc, 294 Washington Street, Suite 510, Boston, MA, 02108, United States, 1 516 526 3395, nicole.zahradka@currenthealth.com %K evaluation study %K telemedicine %K remote consultation %K digital divide %K research design %K virtual clinical trial %K decentralized %K COVID-19 %K primary recruitment %K social media %K virtual care %K heart rate %K wearable %K health care cost %K health technology %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 (COVID-19) pandemic may accelerate the adoption of digital, decentralized clinical trials. Conceptual recommendations for digitalized and remote clinical studies and technology are available to enable digitalization. Fully remote studies may break down some of the participation barriers in traditional trials. However, they add logistical complexity and offer fewer opportunities to intervene following a technical failure or adverse event. Objective: Our group designed an end-to-end digitalized clinical study protocol, using the Food and Drug Administration (FDA)–cleared Current Health (CH) remote monitoring platform to collect symptoms and continuous physiological data of individuals recently infected with COVID-19 in the community. The purpose of this work is to provide a detailed example of an end-to-end digitalized protocol implementation based on conceptual recommendations by describing the study setup in detail, evaluating its performance, and identifying points of success and failure. Methods: Primary recruitment was via social media and word of mouth. Informed consent was obtained during a virtual appointment, and the CH-monitoring kit was shipped directly to the participants. The wearable continuously recorded pulse rate (PR), respiratory rate (RR), oxygen saturation (SpO2), skin temperature, and step count, while a tablet administered symptom surveys. Data were transmitted in real time to the CH cloud-based platform and displayed in the web-based dashboard, with alerts to the study team if the wearable was not charged or worn. The study duration was up to 30 days. The time to recruit, screen, consent, set up equipment, and collect data was quantified, and advertising engagement was tracked with a web analytics service. Results: Of 13 different study advertisements, 5 (38.5%) were live on social media at any one time. In total, 38 eligibility forms were completed, and 19 (50%) respondents met the eligibility criteria. Of these, 9 (47.4%) were contactable and 8 (88.9%) provided informed consent. Deployment times ranged from 22 to 110 hours, and participants set up the equipment and started transmitting vital signs within 7.6 (IQR 6.3-10) hours of delivery. The mean wearable adherence was 70% (SD 19%), and the mean daily survey adherence was 88% (SD 21%) for the 8 participants. Vital signs were in normal ranges during study participation, and symptoms decreased over time. Conclusions: Evaluation of clinical study implementation is important to capture what works and what might need to be modified. A well-calibrated approach to online advertising and enrollment can remove barriers to recruitment and lower costs but remains the most challenging part of research. Equipment was effectively and promptly shipped to participants and removed the risk of illness transmission associated with in-person encounters during a pandemic. Wearable technology incorporating continuous, clinical-grade monitoring offered an unprecedented level of detail and ecological validity. However, study planning, relationship building, and troubleshooting are more complex in the remote setting. The relevance of a study to potential participants remains key to its success. %M 35852933 %R 10.2196/37832 %U https://formative.jmir.org/2022/7/e37832 %U https://doi.org/10.2196/37832 %U http://www.ncbi.nlm.nih.gov/pubmed/35852933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35996 %T Using the PMAQ-AB Mobile App and Management System to Evaluate the Quality of Primary Health Care in Brazil: Qualitative Case Study %A Bay Júnior,Osvaldo de Goes %A Diniz Vieira Silva,Cícera Renata %A Santos Martiniano,Cláudia %A de Figueiredo Melo,Lygia Maria %A Barros de Souza,Marize %A Lopes,Monique da Silva %A Coelho,Ardigleusa Alves %A de Medeiros Rocha,Paulo %A de Albuquerque Pinheiro,Themis Xavier %A de Sá Pinto Dantas Rocha,Nadja %A da Costa Uchôa,Severina Alice %+ Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho., Lagoa Nova, Natal, 59064-630, Brazil, 55 84991343560, osvaldobay_jr@hotmail.com %K information technology %K information technology management %K program evaluation %K health evaluation %K meta-evaluation %K primary health care %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The application of cell phones, similar portable devices (ie, tablets), apps, the internet, and GPS in evaluation have established new ways of collecting, storing, retrieving, transmitting, and processing data or information. However, evidence is incipient as to which technological resources remain at the center of assessment practice and the factors that promote their use by the assessment community. Objective: This study aimed to analyze the relationship between the use of the National Program for Improving Primary Healthcare Access and Quality’s (PMAQ-AB; Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica) mobile app and management system and the external evaluation quality of Brazil’s PMAQ-AB. Methods: We conducted a qualitative case study during the external evaluation of Brazil’s PMAQ-AB. Data collection consisted of interviews, focus groups, and document analysis. A total of 7 members from the Department of Primary Care of the Ministry of Health and 47 researchers from various higher education and research institutions across the country participated in the study. Data were categorized using the ATLAS.ti software program, according to the quality standards of the Joint Committee on Standards for Educational Evaluation, following the content analysis approach by Bardin. Results: The results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency. They demonstrated improvements and opportunities for advancements in evaluation mediated by the use of information technology (IT), favored the emergence of new practices and remodeling of existing ones, and took into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulties in technology operation, inoperative systems, and lack of investment in equipment and human resources posed challenges to increasing the effectiveness of IT in evaluation. Conclusions: The use of technology-based tools—the app and the management system—during the external evaluation offered evaluators a greater opportunity for stakeholder engagement. This also allowed the insertion of different organizational, operational, and methodological components that are capable of triggering influences and confluences. In addition, this allowed connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation process with greater possibility of incorporating the results into public health policies. %M 35904848 %R 10.2196/35996 %U https://formative.jmir.org/2022/7/e35996 %U https://doi.org/10.2196/35996 %U http://www.ncbi.nlm.nih.gov/pubmed/35904848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38234 %T Feature-Level Analysis of a Smoking Cessation Smartphone App Based on a Positive Psychology Approach: Prospective Observational Study %A Hoepper,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Taylor,Steven Trevor %A Simpson,Hazel V %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 6th Floor, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K mHealth %K smartphone %K smartphone app %K smoking %K smoking cessation %K nondaily smoking %K positive psychology %K happiness %K positive affect %K clinical trial %K feasibility %K acceptability %K app usage %K mobile health %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective: To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods: Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results: Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions: Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration: ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766 %M 35900835 %R 10.2196/38234 %U https://formative.jmir.org/2022/7/e38234 %U https://doi.org/10.2196/38234 %U http://www.ncbi.nlm.nih.gov/pubmed/35900835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35701 %T Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial %A Lee,Daehyoung %A Frey,Georgia C %A Cothran,Donetta J %A Harezlak,Jaroslaw %A Shih,Patrick C %+ Department of Applied Human Sciences, University of Minnesota Duluth, 123 Sports and Health Center, 1216 Ordean Court, Duluth, MN, 55812, United States, 1 2187267816, lee03284@d.umn.edu %K gamification %K behavior change techniques %K physical activity %K sedentary behavior %K anxiety %K autism %K mobile app %K mental health %K mHealth %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617 %M 35900808 %R 10.2196/35701 %U https://formative.jmir.org/2022/7/e35701 %U https://doi.org/10.2196/35701 %U http://www.ncbi.nlm.nih.gov/pubmed/35900808 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38616 %T Developing a Health Care Transition Intervention With Young People With Spinal Cord Injuries: Co-design Approach %A Bray,Emily Alice %A Everett,Bronwyn %A George,Ajesh %A Salamonson,Yenna %A Ramjan,Lucie M %+ School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 02 9685 9032, 16251104@student.westernsydney.edu.au %K co-design %K participatory action research %K health care transition %K pediatric health care %K adult health care %K spinal cord injury %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Successful transition from pediatric to adult health care settings supports long-term health management and better overall outcomes in all domains. However, young people with spinal cord injuries (SCIs) continue to report challenges and unmet needs during the transition process. Including end users in health care research and intervention design is paramount as interventions designed in this way better meet their specific needs and are often more innovative. Although studies have reported involving young people with chronic conditions in the development of health care transition (HCT) interventions, few details have been provided as to how this was achieved. Objective: This study outlined the co-design and development of an HCT intervention to support young people with SCIs. It contextualized the co-design process, methods, materials used, and steps implemented from defining the problem to conceiving and designing the solution. This was accomplished by understanding and listening to end users’ needs and recommendations for HCT. Methods: Using participatory methods, this qualitative study reports the co-design of an HCT intervention to support young people with SCIs and parents or caregivers. Two co-design workshops were conducted: one with young people with SCIs and one with parents and caregivers. Categories were defined through a hybrid deductive and inductive qualitative content analysis process that was informed by the Care Transitions Framework and guided the development of the HCT intervention. Following the creation of a prototype intervention, young people with SCIs, parents and caregivers, and key pediatric SCI stakeholders provided feedback on the intervention content and design in focus groups. Similar to the workshops, the focus groups were analyzed using a hybrid deductive and inductive qualitative content analysis process informed by the Care Transitions Framework. The Enhancing the Quality and Transparency of Health Research guidelines for qualitative research (Consolidated Criteria for Reporting Qualitative Research) were applied. Results: Overall, 4 young people and 4 parents or caregivers participated in the co-design workshops. Key recommendations for the HCT intervention were that participants wanted a “one-stop shop” for all their transition information needs and an editable portable medical summary to take with them to appointments. On the basis of the analysis of participants’ recommendations from the workshops, it was determined that a website would be an appropriate hosting platform for the interventions. The focus group feedback on the design and content of the prototype website was extremely positive, with minor recommendations for improvement. Conclusions: This is the first study to co-design and develop an HCT intervention in partnership with young people with SCIs and parents and caregivers. Although the study sample was small, it has shown that it is possible to meaningfully engage and empower young people with SCIs and parents and caregivers in the co-design of an HCT intervention. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-053212 %M 35900814 %R 10.2196/38616 %U https://formative.jmir.org/2022/7/e38616 %U https://doi.org/10.2196/38616 %U http://www.ncbi.nlm.nih.gov/pubmed/35900814 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38068 %T Predicting Participant Engagement in a Social Media–Delivered Lifestyle Intervention Using Microlevel Conversational Data: Secondary Analysis of Data From a Pilot Randomized Controlled Trial %A Xu,Ran %A Divito,Joseph %A Bannor,Richard %A Schroeder,Matthew %A Pagoto,Sherry %+ Department of Allied Health Sciences, Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Koons Hall, Room 326, Storrs, CT, 06269, United States, 1 860 486 2945, ran.2.xu@uconn.edu %K weight loss %K social media intervention %K engagement %K data science %K natural language processing %K NLP %K social media %K lifestyle %K machine learning %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media–delivered lifestyle interventions have shown promising outcomes, often generating modest but significant weight loss. Participant engagement appears to be an important predictor of weight loss outcomes; however, engagement generally declines over time and is highly variable both within and across studies. Research on factors that influence participant engagement remains scant in the context of social media–delivered lifestyle interventions. Objective: This study aimed to identify predictors of participant engagement from the content generated during a social media–delivered lifestyle intervention, including characteristics of the posts, the conversation that followed the post, and participants’ previous engagement patterns. Methods: We performed secondary analyses using data from a pilot randomized trial that delivered 2 lifestyle interventions via Facebook. We analyzed 80 participants’ engagement data over a 16-week intervention period and linked them to predictors, including characteristics of the posts, conversations that followed the post, and participants’ previous engagement, using a mixed-effects model. We also performed machine learning–based classification to confirm the importance of the significant predictors previously identified and explore how well these measures can predict whether participants will engage with a specific post. Results: The probability of participants’ engagement with each post decreased by 0.28% each week (P<.001; 95% CI 0.16%-0.4%). The probability of participants engaging with posts generated by interventionists was 6.3% (P<.001; 95% CI 5.1%-7.5%) higher than posts generated by other participants. Participants also had a 6.5% (P<.001; 95% CI 4.9%-8.1%) and 6.1% (P<.001; 95% CI 4.1%-8.1%) higher probability of engaging with posts that directly mentioned weight and goals, respectively, than other types of posts. Participants were 44.8% (P<.001; 95% CI 42.8%-46.9%) and 46% (P<.001; 95% CI 44.1%-48.0%) more likely to engage with a post when they were replied to by other participants and by interventionists, respectively. A 1 SD decrease in the sentiment of the conversation on a specific post was associated with a 5.4% (P<.001; 95% CI 4.9%-5.9%) increase in the probability of participants’ subsequent engagement with the post. Participants’ engagement in previous posts was also a predictor of engagement in subsequent posts (P<.001; 95% CI 0.74%-0.79%). Moreover, using a machine learning approach, we confirmed the importance of the predictors previously identified and achieved an accuracy of 90.9% in terms of predicting participants’ engagement using a balanced testing sample with 1600 observations. Conclusions: Findings revealed several predictors of engagement derived from the content generated by interventionists and other participants. Results have implications for increasing engagement in asynchronous, remotely delivered lifestyle interventions, which could improve outcomes. Our results also point to the potential of data science and natural language processing to analyze microlevel conversational data and identify factors influencing participant engagement. Future studies should validate these results in larger trials. Trial Registration: ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680 %M 35900824 %R 10.2196/38068 %U https://formative.jmir.org/2022/7/e38068 %U https://doi.org/10.2196/38068 %U http://www.ncbi.nlm.nih.gov/pubmed/35900824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35290 %T Study Protocol and Preliminary Results of the Impact of Occupational Health Workers' Activities on Their Health: Nationwide Prospective Internet-Based Survey %A Ikegami,Kazunori %A Yoshimoto,Yasuro %A Baba,Hiroka %A Sekoguchi,Shingo %A Ando,Hajime %A Ogami,Akira %+ Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan, 81 93 603 1611, kikegami@med.uoeh-u.ac.jp %K Japan %K occupational health %K worker %K internet surveys %K questionnaires %K cohort study %K COVID-19 %K mental health %K online health %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Form Res %G English %X Background: Owing to the impact of the COVID-19 pandemic, work environments and systems, as well as occupational health measures or activities that fall within our research field, are constantly changing. It is necessary to assess the impact of these changes on the physical and mental health of workers. Objective: To assess how occupational health measures affect the health of workers, we conducted a baseline, longitudinal internet-based survey among Japanese workers in October 2021 and additionally scheduled 2 follow-up surveys for 2022 and 2023. We describe the details of the protocol of the work systems and health internet research (WSHIR) study, provide an overview of the results of the baseline survey, and discuss the study procedures and data used in the study. Methods: This prospective cohort study was conducted online among internet monitors. The baseline survey was conducted from October 1 to 7, 2021. This study targeted those who were working and between the ages of 20 and 69 years. A total of 5111 respondents who passed the screening survey and proceeded to the main survey were enrolled according to collection units organized by sex and age. For the screening and main surveys, the questionnaire consisted of 9 and 33 items with 9 and 55 questions, respectively. Consistency and completeness checks were performed after the questionnaires were submitted. We compared basic characteristics, such as sex, age group, educational background, and marital status, among all participants, including those who withdrew from the analysis. Results: Of the 5111 initial survey respondents, 571 (11.2%) were considered fraudulent. The data of the remaining 4540 (88.8%) participants (2273, 50.1%, males; 2267, 49.9%, females) included in the analysis were well balanced across participant sex and age groups according to the sampling plan because there was no significant difference by sex and age group using the chi-square test for checking the distribution bias of the participants (P=.84). Compared to female participants, male participants tended to be more likely to be managers and supervisors (323, 14.2%, males; 86, 3.8%, females), to work in a secondary industry (742, 32.6%, males; 357, 15.7%, females), and to have an annual income of ≥5 million yen (976, 42.9%, males; 429, 18.9%, females). For the evaluation of a psychological indicator, Kessler 6 (K6) score, by sex and age group, the characteristics of the score distribution of the included participants were similar to those reported in previous studies. Conclusions: This study presents a protocol and overview of the results of an internet-based occupational health survey of workers. Using the results of this survey, we hope to evaluate the changes in occupational health activities and their impact on workers' health while controlling for the COVID-19 pandemic. %M 35900807 %R 10.2196/35290 %U https://formative.jmir.org/2022/7/e35290 %U https://doi.org/10.2196/35290 %U http://www.ncbi.nlm.nih.gov/pubmed/35900807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38263 %T COVID-box Experiences of Patients and Health Care Professionals (COVID-box Project): Single-Center, Retrospective, Observational Study %A Dirikgil,Ebru %A Brons,Kim %A Duindam,Michael %A Groeneveld,Geert H %A Geelhoed,J J Miranda %A Heringhaus,Christian %A van der Boog,Paul J M %A Rabelink,Ton J %A Bos,Willem Jan W %A Chavannes,Niels H %A Atsma,Douwe E %A Teng,Y K Onno %+ Department of Nephrology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 071 52621, y.k.o.teng@lumc.nl %K COVID-19 %K digital health %K eHealth %K telemedicine %K telemonitoring %K hospital admission %K health care professional %K thematic analysis %K user satisfaction %K usability %K home monitoring %K health care system %D 2022 %7 28.7.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals. Objective: The objective of our study was to determine patients’ and health care professionals’ experiences and satisfaction with employing the COVID-box. Methods: In this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale. Results: A total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10). Conclusions: The positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program—the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems. %M 35816688 %R 10.2196/38263 %U https://formative.jmir.org/2022/7/e38263 %U https://doi.org/10.2196/38263 %U http://www.ncbi.nlm.nih.gov/pubmed/35816688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33562 %T Implementing a Health Utility Assessment Platform to Acquire Health Utilities in a Hemodialysis Outpatient Setting: Feasibility Study %A Adejare,Adeboye A %A Duncan,Heather J %A Motz,R Geoffrey %A Shah,Silvi %A Thakar,Charuhas V %A Eckman,Mark H %+ Department of Biomedical Informatics, University of Cincinnati, CARE/Crawley Building, Suite E-870, Cincinnati, OH, 45220, United States, 1 8566252214, adejaraa@mail.uc.edu %K health utility assessment %K patient reported outcomes %K end-stage kidney disease %K hemodialysis %K hepatitis C %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with end-stage kidney disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is using hepatitis C virus (HCV)–viremic kidneys. Objective: As preparation for developing a shared decision-making tool to assist patients with ESKD with the decision to accept an HCV-viremic kidney transplant, our initial goal was to assess the feasibility of using The Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Our secondary goals were to collect health utilities for patients with ESKD and to explore whether the use of race-matched versus race-mismatched exemplars impacted the knowledge gained during the assessment process. Methods: We used The Gambler II to elicit utilities for the following ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and postintervention knowledge assessments. Results: A total of 63 patients with hemodialysis from 4 outpatient Dialysis Center Inc sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5, respectively. General group knowledge assessment scores improved by 10 points (P<.05) following utility assessment process. The use of race-matched exemplars had little effect on the results of the knowledge assessment of patients. Conclusions: Using The Gambler II to collect utilities for patients with ESKD in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. A wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation. %M 35900828 %R 10.2196/33562 %U https://formative.jmir.org/2022/7/e33562 %U https://doi.org/10.2196/33562 %U http://www.ncbi.nlm.nih.gov/pubmed/35900828 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39335 %T Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool %A Berridge,Clara %A Turner,Natalie R %A Liu,Liu %A Karras,Sierramatice W %A Chen,Amy %A Fredriksen-Goldsen,Karen %A Demiris,George %+ School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, United States, 1 (206) 543 5640, clarawb@uw.edu %K Alzheimer disease %K advance care planning %K dyadic intervention %K technology %K remote monitoring %K artificial intelligence %K older adult %K seniors %K human-computer interaction %K aging %K elderly population %K digital tool %K educational tool %K dementia care %K ethics %K informed consent %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Monitoring technologies are used to collect a range of information, such as one’s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult’s dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let’s Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention’s motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants’ experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. %M 35896014 %R 10.2196/39335 %U https://aging.jmir.org/2022/3/e39335 %U https://doi.org/10.2196/39335 %U http://www.ncbi.nlm.nih.gov/pubmed/35896014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35028 %T Telemedicine Preparedness Among Older Adults With Chronic Illness: Survey of Primary Care Patients %A Ufholz,Kelsey %A Sheon,Amy %A Bhargava,Daksh %A Rao,Goutham %+ Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Suite 1056, 11100 Euclid Avenue, Cleveland, OH, 44016, United States, 1 2162862212, keu8@case.edu %K telemedicine %K seniors %K primary care %K chronic illness %K health equities %K telehealth %K older adult %K healthcare %K health care %K digital health %K senior health %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults are a high priority for telemedicine given their elevated COVID-19 risk and need for frequent provider contact to manage chronic illnesses. It seems that many older adults now use smartphones but few studies have examined their overall readiness for telemedicine. Objective: The aim of this study is to survey older primary care patients about their telemedicine preparedness, including internet usage, internet-capable devices, telemedicine experiences and concerns, and perceived barriers. Results were used to inform a telemedicine preparedness training program. Methods: Community-dwelling older adult patients (aged 65-81 years; N=30) with a chronic health condition that could be managed remotely who were present at a family medicine clinic that primarily serves an urban African American population for a prescheduled in-person appointment were asked to complete a brief survey written for this study. Data were collected February-June 2021 at a large, urban, Midwestern hospital. To minimize patient burden, the survey was limited to 10 questions, focused on the most critical topics. Results: Most participants (21/30, 70%) reported having a device that could be used for telemedicine and using the internet. However, about half had only a single connected device, and messaging and video calling were the most commonly used applications. Few used email and none used online shopping or banking. Only 7 patients had had telemedicine appointments. Telemedicine users were younger than nonusers and used more internet functions than nonusers. Only 2 people reported problems with their telemedicine visits (technology and privacy). Nearly all respondents recognized avoiding travel and COVID-19 exposure as telemedicine benefits. The most common concerns were loss of the doctor-patient connection and inability to be examined. Conclusions: Most older adults reported having devices that could be used for telemedicine, but their internet use patterns did not confirm the adequacy of their devices or skills for telemedicine. Doctor-patient conversations could be helpful in addressing telemedicine concerns but device and skill gaps must be addressed as well. %M 35896013 %R 10.2196/35028 %U https://formative.jmir.org/2022/7/e35028 %U https://doi.org/10.2196/35028 %U http://www.ncbi.nlm.nih.gov/pubmed/35896013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34423 %T Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study %A Ruiz-Burga,Elisa %A Bruijning-Verhagen,Patricia %A Palmer,Paulette %A Sandcroft,Annalisa %A Fernandes,Georgina %A de Hoog,Marieke %A Bryan,Lenroy %A Pierre,Russell %A Bailey,Heather %A Giaquinto,Carlo %A Thorne,Claire %A Christie,Celia D C %A , %+ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford St,, London, WC1N 1EH, United Kingdom, 44 02079052396, e.burga@ucl.ac.uk %K mHealth %K digital health %K arbovirus %K pregnancy %K adherence %K compliance %K low- and middle-income countries %K LMIC %K maternal health %K pregnancy complications %K prenatal care %K pregnancy outcomes %K mobile phone %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. %M 35896029 %R 10.2196/34423 %U https://formative.jmir.org/2022/7/e34423 %U https://doi.org/10.2196/34423 %U http://www.ncbi.nlm.nih.gov/pubmed/35896029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37706 %T Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study %A Adler,Rachel F %A Morales,Paulina %A Sotelo,Jocelyn %A Magasi,Susan %+ Department of Computer Science, Northeastern Illinois University, 5500 N Saint Louis Ave, Chicago, IL, 60625, United States, 1 7734424710, r-adler@neiu.edu %K user-centered design %K co-design %K mobile health %K mHealth %K cancer survivors %K disabilities %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective: This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods: We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results: These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions: Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops. %M 35881439 %R 10.2196/37706 %U https://formative.jmir.org/2022/7/e37706 %U https://doi.org/10.2196/37706 %U http://www.ncbi.nlm.nih.gov/pubmed/35881439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36280 %T Development and Initial Testing of a Personalized, Adaptive, and Socially Focused Web Tool to Support Physical Activity Among Women in Midlife: Multidisciplinary and User-Centered Design Approach %A Arigo,Danielle %A Lobo,Andrea F %A Ainsworth,M Cole %A Baga,Kiri %A Pasko,Kristen %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Robinson 116G, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53775, arigo@rowan.edu %K user-centered design %K digital health %K eHealth %K women’s health %K midlife %K physical activity %K social support %K social comparison %K mobile phone %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Women in midlife are vulnerable to developing cardiovascular disease, particularly those who have conditions such as hypertension. Physical activity (PA) can reduce risk, but efforts to promote PA in this population have been only modestly effective. More attention to social influences on PA behavior may be useful, particularly social support and social comparison processes. Activating these processes with digital tools can provide easy access that is flexible to the needs of women in midlife. Objective: This paper describes the user-centered design processes of developing and conducting initial evaluation of a personalized and adaptive web application, tailored to the social needs of women in midlife. The goal was to gather feedback from the population of interest, before and during the design process. Methods: This study was conducted in 4 stages. The first and second authors (DA and AFL) developed technical specifications, informed by their experience with the population of interest. We collected feedback on potential content for the web application with women in midlife using both interviews (5/10, 50%; mean age 47.4, SD 6.66 years; mean BMI 35.3, SD 9.55 kg/m2) and surveys (5/10, 50%; mean age 51, SD 6.60 years; mean BMI 32.7, SD 8.39 kg/m2). We used their feedback to inform support messages and peer profiles (ie, sources of social comparison information). Nine members of the behavioral science team and 3 testers unfamiliar with the web application completed internal testing. We conducted naturalistic functionality testing with a different group of women in midlife (n=5; mean age 50, SD 6.26 years; mean BMI 30.1, SD 5.83 kg/m2), who used the web application as intended for 4 days and provided feedback at the end of this period. Results: Iterative storyboard development resulted in programming specifications for a prototype of the web application. We used content feedback to select and refine the support messages and peer profiles to be added. The following 2 rounds of internal testing identified bugs and other problems regarding the web application’s functioning and full data collection procedure. Problems were addressed or logged for future consideration. Naturalistic functionality testing revealed minimal further problems; findings showed preliminary acceptability of the web application and suggested that women may select different social content across days. Conclusions: A multidisciplinary and user-centered design approach led to a personalized and adaptive web application, tailored to the social needs of women in midlife. Findings from testing with this population demonstrated the feasibility and acceptability of the new application and supported further development toward its use in daily life. We describe several potential uses of the web application and next steps for its development. We also discuss the lessons learned and offer recommendations for future collaborations between behavioral and computer scientists to develop similar tools. %M 35881431 %R 10.2196/36280 %U https://formative.jmir.org/2022/7/e36280 %U https://doi.org/10.2196/36280 %U http://www.ncbi.nlm.nih.gov/pubmed/35881431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e39004 %T Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study %A Dobias,Mallory L %A Morris,Robert R %A Schleider,Jessica L %+ Department of Psychology, Stony Brook University, Psychology Building B-363, Stony Brook, NY, 11794-2500, United States, 1 512 818 9040, mallory.dobias@stonybrook.edu %K web-based intervention %K internet intervention %K digital intervention %K single-session intervention %K mental health %D 2022 %7 25.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms. Objective: We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko minicourses on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior. Methods: We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program. Results: The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen dz=−0.81, 95% CI −0.85 to −0.77) and REFRAME (P<.001, Cohen dz=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (P<.001, Cohen dz=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen dz=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research. Conclusions: Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports. %M 35877163 %R 10.2196/39004 %U https://formative.jmir.org/2022/7/e39004 %U https://doi.org/10.2196/39004 %U http://www.ncbi.nlm.nih.gov/pubmed/35877163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38054 %T The Association of Medical Preoperative Evaluation Using Clinical Video Telehealth With Hospital Length of Stay: Descriptive Analysis %A Burton,Brittany Nicole %A Arastoo,Sara %A Wu,Simon %A Liu,Nancy %A Ong,Michael K %A Vazirani,Sondra %+ Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles Health, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, United States, 1 310 825 8325, BBurton@mednet.ucla.edu %K telemedicine %K telehealth %K eHealth %K digital health %K hospital %K length of stay %K veteran's health %K video %K veteran %K preoperative %K outpatient %K chart review %K retrospective %K clinical care %K effectiveness %K efficacy %K discharge %D 2022 %7 25.7.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: Preoperative medical evaluation serves to identify risk factors and optimize patients before surgery. Providing a telehealth option in the perioperative setting has played a significant role in reducing barriers to quality perioperative health care. Objective: We aimed to evaluate how telemedicine preoperative evaluations using Clinical Video Telehealth (CVT) impact hospital length of stay. Methods: We performed a retrospective chart review between 2016 and 2017 of adult patients who underwent evaluations in our hospitalist-run preoperative medicine clinic. Patients seen in our preoperative CVT program were compared to patients seen in person to evaluate the association of visit type (preoperative CVT versus in-person evaluation) with hospital length of stay, defined as hospital stay from postoperative day 0 to discharge. There were 62 patients included in this retrospective study. Results: The adjusted incidence rate ratio (IRR) for hospital length of stay was significantly shorter in patients who underwent preoperative CVT compared to an in-person visit (IRR 0.52, 95% CI 0.29-0.92, P=.02). Conclusions: After adjusting for age and comorbidities, we show that preoperative telemedicine in the perioperative setting is associated with a shorter hospital length of stay compared to in-person visits. This suggests that telemedicine can play a viable role in this clinical setting. %M 35877170 %R 10.2196/38054 %U https://formative.jmir.org/2022/7/e38054 %U https://doi.org/10.2196/38054 %U http://www.ncbi.nlm.nih.gov/pubmed/35877170 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34121 %T Translating Promoting Factors and Behavior Change Principles Into a Blended and Technology-Supported Intervention to Stimulate Physical Activity in Children With Asthma (Foxfit): Design Study %A Brons,Annette %A Braam,Katja %A Broekema,Aline %A Timmerman,Annieck %A Millenaar,Karel %A Engelbert,Raoul %A Kröse,Ben %A Visser,Bart %+ Digital Life Center, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091 GM, Netherlands, 31 621156976, a.e.brons@hva.nl %K intervention mapping %K technology-supported intervention %K mobile health %K mHealth %K tailoring %K exercise %K cocreation %K social participation %K gamification %K mobile app %K web-based dashboard %K chronic disease %K mobile phone %D 2022 %7 25.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, health care providers lack interventions for children with asthma that effectively increase their PA levels and achieve behavior change. A technology-supported approach can positively influence PA and physical functioning in children. Objective: The aims of this study were to develop a technology-supported intervention that facilitates health care providers in promoting PA for children (aged 8 to 12 years) with asthma and to systematically describe this developmental process. Methods: Intervention mapping (IM) was applied to develop a blended and technology-supported intervention in cocreation with children with asthma, their parents, and health care providers. In accordance with the IM framework, the following steps were performed: conduct a needs assessment; define the intervention outcome, performance objectives, and change objectives; select theory-based intervention methods and strategies; create components of the intervention and conduct pilot tests; create an implementation plan; and create an evaluation plan. Results: We developed the blended intervention Foxfit that consists of an app with a PA monitor for children (aged 8 to 12 years) with asthma and a web-based dashboard for their health care provider. The intervention focuses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification, including goal setting, rewards, action planning, monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. An evaluation plan was created to assess the intervention’s usability and feasibility for both children and health care providers. Conclusions: The IM framework was very useful for systematically developing a technology-supported intervention and for describing the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology-supported intervention Foxfit that facilitates health care providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention. Trial Registration: International Clinical Trial Registry Platform NTR6658; https://tinyurl.com/3rxejksf %M 35877162 %R 10.2196/34121 %U https://formative.jmir.org/2022/7/e34121 %U https://doi.org/10.2196/34121 %U http://www.ncbi.nlm.nih.gov/pubmed/35877162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36956 %T Association Between Care Modality and Use With Treatment Response Among Members Accessing Virtual Mental Health Services: Real-world Observational Study %A Shih,Emily %A Aylward,Brandon S %A Kunkle,Sarah %A Graziani,Grant %+ Ginger, 116 New Montgomery St. Suite 500, San Francisco, CA, 94105, United States, 1 855 446 4374, eshih@ginger.io %K behavioral coaching %K engagement %K mental health %K telehealth %K treatment response %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing bottleneck in mental health care, as the demand for services has outpaced the availability of mental health professionals. Consequently, many health systems have shifted to teletherapy as a scalable approach to increasing accessibility to care. Within these care models, various treatment modalities (eg, coaching and clinical care) are used to deliver support for anxiety and depression. However, more research is needed to better understand the differences in treatment responses. Objective: The purpose of this study was to examine the association between different care modalities and the levels of use with symptom score changes for members seeking virtual care services. Methods: We conducted an observational study of 4219 members who accessed Ginger, an on-demand mental health service, between September 2020 and September 2021. Using a mobile app, members can access text-based behavioral health coaching and virtual clinical services. This study focused on members with clinically elevated depression or anxiety levels at baseline. Logistic regressions were used to assess the association between care modalities and the levels of use with treatment response in depression and anxiety, using the Patient Health Questionnaire and Generalized Anxiety Disorder Assessment, respectively. Results: Of the 4219 members, 1623 (38.47%) demonstrated a full response to depression, and 1684 (39.91%) demonstrated a full response to anxiety. Members who completed care (ie, text-based coaching, virtual clinical therapy, hybrid of coaching, and clinical care) beyond the introductory session showed significantly increased odds of a full response compared with those who completed only limited care. Members who completed a hybrid of care had the highest odds of improvement; the odds of showing a full response in depression were 2.31 times higher (95% CI 1.91-2.80; P<.001) and in anxiety were 2.23 times higher (95% CI 1.84-2.70; P<.001) compared with members who completed limited care. For members who completed only coaching or clinical care, the largest effects were observed among those with high use. For members who completed a hybrid care program, we observed similar treatment responses across all levels of use. Conclusions: Our real-world study found that members who completed text-based coaching achieved full treatment responses at similar rates compared with members who completed virtual clinical care and members who completed a hybrid of care. There were no significant differences in the predicted probabilities of full treatment response between coaching and clinical care. Generally, the odds for a full response were highest among members with high use within each care modality; however, there were no differences in full-response treatment odds across levels of use with hybrid care. The results support the utility of digital behavioral health interventions and further highlight text-based coaching protocols as an accessible and suitable option when considering virtual care for treating anxiety and depression. %M 35867401 %R 10.2196/36956 %U https://formative.jmir.org/2022/7/e36956 %U https://doi.org/10.2196/36956 %U http://www.ncbi.nlm.nih.gov/pubmed/35867401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e32925 %T Hemodialysis Record Sharing: Solution for Work Burden Reduction and Disaster Preparedness %A Ido,Keisuke %A Miyazaki,Mariko %A Nakayama,Masaharu %+ Department of Medical Informatics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 9808575, Japan, 81 227177572, nakayama@cardio.med.tohoku.ac.jp %K hemodialysis %K electronic health record %K EHR %K information sharing %K information exchange %K data sharing %K document sharing %K health information exchange %K disaster %K work burden %K clinical information %K clinical data %K clinical report %K medical report %K information network %K medical informatics %K renal failure %K kidney %K renal %K clinical record %K medical record %K backup %K data security %K data protection %K data recovery %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: After the Great East Japan Earthquake in 2011, backup systems for clinical information were launched in Japan. The system in Miyagi Prefecture called the Miyagi Medical and Welfare Information Network (MMWIN) is used as a health information exchange network to share clinical information among various medical facilities for patients who have opted in. Hospitals and clinics specializing in chronic renal failure require patients’ data and records during hemodialysis to facilitate communication in daily clinical activity and preparedness for disasters. Objective: This study aimed to facilitate the sharing of clinical data of patients undergoing hemodialysis among different hemodialysis facilities. Methods: We introduced a document-sharing system to make hemodialysis reports available on the MMWIN. We also recruited hospitals and clinics to share the hemodialysis reports of their patients and promoted the development of a network between emergency and dialysis clinics. Results: In addition to basic patient information as well as information on diagnosis, prescription, laboratory data, hospitalization, allergy, and image data from different facilities, specific information about hemodialysis is available, as well as a backup of indispensable information in preparation for disasters. As of June 1, 2021, 12 clinics and 10 hospitals of 68 dialysis facilities in Miyagi participated in the MMWIN. The number of patients who underwent hemodialysis in Miyagi increased by more than 40%. Conclusions: Our backup system successfully developed a network of hemodialysis facilities. We have accumulated data that are beneficial to prevent the fragmentation of patient information and would be helpful in transferring patients efficiently during unpredictable disasters. %M 35867394 %R 10.2196/32925 %U https://formative.jmir.org/2022/7/e32925 %U https://doi.org/10.2196/32925 %U http://www.ncbi.nlm.nih.gov/pubmed/35867394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e23823 %T Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change) %A Gilmore,Amanda K %A Leone,Ruschelle M %A Oesterle,Daniel W %A Davis,Kelly Cue %A Orchowski,Lindsay M %A Ramakrishnan,Viswanathan %A Kaysen,Debra %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302, United States, 1 404 413 1416, agilmore12@gsu.edu %K sexual assault prevention %K alcohol %K college students %K sexual and gender minorities %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation. Objective: We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women. Methods: Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change. Results: Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change. Conclusions: Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation. Trial Registration: ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137 %M 35867393 %R 10.2196/23823 %U https://formative.jmir.org/2022/7/e23823 %U https://doi.org/10.2196/23823 %U http://www.ncbi.nlm.nih.gov/pubmed/35867393 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35197 %T Exploring an Artificial Intelligence–Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study %A C Braga,Bianca %A Nguyen,Phuong H %A Aberman,Noora-Lisa %A Doyle,Frank %A Folson,Gloria %A Hoang,Nga %A Huynh,Phuong %A Koch,Bastien %A McCloskey,Peter %A Tran,Lan %A Hughes,David %A Gelli,Aulo %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 6176363777, curi.bianca@tufts.edu %K adolescent %K dietary quality %K food choice %K gamification %K low- and middle-income country %K smartphone app %K mobile phone %D 2022 %7 21.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. %M 35862147 %R 10.2196/35197 %U https://formative.jmir.org/2022/7/e35197 %U https://doi.org/10.2196/35197 %U http://www.ncbi.nlm.nih.gov/pubmed/35862147 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36055 %T An Urban Population Health Observatory for Disease Causal Pathway Analysis and Decision Support: Underlying Explainable Artificial Intelligence Model %A Brakefield,Whitney S %A Ammar,Nariman %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, R492, Memphis, TN, 38103, United States, 1 901 287 5863, ashabann@uthsc.edu %K health surveillance system %K explainable AI %K decision support %K machine learning %K obesity %K chronic disease %K precision health prevention %K semantic inference %D 2022 %7 20.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many researchers have aimed to develop chronic health surveillance systems to assist in public health decision-making. Several digital health solutions created lack the ability to explain their decisions and actions to human users. Objective: This study sought to (1) expand our existing Urban Population Health Observatory (UPHO) system by incorporating a semantics layer; (2) cohesively employ machine learning and semantic/logical inference to provide measurable evidence and detect pathways leading to undesirable health outcomes; (3) provide clinical use case scenarios and design case studies to identify socioenvironmental determinants of health associated with the prevalence of obesity, and (4) design a dashboard that demonstrates the use of UPHO in the context of obesity surveillance using the provided scenarios. Methods: The system design includes a knowledge graph generation component that provides contextual knowledge from relevant domains of interest. This system leverages semantics using concepts, properties, and axioms from existing ontologies. In addition, we used the publicly available US Centers for Disease Control and Prevention 500 Cities data set to perform multivariate analysis. A cohesive approach that employs machine learning and semantic/logical inference reveals pathways leading to diseases. Results: In this study, we present 2 clinical case scenarios and a proof-of-concept prototype design of a dashboard that provides warnings, recommendations, and explanations and demonstrates the use of UPHO in the context of obesity surveillance, treatment, and prevention. While exploring the case scenarios using a support vector regression machine learning model, we found that poverty, lack of physical activity, education, and unemployment were the most important predictive variables that contribute to obesity in Memphis, TN. Conclusions: The application of UPHO could help reduce health disparities and improve urban population health. The expanded UPHO feature incorporates an additional level of interpretable knowledge to enhance physicians, researchers, and health officials' informed decision-making at both patient and community levels. International Registered Report Identifier (IRRID): RR2-10.2196/28269 %M 35857363 %R 10.2196/36055 %U https://formative.jmir.org/2022/7/e36055 %U https://doi.org/10.2196/36055 %U http://www.ncbi.nlm.nih.gov/pubmed/35857363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37278 %T A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design %A Juniar,Dilfa %A van Ballegooijen,Wouter %A Schulte,Mieke %A van Schaik,Anneke %A Passchier,Jan %A Heber,Elena %A Lehr,Dirk %A Sadarjoen,Sawitri Supardi %A Riper,Heleen %+ Faculty of Psychology, YARSI University, YARSI Tower 6th Floor, Jl. Letjend Soeprapto, Jakarta, 10510, Indonesia, 62 21 4223138, dilfa.juniar@yarsi.ac.id %K Indonesia %K cultural adaptation %K feasibility study %K internet intervention %K telemental health %K digital mental health %K low- and middle-income countries (LMIC) %K stress management %K university students %D 2022 %7 19.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: University students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia. Objective: The aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements. Methods: A single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized. Results: The intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects. Conclusions: This study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed. International Registered Report Identifier (IRRID): RR2-10.2196/11493 %M 35852838 %R 10.2196/37278 %U https://formative.jmir.org/2022/7/e37278 %U https://doi.org/10.2196/37278 %U http://www.ncbi.nlm.nih.gov/pubmed/35852838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36176 %T Machine Learning Prediction of Hypoglycemia and Hyperglycemia From Electronic Health Records: Algorithm Development and Validation %A Witte,Harald %A Nakas,Christos %A Bally,Lia %A Leichtle,Alexander Benedikt %+ University Institute of Clinical Chemistry, Inselspital - Bern University Hospital and University of Bern, Freiburgstrasse 10, Bern, 3010, Switzerland, 41 316328330, Alexander.Leichtle@insel.ch %K diabetes %K blood glucose decompensation %K multiclass prediction model %K dysglycemia %K hyperglycemia %K hypoglycemia %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute blood glucose (BG) decompensations (hypoglycemia and hyperglycemia) represent a frequent and significant risk for inpatients and adversely affect patient outcomes and safety. The increasing need for BG management in inpatients poses a high demand on clinical staff and health care systems in addition. Objective: This study aimed to generate a broadly applicable multiclass classification model for predicting BG decompensation events from patients’ electronic health records to indicate where adjustments in patient monitoring and therapeutic interventions are required. This should allow for taking proactive measures before BG levels are derailed. Methods: A retrospective cohort study was conducted on patients who were hospitalized at a tertiary hospital in Bern, Switzerland. Using patient details and routine data from electronic health records, a multiclass prediction model for BG decompensation events (<3.9 mmol/L [hypoglycemia] or >10, >13.9, or >16.7 mmol/L [representing different degrees of hyperglycemia]) was generated based on a second-level ensemble of gradient-boosted binary trees. Results: A total of 63,579 hospital admissions of 38,250 patients were included in this study. The multiclass prediction model reached specificities of 93.7%, 98.9%, and 93.9% and sensitivities of 67.1%, 59%, and 63.6% for the main categories of interest, which were nondecompensated cases, hypoglycemia, or hyperglycemia, respectively. The median prediction horizon was 7 hours and 4 hours for hypoglycemia and hyperglycemia, respectively. Conclusions: Electronic health records have the potential to reliably predict all types of BG decompensation. Readily available patient details and routine laboratory data can support the decisions for proactive interventions and thus help to reduce the detrimental health effects of hypoglycemia and hyperglycemia. %M 35526139 %R 10.2196/36176 %U https://formative.jmir.org/2022/7/e36176 %U https://doi.org/10.2196/36176 %U http://www.ncbi.nlm.nih.gov/pubmed/35526139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35623 %T Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis %A Ma,Jessica E %A Grubber,Janet %A Coffman,Cynthia J %A Wang,Virginia %A Hastings,S Nicole %A Allen,Kelli D %A Shepherd-Banigan,Megan %A Decosimo,Kasey %A Dadolf,Joshua %A Sullivan,Caitlin %A Sperber,Nina R %A Van Houtven,Courtney H %+ Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, 508 Fulton St (152), Durham, NC, 27705, United States, 1 9192860411, jessica.ma@duke.edu %K veterans %K caregivers %K electronic health record %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers. Objective: Few health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers. Methods: We selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening. Results: During the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver. Conclusions: The EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers. Trial Registration: ClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380 %M 35849430 %R 10.2196/35623 %U https://formative.jmir.org/2022/7/e35623 %U https://doi.org/10.2196/35623 %U http://www.ncbi.nlm.nih.gov/pubmed/35849430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35553 %T Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study %A Kempler,Jessica V %A Love,Penelope %A Bolton,Kristy A %A Rozman,Margaret %A Spence,Alison C %+ School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Geelong, 3216, Australia, 61 3 9246 8651, jkempler@deakin.edu.au %K child care %K preschool %K early childhood services %K child nutrition %K menu planning %K healthy eating %K web-based systems %K web-based tool %K internet-based intervention %K user experience %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective: We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods: We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results: The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions: The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector. %M 35849438 %R 10.2196/35553 %U https://formative.jmir.org/2022/7/e35553 %U https://doi.org/10.2196/35553 %U http://www.ncbi.nlm.nih.gov/pubmed/35849438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33260 %T Evaluation of a Text Message–Based COVID-19 Vaccine Outreach Program Among Older Patients: Cross-sectional Study %A Ahmed,Naheed %A Boxley,Christian %A Dixit,Ram %A Krevat,Seth %A Fong,Allan %A Ratwani,Raj M %A Wesley,Deliya B %+ NYU Grossman School of Medicine, 180 Madison Avenue, 9th Floor, New York, NY, 10016, United States, Naheed.Ahmed@nyulangone.org %K vaccine outreach %K text messaging %K elderly patients %K evaluation %K smartphone %K text message %K SMS %K appointment %K elderly %K older adults %K vaccine %K effectiveness %K engagement %K cross-sectional %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 vaccines are vital tools in the defense against infection and serious disease due to SARS-CoV-2. There are many challenges to implementing mass vaccination campaigns for large, diverse populations from crafting vaccine promotion messages to reaching individuals in a timely and effective manner. During this unprecedented period, with COVID-19 mass vaccination campaigns essential for protecting vulnerable patient populations and attaining herd immunity, health care systems were faced with the dual challenges of vaccine outreach and distribution. Objective: The aim of this cross-sectional study was to assess the effectiveness of a COVID-19 vaccine text outreach approach for patients aged 65 years and older. Our goal was to determine whether this approach was successful in scheduling patients for COVID-19 vaccine appointments. Methods: We developed SMS text messages using the Tavoca platform. These messages informed patients of their vaccine eligibility and allowed them to indicate their interest in scheduling an appointment via a specific method (email or phone) or indicate their lack of interest in the vaccine. We tracked the status of these messages and how patients responded. Messages were sent to patients aged 65 years and older (N=30,826) at a nonprofit health care system in Washington, DC. Data were collected and examined from January 14 to May 10, 2021. Data were analyzed using multivariate multinomial and binary logistic regression models in SAS (version 9.4; SAS Institute Inc). Results: Approximately 57% of text messages were delivered to patients, but many messages received no response from patients (40%). Additionally, 42.1% (12,978/30,826) of messages were not delivered. Of the patients who expressed interest in the vaccine (2938/30,826, 9.5%), Black or African American patients preferred a phone call rather than an email for scheduling their appointment (odds ratio [OR] 1.69, 95% CI 1.29-2.21) compared to White patients. Patients aged 70-74 years were more likely to schedule an appointment (OR 1.38, 95% CI 1.01-1.89) than those aged 65-69 years, and Black or African American patients were more likely to schedule an appointment (OR 2.90, 95% CI 1.72-4.91) than White patients. Conclusions: This study provides insights into some advantages and challenges of using a text messaging vaccine outreach for patients aged 65 years and older. Lessons learned from this vaccine campaign underscore the importance of using multiple outreach methods and sharing of patient vaccination status between health systems, along with a patient-centered approach to address vaccine hesitancy and access issues. %M 35724339 %R 10.2196/33260 %U https://formative.jmir.org/2022/7/e33260 %U https://doi.org/10.2196/33260 %U http://www.ncbi.nlm.nih.gov/pubmed/35724339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38366 %T Active Virtual Reality for Chronic Primary Pain: Mixed Methods Randomized Pilot Study %A Tuck,Natalie %A Pollard,Catherine %A Good,Clinton %A Williams,Caitlin %A Lewis,Gwyn %A Hames,Murray %A Aamir,Tipu %A Bean,Debbie %+ The Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21 2669363, natalie.tuck@aut.ac.nz %K chronic pain %K virtual reality %K VR %K rehabilitation %K serious games %K physiotherapy %K pain management %K acceptability %K intervention %K feasibility %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain. Objective: This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting. Methods: For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention. Results: Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important. Conclusions: The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed. %M 35830224 %R 10.2196/38366 %U https://formative.jmir.org/2022/7/e38366 %U https://doi.org/10.2196/38366 %U http://www.ncbi.nlm.nih.gov/pubmed/35830224 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e31650 %T A Privacy-Preserving Audit and Feedback System for the Antibiotic Prescribing of General Practitioners: Survey Study %A Yigzaw,Kassaye Yitbarek %A Chomutare,Taridzo %A Wynn,Rolf %A Berntsen,Gro Karine Rosvold %A Bellika,Johan Gustav %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Sykehusvneien 23, Tromsø, 9019, Norway, 47 92438720, kassaye.yitbarek.yigzaw@ehealthresearch.no %K learning health care system %K feedback %K antimicrobial stewardship %K quality improvement %K privacy %K electronic health record %K antibiotics %K prescription %K patient privacy %K clinical setting %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Antibiotic resistance is a worldwide public health problem that is accelerated by the misuse and overuse of antibiotics. Studies have shown that audits and feedback enable clinicians to compare their personal clinical performance with that of their peers and are effective in reducing the inappropriate prescribing of antibiotics. However, privacy concerns make audits and feedback hard to implement in clinical settings. To solve this problem, we developed a privacy-preserving audit and feedback (A&F) system. Objective: This study aims to evaluate a privacy-preserving A&F system in clinical settings. Methods: A privacy-preserving A&F system was deployed at three primary care practices in Norway to generate feedback for 20 general practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system. Results: A total of 14 GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with the usefulness of the feedback and the comparisons with peers, as well as the protection of privacy. The majority of the GPs (9/14, 64%) valued the protection of their own privacy as well as that of their patients. Conclusions: The system overcomes important privacy and scaling challenges that are commonly associated with the secondary use of electronic health record data and has the potential to improve antibiotic prescribing behavior; however, further study is required to assess its actual effect. %M 35830221 %R 10.2196/31650 %U https://formative.jmir.org/2022/7/e31650 %U https://doi.org/10.2196/31650 %U http://www.ncbi.nlm.nih.gov/pubmed/35830221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38735 %T Implementation of a Statewide Web-Based Caregiver Resource Information System (CareNav): Mixed Methods Study %A Young,Heather M %A Bell,Janice F %A Tonkikh,Orly %A Kilaberia,Tina R %A Whitney,Robin L %A Mongoven,Jennifer M %A Link,Benjamin M %A Kelly,Kathleen %+ Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Betty Irene Moore Hall, 2570 48th St, Sacramento, CA, 95817, United States, 1 541 261 0395, hmyoung@ucdavis.edu %K online assessment %K caregiver %K technology implementation %K Consolidated Framework for Implementation Research %K CFIR %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the aging population, family caregivers provide increasingly complex and intense care for older adults and persons with disabilities. There is growing interest in developing community-based services to support family caregivers. Caregiving occurs around the clock, and caregivers face challenges in accessing community-based services at convenient times owing to the demands of care. Web-based resources hold promise for accessible real-time support. CareNav (TM), a caregiver resource information system, is a web-based platform designed to support real-time universal caregiver assessment, a record of client encounters, development of a care plan, tailored information and resource content, access to web-based caregiver resources, the capacity to track service authorization and contracts, and secure communications. The assessment includes needs and health conditions of both the care recipient and caregiver; current resources; and priorities for support, information, and referral. In 2019, the California Department of Health Care Services funded the 11 nonprofit California Caregiver Resource Centers (CRCs) to expand and improve family caregiver services and enhance CRC information technology services. Deployment of a statewide information system offered a unique opportunity to examine structures and processes facilitating implementation, providing feedback to the sites as well as lessons learned for similar projects in the future. Objective: The aim of this paper was to describe the statewide implementation of the comprehensive CareNav system using the Consolidated Framework for Implementation Research as an organizing structure for synthesizing the evaluation. Methods: This mixed methods study used two major approaches to evaluate the implementation process: a survey of all staff who completed training (n=82) and in-depth qualitative interviews with 11 CRC teams and 3 key informants (n=35). We initially analyzed interview transcripts using qualitative descriptive methods and then identified subthemes and relationships among ideas, mapping the findings to the Consolidated Framework for Implementation Research. Results: We present findings on the outer setting, inner setting, characteristics of the intervention, characteristics of the staff, and the implementation process. The critical elements for success were leadership, communication, harmonization of processes across sites, and motivation to serve clients in more accessible and convenient ways. Conclusions: These findings have implications for technology deployment in diverse community-based agencies that aspire to enhance web-based services. %M 35830234 %R 10.2196/38735 %U https://formative.jmir.org/2022/7/e38735 %U https://doi.org/10.2196/38735 %U http://www.ncbi.nlm.nih.gov/pubmed/35830234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e32950 %T Online Guided Self-help Cognitive Behavioral Therapy With Exposure to Anxiety and Problem Solving in Type 1 Diabetes Mellitus: Case Study %A Kern,Dorian %A Ljótsson,Brjánn %A Bonnert,Marianne %A Lindefors,Nils %A Kraepelien,Martin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 723243235, dorian.kern@ki.se %K fear of hypoglycemia %K problem solving %K cognitive behavioral therapy %K psychology %K self-help %K diabetes %K type 1 diabetes mellitus %K high blood glucose %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 1 diabetes mellitus (T1DM) is dependent on self-care to avoid short- and long-term complications. There are several problem areas in diabetes that could be addressed by psychological interventions, such as suboptimal problem-solving strategies and fear of hypoglycemia. There is empirical support for a few psychological interventions, most often cognitive behavioral therapy, with various treatment aims. However, these interventions are largely unavailable in regular diabetes health care. Online guided self-help cognitive behavioral therapy could help achieve greater outreach. Objective: We tested a manualized treatment in the early stage for further development, with the long-term aim to increase access to care. The purpose of this report was to show the potential of this newly developed online intervention by describing 2 illustrative cases. Methods: An online guided self-help cognitive behavioral therapy protocol featuring problem solving and exposure was developed. The treatment was administered from a secure online platform and lasted for 8 weeks. Case 1 was a male participant. He had a number of diabetes-related complications and was worried about his future. He reported that he had a general idea that he needed to change his lifestyle but found it difficult to get started. Case 2 was a female participant. She had fear of hypoglycemia and unhelpful avoidance behaviors. She kept her blood glucose levels unhealthily high in order to prevent hypoglycemic episodes. Furthermore, she avoided contact with diabetes health care. Results: The 2 participants showed clinically significant improvements in their most relevant problem areas. In case 1, the participant’s blood glucose levels reduced, and he was able to establish healthy routines, such as increase physical exercise and decrease overeating. In case 2, the participant’s fear of hypoglycemia greatly decreased, and she was able to confront many of her avoided situations and increase necessary visits to her diabetes clinic. Treatment satisfaction was high, and no adverse events were reported. Conclusions: It is possible to deliver a cognitive behavioral therapy intervention aimed at problem areas in diabetes online. Problem solving appears to help with problems in everyday routines and lifestyle choices. Exposure to aversive stimuli appears to be a plausible intervention specifically aimed at the fear of hypoglycemia. Larger and controlled studies are needed. %M 35830220 %R 10.2196/32950 %U https://formative.jmir.org/2022/7/e32950 %U https://doi.org/10.2196/32950 %U http://www.ncbi.nlm.nih.gov/pubmed/35830220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36018 %T Improving Well-being With a Mobile Artificial Intelligence–Powered Acceptance Commitment Therapy Tool: Pragmatic Retrospective Study %A Naor,Navot %A Frenkel,Alex %A Winsberg,Mirène %+ Kai.ai, Yigal Alon St 114, Tel Aviv, 6744320, Israel, 972 502183965, navot@kai.ai %K Acceptance Commitment Therapy %K well-being %K WHO-5 %K World Health Organization-Five Well-Being Index %K mHealth %K mobile health %K smartphone %K health application %K mental health %K quality of life %K artificial intelligence %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Research and dissemination of smartphone apps to deliver coaching and psychological driven intervention had seen a great surge in recent years. Notably, Acceptance Commitment Therapy (ACT) protocols were shown to be uniquely effective in treating symptoms for both depression and anxiety when delivered through smartphone apps. The aim of this study is to expand on that work and test the suitability of artificial intelligence–driven interventions delivered directly through popular texting apps. Objective: This study evaluated our hypothesis that using Kai.ai will result in improved well-being. Methods: We performed a pragmatic retrospective analysis of 2909 users who used Kai.ai on one of the top messaging apps (iMessage, WhatsApp, Discord, Telegram, etc). Users’ well-being levels were tracked using the World Health Organization-Five Well-Being Index throughout the engagement with service. A 1-tailed paired samples t test was used to assess well-being levels before and after usage, and hierarchical linear modeling was used to examine the change in symptoms over time. Results: The median well-being score at the last measurement was higher (median 52) than that at the start of the intervention (median 40), indicating a significant improvement (W=2682927; P<.001). Furthermore, HLM results showed that the improvement in well-being was linearly related to the number of daily messages a user sent (β=.029; t81.36=4; P<.001), as well as the interaction between the number of messages and unique number of days (β=–.0003; t81.36=–2.2; P=.03). Conclusions: Mobile-based ACT interventions are effective means to improve individuals’ well-being. Our findings further demonstrate Kai.ai’s great promise in helping individuals improve and maintain high levels of well-being and thus improve their daily lives. %M 35598216 %R 10.2196/36018 %U https://formative.jmir.org/2022/7/e36018 %U https://doi.org/10.2196/36018 %U http://www.ncbi.nlm.nih.gov/pubmed/35598216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e25982 %T Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study %A Knowles,Kayla %A Dowshen,Nadia %A Lee,Susan %A Tanner,Amanda %+ PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 10th Floor, #10-2222, Philadelphia, PA, 19146, United States, 1 267 425 1449, knowlesk1@chop.edu %K HIV prevention and care %K adolescents %K mHealth %K mobile apps %K Delphi method %K health application %K HIV care %K HIV prevention %K health intervention %K public health %K health care %K health accessibility %K health technology %K digital health %K HIV %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped. Objective: The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions. Methods: Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached. Results: Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention. Conclusions: The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers. %M 35819824 %R 10.2196/25982 %U https://formative.jmir.org/2022/7/e25982 %U https://doi.org/10.2196/25982 %U http://www.ncbi.nlm.nih.gov/pubmed/35819824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36757 %T A Web Platform for Standardized Data Acquisition, Processing, and Export in the Child Psychopathology Clinical Routine (MedicalBIT): Design and Implementation Study %A Colombo,Paola %A Busti Ceccarelli,Silvia %A Pacchiarini,Stefano %A Cribellati,Stefano %A Molteni,Massimo %+ Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Via Don Luigi Monza 20, Bosisio Parini, 23842, Italy, 39 +39 031 877623, silvia.busti@lanostrafamiglia.it %K digital health %K big data %K developmental psychopathology %K neurodevelopmental disorders %K digital data %K digital innovation %K mental health %K screening tool %K children %K psychopathology %K web platform %K digital intervention %K clinical outcome %D 2022 %7 11.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid extent of digital innovation for the collection of data has transformed the way in which health professionals collect, share, and analyze health information for better clinical decision-making and health care. In the last decade, there has been an increased interest in telemedicine by mental health agencies; the gap between the need for care and both diagnosis and treatment is wide, and digital technology could play an important role in filling this gap. However, there are limited data on the effectiveness of the clinical process and cost-effectiveness of most telemedicine applications. Objective: This study examined the implementation of the first Italian online, web-based, comprehensive screening tool and described the screening and diagnostic process through the interactive web platform in a child psychopathology clinic. This is a feasibility study that aims to present the design and implementation of the best practices to improve patient experiences and clinical outcomes. Moreover, the paper evaluates the platform with qualitative and quantitative measures. Methods: We planned, designed, and implemented a web-based system to collect, store, and manage clinical data. The platform was developed by a multidisciplinary team composed of researchers, clinicians, and informatics professionals through different steps. First, we defined the clinical information to be collected. A number of measures were chosen, tapping several clinical risk areas such as neurodevelopmental disorders and emotional and behavioral problems. The web application architecture and process were then designed. The three phases of process design are described in detail: design of the input interface, processing design, and design of the output interface. Finally, the system has been implemented and evaluated. Based on indicators recommended by the National Quality Forum and the Italian National Guidelines, we evaluated the quality of the system and used quantitative measures that were replicable and comparable over time. Results: We present the implemented architecture and features of Medea Information and Clinical Assessment On-Line (MedicalBIT), and we provide performance measures for the data collected between October 2018 and June 2021. The measured concepts pertain to four domains: access to care, financial impact/cost, experience, and effectiveness. Conclusions: In this study, we present the successful implementation of an innovative digital tool. The findings of this study show that the implemented web-based platform appears to be an efficient, cost-effective, and feasible way to improve digital care in the field of child psychiatry. %M 35816380 %R 10.2196/36757 %U https://formative.jmir.org/2022/7/e36757 %U https://doi.org/10.2196/36757 %U http://www.ncbi.nlm.nih.gov/pubmed/35816380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34271 %T Novel Implementation Strategy to Electronically Screen and Signpost Patients to Health Behavior Apps: Mixed Methods Implementation Study (OptiMine Study) %A Khadjesari,Zarnie %A Brown,Tracey J %A Ramsey,Alex T %A Goodfellow,Henry %A El-Toukhy,Sherine %A Abroms,Lorien C %A Jopling,Helena %A Dierker Viik,Arden %A Amato,Michael S %+ Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 01603457648, Z.Khadjesari@uea.ac.uk %K electronic health record %K EHR %K alcohol reduction %K electronic messages %K proactive messages %K proactive outreach %K smoking cessation %K tobacco use %K alcohol use %K alcohol %K smoking %K mobile health %K mHealth %K mobile app %D 2022 %7 11.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavior change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) in acute care hospitals provide a valuable resource for identifying patients at risk, who may benefit from behavior change apps. A novel, emerging implementation strategy is to use digital technologies not only for providing support to help-seeking individuals but also for signposting patients at risk to support services (also called proactive referral in the United States). Objective: The OptiMine study aimed to increase the reach of behavior change apps by implementing electronic signposting for smoking cessation and alcohol reduction in a large, at-risk population that was identified through an acute care hospital EHR. Methods: This 3-phase, mixed methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behavior change apps by using a hospital’s EHR system to identify patients who are at risk. Phase 1 explored the acceptability of the implementation strategy among the patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviors and contact them via SMS text message, email, or patient portal. Phase 3 assessed the impact of SMS text messages sent to patients who were identified as smokers or risky drinkers, which signposted them to behavior change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the SMS text message to access information about the apps. The acceptability of the SMS text messages among the patients who had received them was also explored in a web-based survey. Results: Our electronic signposting strategy—using SMS text messages to promote health behavior change apps to patients at risk—was found to be acceptable and feasible and had good reach. The hospital sent 1526 SMS text messages, signposting patients to either the National Health Service Smokefree or Drink Free Days apps. A total of 13.56% (207/1526) of the patients clicked on the embedded link to the apps, which exceeded our 5% a priori success criterion. Patients and staff contributed to the SMS text message content and delivery approach, which were perceived as acceptable before and after the delivery of the SMS text messages. The feasibility of the SMS text message format was determined and the target population was identified by mining the EHR. Conclusions: The OptiMine study demonstrated the proof of concept for this novel implementation strategy, which used SMS text messages to signpost at-risk individuals to behavior change apps at scale. The level of reach exceeded our a priori success criterion in a non–help-seeking population of patients receiving unsolicited SMS text messages, disconnected from hospital visits. International Registered Report Identifier (IRRID): RR2-10.2196/23669 %M 35816374 %R 10.2196/34271 %U https://formative.jmir.org/2022/7/e34271 %U https://doi.org/10.2196/34271 %U http://www.ncbi.nlm.nih.gov/pubmed/35816374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35636 %T Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study %A Whitehead,Jocelyne C %A Neeman,Ron %A Doniger,Glen M %+ Integrated Program in Neuroscience, McGill University, 845 Rue Sherbrooke O, Montreal, QC, H3A 0G4, Canada, 1 866 994 3210, jocelyne.whitehead@mail.mcgill.ca %K EEG biofeedback %K remote care %K neurofeedback %K attention-deficit/hyperactivity disorder %K delta/alpha ratio %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurofeedback training (NFT) has been shown to be effective in treating several disorders (eg, attention-deficit/hyperactivity disorder [ADHD], anxiety, and depression); however, little is currently known regarding the effectiveness of remote NFT systems. Objective: This retrospective study provides real-world data (N=593) to assess the efficacy of app-based remote NFT in improving brain health and cognitive performance. Methods: Improvement was measured from pre- to postintervention of in-app assessments that included validated symptom questionnaires (the 12-item General Health Questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, and the 9-item Patient Health Questionnaire), a cognitive test of attention and executive functioning (ie, continuous performance task), and resting electroencephalography (EEG) markers. Clinically significant improvement was evaluated using standard approaches. Results: The greatest improvement was reported for the anxiety questionnaire, for which 69% (68/99) of participants moved from abnormal to healthy score ranges. Overall, adult and child participants who engaged in neurofeedback to improve attention and executive functions demonstrated improved ADHD scores and enhanced performance on a cognitive (ie, response inhibition) task. Adults with ADHD additionally demonstrated elevated delta/alpha and theta/alpha ratios at baseline and a reduction in the delta/alpha ratio indicator following neurofeedback. Conclusions: Preliminary findings suggest the efficacy of app-based remote neurofeedback in improving mental health, given the reduced symptom severity from pre- to postassessment for general psychological health, ADHD, anxiety, and depression, as well as adjusted resting EEG neural markers for individuals with symptoms of ADHD. Collectively, this supports the utility of the in-app assessment in monitoring behavioral and neural indices of mental health. %M 35802411 %R 10.2196/35636 %U https://formative.jmir.org/2022/7/e35636 %U https://doi.org/10.2196/35636 %U http://www.ncbi.nlm.nih.gov/pubmed/35802411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37211 %T Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study %A Tran,Ha V %A Nong,Ha T T %A Tran,Thuy T T %A Filipowicz,Teresa R %A Landrum,Kelsey R %A Pence,Brian W %A Le,Giang M %A Nguyen,Minh X %A Chibanda,Dixon %A Verhey,Ruth %A Go,Vivian F %A Ho,Hien T %A Gaynes,Bradley N %+ The University of North Carolina, Vietnam Office, Room 407 – 408, Block A2, Van Phuc Diplomatic Compound 298 Kim Ma, Ba Dinh, Hanoi, 10000, Vietnam, 84 24 3211 5839 ext 108, vietha@live.unc.edu %K Friendship Bench %K Vietnam %K Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing %K ADAPT-ITT %K common mental disorders %K people living with HIV %K PWH %K people who inject drugs %K PWID %K methadone maintenance treatment %K MMT %K depression %K anxiety %K stress disorder %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)–based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam. Objective: This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework. Methods: The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases. Results: The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual. Conclusions: This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam. Trial Registration: ClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201 %M 35802402 %R 10.2196/37211 %U https://formative.jmir.org/2022/7/e37211 %U https://doi.org/10.2196/37211 %U http://www.ncbi.nlm.nih.gov/pubmed/35802402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33978 %T Developing Educational Animations on HIV Pre-exposure Prophylaxis (PrEP) for Women: Qualitative Study %A Young,Anna Marie %A Fruhauf,Timothee %A Okonkwo,Obianuju %A Gingher,Erin %A Coleman,Jenell %+ Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps Room 254A, Baltimore, MD, United States, 1 410 614 4496, colemanj@jhmi.edu %K PrEP %K animations %K education %K HIV %K prevention %K women %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite experiencing the second-highest rate of HIV incidence in the United States, pre-exposure prophylaxis (PrEP) use remains low among Black women due, in part, to a lack of patients’ awareness and providers’ knowledge. Objective: Our goal was to design animated educational tools informed by patients and women’s health providers to address these barriers, specifically for women at risk for HIV. Methods: Two animation storyboards about PrEP for women were created by academic stakeholders (eg, HIV clinical experts, educators, and HIV peer counselors), one for patients and one for providers. Four focus groups with community members from Baltimore, Maryland and four with women’s health providers (eg, obstetrician/gynecologists, midwives, nurse practitioners, and peer counselors) at an academic center were conducted to discuss the storyboards. Transcripts were analyzed using conventional content analysis, and themes were incorporated into the final versions of the animations. Results: Academic stakeholders and 30 focus group participants (n=16 female community members and n=14 women’s health providers) described important themes regarding PrEP. The themes most commonly discussed about the patient animation were understandability of side effects, HIV risk factors, messaging, PrEP access, and use confidence. Provider animation themes were indications for PrEP, side effects, and prescribing confidence. Conclusions: We created two PrEP animations focused on women. Stakeholder feedback highlighted the importance of ensuring the understandability and applicability of PrEP educational materials while including necessary information to facilitate use or prescribing confidence. Both community members and women’s health providers reported greater use confidence after viewing the animations. %M 35802416 %R 10.2196/33978 %U https://formative.jmir.org/2022/7/e33978 %U https://doi.org/10.2196/33978 %U http://www.ncbi.nlm.nih.gov/pubmed/35802416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33541 %T Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 451994827, sarah.perkes@newcastle.edu.au %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. %M 35802404 %R 10.2196/33541 %U https://formative.jmir.org/2022/7/e33541 %U https://doi.org/10.2196/33541 %U http://www.ncbi.nlm.nih.gov/pubmed/35802404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e30230 %T Feasibility of Mobile Health and Social Media–Based Interventions for Young Adults With Early Psychosis and Clinical Risk for Psychosis: Survey Study %A Franco,Olivia H %A Calkins,Monica E %A Giorgi,Salvatore %A Ungar,Lyle H %A Gur,Raquel E %A Kohler,Christian G %A Tang,Sunny X %+ Feinstein Institutes for Medical Research, Northwell Health, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 631 786 3737, stang3@northwell.edu %K social media %K psychosis %K clinical high risk %K technology %K digital health %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technology, the internet, and social media are increasingly investigated as promising means for monitoring symptoms and delivering mental health treatment. These apps and interventions have demonstrated preliminary acceptability and feasibility, but previous reports suggest that access to technology may still be limited among individuals with psychotic disorders relative to the general population. Objective: We evaluated and compared access to and use of technology and social media in young adults with psychotic disorders (PD), young adults with clinical risk for psychosis (CR), and psychosis-free youths (PF). Methods: Participants were recruited through a coordinated specialty care clinic dedicated toward early psychosis as well as ongoing studies. We surveyed 21 PD, 23 CR, and 15 PF participants regarding access to technology and use of social media, specifically Facebook and Twitter. Statistical analyses were conducted in R. Categorical variables were compared among groups using Fisher exact test, continuous variables were compared using 1-way ANOVA, and multiple linear regressions were used to evaluate for covariates. Results: Access to technology and social media were similar among PD, CR, and PF participants. Individuals with PD, but not CR, were less likely to post at a weekly or higher frequency compared to PF individuals. We found that decreased active social media posting was unique to psychotic disorders and did not occur with other psychiatric diagnoses or demographic variables. Additionally, variation in age, sex, and White versus non-White race did not affect posting frequency. Conclusions: For young people with psychosis spectrum disorders, there appears to be no “technology gap” limiting the implementation of digital and mobile health interventions. Active posting to social media was reduced for individuals with psychosis, which may be related to negative symptoms or impairment in social functioning. %M 35802420 %R 10.2196/30230 %U https://formative.jmir.org/2022/7/e30230 %U https://doi.org/10.2196/30230 %U http://www.ncbi.nlm.nih.gov/pubmed/35802420 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38684 %T Smartphone Ownership, Smartphone Utilization, and Interest in Using Mental Health Apps to Address Substance Use Disorders: Literature Review and Cross-sectional Survey Study Across Two Sites %A Hsu,Michael %A Martin,Bianca %A Ahmed,Saeed %A Torous,John %A Suzuki,Joji %+ Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 617 732 6753, mhsu24@emory.edu %K smartphone %K mobile phone %K addiction %K substance use %K phone ownership %K health equity %K digital psychiatry %K digital phenotyping %K phone applications %K substance abuse %K mHealth %K phone utilization %K mental health %K mindfulness %K digital mental health %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, there has been increasing interest in implementing digital technologies to diagnose, monitor, and intervene in substance use disorders. Smartphones are now a vehicle for facilitating telepsychiatry visits, measuring health metrics, and communicating with health care professionals. In light of the COVID-19 pandemic and the movement toward web-based and hybrid clinic visits and meetings, it has become especially salient to assess phone ownership among individuals with substance use disorders and their comfort in navigating phone functionality and using phones for mental health purposes. Objective: The aims of this study were to summarize the current literature around smartphone ownership, smartphone utilization, and the acceptability of using smartphones for mental health purposes and assess these variables across two disparate substance use treatment sites. Methods: We performed a focused literature review via a search of two academic databases (PubMed and Google Scholar) for publications since 2007 on the topics of smartphone ownership, smartphone utilization, and the acceptability of using mobile apps for mental health purposes among the substance use population. Additionally, we conducted a cross-sectional survey study that included 51 participants across two sites in New England—an inpatient detoxification unit that predominantly treats patients with alcohol use disorder and an outpatient methadone maintenance treatment clinic. Results: Prior studies indicated that mobile phone ownership among the substance use population between 2013 and 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94%. The results from our study across the two sites indicated 96% (49/51) mobile phone ownership and 92% (47/51) smartphone ownership among the substance use population. Although most (43/49, 88%) patients across both sites reported currently using apps on their phone, a minority (19/48, 40%) reported previously using any apps for mental health purposes. More than half of the participants reported feeling at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most patients were concerned about privacy (34/51, 67%) and felt uncomfortable with an app gathering location (29/47, 62%) and social (27/47, 57%) information for health care purposes. Conclusions: The majority of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%), consistent with prior studies. Many respondents felt comfortable with mental health apps gathering most forms of personal information and with communicating with their clinician about their mental health. The differential results from the two sites, namely greater concerns about the cost of mental health apps among the methadone maintenance treatment cohort and less experience with downloading apps among the older inpatient detoxification cohort, may indicate that clinicians should tailor technological interventions based on local demographics and practice sites and that there is likely not a one-size-fits-all digital psychiatry solution. %M 35797102 %R 10.2196/38684 %U https://formative.jmir.org/2022/7/e38684 %U https://doi.org/10.2196/38684 %U http://www.ncbi.nlm.nih.gov/pubmed/35797102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36869 %T Exploring Users’ Experiences With a Quick-Response Chatbot Within a Popular Smoking Cessation Smartphone App: Semistructured Interview Study %A Alphonse,Alice %A Stewart,Kezia %A Brown,Jamie %A Perski,Olga %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 0207679 ext 1258, olga.perski@ucl.ac.uk %K chatbot %K conversational agent %K engagement %K smartphone app %K smoking cessation %K accountability %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with smartphone apps for smoking cessation tends to be low. Chatbots (ie, software that enables conversations with users) offer a promising means of increasing engagement. Objective: We aimed to explore smokers’ experiences with a quick-response chatbot (Quit Coach) implemented within a popular smoking cessation app and identify factors that influence users’ engagement with Quit Coach. Methods: In-depth, one-to-one, semistructured qualitative interviews were conducted with adult, past-year smokers who had voluntarily used Quit Coach in a recent smoking cessation attempt (5/14, 36%) and current smokers who agreed to download and use Quit Coach for a minimum of 2 weeks to support a new cessation attempt (9/14, 64%). Verbal reports were audio recorded, transcribed verbatim, and analyzed within a constructivist theoretical framework using inductive thematic analysis. Results: A total of 3 high-order themes were generated to capture users’ experiences and engagement with Quit Coach: anthropomorphism of and accountability to Quit Coach (ie, users ascribing human-like characteristics and thoughts to the chatbot, which helped foster a sense of accountability to it), Quit Coach’s interaction style and format (eg, positive and motivational tone of voice and quick and easy-to-complete check-ins), and users’ perceived need for support (ie, chatbot engagement was motivated by seeking distraction from cravings or support to maintain motivation to stay quit). Conclusions: Anthropomorphism of a quick-response chatbot implemented within a popular smoking cessation app appeared to be enabled by its interaction style and format and users’ perceived need for support, which may have given rise to feelings of accountability and increased engagement. %M 35797093 %R 10.2196/36869 %U https://formative.jmir.org/2022/7/e36869 %U https://doi.org/10.2196/36869 %U http://www.ncbi.nlm.nih.gov/pubmed/35797093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e32593 %T A German Smartphone-Based Self-management Tool for Psoriasis: Community-Driven Development and Evaluation of Quality-of-Life Effects %A Brandl,Lea C %A Liebram,Claudia %A Schramm,Wendelin %A Pobiruchin,Monika %+ Institute of Telematics, University of Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany, 49 451 3101 6401, brandl@itm.uni-luebeck.de %K psoriasis %K self-management %K mobile apps %K quality of life %K mobile phones %K smartphones %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Psoriasis is a chronic disease characterized by inflammation, increased scaling, itching, and other symptoms. Psoriasis is not contagious, but patients have often felt shunned. Therefore, in addition to psoriasis symptoms, stress, anxiety, and depression can also affect quality of life (QoL). Surveys show that only a quarter of patients are satisfied with the success of their therapy. However, in addition to medical therapy, self-management can also make it easier to deal with chronic diseases like psoriasis. Objective: The aim of this project was to develop a smartphone-based self-management tool (SMT) specifically for patients with psoriasis using a community-driven process. The impact of the SMT on QoL as well as its acceptance and usability were evaluated. Methods: In collaboration with an internet-based self-help community, 2 user surveys were conducted to determine the requirements for a smartphone-based SMT. The surveys consisted of semistructured questionnaires asking for desired features in an SMT for psoriasis. A pilot study was conducted to evaluate QoL, acceptance, and usability. Community users were recruited to use the app for 21 days and complete the Dermatology Life Quality Index (DLQI) questionnaire at the beginning (T0) and end (T1). Afterward, participants were asked to complete another questionnaire on usability and ease of use. Results: SMT requirements were collected from 97 members of an internet-based community. The SMT was built as a progressive web app that communicates with a server back end and an Angular web app for content management. The app was used by 15 participants who also provided qualitative feedback, and 10 participants answered all questionnaires. The average DLQI score was 7.1 (SD 6.2) at T0 and 6.9 (SD 6.6) at T1. The minimal required sample size of 27 was not reached. Conclusions: The high degree of community participation in the development process and the responses during the requirement engineering process indicated that there is a general need for an independently developed SMT for patients with psoriasis. However, the feedback received after app use shows that the SMT does not meet the needs of the community. It can be concluded that a more customizable app is needed. The focus and needs of the users were very heterogeneous. Similar developments and research could benefit from the findings of this project. %M 35797109 %R 10.2196/32593 %U https://formative.jmir.org/2022/7/e32593 %U https://doi.org/10.2196/32593 %U http://www.ncbi.nlm.nih.gov/pubmed/35797109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e32103 %T Perspectives of Patients and Therapists on Social Media and Digital Data Use in Mental Health Therapy: Thematic Analysis %A Southwick,Lauren %A Suh,Rebecca %A Kranzler,Elissa %A Bradley,Megan %A Merchant,Raina M %+ University of Pennsylvania, 3600 Civic Center Blvd, Philadelphia, PA, 19014, United States, 1 9145826995, lauren.southwick@pennmedicine.upenn.edu %K social media %K digital health %K digital data %K mental health therapy %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Incorporating insights from social media into the patient-provider encounter is increasingly being explored in health care settings. Less is known about the utility of these data in mental health therapy. Objective: This study aims to prospectively investigate and characterize how social media and digital data are used in mental health therapy from both the patient and mental health therapist perspective. Methods: Patients enrolled in mental health therapy and mental health therapists were interviewed using a semistructured interview guide. All interviews were transcribed and coded using a deductive framework analysis. Themes and subthemes were identified. Participants completed a sociodemographic survey, while mental health therapists also completed a behavioral norms and elicitation survey. Results: Seventeen participants, that is, 8 (48%) mental health therapists and 9 (52%) patients were interviewed. Overall, participants identified 4 themes and 9 subthemes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most subthemes were related to the advantages and disadvantages of incorporating digital data in mental health therapy. Advantage subthemes included convenience, objective, builds rapport, and user-friendliness while disadvantage subthemes were nonreflective, ethically ambiguous, and nongeneralizable. The mental health therapists' behavioral norms and elicitation survey found that injunctive and descriptive normative beliefs mapped onto 2 advantage subthemes: convenience and objectivity. Conclusions: This qualitative pilot study established the advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and are comfortable to use and discuss social media and digital data in mental health therapy. %M 35797103 %R 10.2196/32103 %U https://formative.jmir.org/2022/7/e32103 %U https://doi.org/10.2196/32103 %U http://www.ncbi.nlm.nih.gov/pubmed/35797103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37933 %T Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Li,Rongying %A Qian,Xiaobo %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, Number 9, Seyuan Road, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K mHealth app %K usability %K Chinese version of MAUQ %K improved translation %K validity %K stability %K reliability %K cross-cultural adaptability %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular “reaching out to patients” interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential “reaching out to patients” mHealth apps without chatbot function in China. After asking for the researchers’ approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference–induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach α=.988), and validity (Kaiser–Meyer–Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80% of informants’ positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users’ age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. %M 35793132 %R 10.2196/37933 %U https://formative.jmir.org/2022/7/e37933 %U https://doi.org/10.2196/37933 %U http://www.ncbi.nlm.nih.gov/pubmed/35793132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37301 %T Experimental Implementation of NSER Mobile App for Efficient Real-Time Sharing of Prehospital Patient Information With Emergency Departments: Interrupted Time-Series Analysis %A Fukaguchi,Kiyomitsu %A Goto,Tadahiro %A Yamamoto,Tadatsugu %A Yamagami,Hiroshi %+ Department of Emergency Medicine, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura-shi, Kanagawa, 247-0072, Japan, 81 467 46 1717, fukaskgh@gmail.com %K emergency department %K emergency medical services %K mobile apps %K interrupted time series analysis %K emergency %K patient record %K implementation %K patient care %K app %K implement %K medical informatics %K clinical informatics %K decision support %K electronic health record %K eHealth %K digital health %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources. Objective: In this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time). Methods: We performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests. Results: During the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; −45 seconds; 95% CI −71 to −18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI −2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED. Conclusions: The implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use. %M 35793142 %R 10.2196/37301 %U https://formative.jmir.org/2022/7/e37301 %U https://doi.org/10.2196/37301 %U http://www.ncbi.nlm.nih.gov/pubmed/35793142 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37291 %T Optimization of the Chronic Kidney Disease–Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study %A Lukkanalikitkul,Eakalak %A Kongpetch,Sawinee %A Chotmongkol,Wijittra %A Morley,Michael G %A Anutrakulchai,Sirirat %A Srichan,Chavis %A Thinkhamrop,Bandit %A Chunghom,Theenatchar %A Wiangnon,Pongsai %A Thinkhamrop,Wilaiphorn %A Morley,Katharine E %+ Massachusetts General Hospital Center for Global Health, Harvard Medical School, 125 Nashua St. Suite 722, Boston, MA, 02114, United States, 1 617 726 2000, kemorley@mgh.harvard.edu %K peritoneal %K dialysis %K peritoneum %K mobile health %K mHealth %K rapid cycle process improvement methodology %K home monitoring %K near-field communication %K monitor %K kidney %K rapid cycle improvement %K quality improvement %K process improvement %K methodology %K nephrology %K nephrologist %K internal medicine %K computer program %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K usability %K interface %K metric capture %K barrier %K renal %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective: This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods: A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results: The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions: Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding. %M 35793137 %R 10.2196/37291 %U https://formative.jmir.org/2022/7/e37291 %U https://doi.org/10.2196/37291 %U http://www.ncbi.nlm.nih.gov/pubmed/35793137 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38005 %T Improvements in Depression Outcomes Following a Digital Cognitive Behavioral Therapy Intervention in a Polychronic Population: Retrospective Study %A Venkatesan,Aarathi %A Forster,Benjamin %A Rao,Prasanna %A Miller,Melissa %A Scahill,Michael %+ Vida Health, 100 Montgomery St, Ste 750, San Francisco, CA, 94104, United States, 1 14159891017, aarathi.venkatesan@vida.com %K depression %K anxiety %K CBT %K digital mental health intervention %K cognitive behavioral therapy %K digital health %K obesity %K diabetes %K mental health %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions have shown promise in reducing barriers to effective care for depression. Depression and related mental disorders are known to be highly comorbid with common chronic physical conditions, such as obesity and type 2 diabetes. While some research has explored the interaction dynamics of treating populations living with both mental and physical disorders, very little is known about such dynamics in digital care. Objective: We aimed to examine the effectiveness of a 12-week, therapist-supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety. The studied population included adults with a heavy burden of chronic physical disease, including obesity and type 2 diabetes. Methods: A total of 1512 participants with at least moderate depression were enrolled. The treatment cohort consisted of 831 (54.96%) participants who completed a follow-up assessment. The program included structured lessons and tools (ie, exercises and practices) and offered one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly sessions thereafter. The clinically validated 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. Given correlation among various measures of program usage, a composite variable for depth of usage was used to analyze the correlation between usage and changes in depressive symptoms. Body weight changes from baseline were assessed primarily with digitally connected scales. Results: Out of 831 participants in the treatment cohort, 74.5% (n=619) showed a clinically significant reduction in depressive symptom severity after 12 weeks, where follow-up PHQ-8 scores had shifted downward by at least one diagnostic category. In total, 67.5% (n=561) of the participants showed a reliable improvement in PHQ-8 scores as measured by the reliable change index. There was an average reduction of 5.9 (SD 5.2) points (P<.001) between baseline and follow-up. Greater program usage was correlated with greater likelihood of reliable improvement in depressive symptoms (odds ratio 1.3, 95% CI 1.1-1.5; P=.002). An exploratory analysis of body weight changes with a multilevel, mixed-effect model suggested that reliable improvement in depressive symptoms at follow-up was associated with significantly greater weight loss at 9 months (β=–1.11, P=.002). Conclusions: The results provide further support that digital interventions can support clinically meaningful improvements in depression. Some form of synergy in treatment of comorbid depression and obesity or diabetes could be studied in future research. The study was limited by postintervention participant attrition as well as the retrospective observational study design. %M 35788442 %R 10.2196/38005 %U https://formative.jmir.org/2022/7/e38005 %U https://doi.org/10.2196/38005 %U http://www.ncbi.nlm.nih.gov/pubmed/35788442 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e29725 %T Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis %A Hardy,Amy %A Ward,Thomas %A Emsley,Richard %A Greenwood,Kathryn %A Freeman,Daniel %A Fowler,David %A Kuipers,Elizabeth %A Bebbington,Paul %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K paranoia %K psychosis %K digital health %K apps %K human-centered design %K user experience %K adherence %K engagement %K therapy %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 %M 35776506 %R 10.2196/29725 %U https://humanfactors.jmir.org/2022/3/e29725 %U https://doi.org/10.2196/29725 %U http://www.ncbi.nlm.nih.gov/pubmed/35776506 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37456 %T Exploring a Need for a Cardiometabolic Disease Staging System as a Computerized Clinical Decision Support Tool: Qualitative Study %A Karabukayeva,Aizhan %A Anderson,Jami L %A Hall,Allyson G %A Feldman,Sue S %A Mehta,Tapan %+ Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1716 9th Avenue South, Birmingham, AL, 35294, United States, 1 2055155146, ak1984@uab.edu %K cardiometabolic disease staging system %K risk assessment %K cardiometabolic disease %K clinical decision support system %K primary care %K obesity %K overweight %K medical management %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although cardiometabolic diseases are leading causes of morbidity and mortality in the United States, computerized tools for risk assessment of cardiometabolic disease are rarely integral components of primary care practice. Embedding cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) may assist with identifying and treating patients at greatest risk for developing cardiometabolic disease. Objective: This study aimed to explore the current approach to medical management of obesity and the need for CMDS designed to aid medical management of people living with obesity, at risk of being obese, or diabetic at the point of care. Methods: Using a general inductive approach, this qualitative research study was guided by an interpretive epistemology. The method included semistructured, in-depth interviews with primary care providers (PCPs) from university-based community health clinics. The literature informed the interview protocol and included questions on PCPs’ experiences and the need for a tool to improve their ability to manage and prevent complications from overweight and obesity. Results: PCPs (N=10) described their current approaches and emphasized behavioral treatments consisting of combined diet, physical activity, and behavior therapy as the first line of treatment for people who were overweight or obese. Results suggest that beneficial features of CDSS include (1) clinically relevant and customizable support, (2) provision of a comprehensive medical summary with trends, (3) availability of patient education materials and community resources, and (4) simplicity and ease of navigation. Conclusions: Implementation of a CMDS via a CDSS could enable PCPs to conduct comprehensive cardiometabolic disease risk assessments, supporting clinical management of overweight, obesity, and diabetes. Results from this study provide unique insights to developers and researchers by identifying areas for design optimization, improved end user experience, and successful adoption of the CDSS. %M 35776499 %R 10.2196/37456 %U https://formative.jmir.org/2022/7/e37456 %U https://doi.org/10.2196/37456 %U http://www.ncbi.nlm.nih.gov/pubmed/35776499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36021 %T An mHealth Platform for Augmenting Behavioral Health in Primary Care: Longitudinal Feasibility Study %A Moon,Khatiya Chelidze %A Sobolev,Michael %A Grella,Megan %A Alvarado,George %A Sapra,Manish %A Ball,Trever %+ Zucker Hillside Hospital, Kaufmann Building, Suite k204, 75-59 263rd Street, Glen Oaks, NY, 11004, United States, 1 7184704367, kmoon2@northwell.edu %K collaborative care %K mobile health %K psychiatry %K depression %K virtual care %K psychoeducation %K mobile app %K mobile phone %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The collaborative care model is a well-established system of behavioral health care within primary care settings. There is potential for mobile health (mHealth) technology to augment collaborative behavioral health care in primary care settings, thereby improving scalability, efficiency, and clinical outcomes. Objective: We aimed to assess the feasibility of engaging with and the preliminary clinical outcomes of an mHealth platform that was used to augment an existing collaborative care program in primary care settings. Methods: We performed a longitudinal, single-arm feasibility study of an mHealth platform that was used to augment collaborative care. A total of 3 behavioral health care managers, who were responsible for coordinating disease management in 6 primary care practices, encouraged participants to use a mobile app to augment the collaborative model of behavioral health care. The mHealth platform’s functions included asynchronous chats with the behavioral health care managers, depression self-report assessments, and psychoeducational content. The primary outcome was the feasibility of engagement, which was based on the number and type of participant-generated actions that were completed in the app. The primary clinical end point was a comparison of the baseline and final assessments of the Patient Health Questionnaire-9. Results: Of the 245 individuals who were referred by their primary care provider for behavioral health services, 89 (36.3%) consented to app-augmented behavioral health care. Only 12% (11/89) never engaged with the app during the study period. Across all participants, we observed a median engagement of 7 (IQR 12; mean 10.4; range 0-130) actions in the app (participants: n=78). The chat function was the most popular, followed by psychoeducational content and assessments. The subgroup analysis revealed no significant differences in app usage by age (P=.42) or sex (P=.84). The clinical improvement rate in our sample was 73% (32/44), although follow-up assessments were only available for 49% (44/89) of participants. Conclusions: Our preliminary findings indicate the moderate feasibility of using mHealth technology to augment behavioral health care in primary care settings. The results of this study are applicable to improving the design and implementation of mobile apps in collaborative care. %M 35776491 %R 10.2196/36021 %U https://formative.jmir.org/2022/7/e36021 %U https://doi.org/10.2196/36021 %U http://www.ncbi.nlm.nih.gov/pubmed/35776491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36091 %T Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study %A Jiang,Nan %A Rogers,Erin S %A Cupertino,Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Lyu,Joanne Chen %A Hu,Lu %A Sherman,Scott E %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Rm #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mobile health %K Chinese American %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. %M 35771603 %R 10.2196/36091 %U https://formative.jmir.org/2022/6/e36091 %U https://doi.org/10.2196/36091 %U http://www.ncbi.nlm.nih.gov/pubmed/35771603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33813 %T Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial %A Stoeten,Claudia %A de Haan,Hein Arnoud %A Postel,Marloes Gerda %A Brusse-Keizer,Marjolein %A ter Huurne,Elke Daniëlle %+ Tactus Addiction Care, Keulenstraat 3, 7418 ET, Deventer, 7400 AD, Netherlands, 31 883822887, h.dehaan@tactus.nl %K therapeutic alliance %K TA %K treatment completion %K cognitive behavioral therapy %K CBT %K web-CBT %K eating disorders %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists. Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion. Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion. Results: For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion. %M 35771608 %R 10.2196/33813 %U https://formative.jmir.org/2022/6/e33813 %U https://doi.org/10.2196/33813 %U http://www.ncbi.nlm.nih.gov/pubmed/35771608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32219 %T Experiences of Community Members Engaged in eCPR (Emotional Connecting, Empowering, Revitalizing) Training: Qualitative Focus Group Study %A Myers,Amanda L %A Mbao,Mbita %A Kadakia,Arya %A Collings,Shira %A Fortuna,Karen L %+ Heller School, Brandeis University, 415 South Street, Waltham, MA, 02453, United States, 1 6038090845, amanda@digitalpeersupport.org %K mental health %K trauma %K peer support %K community mental health education %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The United Nations has called for wide-scale community mental health psychoeducation; however, few programs currently exist. Emotional Connecting, Empowering, Revitalizing (eCPR) is a community education and training program developed by individuals with a lived experience of mental health challenges or trauma. It is designed to provide community members with skills and confidence to support someone experiencing mental health challenges. Objective: This qualitative study aimed to examine the user experiences of diverse community members engaged in eCPR training. This study reviewed their attitudes toward training and opportunities for improvement in future implementations of training. Methods: eCPR training participants (N=31) were invited to participate in virtual focus groups between June 2020 and July 2020. Data were analyzed using the rigorous and accelerated data reduction method, which converts raw textual data into concise data tables to develop a codebook, and thematic analysis was performed to identify common themes. Results: The themes identified when analyzing the data included emotional holding and containment, training feedback, principles and practices of eCPR, implementation, connection in a digital environment, skills practice, and shared experiences. Conclusions: eCPR may benefit individuals from multiple, diverse demographics. It can enhance their ability to connect with others to understand what it means to be with someone who is experiencing a mental health challenge or crisis, to accept their own emotions, and to be confident in being their most authentic self in both their work and personal lives. eCPR may answer the call of the United Nations by bringing opportunities for authenticity and healing to community settings. Exploring the effects of delivering eCPR in communities on individuals experiencing distress is an important next step. This study found that eCPR may be beneficial to many groups of trainees with varying backgrounds and experiences. These findings are important, as they speak to the potential for eCPR to be implemented in a variety of community settings with the intention of working to improve mental health in everyday settings. %M 35771610 %R 10.2196/32219 %U https://formative.jmir.org/2022/6/e32219 %U https://doi.org/10.2196/32219 %U http://www.ncbi.nlm.nih.gov/pubmed/35771610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36870 %T Monitoring and Managing Lifestyle Behaviors Using Wearable Activity Trackers: Mixed Methods Study of Views From the Huntington Disease Community %A Morgan-Jones,Philippa %A Jones,Annabel %A Busse,Monica %A Mills,Laura %A Pallmann,Philip %A Drew,Cheney %A Arnesen,Astri %A Wood,Fiona %A , %+ Division of Population Medicine, Cardiff University, 8th floor, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, CF14 4YS, United Kingdom, 44 2920687185, wood@cardiff.ac.uk %K Huntington disease %K activity tracker %K perceptions %K digital technologies %K physical activity %K qualitative research %K survey %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are early indications that lifestyle behaviors, specifically physical activity and sleep, may be associated with the onset and progression of Huntington disease (HD). Wearable activity trackers offer an exciting opportunity to collect long-term activity data to further investigate the role of lifestyle, physical activity, and sleep in disease modification. Given how wearable devices rely on user acceptance and long-term adoption, it is important to understand users’ perspectives on how acceptable any device might be and how users might engage over the longer term. Objective: This study aimed to explore the perceptions, motivators, and potential barriers relating to the adoption of wearable activity trackers by people with HD for monitoring and managing their lifestyle and sleep. This information intended to guide the selection of wearable activity trackers for use in a longitudinal observational clinical study. Methods: We conducted a mixed methods study; this allowed us to draw on the potential strengths of both quantitative and qualitative methods. Opportunistic participant recruitment occurred at 4 Huntington’s Disease Association meetings, including 1 international meeting and 3 United Kingdom–based regional meetings. Individuals with HD, their family members, and carers were invited to complete a user acceptance questionnaire and participate in a focus group discussion. The questionnaire consisted of 35 items across 8 domains using a 0 to 4 Likert scale, along with some additional demographic questions. Average questionnaire responses were recorded as positive (score>2.5), negative (score<1.5), or neutral (score between 1.5 and 2.5) opinions for each domain. Differences owing to demographics were explored using the Kruskal-Wallis and Wilcoxon rank sum tests. Focus group discussions (conducted in English) were driven by a topic guide, a vignette scenario, and an item ranking exercise. The discussions were audio recorded and then analyzed using thematic analysis. Results: A total of 105 completed questionnaires were analyzed (47 people with HD and 58 family members or carers). All sections of the questionnaire produced median scores >2.5, indicating a tendency toward positive opinions on wearable activity trackers, such as the devices being advantageous, easy and enjoyable to use, and compatible with lifestyle and users being able to understand the information from trackers and willing to wear them. People with HD reported a more positive attitude toward wearable activity trackers than their family members or caregivers (P=.02). A total of 15 participants participated in 3 focus groups. Device compatibility and accuracy, data security, impact on relationships, and the ability to monitor and self-manage lifestyle behaviors have emerged as important considerations in device use and user preferences. Conclusions: Although wearable activity trackers were broadly recognized as acceptable for both monitoring and management, various aspects of device design and functionality must be considered to promote acceptance in this clinical cohort. %M 35767346 %R 10.2196/36870 %U https://formative.jmir.org/2022/6/e36870 %U https://doi.org/10.2196/36870 %U http://www.ncbi.nlm.nih.gov/pubmed/35767346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e26196 %T Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study %A Nogueira,Mª Nilza %A Silva,Joana %A Nogueira,Isabel %A Pacheco,Maria Neto %A Lopes,Joana %A Araújo,Fátima %+ Escola Superior de Enfermagem do Porto, Centro de Investigação em Tecnologias e Serviços de Saúde, Escola Superior de Enfermagem do Porto, Porto, 4200-072, Portugal, 351 225 073 500, nilza@esenf.pt %K functional tests %K fall assessment %K exercices %K older adults: games %K technology %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools. Objective: The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting. Methods: This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed. Results: A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors. Conclusions: In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results. %M 35767321 %R 10.2196/26196 %U https://formative.jmir.org/2022/6/e26196 %U https://doi.org/10.2196/26196 %U http://www.ncbi.nlm.nih.gov/pubmed/35767321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34424 %T Feasibility and Acceptability of a Ugandan Telehealth Engagement Platform for Informational Messaging on Modern Contraception: Pilot Cross-sectional Study %A Kamulegeya,Louis Henry %A Bwanika,JohnMark %A Banonya,Joy %A Atuhaire,Joan %A Musinguzi,Davis %A Nakate,Vivian %A Kyenkya,Joshua %A Namatende,Lydia %A Horvath,Keith J %A Kiragga,Agnes %+ The Medical Concierge Group, Projects and Research Department, Lugogo Bypass, Mirembe Business Center, Kampala, 256, Uganda, 256 783216066, louis@tmcg.co.ug %K telehealth %K mHealth %K digital health %K family planning %K contraception %K messaging %K male involvement %K health education %K Uganda %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the region’s highest population growth rate (30%), Uganda is on the brink of a population explosion, yet access to and utilization of public health control measures like modern contraception is a challenge. This is due to remotely located health facilities, noncustomized health content, and poor or nonfunctional post-facility follow-up. Objective: The aim of our study was to evaluate the feasibility and acceptability of a telehealth engagement platform primarily targeting men; the platform provided behavioral and informational messaging on modern contraception (ie, family planning) and its impact on shaping sexual and reproductive health and knowledge and uptake of family planning services. Methods: A longitudinal cohort of men aged 18 years and older gave consent to receive mobile phone messages on family planning; follow-up was performed at months 1, 4, and 6 to assess key study-related outcomes on knowledge transfer and acquisition on modern contraception, partner communication, and spousal uptake of family planning. Qualitative interviews with the study participants’ spouses were also performed. Results: The study included 551 study participants, 450 of whom were men, the primary study participants, who received the family planning mobile messages and 101 of whom were their spouses. Of the 450 primary participants, 426 (95%) successfully received the messages and only 24 (5%) reported not receiving them. The average response (ie, participation) rate in weekly quizzes was 23%. There was a noted 18.1% increase in couple communication attributed to the intervention; couples opened up more to each other on matters concerning family planning. Conclusions: Using digital channels to address the concerns and inquiries of participants in real time or as fast as possible helped to increase the likelihood that couples adopted family planning. %M 35763336 %R 10.2196/34424 %U https://formative.jmir.org/2022/6/e34424 %U https://doi.org/10.2196/34424 %U http://www.ncbi.nlm.nih.gov/pubmed/35763336 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e24903 %T Encouraging Hearing Loss Prevention in Music Listeners Using Personalized Technology: Questionnaire Study %A Zhu,Dylan Tianyu %+ Blair Academy, 2 Park St., Blairstown, NJ, 07825, United States, 1 9089777453, dylan.zhu.research@gmail.com %K mHealth %K mobile health %K prevention %K NIHL %K noise induced hearing loss %K MIHL %K music induced hearing loss %K intervention %K wearable device %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Noise-induced hearing loss (NIHL) affects millions of people despite being almost completely preventable. For recreational music listening through personal listening equipment (such as earbuds), it seems that listeners do not yet have a way to accurately assess their risk of developing hearing loss and prevent it accordingly. Objective: The aim of this study is to analyze the perceived utility of a hypothetical device that encourages NIHL prevention based on listeners’ exposure to noise and to determine the most effective methods of such encouragement. Here, we describe 3 different potential NIHL risk notification method types, as follows: auditory, external visual, and visual. Methods: An open, web-based survey was created on Google Forms, and the link was posted to Amazon’s Mechanical Turk as well as music-related Reddit communities. The survey was designed to gauge each respondent’s self-assessed NIHL awareness, willingness to lower their audio if reminded, and NIHL risk notification type preference. The likelihood of a specific notification type to encourage NIHL prevention among its users was based on the average of each user’s responses to 2 survey questions. Data collection started on July 13, 2020, and ended on July 17, 2020. Results: Of the 116 respondents, 92 (79.3%) reported having prior awareness about NIHL; however, 60 (51.7%) described doing nothing to prevent it despite 96 (82.8%) feeling a moderate, high, or extreme risk of developing NIHL. Of those who already prevented NIHL, 96% (53.5/56) described using estimates to guide their prevention instead of using data. A Kruskal-Wallis test corrected for ties showed that despite the visual NIHL risk notification type being selected by the highest number of participants (84/116, 72.4%), the auditory type had a significantly higher (H1=6.848; P=.03) average percentage likelihood of encouraging NIHL prevention (62%, SD 24%) among the 40 respondents who chose it, with a median likelihood of 56% (95% CI 50%-75%). The visual type’s average likelihood was 50% (SD 28.1%), with a median of 50% (95% CI 37.5%-56.3%). Regardless of the NIHL risk notification type, 69% (80/116) of respondents were not opposed to using NIHL risk notifications and lowering their audio volume accordingly. Conclusions: The hypothetical device detailed here was thought to be useful because most respondents (82.8%, 96/116) felt an extreme to moderate risk of developing NIHL and such a device could provide accurate data to those who currently use estimates to prevent NIHL, and most respondents were willing to act on NIHL risk notifications. The most effective NIHL risk notification type seemed to be the auditory type, but many aspects of this study need further research to determine which implementation method should reach the public. %M 35759318 %R 10.2196/24903 %U https://formative.jmir.org/2022/6/e24903 %U https://doi.org/10.2196/24903 %U http://www.ncbi.nlm.nih.gov/pubmed/35759318 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36687 %T Quantification of Digital Body Maps for Pain: Development and Application of an Algorithm for Generating Pain Frequency Maps %A Dixit,Abhishek %A Lee,Michael %+ Division of Anaesthesia, Department of Medicine, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 1223217 ext 889, ad825@cam.ac.uk %K Scalable Vector Graphics %K SVG %K pain drawing %K pain location %K Body Pain Map %K overlap computation %K heat map %K pain frequency map %K algorithm %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain is an unpleasant sensation that signals potential or actual bodily injury. The locations of bodily pain can be communicated and recorded by freehand drawing on 2D or 3D (manikin) surface maps. Freehand pain drawings are often part of validated pain questionnaires (eg, the Brief Pain Inventory) and use 2D templates with undemarcated body outlines. The simultaneous analysis of drawings allows the generation of pain frequency maps that are clinically useful for identifying areas of common pain in a disease. The grid-based approach (dividing a template into cells) allows easy generation of pain frequency maps, but the grid’s granularity influences data capture accuracy and end-user usability. The grid-free templates circumvent the problem related to grid creation and selection and provide an unbiased basis for drawings that most resemble paper drawings. However, the precise capture of drawn areas poses considerable challenges in producing pain frequency maps. While web-based applications and mobile-based apps for freehand digital drawings are widely available, tools for generating pain frequency maps from grid-free drawings are lacking. Objective: We sought to provide an algorithm that can process any number of freehand drawings on any grid-free 2D body template to generate a pain frequency map. We envisage the use of the algorithm in clinical or research settings to facilitate fine-grain comparisons of human pain anatomy between disease diagnosis or disorders or as an outcome metric to guide monitoring or discovery of treatments. Methods: We designed a web-based tool to capture freehand pain drawings using a grid-free 2D body template. Each drawing consisted of overlapping rectangles (Scalable Vector Graphics elements) created by scribbling in the same area of the body template. An algorithm was developed and implemented in Python to compute the overlap of rectangles and generate a pain frequency map. The utility of the algorithm was demonstrated on drawings obtained from 2 clinical data sets, one of which was a clinical drug trial (ISRCTN68734605). We also used simulated data sets of overlapping rectangles to evaluate the performance of the algorithm. Results: The algorithm produced nonoverlapping rectangles representing unique locations on the body template. Each rectangle carries an overlap frequency that denotes the number of participants with pain at that location. When transformed into an HTML file, the output is feasibly rendered as a pain frequency map on web browsers. The layout (vertical-horizontal) of the output rectangles can be specified based on the dimensions of the body regions. The output can also be exported to a CSV file for further analysis. Conclusions: Although further validation in much larger clinical data sets is required, the algorithm in its current form allows for the generation of pain frequency maps from any number of freehand drawings on any 2D body template. %M 35749160 %R 10.2196/36687 %U https://formative.jmir.org/2022/6/e36687 %U https://doi.org/10.2196/36687 %U http://www.ncbi.nlm.nih.gov/pubmed/35749160 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33834 %T Identifying Patients With Delirium Based on Unstructured Clinical Notes: Observational Study %A Ge,Wendong %A Alabsi,Haitham %A Jain,Aayushee %A Ye,Elissa %A Sun,Haoqi %A Fernandes,Marta %A Magdamo,Colin %A Tesh,Ryan A %A Collens,Sarah I %A Newhouse,Amy %A MVR Moura,Lidia %A Zafar,Sahar %A Hsu,John %A Akeju,Oluwaseun %A Robbins,Gregory K %A Mukerji,Shibani S %A Das,Sudeshna %A Westover,M Brandon %+ Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, United States, 1 650 862 1154, mwestover@mgh.harvard.edu %K delirium %K electronic health records %K clinical notes %K machine learning %K natural language processing %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Delirium in hospitalized patients is a syndrome of acute brain dysfunction. Diagnostic (International Classification of Diseases [ICD]) codes are often used in studies using electronic health records (EHRs), but they are inaccurate. Objective: We sought to develop a more accurate method using natural language processing (NLP) to detect delirium episodes on the basis of unstructured clinical notes. Methods: We collected 1.5 million notes from >10,000 patients from among 9 hospitals. Seven experts iteratively labeled 200,471 sentences. Using these, we trained three NLP classifiers: Support Vector Machine, Recurrent Neural Networks, and Transformer. Testing was performed using an external data set. We also evaluated associations with delirium billing (ICD) codes, medications, orders for restraints and sitters, direct assessments (Confusion Assessment Method [CAM] scores), and in-hospital mortality. F1 scores, confusion matrices, and areas under the receiver operating characteristic curve (AUCs) were used to compare NLP models. We used the φ coefficient to measure associations with other delirium indicators. Results: The transformer NLP performed best on the following parameters: micro F1=0.978, macro F1=0.918, positive AUC=0.984, and negative AUC=0.992. NLP detections exhibited higher correlations (φ) than ICD codes with deliriogenic medications (0.194 vs 0.073 for ICD codes), restraints and sitter orders (0.358 vs 0.177), mortality (0.216 vs 0.000), and CAM scores (0.256 vs –0.028). Conclusions: Clinical notes are an attractive alternative to ICD codes for EHR delirium studies but require automated methods. Our NLP model detects delirium with high accuracy, similar to manual chart review. Our NLP approach can provide more accurate determination of delirium for large-scale EHR-based studies regarding delirium, quality improvement, and clinical trails. %M 35749214 %R 10.2196/33834 %U https://formative.jmir.org/2022/6/e33834 %U https://doi.org/10.2196/33834 %U http://www.ncbi.nlm.nih.gov/pubmed/35749214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37414 %T Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet: Pilot Acceptability, Feasibility, and Preliminary Results %A Chwyl,Christina %A Wright,Nicholas %A M Turner-McGrievy,Gabrielle %A L Butryn,Meghan %A M Forman,Evan %+ Center for Weight, Eating, and Lifestyle Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA, 19104, United States, 1 267 606 0414, cmc646@drexel.edu %K vegetarian diet %K vegan diet %K overweight %K eHealth %K behavioral intervention %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change. Objective: This open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD. Methods: Over 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks). Results: The intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7%). In all, intention-to-treat analyses revealed that 69% (10.4/15) of the participants lost 5% of their weight (mean –5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met. Conclusions: A pilot digital behavioral weight loss intervention with a non–energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69% and 11.8/15, 79%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life. Trial Registration: ClinicalTrials.gov NCT04892030; https://clinicaltrials.gov/ct2/show/NCT04892030 %M 35737443 %R 10.2196/37414 %U https://formative.jmir.org/2022/6/e37414 %U https://doi.org/10.2196/37414 %U http://www.ncbi.nlm.nih.gov/pubmed/35737443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36931 %T Development of a Head-Mounted Holographic Needle Guidance System for Enhanced Ultrasound-Guided Neuraxial Anesthesia: System Development and Observational Evaluation %A Tanwani,Jaya %A Alam,Fahad %A Matava,Clyde %A Choi,Stephen %A McHardy,Paul %A Singer,Oskar %A Cheong,Geraldine %A Wiegelmann,Julian %+ Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 6100, jayatanwani9@gmail.com %K mixed reality %K virtual reality %K augmented reality %K HoloLens %K holograms %K neuraxial anesthesia %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Neuraxial anesthesia is conventionally performed using a landmark-based technique. Preprocedural ultrasound is often used in challenging clinical scenarios to identify an ideal needle path. The procedure is then carried out by the operator recreating the ultrasound needle path from memory. We suggest that a needle guidance system using the Microsoft HoloLens mixed reality headset, which projects a hologram of the ideal needle path, can assist operators in replicating the correct needle angulation and result in fewer needle passes. Objective: The objective of the study was to develop software for the mixed reality HoloLens headset, which could be used to augment the performance of neuraxial anesthesia, and establish its face validity in lumbar spine phantom models. Methods: We developed an ultrasound transducer marker and software for the HoloLens, which registers the position and angulation of the ultrasound transducer during preprocedural scans. Once an image of a clear path from skin to the intrathecal space is acquired, a hologram of the ideal needle path is projected onto the user’s visual field. The ultrasound probe is removed while the hologram remains in the correct spatial position to visualize the needle trajectory during the procedure as if conducting real-time ultrasound. User testing was performed using a lumbar spine phantom. Results: Preliminary work demonstrates that novice (2 anesthesia residents) and experienced operators (5 attending anesthesiologists) can rapidly learn to use mixed reality holograms to perform neuraxial anesthesia on lumbar spine phantoms. Conclusions: Our study shows promising results for performing neuraxial anesthesia in phantoms using the HoloLens. Although this may have wide-ranging implications for image-guided therapies, further study is required to quantify the accuracy and safety benefit of using holographic guidance. Trial Registration: ClinicalTrials.gov NCT04028284; https://clinicaltrials.gov/ct2/show/NCT04028284 %M 35737430 %R 10.2196/36931 %U https://formative.jmir.org/2022/6/e36931 %U https://doi.org/10.2196/36931 %U http://www.ncbi.nlm.nih.gov/pubmed/35737430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36914 %T Mobile-Based and Self-Service Tool (iPed) to Collect, Manage, and Visualize Pedigree Data: Development Study %A Sun,Chen %A Xu,Jing %A Tao,Junxian %A Dong,Yu %A Chen,Haiyan %A Jia,Zhe %A Ma,Yingnan %A Zhang,Mingming %A Wei,Siyu %A Tang,Guoping %A Lyu,Hongchao %A Jiang,Yongshuai %+ College of Bioinformatics Science and Technology, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China, 86 451 86620941, jiangyongshuai@gmail.com %K pedigree %K pedigree data %K visualization %K self-service %K mobile-based %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pedigree data (family history) are indispensable for genetics studies and the assessment of individuals' disease susceptibility. With the popularity of genetics testing, the collection of pedigree data is becoming more common. However, it can be time-consuming, laborious, and tedious for clinicians to investigate all pedigree data for each patient. A self-service robot could inquire about patients' family history in place of professional clinicians or genetic counselors. Objective: The aim of this study was to develop a mobile-based and self-service tool to collect and visualize pedigree data, not only for professionals but also for those who know little about genetics. Methods: There are 4 main aspects in the iPed construction, including interface building, data processing, data storage, and data visualization. The user interface was built using HTML, JavaScript libraries, and Cascading Style Sheets (version 3; Daniel Eden). Processing of the submitted data is carried out by PHP programming language. MySQL is used to document and manage the pedigree data. PHP calls the R script to accomplish the visualization. Results: iPed is freely available to all users through the iPed website. No software is required to be installed, no pedigree files need to be prepared, and no knowledge of genetics or programs is required. The users can easily complete their pedigree data collection and visualization on their own and through a dialogue with iPed. Meanwhile, iPed provides a database that stores all users’ information. Therefore, when the users need to construct new pedigree trees for other genetic traits or modify the pedigree trees that have already been created, unnecessary duplication of operations can be avoided. Conclusions: iPed is a mobile-based and self-service tool that could be used by both professionals and nonprofessionals at any time and from any place. It reduces the amount of time required to collect, manage, and visualize pedigree data. %M 35737451 %R 10.2196/36914 %U https://formative.jmir.org/2022/6/e36914 %U https://doi.org/10.2196/36914 %U http://www.ncbi.nlm.nih.gov/pubmed/35737451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35797 %T Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study %A Arevalo,Mariana %A Brownstein,Naomi C %A Whiting,Junmin %A Meade,Cathy D %A Gwede,Clement K %A Vadaparampil,Susan T %A Tillery,Kristin J %A Islam,Jessica Y %A Giuliano,Anna R %A Christy,Shannon M %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, United States, 1 813 745 8840, shannon.christy@moffitt.org %K data cleaning %K data management %K data integrity %K quality assessment %K research panel %K web-based survey %K interdisciplinary research %K surveys and questionnaires %K health behavior %K internet %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported. Objective: The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements. Methods: Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators. Results: Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample. Conclusions: Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research. %M 35737436 %R 10.2196/35797 %U https://formative.jmir.org/2022/6/e35797 %U https://doi.org/10.2196/35797 %U http://www.ncbi.nlm.nih.gov/pubmed/35737436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33849 %T Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study %A Al-Mondhiry,Jafar %A D'Ambruoso,Sarah %A Pietras,Christopher %A Strouse,Thomas %A Benzeevi,Dikla %A Arevian,Armen C %A Wells,Kenneth B %+ Division of Medical Oncology, Department of Medicine, University of Southern California, Keck School of Medicine, 1441 Eastlake Ave., NTT 3440, Los Angeles, CA, 90089, United States, 1 717 919 2250, Jafar.AlMondhiry@med.usc.edu %K mobile phone %K mobile apps %K mobile health %K mHealth %K eHealth %K digital health %K palliative care %K quality of life %K survivorship %K patient advocacy %K oncology %K patient-reported outcomes %K PRO %K community-partnered participatory research %K CPPR %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective: This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods: In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results: Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions: The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation. %M 35737441 %R 10.2196/33849 %U https://formative.jmir.org/2022/6/e33849 %U https://doi.org/10.2196/33849 %U http://www.ncbi.nlm.nih.gov/pubmed/35737441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33411 %T Women’s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: User Involvement Study %A Siddhpuria,Shailee %A Breau,Genevieve %A Lackie,Madison E %A Lavery,Brynn M %A Ryan,Deirdre %A Shulman,Barbara %A Kennedy,Andrea L %A Brotto,Lori A %+ Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111 ext 68898, lori.brotto@vch.ca %K postpartum %K depression %K perinatal mental health %K patient engagement %K women’s health %K qualitative %K psychoeducation %K digital tools %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Postpartum depression (PPD) is one of the leading causes of maternal morbidity, affecting up to 18% of Canadian new mothers. Yet, PPD often remains untreated due to numerous barriers in access to care, including location and cost. Development of eHealth interventions in collaboration with patient partners offers an exciting opportunity to fill this care gap and provide effective and affordable care to new parents across British Columbia. Objective: Our aim was to determine the content and design preferences of women previously diagnosed with PPD to inform changes to the development of a web-enabled intervention for education and management of PPD. Methods: Webpage prototypes were created to mimic the web-enabled resource using findings from completed focus group research that assessed what women want in a web-enabled support resource for PPD. A convenience sample of women aged >18 years and previously diagnosed with PPD was recruited. Feedback was collected on the content and design of the prototypes via semistructured interviews and online surveys. Qualitative, inductive analytic, and quantitative methods were used. Results: A total of 9 women (mean age 37.2 years, SD 4.8 years) completed the interview and a majority of the survey. The following 6 themes were identified: (1) inefficacy of text-heavy layouts, (2) highlighting key information, (3) clarity/understandability of the language, (4) finding support groups, (5) validation and immediate help for feelings of isolation, and (6) helpfulness and accessibility of the resource. Each theme identified elements of content or design that were either effective or may be improved upon. Most women (8/9, 89%) favored content relating to foundational knowledge of PPD, such as symptoms and management options. The layout, language, and content were found to be generally easy to understand, clear, trustworthy, and helpful. Conclusions: Six key areas were identified by women previously diagnosed with PPD, as requiring focus in a web-enabled psychoeducation program. Consistent with past research, this study also found that support and enthusiasm for web-enabled programs support PPD management as an adjunct to other evidence-based treatments. %M 35737435 %R 10.2196/33411 %U https://formative.jmir.org/2022/6/e33411 %U https://doi.org/10.2196/33411 %U http://www.ncbi.nlm.nih.gov/pubmed/35737435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32577 %T Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study %A Reid,Hadley Woodruff %A Proeschold-Bell,Rae Jean %A Makarushka,Christina %A Melgar Vega,Katherine Dayllan %A Huchko,Megan %A Jeronimo,Jose %A Vasudevan,Lavanya %+ Department of Family Medicine and Community Health, Duke University, Suite 600, 2200 West Main Street, Durham, NC, 27705, United States, 1 919 613 1423, lavanya.vasudevan@duke.edu %K cervical cancer %K mobile health %K Peru %K colposcopy %K implementation science %K Consolidated Framework for Implementation Research %K CFIR %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective: We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods: We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results: In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions: The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting. %M 35737455 %R 10.2196/32577 %U https://formative.jmir.org/2022/6/e32577 %U https://doi.org/10.2196/32577 %U http://www.ncbi.nlm.nih.gov/pubmed/35737455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38162 %T Digital Screening and Automated Resource Identification System to Address COVID-19–Related Behavioral Health Disparities: Feasibility Study %A Stiles-Shields,Colleen %A Batts,Kathryn R %A Reyes,Karen M %A Archer,Joseph %A Crosby,Sharad %A Draxler,Janel M %A Lennan,Nia %A Held,Philip %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Suite 302, Chicago, IL, 60612, United States, 1 312 942 9998, colleen_stiles-shields@rush.edu %K digital mental health %K underserved %K health disparities %K COVID-19 %K screening %K referral %K mental health %K digital health %K feasibility study %K mobile app %K mHealth %K mobile health %K emotional need %K digital health tool %K health resource %K health care cost %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant’s responses. Methods: Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant’s responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. %M 35696607 %R 10.2196/38162 %U https://formative.jmir.org/2022/6/e38162 %U https://doi.org/10.2196/38162 %U http://www.ncbi.nlm.nih.gov/pubmed/35696607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36521 %T Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study %A Darnell,Doyanne %A Pullmann,Michael D %A Hull,Thomas D %A Chen,Shiyu %A Areán,Patricia %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, United States, 1 206 744 9108, darnelld@uw.edu %K depression %K psychotherapy %K disengagement %K internet %K web-based %K technology-mediated psychotherapy %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a common psychiatric condition with an estimated lifetime prevalence for major depression of 16.6% in the US adult population and is effectively treated through psychotherapy. The widespread availability of the internet and personal devices such as smartphones are changing the landscape of delivery of psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial, and whether having synchronous video-based sessions provides additional benefits to clients above and beyond messaging-based therapy. Objective: This study examined the outcomes associated with the use of a digital platform (Talkspace) for technology-mediated psychotherapy. We examined the duration of client engagement in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and service plan type with time-to-disengagement and trajectories of change in depression scores. Methods: This naturalistic observational study assessed data collected routinely by the platform between January 2016 and January 2018 and examined psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than 4 weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression analysis was used to examine the time until and predictors of disengagement. Changes in depression scores and predictors of change over time were examined using mixed-effects regression. Results: The study included 5890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. At the same time point, 37% of clients had disengaged from the therapy. When combined into a final Cox regression model, those who were more likely to disengage were clients aged 18 to 25 years versus those aged ≥50 years (odds ratio [OR] 0.82, 95% CI 0.74-0.9; P<.001), had higher education (OR 1.14, 95% CI 1.06-1.22; P<.001), had been in therapy before (OR 1.09, 95% CI 1.02-1.17; P=.01), and were living with a partner but unmarried versus single (OR 1.14, 95% CI 1.02-1.27; P=.02). Having a therapist with >10 years of experience was related to lower odds of disengagement (OR 0.87, 95% CI 0.8-0.94; P=.01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an associate’s degree or higher (linear estimate=−0.07, P=.002) and higher intake PHQ-8 scores (estimate=3.73, P<.001). There were no differences based on the plan type. Conclusions: Our findings add to the growing literature showing the benefits of technology-mediated psychotherapy over a relatively brief period (16 weeks). %M 35731563 %R 10.2196/36521 %U https://formative.jmir.org/2022/6/e36521 %U https://doi.org/10.2196/36521 %U http://www.ncbi.nlm.nih.gov/pubmed/35731563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35961 %T Digital Health Apps in the Context of Dementia: Questionnaire Study to Assess the Likelihood of Use Among Physicians %A Schinle,Markus %A Erler,Christina %A Kaliciak,Mayumi %A Milde,Christopher %A Stock,Simon %A Gerdes,Marius %A Stork,Wilhelm %+ Medical Information Technology, Embedded Systems and Sensors Engineering, FZI Research Center for Information Technology, Haid-und-Neu-Str. 10-14, Karlsruhe, 76131, Germany, 49 721 9654 75, schinle@fzi.de %K digital health applications %K likelihood of use %K usability %K adherence %K dementia %K screening %K treatment %K physician %K eHealth %K questionnaire %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Age-related diseases such as dementia are playing an increasingly important role in global population development. Thus, prevention, diagnostics, and interventions require more accessibility, which can be realized through digital health apps. With the app on prescription, Germany made history by being the first country worldwide to offer physicians the possibility to prescribe and reimburse digital health apps as of the end of the year 2020. Objective: Considering the lack of knowledge about correlations with the likelihood of use among physicians, this study aimed to address the question of what makes the use of a digital health app by physicians more likely. Methods: We developed and validated a novel measurement tool—the Digital Health Compliance Questionnaire (DHCQ)—in an interdisciplinary collaboration of experts to assess the role of proposed factors in the likelihood of using a health app. Therefore, a web-based survey was conducted to evaluate the likelihood of using a digital app called DemPredict to screen for Alzheimer dementia. Within this survey, 5 latent dimensions (acceptance, attitude toward technology, technology experience, payment for time of use, and effort of collection), the dependent variable likelihood of use, and answers to exploratory questions were recorded and tested within directed correlations. Following a non–probability-sampling strategy, the study was completed by 331 physicians from Germany in the German language, of whom 301 (90.9%) fulfilled the study criteria (eg, being in regular contact with patients with dementia). These data were analyzed using a range of statistical methods to validate the dimensions of the DHCQ. Results: The DHCQ revealed good test theoretical measures—it showed excellent fit indexes (Tucker-Lewis index=0.98; comparative fit index=0.982; standardized root mean square residual=0.073; root mean square error of approximation=0.037), good internal consistency (Cronbach α=.83), and signs of moderate to large correlations between the DHCQ dimensions and the dependent variable. The correlations between the variables acceptance, attitude toward technology, technology experience, and payment for the time of use and the dependent variable likelihood of use ranged from 0.29 to 0.79, and the correlation between effort of the collection and likelihood of use was −0.80. In addition, we found high levels of skepticism regarding data protection, and the age of the participants was found to be negatively related to their technical experience and attitude toward technology. Conclusions: In the context of the results, increased communication between the medical and technology sectors and significantly more awareness raising are recommended to make the use of digital health apps more attractive to physicians as they can be adjusted to their everyday needs. Further research could explore the connection between areas such as adherence on the patient side and its impact on the likelihood of use by physicians. %M 35731567 %R 10.2196/35961 %U https://formative.jmir.org/2022/6/e35961 %U https://doi.org/10.2196/35961 %U http://www.ncbi.nlm.nih.gov/pubmed/35731567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33929 %T A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial %A Thomas,Tainayah %A Xu,Fei %A Sridhar,Sneha %A Sedgwick,Tali %A Nkemere,Linda %A Badon,Sylvia E %A Quesenberry,Charles %A Ferrara,Assiamira %A Mandel,Sarah %A Brown,Susan D %A Hedderson,Monique %+ Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, United States, 1 3107211208, tainayah@stanford.edu %K mobile health %K gestational weight gain %K obesity %K physical activity %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective: This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods: We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results: Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions: The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration: ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283 %M 35731565 %R 10.2196/33929 %U https://formative.jmir.org/2022/6/e33929 %U https://doi.org/10.2196/33929 %U http://www.ncbi.nlm.nih.gov/pubmed/35731565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32354 %T Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study %A Signorelli,Gabriel Ruiz %A Monteiro-Guerra,Francisco %A Rivera-Romero,Octavio %A Núñez-Benjumea,Francisco J %A Fernández-Luque,Luis %+ Adhera Health, Inc, Circuito II Bldg, Av de los Descubrimientos, s/n, Mairena del Aljarafe - Seville, Palo Alto, CA, United States, 1 656930901, luis@adherahealth.com %K breast cancer %K BC %K mobile app %K physical activity %K mHealth %K acceptability %K user experience %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. Objective: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. Methods: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire–Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. Results: The International Physical Activity Questionnaire–Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. Conclusions: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC. %M 35731554 %R 10.2196/32354 %U https://formative.jmir.org/2022/6/e32354 %U https://doi.org/10.2196/32354 %U http://www.ncbi.nlm.nih.gov/pubmed/35731554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e28013 %T System for Context-Specific Visualization of Clinical Practice Guidelines (GuLiNav): Concept and Software Implementation %A Fortmann,Jonas %A Lutz,Marlene %A Spreckelsen,Cord %+ Institute of Medical Informatics, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen University, Pauwelsstrasse 30, Aachen, 52074, Germany, 49 024 1808 0260, jonas.fortmann@rwth-aachen.de %K clinical practice guideline %K clinical decision support system %K decision support techniques %K computer-assisted decision making %K guideline representation %K workflow control patterns %K workflow %K clinical %K decision making %K support systems %K software %K eHealth %K electronic health %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical decision support systems often adopt and operationalize existing clinical practice guidelines leading to higher guideline availability, increased guideline adherence, and data integration. Most of these systems use an internal state-based model of a clinical practice guideline to derive recommendations but do not provide the user with comprehensive insight into the model. Objective: Here we present a novel approach based on dynamic guideline visualization that incorporates the individual patient’s current treatment context. Methods: We derived multiple requirements to be fulfilled by such an enhanced guideline visualization. Using business process and model notation as the representation format for computer-interpretable guidelines, a combination of graph-based representation and logical inferences is adopted for guideline processing. A context-specific guideline visualization is inferred using a business rules engine. Results: We implemented and piloted an algorithmic approach for guideline interpretation and processing. As a result of this interpretation, a context-specific guideline is derived and visualized. Our implementation can be used as a software library but also provides a representational state transfer interface. Spring, Camunda, and Drools served as the main frameworks for implementation. A formative usability evaluation of a demonstrator tool that uses the visualization yielded high acceptance among clinicians. Conclusions: The novel guideline processing and visualization concept proved to be technically feasible. The approach addresses known problems of guideline-based clinical decision support systems. Further research is necessary to evaluate the applicability of the approach in specific medical use cases. %M 35731571 %R 10.2196/28013 %U https://formative.jmir.org/2022/6/e28013 %U https://doi.org/10.2196/28013 %U http://www.ncbi.nlm.nih.gov/pubmed/35731571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35754 %T Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion %A Ritschl,Valentin %A Eibensteiner,Fabian %A Mosor,Erika %A Omara,Maisa %A Sperl,Lisa %A Nawaz,Faisal A %A Siva Sai,Chandragiri %A Cenanovic,Merisa %A Devkota,Hari Prasad %A Hribersek,Mojca %A De,Ronita %A Klager,Elisabeth %A Schaden,Eva %A Kletecka-Pulker,Maria %A Völkl-Kernstock,Sabine %A Willschke,Harald %A Aufricht,Christoph %A Atanasov,Atanas G %A Stamm,Tanja %+ Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, Vienna, 1190, Austria, 43 140400 ext 16370, tanja.stamm@meduniwien.ac.at %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccination %K Twitter %K survey %K mandatory vaccination %K vaccination hesitancy %K coronavirus %K hesitancy %K social media %K questionnaire %K mandatory %K support %K poll %K opinion %K public health %K perception %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective: The purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods: Two Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results: Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions: Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity. %M 35617671 %R 10.2196/35754 %U https://formative.jmir.org/2022/6/e35754 %U https://doi.org/10.2196/35754 %U http://www.ncbi.nlm.nih.gov/pubmed/35617671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35021 %T UK Adults’ Exercise Locations, Use of Digital Programs, and Associations with Physical Activity During the COVID-19 Pandemic: Longitudinal Analysis of Data From the Health Behaviours During the COVID-19 Pandemic Study %A Schneider,Verena %A Kale,Dimitra %A Herbec,Aleksandra %A Beard,Emma %A Fisher,Abigail %A Shahab,Lion %+ Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 20 7679 1720, verena.schneider.19@ucl.ac.uk %K pandemic %K physical activity %K longitudinal %K United Kingdom %K digital health %K tele-exercise %K moderate-to-vigorous physical activity %K muscle-strengthening activity %K COVID-19 %K home-based exercise %K exercise %K telemedicine %K longitudinal %K health behavior %K behavior %K data %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital physical activity (PA) program use has been associated with higher PA guideline adherence during COVID-19 pandemic confinements. However, little is known longitudinally about exercise locations (inside vs outside the home environment), digital program use, and their associations with moderate-to-vigorous PA (MVPA) and muscle-strengthening activities (MSAs) during the pandemic. Objective: The aims of this study were to assess the relationship between exercise location and use of digital programs with PA guideline adherence during the COVID-19 pandemic, describe how individuals exercised inside and outside of their home environments, and explore which sociodemographic and contextual factors were associated with exercise locations and digital PA program use. Methods: Active UK adults (N=1938) who participated in the 1-month follow-up survey of the Health Behaviours During the COVID-19 Pandemic (HEBECO) study (FU1, June-July 2020) and at least one more follow-up survey (FU2, August-September; FU3, November-December 2020) reported exercise locations and types of exercises inside and outside their homes, including digital programs (online/app-based fitness classes/programs), MVPA, and MSA. Generalized linear mixed models were used to assess associations of exercise location and digital PA program use with PA guideline adherence (MVPA, MSA, full [combined] adherence), and predictors of exercise location and digital program use. Results: As the pandemic progressed, active UK adults were less likely to exercise inside or to use digital PA programs compared with periods of initial confinement: 61% (95% CI 58%-63%; weighted n=1024), 50% (95% CI 48%-53%; weighted n=786), and 49% (95% CI 46%-51%; weighted n=723) performed any exercise inside their homes at FU1, FU2, and FU3, respectively. At FU1, FU2, and FU3, 22% (95% CI 21%-25%; weighted n=385), 17% (95% CI 15%-19%; weighted n=265), and 16% (95% CI 14%-18%; weighted n=241) used digital PA programs, respectively. Most participants who exercised inside already owned indoor equipment, used digital PA programs, or had their own workout routines, whereas MVPA and gentle walking were the most common exercise types performed outside the home. Being female, nonwhite, having a condition limiting PA, indoor exercising space, a lower BMI, and living in total isolation were associated with increased odds of exercising inside the home or garden compared with outside exercise only. Digital PA program users were more likely to be younger, female, highly educated, have indoor space to exercise, and a lower BMI. While exercising inside was positively associated with MSA and exercising outside was positively associated with MVPA guideline adherence, both inside (vs outside only) and outside (vs inside only) activities contributed to full PA guideline adherence (odds ratio [OR] 5.05, 95% CI 3.17-8.03 and OR 1.89, 95% CI 1.10-3.23, respectively). Digital PA program use was associated with a higher odds of MSA (OR 3.97-8.71) and full PA (OR 2.24-3.95), but not with MVPA guideline adherence. Conclusions: During the COVID-19 pandemic, full PA guideline adherence was associated with exercising inside and outside of one’s home environment and using digital PA programs. More research is needed to understand the reach, long-term adherence, and differences between digital PA solutions. %M 35584123 %R 10.2196/35021 %U https://formative.jmir.org/2022/6/e35021 %U https://doi.org/10.2196/35021 %U http://www.ncbi.nlm.nih.gov/pubmed/35584123 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34995 %T A Telehealth-Delivered Tai Chi Intervention (TaiChi4Joint) for Managing Aromatase Inhibitor–Induced Arthralgia in Patients With Breast Cancer During COVID-19: Longitudinal Pilot Study %A Gomaa,Sameh %A West,Carly %A Lopez,Ana Maria %A Zhan,Tingting %A Schnoll,Max %A Abu-Khalaf,Maysa %A Newberg,Andrew %A Wen,Kuang-Yi %+ Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street Suite 300, Philadelphia, PA, 19106, United States, 1 2155034623, Kuang-Yi.Wen@jefferson.edu %K breast cancer %K arthralgia %K tai chi %K telehealth, pain %K mind-body therapy %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Estrogen receptor–positive breast cancer is the most common type of breast cancer in postmenopausal women. Aromatase inhibitors (AIs) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop arthralgia, often resulting in poor adherence and decreased quality of life. Objective: The study is a single-arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability, and potential efficacy of TaiChi4Joint, a remotely delivered 12-week tai chi intervention designed to relieve AI-induced joint pain. Methods: Women diagnosed with stage 0-III breast cancer who received an AI for at least 2 months and reported arthralgia with a ≥4 score on a 0 to 10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join tai chi classes delivered over Zoom three times a week for 12 weeks. Program engagement strategies included using a private Facebook study group and a Box cloud for archiving live class recordings. The program uses SMS text messaging and emails with periodic positive quotes and evidence-based information on tai chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments at baseline and at 1-, 2-, and 3-month intervals from study enrollment: Brief Pain Inventory, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory, Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies–Depression (CES-D). Results: A total of 55 eligible patients were invited to participate, and 39 (71%) consented and completed the baseline assessments. Participants attended 61% (median) of the suggested classes, with no tai chi–related adverse events reported. Of the 39 participants, 22 completed the 3-month follow-up assessment with a 56% retention rate. Study participants reported improvement from baseline compared to 3 months as follows (paired t test): Brief Pain Inventory (P<.001), AUSCAN pain subscale (P=.007), AUSCAN function subscale (P=.004), Fatigue Symptom Inventory (P=.004) and PSQI (P<.001), and HFRDIS (P=.02) and CES-D (P<.001). In particular, for our primary end point of interest, improvements in hip and knee symptoms, measured by WOMAC’s three subscales, were clinically meaningful and statistically significant when adjusted for multiple comparisons from baseline to 3 months post intervention. Conclusions: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a telehealth-based tai chi intervention for reducing AI-induced arthralgia. The intervention decreased patient-reported pain and stiffness, and improved sleep quality and depressive symptoms. Fully powered, large, telehealth-based tai chi trials for AI-associated arthralgia are needed considering our promising findings. Trial Registration: ClinicalTrials.gov NCT04716920; https://www.clinicaltrials.gov/ct2/show/NCT04716920 %M 35727609 %R 10.2196/34995 %U https://formative.jmir.org/2022/6/e34995 %U https://doi.org/10.2196/34995 %U http://www.ncbi.nlm.nih.gov/pubmed/35727609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35717 %T A Scalable Risk-Scoring System Based on Consumer-Grade Wearables for Inpatients With COVID-19: Statistical Analysis and Model Development %A Föll,Simon %A Lison,Adrian %A Maritsch,Martin %A Klingberg,Karsten %A Lehmann,Vera %A Züger,Thomas %A Srivastava,David %A Jegerlehner,Sabrina %A Feuerriegel,Stefan %A Fleisch,Elgar %A Exadaktylos,Aristomenis %A Wortmann,Felix %+ Department of Emergency Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse 16C, Bern, 3010, Switzerland, 41 31632244, Aristomenis.Exadaktylos@insel.ch %K COVID-19 %K risk scoring %K wearable devices %K wearable %K smartwatches %K smartwatch %K Bayesian survival analysis %K remote monitoring %K patient monitoring %K remote patient monitoring %K smart device %K digital health %K risk score %K scalable %K general ward %K hospital %K measurement tool %K measurement instrument %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards. Objective: In this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches). Methods: Patients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland. Results: First, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation. Conclusions: Our results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system. Trial Registration: Clinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834 %M 35613417 %R 10.2196/35717 %U https://formative.jmir.org/2022/6/e35717 %U https://doi.org/10.2196/35717 %U http://www.ncbi.nlm.nih.gov/pubmed/35613417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33368 %T The Drivers of Acceptance of Artificial Intelligence–Powered Care Pathways Among Medical Professionals: Web-Based Survey Study %A Cornelissen,Lisa %A Egher,Claudia %A van Beek,Vincent %A Williamson,Latoya %A Hommes,Daniel %+ Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 655320046, lisa.cornelissen@dearhealth.com %K technology acceptance %K artificial intelligence %K health care providers %K machine learning %K technology adoption %K health innovation %K user adoption %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of Artificial Intelligence (AI) has been proven beneficial in several health care areas. Nevertheless, the uptake of AI in health care delivery remains poor. Despite the fact that the acceptance of AI-based technologies among medical professionals is a key barrier to their implementation, knowledge about what informs such attitudes is scarce. Objective: The aim of this study was to identify and examine factors that influence the acceptability of AI-based technologies among medical professionals. Methods: A survey was developed based on the Unified Theory of Acceptance and Use of Technology model, which was extended by adding the predictor variables perceived trust, anxiety and innovativeness, and the moderator profession. The web-based survey was completed by 67 medical professionals in the Netherlands. The data were analyzed by performing a multiple linear regression analysis followed by a moderating analysis using the Hayes PROCESS macro (SPSS; version 26.0, IBM Corp). Results: Multiple linear regression showed that the model explained 75.4% of the variance in the acceptance of AI-powered care pathways (adjusted R2=0.754; F9,0=22.548; P<.001). The variables medical performance expectancy (β=.465; P<.001), effort expectancy (β=–.215; P=.005), perceived trust (β=.221; P=.007), nonmedical performance expectancy (β=.172; P=.08), facilitating conditions (β=–.160; P=.005), and professional identity (β=.156; P=.06) were identified as significant predictors of acceptance. Social influence of patients (β=.042; P=.63), anxiety (β=.021; P=.84), and innovativeness (β=.078; P=.30) were not identified as significant predictors. A moderating effect by gender was found between the relationship of facilitating conditions and acceptance (β=–.406; P=.09). Conclusions: Medical performance expectancy was the most significant predictor of AI-powered care pathway acceptance among medical professionals. Nonmedical performance expectancy, effort expectancy, perceived trust, and professional identity were also found to significantly influence the acceptance of AI-powered care pathways. These factors should be addressed for successful implementation of AI-powered care pathways in health care delivery. The study was limited to medical professionals in the Netherlands, where uptake of AI technologies is still in an early stage. Follow-up multinational studies should further explore the predictors of acceptance of AI-powered care pathways over time, in different geographies, and with bigger samples. %M 35727614 %R 10.2196/33368 %U https://formative.jmir.org/2022/6/e33368 %U https://doi.org/10.2196/33368 %U http://www.ncbi.nlm.nih.gov/pubmed/35727614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33036 %T Predicting Mental Health Status in Remote and Rural Farming Communities: Computational Analysis of Text-Based Counseling %A Antoniou,Mark %A Estival,Dominique %A Lam-Cassettari,Christa %A Li,Weicong %A Dwyer,Anne %A Neto,Abìlio de Almeida %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 2 9772 6673, m.antoniou@westernsydney.edu.au %K e-mental health %K text-based %K counseling %K Linguistic Inquiry and Word Count %K LIWC %K depression %K anxiety %K stress %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Australians living in rural and remote areas are at elevated risk of mental health problems and must overcome barriers to help seeking, such as poor access, stigma, and entrenched stoicism. e-Mental health services circumvent such barriers using technology, and text-based services are particularly well suited to clients concerned with privacy and self-presentation. They allow the client to reflect on the therapy session after it has ended as the chat log is stored on their device. The text also offers researchers an opportunity to analyze language use patterns and explore how these relate to mental health status. Objective: In this project, we investigated whether computational linguistic techniques can be applied to text-based communications with the goal of identifying a client’s mental health status. Methods: Client-therapist text messages were analyzed using the Linguistic Inquiry and Word Count tool. We examined whether the resulting word counts related to the participants’ presenting problems or their self-ratings of mental health at the completion of counseling. Results: The results confirmed that word use patterns could be used to differentiate whether a client had one of the top 3 presenting problems (depression, anxiety, or stress) and, prospectively, to predict their self-rated mental health after counseling had been completed. Conclusions: These findings suggest that language use patterns are useful for both researchers and clinicians trying to identify individuals at risk of mental health problems, with potential applications in screening and targeted intervention. %M 35727623 %R 10.2196/33036 %U https://formative.jmir.org/2022/6/e33036 %U https://doi.org/10.2196/33036 %U http://www.ncbi.nlm.nih.gov/pubmed/35727623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37008 %T Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey %A Wray,Tyler B %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 14018636659, tyler_wray@brown.edu %K addiction %K alcohol %K drug use %K substance use %K adoption %K smartphone %K mobile health %K mHealth %K marketing %K dissemination %K counselor %K health care professional %K digital health %K eHealth %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work. Objective: The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so. Methods: Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey. Results: In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app. Conclusions: Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics. %M 35723917 %R 10.2196/37008 %U https://formative.jmir.org/2022/6/e37008 %U https://doi.org/10.2196/37008 %U http://www.ncbi.nlm.nih.gov/pubmed/35723917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35365 %T Perspectives on Participation in a Feasibility Study on Exercise-Based Cardiac Telerehabilitation After Transcatheter Aortic Valve Implantation: Qualitative Interview Study Among Patients and Health Professionals %A Thorup,Charlotte Brun %A Villadsen,Anne %A Andreasen,Jan Jesper %A Aarøe,Jens %A Andreasen,Jane %A Brocki,Barbara Cristina %+ Department of Cardiothoracic Surgery, Aalborg University Hospital, Hoborvej 18-22, Aalborg, 9000, Denmark, 45 30739950, cbt@rn.dk %K transcatheter aortic valve implantation %K aortic valve %K implant %K TAVI %K telerehabilitation %K rehabilitation %K aortic stenosis %K patients’ perspective %K older people %K elder %K aged %K geriatric %K gerontology %K patient experience %K user experience %K health professional experience %K physician experience %K telehealth %K older adult %K telemedicine %K cardiac %K cardiology %K heart %K perspective %K home-based %K exercise %K activity tracker %K physical activity %K mHealth %K mobile health %K fitness %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Aortic valve stenosis affects approximately half of people aged ≥85 years, and the recommended surgical treatment for older patients is transcatheter aortic valve implantation (TAVI). Despite strong evidence for its advantages, low attendance rate in cardiac rehabilitation is observed among patients after TAVI. Cardiac telerehabilitation (CTR) has proven comparable with center-based rehabilitation; however, no study has investigated CTR targeting patients after TAVI. On the basis of participatory design, an exercise-based CTR program (TeleTAVI) was developed, which included a web-based session with a cardiac nurse, a tablet containing an informative website, an activity tracker, and supervised home-based exercise sessions that follow the national recommendations for cardiac rehabilitation. Objective: This study aims to explore patients’ and health professionals’ experiences with using health technologies and participating in the exercise-based CTR program, TeleTAVI. Methods: This study is a part of a feasibility study and will only report patients’ and health professionals’ experiences of being a part of TeleTAVI. A total of 11 qualitative interviews were conducted using a semistructured interview guide (n=7, 64% patients and n=4, 36% health professionals). Patient interviews were conducted after 8 weeks of participation in TeleTAVI, and interviews with health professionals were conducted after the end of the program. The analysis was conducted as inductive content analysis to create a condensed meaning presented as themes. Results: Reticence toward using the website was evident with reduced curiosity to explore it, and reduced benefit from using the activity tracker was observed, as the patients’ technical competencies were challenged. This was also found when using the tablet for web-based training sessions, leading to patients feeling worried before the training, as they anticipated technical problems. Disadvantages of the TeleTAVI program were technical problems and inability to use hands-on guidance with the patients. However, both physiotherapists and patients reported a feeling of improvement in patients’ physical fitness. The home training created a feeling of safety, supported adherence, and made individualization possible, which the patients valued. A good relationship and continuity in the contact with health professionals seemed very important for the patients and affected their positive attitude toward the program. Conclusions: The home-based nature of the TeleTAVI program seems to provide the opportunity to support individualization, autonomy, independence, and adherence to physical training in addition to improvement in physical capability in older patients. Despite technological challenges, basing the relationship between the health professionals and patients on continuity may be beneficial for patients. Prehabilitation may also be considered, as it may create familiarity toward technology and adherence to the training. %M 35723925 %R 10.2196/35365 %U https://formative.jmir.org/2022/6/e35365 %U https://doi.org/10.2196/35365 %U http://www.ncbi.nlm.nih.gov/pubmed/35723925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34741 %T Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: Observational Analysis %A Dinh,Nhi %A Agarwal,Smisha %A Avery,Lisa %A Ponnappan,Priya %A Chelangat,Judith %A Amendola,Paul %A Labrique,Alain %A Bartlett,Linda %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 510 1055, linda.bartlett@jhu.edu %K newborn %K neonatal health %K maternal health %K intrapartum care %K labor and delivery %K Kenya %K digital clinical decision support %K health information systems %K digital health %K implementation research %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: iDeliver, a digital clinical support system for maternal and neonatal care, was developed to support quality of care improvements in Kenya. Objective: Taking an implementation research approach, we evaluated the adoption and fidelity of iDeliver over time and assessed the feasibility of its use to provide routine Ministry of Health (MOH) reports. Methods: We analyzed routinely collected data from iDeliver, which was implemented at the Transmara West Sub-County Hospital from December 2018 to September 2020. To evaluate its adoption, we assessed the proportion of actual facility deliveries that was recorded in iDeliver over time. We evaluated the fidelity of iDeliver use by studying the completeness of data entry by care providers during each stage of the labor and delivery workflow and whether the use reflected iDeliver’s envisioned function. We also examined the data completeness of the maternal and neonatal indicators prioritized by the Kenya MOH. Results: A total of 1164 deliveries were registered in iDeliver, capturing 45.31% (1164/2569) of the facility’s deliveries over 22 months. This uptake of registration improved significantly over time by 6.7% (SE 2.1) on average in each quarter-year (P=.005), from 9.6% (15/157) in the fourth quarter of 2018 to 64% (235/367) in the third quarter of 2020. Across iDeliver’s workflow, the overall completion rate of all variables improved significantly by 2.9% (SE 0.4) on average in each quarter-year (P<.001), from 22.25% (257/1155) in the fourth quarter of 2018 to 49.21% (8905/18,095) in the third quarter of 2020. Data completion was highest for the discharge-labor summary stage (16,796/23,280, 72.15%) and lowest for the labor signs stage (848/5820, 14.57%). The completion rate of the key MOH indicators also improved significantly by 4.6% (SE 0.5) on average in each quarter-year (P<.001), from 27.1% (69/255) in the fourth quarter of 2018 to 83.75% (3346/3995) in the third quarter of 2020. Conclusions: iDeliver’s adoption and data completeness improved significantly over time. The assessment of iDeliver’ use fidelity suggested that some features were more easily used because providers had time to enter data; however, there was low use during active childbirth, which is when providers are necessarily engaged with the woman and newborn. These insights on the adoption and fidelity of iDeliver use prompted the team to adapt the application to reflect the users’ culture of use and further improve the implementation of iDeliver. %M 35723911 %R 10.2196/34741 %U https://formative.jmir.org/2022/6/e34741 %U https://doi.org/10.2196/34741 %U http://www.ncbi.nlm.nih.gov/pubmed/35723911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33709 %T Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion %A Engeltjes,Bernice %A Rosman,Ageeth %A Scheele,Fedde %A Vis,Christiaan %A Wouters,Eveline %+ Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015AK, Netherlands, 31 641804881, engeltjesbernice@gmail.com %K obstetric triage %K Normalization Process Theory %K implementation strategy %K hierarchy %K medical staff %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff. Objective: The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals. Methods: An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group. Results: Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement. Conclusions: The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital. %M 35616176 %R 10.2196/33709 %U https://formative.jmir.org/2022/6/e33709 %U https://doi.org/10.2196/33709 %U http://www.ncbi.nlm.nih.gov/pubmed/35616176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33089 %T Feasibility of Using Games to Improve Healthy Lifestyle Knowledge in Youth Aged 9-16 Years at Risk for Type 2 Diabetes: Pilot Randomized Controlled Trial %A Maddison,Ralph %A Baghaei,Nilufar %A Calder,Amanda %A Murphy,Rinki %A Parag,Varsha %A Heke,Ihirangi %A Dobson,Rosie %A Marsh,Samantha %+ Institute for Physical Activity and Nutrition, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392446218, ralph.maddison@deakin.edu.au %K children’s health %K diabetes mellitus %K type 2 diabetes %K experimental games %K recruitment %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile games can be effective and motivating tools for promoting children’s health. Objective: We aimed to determine the comparative use of 2 prototype serious games for health and assess their effects on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D). Methods: A 3-arm parallel pilot randomized controlled trial was undertaken to determine the feasibility and preliminary effectiveness of 2 serious games. Feasibility aspects included recruitment, participant attitudes toward the games, the amount of time the participants played each game at home, and the effects of the games on healthy lifestyle and T2D knowledge. Participants were allocated to play Diabetic Jumper (n=7), Ari and Friends (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and 4 weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game (specifically, the number of minutes played over 4 weeks). Results: In terms of feasibility, we were unable to recruit our target of 60 participants. In total, 23 participants were recruited. Participants generally viewed the games positively. There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only 1 participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks. Conclusions: It was not feasible to recruit the target sample for this trial. The 2 prototype serious games were unsuccessful at sustaining long-term game play outside a clinic environment. Based on positive participant attitudes toward the games, it is possible to use these games or similar games as short-term stimuli to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting; however, future research is required to explore this area. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619000380190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123 %M 35713955 %R 10.2196/33089 %U https://formative.jmir.org/2022/6/e33089 %U https://doi.org/10.2196/33089 %U http://www.ncbi.nlm.nih.gov/pubmed/35713955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38113 %T Design and Preliminary Findings of Adherence to the Self-Testing for Our Protection From COVID-19 (STOP COVID-19) Risk-Based Testing Protocol: Prospective Digital Study %A Herbert,Carly %A Kheterpal,Vik %A Suvarna,Thejas %A Broach,John %A Marquez,Juan Luis %A Gerber,Ben %A Schrader,Summer %A Nowak,Christopher %A Harman,Emma %A Heetderks,William %A Fahey,Nisha %A Orvek,Elizabeth %A Lazar,Peter %A Ferranto,Julia %A Noorishirazi,Kamran %A Valpady,Shivakumar %A Shi,Qiming %A Lin,Honghuang %A Marvel,Kathryn %A Gibson,Laura %A Barton,Bruce %A Lemon,Stephenie %A Hafer,Nathaniel %A McManus,David %A Soni,Apurv %+ Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 774 442 4107, apurv.soni@umassmed.edu %K COVID-19 %K rapid antigen tests %K COVID-19 testing %K infectious disease %K disease spread %K prevention %K coronavirus %K adherence %K reporting %K mHealth %K health application %K mobile health %K digital health %K public health %K surveillance %K health care %K smartphone app %K vaccination %K digital surveillance %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. Objective: The Self-Testing for Our Protection from COVID-19 (STOP COVID-19) study aims to examine adherence to a risk-based COVID-19 testing strategy using rapid antigen tests and reporting of test results to health departments. Methods: STOP COVID-19 is a 12-week digital study, facilitated using a smartphone app for testing assistance and reporting. We are recruiting 20,000 participants throughout the United States. Participants are stratified into high- and low-risk groups based on history of COVID-19 infection and vaccination status. High-risk participants are instructed to perform twice-weekly testing for COVID-19 using rapid antigen tests, while low-risk participants test only in the case of symptoms or exposure to COVID-19. All participants complete COVID-19 surveillance surveys, and rapid antigen results are recorded within the smartphone app. Primary outcomes include participant adherence to a risk-based serial testing protocol and percentage of rapid tests reported to health departments. Results: As of February 2022, 3496 participants have enrolled, including 1083 high-risk participants. Out of 13,730 tests completed, participants have reported 13,480 (98.18%, 95% CI 97.9%-98.4%) results to state public health departments with full personal identifying information or anonymously. Among 622 high-risk participants who finished the study period, 35.9% showed high adherence to the study testing protocol. Participants with high adherence reported a higher percentage of test results to the state health department with full identifying information than those in the moderate- or low-adherence groups (high: 71.7%, 95% CI 70.3%-73.1%; moderate: 68.3%, 95% CI 66.0%-70.5%; low: 63.1%, 59.5%-66.6%). Conclusions: Preliminary results from the STOP COVID-19 study provide important insights into rapid antigen test reporting and usage, and can thus inform the use of rapid testing interventions for COVID-19 surveillance. %M 35649180 %R 10.2196/38113 %U https://formative.jmir.org/2022/6/e38113 %U https://doi.org/10.2196/38113 %U http://www.ncbi.nlm.nih.gov/pubmed/35649180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e29856 %T Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study %A Lambert,Yann %A Galindo,Muriel %A Suárez-Mutis,Martha %A Mutricy,Louise %A Sanna,Alice %A Garancher,Laure %A Cairo,Hedley %A Hiwat,Helene %A Bordalo Miller,Jane %A Gomes,José Hermenegildo %A Marchesini,Paola %A Adenis,Antoine %A Nacher,Mathieu %A Vreden,Stephen %A Douine,Maylis %+ Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Avenue des Flamboyants, Cayenne, 97300, French Guiana, 594 594 39 48 64, yann.lambert@ch-cayenne.fr %K malaria %K Guiana Shield %K information system %K mobile data collection %K Open Data Kit %K ODK %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. Trial Registration: ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770 %M 35708763 %R 10.2196/29856 %U https://formative.jmir.org/2022/6/e29856 %U https://doi.org/10.2196/29856 %U http://www.ncbi.nlm.nih.gov/pubmed/35708763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34882 %T Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey %A Paradis,Sabrina %A Roussel,Jeremy %A Bosson,Jean-Luc %A Kern,Jean-Baptiste %+ Translational Innovation in Medicine and Complexity, National Institute of Health and Medical Research, Laboratoire TIMC, Bâtiment Taillefer, Rond-Point de la Croix de Vie, Domaine de la Merci, La Tronche, 38706, France, 33 678863377, sabrina.paradis@univ-grenoble-alpes.fr %K smartphone %K health applications %K mHealth %K apps %K mobile health %K digital health %K well-being %K epidemiology %K primary care %K population survey %K fitness %K physical activity %K health behavior %K patient %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization has defined mobile health (mHealth) as the “use of mobile and wireless technologies to support the achievement of health objectives.” Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results: The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491 %M 35708744 %R 10.2196/34882 %U https://formative.jmir.org/2022/6/e34882 %U https://doi.org/10.2196/34882 %U http://www.ncbi.nlm.nih.gov/pubmed/35708744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38283 %T Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study %A Saha,Sanjoy %A Lozano,Chloe Panizza %A Broyles,Stephanie %A Martin,Corby K %A Apolzan,John W %+ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632827, john.apolzan@pbrc.edu %K dietary assessment %K eating %K food intake %K energy intake %K portion size %K mHealth %K digital health %K eHealth %K nutrition %K food groups %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. Results: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback. %M 35704355 %R 10.2196/38283 %U https://formative.jmir.org/2022/6/e38283 %U https://doi.org/10.2196/38283 %U http://www.ncbi.nlm.nih.gov/pubmed/35704355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34708 %T The Dispersion of Health Information–Seeking Behavior and Health Literacy in a State in the Southern United States: Cross-sectional Study %A Rao,Nikita %A Tighe,Elizabeth L %A Feinberg,Iris %+ Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P O Box 3995, Atlanta, GA, 30302, United States, 1 404 413 1281, nrao3@gsu.edu %K health information–seeking behavior %K health literacy %K digital literacy %K information retrieval %K health literacy questionnaire %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transmission of health information from in-person communication to web-based sources has changed over time. Patients can find, understand, and use their health information without meeting a health care provider and are able to participate more in their health care management. In recent years, the internet has emerged as the primary source of health information, although clinical providers remain the most credible source. The ease of access, anonymity, and busy schedules may be motivating factors to seek health information on the web. Social media has surfaced as a popular source of health information, as it can provide news in real time. The increase in the breadth and depth of health information available on the web has also led to a plethora of misinformation, and individuals are often unable to discern facts from fiction. Competencies in health literacy (HL) can help individuals better understand health information and enhance patient decision-making, as adequate HL is a precursor to positive health information–seeking behaviors (HISBs). Several factors such as age, sex, and socioeconomic status are known to moderate the association between HL and HISBs. Objective: In this study, we aimed to examine the relationship between HL and HISBs in individuals living in a southern state in the United States by considering different demographic factors. Methods: Participants aged ≥18 years were recruited using Qualtrics Research Services and stratified to match the statewide demographic characteristics of race and age. Demographics and source and frequency of health information were collected. The Health Literacy Questionnaire was used to collect self-reported HL experiences. SPSS (version 27; IBM Corp) was used for the analysis. Results: A total of 520 participants met the criteria and completed the survey (mean age 36.3, SD 12.79 years). The internet was cited as the most used source of health information (mean 2.41, SD 0.93). Females are more likely to seek health information from physicians than males (r=0.121; P=.006). Older individuals are less likely to seek health information from the internet (r=−0.108; P=.02), social media (r=−0.225; P<.001), and friends (r=−0.090; P=.045) than younger individuals. Cluster analysis demonstrated that individuals with higher levels of HISBs were more likely to seek information from multiple sources than those with lower levels of HISBs (mean range 3.05-4.09, SD range 0.57-0.66; P<.001). Conclusions: Age and sex are significantly associated with HISB. Older adults may benefit from web-based resources to monitor their health conditions. Higher levels of HL are significantly associated with greater HISB. Targeted strategies to improve HISB among individuals with lower levels of HL may improve their access, understanding, and use of health information. %M 35704357 %R 10.2196/34708 %U https://formative.jmir.org/2022/6/e34708 %U https://doi.org/10.2196/34708 %U http://www.ncbi.nlm.nih.gov/pubmed/35704357 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34366 %T Fairness in Mobile Phone–Based Mental Health Assessment Algorithms: Exploratory Study %A Park,Jinkyung %A Arunachalam,Ramanathan %A Silenzio,Vincent %A Singh,Vivek K %+ School of Communication & Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 848 932 7588, v.singh@rutgers.edu %K algorithmic bias %K mental health %K health equity %K medical informatics %K health information systems %K gender bias %K mobile phone %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1 in 5 American adults experience mental illness every year. Thus, mobile phone–based mental health prediction apps that use phone data and artificial intelligence techniques for mental health assessment have become increasingly important and are being rapidly developed. At the same time, multiple artificial intelligence–related technologies (eg, face recognition and search results) have recently been reported to be biased regarding age, gender, and race. This study moves this discussion to a new domain: phone-based mental health assessment algorithms. It is important to ensure that such algorithms do not contribute to gender disparities through biased predictions across gender groups. Objective: This research aimed to analyze the susceptibility of multiple commonly used machine learning approaches for gender bias in mobile mental health assessment and explore the use of an algorithmic disparate impact remover (DIR) approach to reduce bias levels while maintaining high accuracy. Methods: First, we performed preprocessing and model training using the data set (N=55) obtained from a previous study. Accuracy levels and differences in accuracy across genders were computed using 5 different machine learning models. We selected the random forest model, which yielded the highest accuracy, for a more detailed audit and computed multiple metrics that are commonly used for fairness in the machine learning literature. Finally, we applied the DIR approach to reduce bias in the mental health assessment algorithm. Results: The highest observed accuracy for the mental health assessment was 78.57%. Although this accuracy level raises optimism, the audit based on gender revealed that the performance of the algorithm was statistically significantly different between the male and female groups (eg, difference in accuracy across genders was 15.85%; P<.001). Similar trends were obtained for other fairness metrics. This disparity in performance was found to reduce significantly after the application of the DIR approach by adapting the data used for modeling (eg, the difference in accuracy across genders was 1.66%, and the reduction is statistically significant with P<.001). Conclusions: This study grounds the need for algorithmic auditing in phone-based mental health assessment algorithms and the use of gender as a protected attribute to study fairness in such settings. Such audits and remedial steps are the building blocks for the widespread adoption of fair and accurate mental health assessment algorithms in the future. %M 35699997 %R 10.2196/34366 %U https://formative.jmir.org/2022/6/e34366 %U https://doi.org/10.2196/34366 %U http://www.ncbi.nlm.nih.gov/pubmed/35699997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32964 %T Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic %A Downie,Andrew %A Mashanya,Titus %A Chipwaza,Beatrice %A Griffiths,Frances %A Harris,Bronwyn %A Kalolo,Albino %A Ndegese,Sylvester %A Sturt,Jackie %A De Valliere,Nicole %A Pemba,Senga %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7HL, United Kingdom, 44 024 7657 4880, F.E.Griffiths@warwick.ac.uk %K remote consultation %K mobile consulting %K digital health %K telehealth %K mHealth %K eHealth %K mobile health %K health care %K cascade %K train the trainer %K low- and middle-income countries %K rural areas %K Tanzania %K Kirkpatrick %K consultation %K training %K low- and middle-income %K rural %K COVID-19 %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. %M 35507772 %R 10.2196/32964 %U https://formative.jmir.org/2022/6/e32964 %U https://doi.org/10.2196/32964 %U http://www.ncbi.nlm.nih.gov/pubmed/35507772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e39198 %T Authors’ Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on “Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Carney,Colleen E %A Carmona,Nicole E %+ Toronto Metropolitan University, Jorgenson Hall, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 4169795000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35699990 %R 10.2196/39198 %U https://formative.jmir.org/2022/6/e39198 %U https://doi.org/10.2196/39198 %U http://www.ncbi.nlm.nih.gov/pubmed/35699990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38075 %T Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States %A Jones,Jeb %A Edwards,O Winslow %A Merrill,Leland %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K men who have sex with men %K transgender persons %K nonbinary persons %K mHealth %K mobile app %K HIV %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infection testing %K STI testing %K HIV testing %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app’s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. %M 35699980 %R 10.2196/38075 %U https://formative.jmir.org/2022/6/e38075 %U https://doi.org/10.2196/38075 %U http://www.ncbi.nlm.nih.gov/pubmed/35699980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35959 %T Additional Measurement Approaches for Sleep Disturbances. Comment on “A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Tsai,Wan-Tong %A Liu,Tzung-Liang %+ Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung City, 40201, Taiwan, 886 968938360, science.tsai@gmail.com %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35700003 %R 10.2196/35959 %U https://formative.jmir.org/2022/6/e35959 %U https://doi.org/10.2196/35959 %U http://www.ncbi.nlm.nih.gov/pubmed/35700003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36501 %T Acceptance, Barriers, and Facilitators to Implementing Artificial Intelligence–Based Decision Support Systems in Emergency Departments: Quantitative and Qualitative Evaluation %A Fujimori,Ryo %A Liu,Keibun %A Soeno,Shoko %A Naraba,Hiromu %A Ogura,Kentaro %A Hara,Konan %A Sonoo,Tomohiro %A Ogura,Takayuki %A Nakamura,Kensuke %A Goto,Tadahiro %+ Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1138655, Japan, 81 08095261328, fujimori0203@gmail.com %K clinical decision support system %K preimplementation %K qualitative %K mixed methods %K artificial intelligence %K emergency medicine %K CDSS %K computerized decision %K computerized decision support system %K AI %K AI-based %K CFIR %K quantitative analysis %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing availability of clinical decision support systems (CDSSs) and rising expectation for CDSSs based on artificial intelligence (AI), little is known about the acceptance of AI-based CDSS by physicians and its barriers and facilitators in emergency care settings. Objective: We aimed to evaluate the acceptance, barriers, and facilitators to implementing AI-based CDSSs in the emergency care setting through the opinions of physicians on our newly developed, real-time AI-based CDSS, which alerts ED physicians by predicting aortic dissection based on numeric and text information from medical charts, by using the Unified Theory of Acceptance and Use of Technology (UTAUT; for quantitative evaluation) and the Consolidated Framework for Implementation Research (CFIR; for qualitative evaluation) frameworks. Methods: This mixed methods study was performed from March to April 2021. Transitional year residents (n=6), emergency medicine residents (n=5), and emergency physicians (n=3) from two community, tertiary care hospitals in Japan were included. We first developed a real-time CDSS for predicting aortic dissection based on numeric and text information from medical charts (eg, chief complaints, medical history, vital signs) with natural language processing. This system was deployed on the internet, and the participants used the system with clinical vignettes of model cases. Participants were then involved in a mixed methods evaluation consisting of a UTAUT-based questionnaire with a 5-point Likert scale (quantitative) and a CFIR-based semistructured interview (qualitative). Cronbach α was calculated as a reliability estimate for UTAUT subconstructs. Interviews were sampled, transcribed, and analyzed using the MaxQDA software. The framework analysis approach was used during the study to determine the relevance of the CFIR constructs. Results: All 14 participants completed the questionnaires and interviews. Quantitative analysis revealed generally positive responses for user acceptance with all scores above the neutral score of 3.0. In addition, the mixed methods analysis identified two significant barriers (System Performance, Compatibility) and two major facilitators (Evidence Strength, Design Quality) for implementation of AI-based CDSSs in emergency care settings. Conclusions: Our mixed methods evaluation based on theoretically grounded frameworks revealed the acceptance, barriers, and facilitators of implementation of AI-based CDSS. Although the concern of system failure and overtrusting of the system could be barriers to implementation, the locality of the system and designing an intuitive user interface could likely facilitate the use of optimal AI-based CDSS. Alleviating and resolving these factors should be key to achieving good user acceptance of AI-based CDSS. %M 35699995 %R 10.2196/36501 %U https://formative.jmir.org/2022/6/e36501 %U https://doi.org/10.2196/36501 %U http://www.ncbi.nlm.nih.gov/pubmed/35699995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35548 %T Geosocial Networking App Use Associated With Sexual Risk Behavior and Pre-exposure Prophylaxis Use Among Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-sectional Web-Based Survey %A Gibson,Laurel P %A Kramer,Emily B %A Bryan,Angela D %+ Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309, United States, 1 303 492 8662, laurel.gibson@colorado.edu %K dating app %K mobile dating %K hookup %K gay %K pre-exposure prophylaxis %K sexual risk %K HIV %K STI %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, geosocial networking (GSN) apps (ie, mobile dating apps) have become central to dating and sexual interactions in recent years. Among gay, bisexual, and other men who have sex with men (GBM), these apps play an important role in reducing barriers and facilitating partner seeking. However, despite these benefits, there are concerns that these apps may facilitate risky sexual behavior and transmission of sexually transmitted infections (STIs) among GBM. Objective: This study aimed to examine the association between GSN app use and sexual risk in a US sample of GBM. Methods: Using a cross-sectional design, respondents (N=223) completed a web-based survey assessing their use of GSN apps, sexual risk and protective behaviors, HIV serostatus, and previous STI diagnoses. Results: Respondents were aged 21-78 (mean 31.90, SD 10.06) years and 69.5% (155/223) were non-Hispanic White. The sample included respondents from 40 states and the District of Columbia. Nearly half (104/223, 47%) of the participants reported using GSN apps. GSN users were more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P<.001), and a previous STI diagnosis (P=.001) than nonusers. GSN users also reported more frequent use of recreational drugs before sex (P=.001), alcohol use before sex (P<.001), and cannabis use before sex (P=.01). Interestingly, GSN users were also more likely to report having ever taken an HIV test (P<.001) and using pre-exposure prophylaxis (P=.03). The rates of HIV seropositivity did not differ significantly between GSN users and nonusers (P=.53). Among the subset of GSN users, 38 participants reported using only GBM-specific GSN apps (eg, Grindr), whereas 27 participants reported using only sexuality nonspecific GSN apps (eg, Tinder). Exclusive users of GBM–specific apps reported more frequent recreational drug use before sex (P=.01) and were also more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P=.004), a previous STI diagnosis (P=.002), and HIV testing (P=.003). Alcohol use before sex, cannabis use before sex, pre-exposure prophylaxis use, and HIV rates were similar between both groups (P>.11). Conclusions: The findings suggest that GSN apps may be a useful pathway for interventions aimed at reducing STI risk in GBM. Future prospective studies should examine how risk levels change after the initiation of GSN app use. %M 35699992 %R 10.2196/35548 %U https://formative.jmir.org/2022/6/e35548 %U https://doi.org/10.2196/35548 %U http://www.ncbi.nlm.nih.gov/pubmed/35699992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e28025 %T Data Privacy Concerns Using mHealth Apps and Smart Speakers: Comparative Interview Study Among Mature Adults %A Schroeder,Tanja %A Haug,Maximilian %A Gewald,Heiko %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia, 61 2 9850 ext 6281, tanja.schroeder@hdr.mq.edu.au %K data privacy concerns %K privacy paradox %K mHealth app %K smart speaker %K mature adults %K smartphone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: New technologies such as mobile health (mHealth) apps and smart speakers make intensive use of sensitive personal data. Users are typically aware of this and express concerns about their data privacy. However, many people use these technologies although they think their data are not well protected. This raises specific concerns for sensitive health data. Objective: This study aimed to contribute to a better understanding of data privacy concerns of mature adults using new technologies and provide insights into their data privacy expectations and associated risks and the corresponding actions of users in 2 different data contexts: mHealth apps and smart speakers. Methods: This exploratory research adopted a qualitative approach, engaging with 20 mature adults (aged >45 years). In a 6-month test period, 10 (50%) participants used a smart speaker and 10 (50%) participants used an mHealth app. In interviews conducted before and after the test period, we assessed the influence of data privacy concerns on technology acceptance, use behavior, and continued use intention. Results: Our results show that although participants are generally aware of the need to protect their data privacy, they accept the risk of misuse of their private data when using the technology. Surprisingly, the most frequently stated risk was not the misuse of personal health data but the fear of receiving more personalized advertisements. Similarly, surprisingly, our results indicate that participants value recorded verbal data higher than personal health data. Conclusions: Older adults are initially concerned about risks to their data privacy associated with using data-intensive technologies, but those concerns diminish fairly quickly, culminating in resignation. We find that participants do not differentiate between risky behaviors, depending on the type of private data used by different technologies. %M 35699993 %R 10.2196/28025 %U https://formative.jmir.org/2022/6/e28025 %U https://doi.org/10.2196/28025 %U http://www.ncbi.nlm.nih.gov/pubmed/35699993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37777 %T Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders %A Sadural,Ernani %A Riley,Kristen E %A Zha,Peijia %A Pacquiao,Dula %A Faust,Amanda %+ Department of Obstetrics and Gynecology, Cooperman Barnabas Medical Center, RWJBarnabas Health, 94 Old Short Hills Road, Suite 3148, Livingston, NJ, 07039, United States, 1 973 885 9190, ernani.sadural@rwjbh.org %K maternal mortality %K health disparity %K mHealth %K patient engagement %K postbirth warning signs %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal morbidity and mortality in the United States continue to be a worsening public health crisis, with persistent racial disparities among Black women during the COVID-19 pandemic. Innovations in mobile health (mHealth) technology are being developed as a strategy to connect birthing women to their health care providers during the first 6 weeks of the postpartum period. Objective: This study aimed to inform a process to evaluate the barriers to mHealth implementation in the context of the COVID-19 pandemic by exploring the experiences of mothers and stakeholders who were directly involved in the pilot program. Methods: The qualitative design used GoToMeeting (GoTo) individual interviews of 13 mothers and 7 stakeholders at a suburban teaching hospital in New Jersey. Mothers were aged ≥18 years, able to read and write in English or Spanish, had a vaginal or cesarean birth at >20 weeks of estimated gestational age, and were admitted for delivery at the hospital with at least a 24-hour postpartum stay. Stakeholders were part of the hospital network’s obstetrics collaborative subcommittee comprising administrators, physicians, registered nurses, and informatics. Responses were transcribed verbatim and analyzed for emerging themes. The socioecological framework provided a holistic lens for analyzing the multilevel influences on individual experiences. Results: A total of 3 major themes were identified: mothers experienced barriers from personal situations at home and with services in the hospital and community, which were intensified by the COVID-19 pandemic; the COVID-19 pandemic negatively impacted hospital services, priorities, and individual staff; and mothers and stakeholders had positive experiences and perceptions of the mHealth intervention. Conclusions: The use and reach of the mHealth intervention were negatively influenced by interrelated factors operating at multiple levels. The system-wide and multilevel impact of the pandemic was reflected in participants’ responses, providing evidence for the need to re-evaluate mHealth implementation with more adaptable systems and structures in place using a socioecological framework. %M 35699998 %R 10.2196/37777 %U https://formative.jmir.org/2022/6/e37777 %U https://doi.org/10.2196/37777 %U http://www.ncbi.nlm.nih.gov/pubmed/35699998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34080 %T Patient Onboarding and Engagement to Build a Digital Study After Enrollment in a Clinical Trial (TAILOR-PCI Digital Study): Intervention Study %A Avram,Robert %A So,Derek %A Iturriaga,Erin %A Byrne,Julia %A Lennon,Ryan %A Murthy,Vishakantha %A Geller,Nancy %A Goodman,Shaun %A Rihal,Charanjit %A Rosenberg,Yves %A Bailey,Kent %A Farkouh,Michael %A Bell,Malcolm %A Cagin,Charles %A Chavez,Ivan %A El-Hajjar,Mohammad %A Ginete,Wilson %A Lerman,Amir %A Levisay,Justin %A Marzo,Kevin %A Nazif,Tamim %A Olgin,Jeffrey %A Pereira,Naveen %+ Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94117, United States, 1 451 476 1325, Jeffrey.Olgin@ucsf.edu %K digital study %K clinical trial %K cardiology %K smartphone %K digital health %K mobile health %K clinical trial %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study is a novel proof-of-concept study that evaluated the feasibility of extending the TAILOR-PCI randomized controlled trial (RCT) follow-up period by using a remote digital platform. Objective: The aim of this study is to describe patients’ onboarding, engagement, and results in a digital study after enrollment in an RCT. Methods: In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letter to download the study app. Those who did not respond to the letter were contacted by phone to survey the reasons for nonparticipation. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard patients, obtain consent, and administer activities in the digital study. The patients were asked to complete health-related surveys and digitally provide follow-up data. Our primary end points were the consent rate, the duration of participation, and the monthly activity completion rate in the digital study. The hypothesis being tested was formulated before data collection began. Results: After the parent trial was completed, letters were mailed to 907 eligible patients (representing 18.8% [907/4837] of total enrolled in the RCT) within 15.6 (SD 5.2) months of randomization across 24 sites. Among the 907 patients invited, 290 (32%) visited the study website and 110 (12.1%) consented—40.9% (45/110) after the letter, 33.6% (37/110) after the first phone call, and 25.5% (28/110) after the second call. Among the 47.4% (409/862) of patients who responded, 41.8% (171/409) declined to participate because of a lack of time, 31.2% (128/409) declined because of the lack of a smartphone, and 11.5% (47/409) declined because of difficulty understanding what was expected of them in the study. Patients who consented were older (aged 65.3 vs 62.5 years; P=.006) and had a lower prevalence of diabetes (19% vs 30%; P=.02) or tobacco use (6.4% vs 24.8%; P<.001). A greater proportion had bachelor’s degrees (47.2% vs 25.7%; P<.001) and were more computer literate (90.5% vs 62.3% of daily internet use; P<.001) than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9% (SD 7.6%); there was no decrease in this rate throughout the study duration. Conclusions: Extended follow-up after enrollment in an RCT by using a digital study was technically feasible but was limited because of the inability to contact most eligible patients or a lack of time or access to a smartphone. Among the enrolled patients, most completed the required electronic visits. Enhanced recruitment methods, such as the introduction of a digital study at the time of RCT consent, smartphone provision, and robust study support for onboarding, should be explored further. Trial Registration: Clinicaltrails.gov NCT01742117; https://clinicaltrials.gov/ct2/show/NCT01742117 %M 35699977 %R 10.2196/34080 %U https://formative.jmir.org/2022/6/e34080 %U https://doi.org/10.2196/34080 %U http://www.ncbi.nlm.nih.gov/pubmed/35699977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37743 %T Time-Varying Associations Between Device-Based and Ecological Momentary Assessment–Reported Sedentary Behaviors and the Concurrent Affective States Among Adolescents: Proof-of-Concept Study %A Zink,Jennifer %A Yang,Chih-Hsiang %A Alves,Jasmin M %A McAlister,Kelsey L %A Huh,Jimi %A Pentz,Mary Ann %A Page,Kathleen A %A Dunton,Genevieve F %A Belcher,Britni R %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90032, United States, 1 323 442 8225, bbelcher@usc.edu %K accelerometry %K intensive longitudinal data %K mood %K youth %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies on affective state–sedentary behavior (SB) associations have not accounted for their potentially time-varying nature and have used inconsistent SB measurement modalities. We investigated whether the strength of the associations between affective states and SB varied as a function of the time of day and by SB measurement modality (device-measured SB vs ecological momentary assessment–reported screen-based SB) in youth. Objective: This study aimed to establish a proof of concept that SB–affective state associations may not be static during the day. In addition, we aimed to inform the methodology of future work, which may need to model associations as functions of the time of day and carefully consider how SB is operationalized or measured. Methods: A total of 15 adolescents (age: mean 13.07, SD 1.03 years; 10/15, 67% female; 6/15, 40% Hispanic; 10/15, 67% healthy weight) wore thigh-mounted activPAL accelerometers and simultaneously reported their screen-based SBs and concurrent positive and negative affective states via ecological momentary assessment for 7 to 14 days (N=636 occasions). Time-varying effect models (varying slopes) examined how each measure of SB was associated with concurrent affective states from 7 AM to 8 PM. Results: Time-varying effect model plots revealed that these associations varied in strength throughout the day. Specifically, device-based SB was related to greater concurrent negative affect only after approximately 5 PM and was unrelated to concurrent positive affect. Screen-based SB was related to greater concurrent negative affect only from 7 AM to approximately 9 AM. This was also related to greater concurrent positive affect from 7 AM to approximately 9:30 AM and from approximately 3 PM to approximately 7 PM. Conclusions: We provide preliminary evidence to suggest that future confirmatory studies investigating the SB–affective state relationship should consider the time-varying nature of these associations and SB measurement modality. There may be critical time windows when specific types of SBs co-occur with affect, suggesting that interventions may need tailoring to the time of day and type of SB if future studies using similar methodologies can replicate our findings. %M 35687383 %R 10.2196/37743 %U https://formative.jmir.org/2022/6/e37743 %U https://doi.org/10.2196/37743 %U http://www.ncbi.nlm.nih.gov/pubmed/35687383 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36052 %T A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study %A Plantinga,Laura C %A Hoge,Courtney %A Vandenberg,Ann E %A James,Kyle %A Masud,Tahsin %A Khakharia,Anjali %A Gray,Carol %A Jaar,Bernard G %A Lea,Janice P %A O'Donnell,Christopher M %A Mutell,Richard %+ Department of Medicine, Emory University, 1841 Clifton Road, Room 552, Atlanta, GA, 30329, United States, 1 4047273460, laura.plantinga@emory.edu %K dialysis %K hospitals %K physicians %K advanced practice providers %K nurses %K care coordination %K mobile app %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: We piloted a web-based, provider-driven mobile app (DialysisConnect) to fill the communication and care coordination gap between hospitals and dialysis facilities. Objective: This study aimed to describe the development and pilot implementation of DialysisConnect. Methods: DialysisConnect was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using DialysisConnect. Results: The pilot version of DialysisConnect included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users versus nonusers (eg, “I can see the potential value of DialysisConnect for my work with dialysis patients”: mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; P=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42%) and a lack of time to use the system as a barrier (8/26, 31%) at the end of the pilot. Conclusions: This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations. %M 35687405 %R 10.2196/36052 %U https://formative.jmir.org/2022/6/e36052 %U https://doi.org/10.2196/36052 %U http://www.ncbi.nlm.nih.gov/pubmed/35687405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35056 %T Online Partner Seeking and Sexual Behaviors Among Men Who Have Sex With Men From Small and Midsized Towns: Cross-sectional Study %A Pravosud,Vira %A Ballard,April M %A Holloway,Ian W %A Young,April M %+ Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, United States, 1 415 514 8627, vira.pravosud@ucsf.edu %K men who have sex with men %K MSM %K sexual risk behaviors %K social networking and dating apps %K online tools %K HIV %K sexually transmitted infection %K STI prevention %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) residing outside of large urban areas are underrepresented in research on online partner seeking and sexual behaviors related to transmission of HIV. Objective: We aimed to determine associations between the use of the internet or social networking apps (online tools) to meet partners for sex, dating, or for both purposes (online partner seeking) and sexual behaviors among MSM residing in small and midsized towns in Kentucky, United States. Methods: Using peer-referral sampling and online self-administered questionnaires, data were collected from 252 men, aged 18 to 34 years, who had recently (past 6 months) engaged in anal sex with another man and resided in Central Kentucky. Using multivariable logistic regression models, we assessed associations of online partner seeking and HIV-related sexual behaviors. Results: Most (181/252, 71.8%) of the participants reported using online tools for partner seeking. Of these 181 respondents, 166 (91.7%) had used online tools to meet partners for sex (n=45, 27.1% for sex only; and n=121, 72.9% for sex and dating) and 136 (75.1%) had used online tools to meet partners for dating (n=15, 11% for dating only; and n=121, 89% for sex and dating). Adjusted analyses revealed that MSM who had engaged in condomless insertive and receptive anal intercourse were less likely to report online partner seeking (adjusted odds ratio [aOR] 0.22, 95% CI 0.07-0.68; P=.009 and aOR 0.25, 95% CI 0.10-0.66; P=.005, respectively). Increased number of insertive and receptive anal sex partners and substance use before or during sex were associated with higher odds of online partner seeking (aOR 1.31, 95% CI 1.11-1.55; P=.001; aOR 1.20, 95% CI 1.05-1.39; P=.008; and aOR 2.50, 95% CI 1.41-4.44; P=.002, respectively). Conclusions: Among MSM who reside outside of large urban areas and practice online partner seeking, HIV risk-reduction interventions should address safer sex practices, including the risks for HIV transmission associated with alcohol or drug use before or during sex. MSM who do not practice online partner seeking are in need of continued outreach to reduce condomless anal sex. %M 35687395 %R 10.2196/35056 %U https://formative.jmir.org/2022/6/e35056 %U https://doi.org/10.2196/35056 %U http://www.ncbi.nlm.nih.gov/pubmed/35687395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32874 %T Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study %A Baratta,Juliana %A Brown-Johnson,Cati %A Safaeinili,Nadia %A Goldman Rosas,Lisa %A Palaniappan,Latha %A Winget,Marcy %A Mahoney,Megan %+ Division of Primary Care and Population Health, Stanford School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 5858807040, jbaratta@alumni.stanford.edu %K hypertension %K remote blood pressure monitoring %K precision health %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the US adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management. Objective: From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program’s acceptability, appropriateness, feasibility, and sustainability. Methods: We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity. Results: A total of 63% (10/16) of the patients and 40% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time. Conclusions: Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs. %M 35687380 %R 10.2196/32874 %U https://formative.jmir.org/2022/6/e32874 %U https://doi.org/10.2196/32874 %U http://www.ncbi.nlm.nih.gov/pubmed/35687380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e29930 %T Digital Health Solutions and State of Interoperability: Landscape Analysis of Sierra Leone %A Chukwu,Emeka %A Garg,Lalit %A Foday,Edward %A Konomanyi,Abdul %A Wright,Royston %A Smart,Francis %+ Department of Computer Information Systems, Faculty of Information and Communication Technology, University of Malta, PG room A24, Level 0, Msida, MSD2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K digital health %K mHealth %K mobile health %K eHealth %K Health information and communication technologies %K Sierra Leone %K big data %K HIE %K interoperability %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone’s government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies. Objective: This paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications. Methods: All the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed. Results: The National Health Management Information System’s (NHMIS’s) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility–based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification. Conclusions: Many digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision. %M 35687406 %R 10.2196/29930 %U https://formative.jmir.org/2022/6/e29930 %U https://doi.org/10.2196/29930 %U http://www.ncbi.nlm.nih.gov/pubmed/35687406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35118 %T A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study %A Domin,Alex %A Uslu,Arif %A Schulz,André %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, 4366, Luxembourg, 352 46 66 44 93, alex.domin@uni.lu %K mobile health %K physical activity %K app %K adolescents %K within-subject %K mHealth %K sedentary behavior %K behavior change techniques %K BCTs %K Fitbit %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents. %M 35687409 %R 10.2196/35118 %U https://formative.jmir.org/2022/6/e35118 %U https://doi.org/10.2196/35118 %U http://www.ncbi.nlm.nih.gov/pubmed/35687409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e23879 %T Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis %A Bright,Katherine S %A Stuart,Scott %A Mcneil,Deborah A %A Murray,Lindsay %A Kingston,Dawn E %+ Faculty of Nursing, University of Calgary, PF2500B, 2500 University Drive NW,, Calgary, AB, T2N 1N4, Canada, 1 403 220 6262, ksbright@ucalgary.ca %K internet-based %K interpersonal psychotherapy %K mental health %K prenatal %K anxiety %K depression %K stress %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. Objective: This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. Methods: Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded. Results: A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. Conclusions: This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. Trial Registration: ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796 %M 35687403 %R 10.2196/23879 %U https://formative.jmir.org/2022/6/e23879 %U https://doi.org/10.2196/23879 %U http://www.ncbi.nlm.nih.gov/pubmed/35687403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e16996 %T Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study %A Vosburg,Suzanne K %A Dailey-Govoni,Taryn %A Beaumont,Jared %A Butler,Stephen F %A Green,Jody L %+ Inflexxion, An Uprise Health | IBH Company, 2 Park Plaza, Suite 1200, Irvine, CA, 92614, United States, 1 617 765 3138, Jody.Green@uprisehealth.com %K tapentadol %K opioid %K prescription opioid %K nonmedical use %K addiction %K chronic pain %K web-based survey %K Bluelight %K drug safety %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of abuse, diversion, and web-based endorsement of tapentadol (extended-release [ER], immediate-release [IR]) has been characterized as low compared with other prescription opioids. Little is known about individual experience with tapentadol nonmedical use (NMU). Objective: This study aims to pilot web-based survey technologies to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used, and impressions of tapentadol products (Nucynta and Nucynta ER). Methods: Recruitment flyers and banner advertisements were placed on the Bluelight website [DragonByte Technologies Ltd] with a link to a web-based survey (Qualtrics) designed to query about individuals’ lifetime tapentadol NMU. This web-based survey was followed by an interactive web-based chat (Cryptocat) with respondents who were willing to be contacted. Respondents were queried about sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued or discontinued use. Desirability and attractiveness for NMU was rated. Results: Web-based recruitment successfully attracted difficult-to-find study participants. A total of 78 participants reported that tapentadol was obtained from friends and family (ER 11/30, 37%; IR 18/67, 27%), the internet (ER 11/30, 37%; IR 12/67, 18%) or participants’ own prescriptions from a doctor (ER 9/30, 30%; IR 17/67, 25%). It was used nonmedically for pain relief (ER 18/30, 60%; IR 33/67, 49%) and multiple psychotropic effects, including relaxation (ER 13/30, 43%; IR 29/67, 43%), reduction in depression or anxiety (ER 7/30, 23%; IR 30/67, 45%), or getting high (ER 12/30, 40%; IR 33/67, 49%). Tapentadol was primarily swallowed (ER 22/30, 73%; IR 55/67, 82%), although snorting (ER 2/30, 7%; IR 8/67, 12%) and injection (ER 2/30, 7%; IR 5/67, 8%) were also reported. The preferred dose for NMU was 100 mg (both ER and IR). The participants reported tapentadol use with benzodiazepines (ER 12/21, 57%; IR 28/47, 60%). Most participants had discontinued tapentadol NMU at the time of survey completion (ER 22/30, 73%; IR 55/67, 82%). Reasons for discontinued ER NMU included side effects (10/22, 46%) and lack of effective treatment (10/22, 46%). Reasons for discontinued IR NMU included lack of access (26/55, 47%) and better NMU options (IR 21/55, 38%). Few individuals were willing to divulge identifying information about themselves for the interactive chat (8/78, 10%), demonstrating the strength of anonymous, web-based surveys. Interactive chat supported the survey findings. A subgroup of participants (4/78, 5%) reported hallucinogenic side effects with high doses. Conclusions: Web-based surveys can successfully recruit individuals who report drug NMU and those who are difficult to find. Tapentadol NMU appears to occur primarily for pain relief and for its psychotropic effects. Although it was liked by some, tapentadol did not receive a robust pattern of endorsement for NMU. %M 35687397 %R 10.2196/16996 %U https://formative.jmir.org/2022/6/e16996 %U https://doi.org/10.2196/16996 %U http://www.ncbi.nlm.nih.gov/pubmed/35687397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36066 %T Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study %A Itelman,Edward %A Shlomai,Gadi %A Leibowitz,Avshalom %A Weinstein,Shiri %A Yakir,Maya %A Tamir,Idan %A Sagiv,Michal %A Muhsen,Aia %A Perelman,Maxim %A Kant,Daniella %A Zilber,Eyal %A Segal,Gad %+ Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Sheba Road 2, Ramat Gan, 555710, Israel, 972 526669580, gad.segal@sheba.health.gov.il %K remote patient monitoring %K noninvasive monitoring %K general ward %K early warning score system %K patient deterioration %K clinical prediction %K wearable devices %K uHealth %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective: This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods: This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a “wish list” score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results: In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions: Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration: ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359 %M 35679119 %R 10.2196/36066 %U https://formative.jmir.org/2022/6/e36066 %U https://doi.org/10.2196/36066 %U http://www.ncbi.nlm.nih.gov/pubmed/35679119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33793 %T General Demographics and Behavioral Patterns of Visitors Using a Self-help Website for Identification of and Intervention in Alcoholism and Common Mental Disorders in Suriname: Descriptive Study %A Jadnanansing,Raj %A Dekker,Jack %A Etwaroo,Kajal %A Dwarkasing,Rudi %A Lumsden,Vincent %A Bipat,Robbert %A Blankers,Matthijs %+ Psychiatrisch Centrum Suriname, L. Vriesdelaan, Paramaribo, Suriname, 597 8781948, raj.jadnanansing@pcs.sr %K eHealth %K mental health %K alcohol use disorder %K depression %K anxiety %K Facebook %K alcohol disorder %K alcohol %K self-help %K alcoholism %K Suriname %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health applications have been shown to be an accepted means to provide mental health information and advice in various high- and middle-income countries. Started in 2015, ehealth.sr was the first website to offer preventive information, self-tests, and unguided digital self-help for depression, anxiety symptoms, and problematic alcohol use in Suriname, an upper middle-income country in South America. Objective: This study aimed to assess the general demographics and behavioral patterns of the visitors of ehealth.sr, as well as to evaluate different promotional channels to attract the target audience to the website. Methods: Data collection for this study took place between August 2015 and December 2020. Conventional promotion channels such as newspaper and radio advertisements as well as social media advertisements were used to attract users to the website. The number of visits and activity on the website was registered using Google analytics and the website’s internal activity log. Results: On average, about 115 unique visitors accessed the website per month. The average number of visits to the website increased notably when social media advertisement campaigns were conducted (266 per month in 2018) compared to when traditional advertisements campaigns through papers, radio, and television were used (34 per month in 2019). Of the 1908 new visitors, 1418 (74.32%) were female. On average, visitors accessed 2 (SD 0.3) pages of the website and a session lasted 2.6 (SD 0.9) minutes. The most popular pages for intervention on the website were those for the mood or anxiety screening (731/942, 77.6%) as opposed to those for alcohol screening (211/942, 22.4%). People aged <45 years (on average, 2.2 pages per session for 3.2 minutes) made more use of the website than people aged ≥45 years (on average, 1.7 pages per session for 2 minutes). Conclusions: Promotion via social media led to more visitors to the website than newspaper or radio advertisements. Younger age groups and females visited the website more often. The pages on preventive information and brief self-tests were visited more frequently than the self-help modules. In general, user adherence to the website in terms of the average session duration and number of viewed pages per session is low and is a key point of concern for the successful implementation of digital mental health websites. %M 35679108 %R 10.2196/33793 %U https://formative.jmir.org/2022/6/e33793 %U https://doi.org/10.2196/33793 %U http://www.ncbi.nlm.nih.gov/pubmed/35679108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32416 %T Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis %A Lightfoot,Marguerita %A Jackson-Morgan,Joi %A Pollack,Lance %A Bennett,Ayanna %+ Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, United States, 1 415 502 4320, lightfom@ohsu.edu %K HIV prevention %K STI prevention %K adolescents %K youth %K text messaging %K SMS %K peer-to-peer intervention %K HIV %K STI %K HIV testing %D 2022 %7 9.6.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective: We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods: The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results: Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions: Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services. %M 35686737 %R 10.2196/32416 %U https://formative.jmir.org/2022/6/e32416 %U https://doi.org/10.2196/32416 %U http://www.ncbi.nlm.nih.gov/pubmed/35686737 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e31485 %T Toward Improved Treatment and Empowerment of Individuals With Parkinson Disease: Design and Evaluation of an Internet of Things System %A Karni,Liran %A Jusufi,Ilir %A Nyholm,Dag %A Klein,Gunnar Oskar %A Memedi,Mevludin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 702 81, Sweden, 46 19 301218, liran.karni@oru.se %K Internet of Things %K wearable technology %K Parkinson disease %K patient empowerment %K objective measures %K self-assessment %K self-management %K web interface %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual’s quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers. Objective: Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD. Methods: We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model. Results: Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD. Conclusions: The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research. %M 35679097 %R 10.2196/31485 %U https://formative.jmir.org/2022/6/e31485 %U https://doi.org/10.2196/31485 %U http://www.ncbi.nlm.nih.gov/pubmed/35679097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34951 %T Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study %A Pace,Thaddeus W W %A Zeiders,Katharine H %A Cook,Stephanie H %A Sarsar,Evelyn D %A Hoyt,Lindsay T %A Mirin,Nicholas L %A Wood,Erica P %A Tatar,Raquel %A Davidson,Richard J %+ Division of Biobehavioral Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 520 626 3520, twwpace@arizona.edu %K firefighter %K meditation %K smartphone app %K anxiety %K cortisol %K digital health %K mobile health %K mHealth %K mental health %K burnout %K stress management %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. Objective: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. Methods: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. Results: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. Conclusions: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters. %M 35675115 %R 10.2196/34951 %U https://formative.jmir.org/2022/6/e34951 %U https://doi.org/10.2196/34951 %U http://www.ncbi.nlm.nih.gov/pubmed/35675115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33734 %T Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study %A Petros,Nuhamin Gebrewold %A Hadlaczky,Gergo %A Carletto,Sara %A Martinez,Sergio Gonzalez %A Ostacoli,Luca %A Ottaviano,Manuel %A Meyer,Björn %A Scilingo,Enzo Pasquale %A Carli,Vladimir %+ National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Ethics and Management, Karolinska Institute, Granits väg 4, Stockholm, 171 65, Sweden, 46 707313324, nuhamin.petros@ki.se %K mental health %K depression %K eHealth %K usability %K breast cancer %K prostate cancer %K System Usability Scale %K SUS %K the user version of the Mobile App Rating Scale %K uMARS %K Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases %K NEVERMIND system %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions. Objective: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer. Methods: The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period. Results: The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (β=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (β=–0.13; P=.04, 95% CI −0.25 to −0.01), after adjusting for other covariates. Conclusions: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability. Trial Registration: German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391 %M 35675116 %R 10.2196/33734 %U https://formative.jmir.org/2022/6/e33734 %U https://doi.org/10.2196/33734 %U http://www.ncbi.nlm.nih.gov/pubmed/35675116 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e30630 %T Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial %A Okaniwa,Fusae %A Yoshida,Hiroshi %+ Department of Theoretical Social Security Research, National Institute of Population and Social Security Research, 2-2-3 Uchisaiwaicho, Chiyoda-ku, Tokyo, 100-0011, Japan, 81 3 3595 2984, okaniwa-fusae@ipss.go.jp %K health promotion %K dietary management %K intervention %K artificial intelligence %K body fat percentage %K body mass index %K behavioral economics %K nonprofessional %K Japan %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present. Objective: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness. Methods: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators. Results: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP. Conclusions: This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions. %M 35675107 %R 10.2196/30630 %U https://formative.jmir.org/2022/6/e30630 %U https://doi.org/10.2196/30630 %U http://www.ncbi.nlm.nih.gov/pubmed/35675107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37779 %T Mobile Health App for Tuberculosis Screening and Compliance to Undergo Chest X-ray Examination Among Presumptive Cases Detected by the App in Myanmar: Usability Study %A Htet,Kyaw Ko Ko %A Phyu,Aye Nyein %A Thwin,Thandar %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K usability %K mobile app %K TB screening %K chest X-ray compliance %K mobile health %K health application %K risk score %K tuberculosis %K COVID-19 %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Myanmar, the use of a mobile app for tuberculosis (TB) screening and its operational effect on seeking TB health care have not been evaluated yet. Objective: This study aims to report the usability of a simple mobile app to screen TB and comply with chest X-ray (CXR) examination of presumptive cases detected by the app. Methods: A new “TB-screen” app was developed from a Google Sheet based on a previously published algorithm. The app calculates a TB risk propensity score from an individual’s sociodemographic characteristics and TB clinical history and suggests whether the individual should undergo a CXR. The screening program was launched in urban slum areas soon after the COVID-19 outbreak subsided. A standard questionnaire was used to assess the app’s usability rated by presumptive cases. Compliance to undergo CXR was confirmed by scanning the referral quick response (QR) code via the app. Results: Raters were 453 presumptive cases detected by the app. The mean usability rating score was 4.1 out of 5. Compliance to undergo CXR examination was 71.1% (n=322). Active TB case detection among CXR compliances was 7.5% (n=24). One standard deviation (SD) increase in the app usability score was significantly associated with a 59% increase in the odds to comply with CXR (β=.464) after adjusting for other variables (P<.001). Conclusions: This simple mobile app got a high usability score rated by 453 users. The mobile app usability score successfully predicted compliance to undergo CXR examination. Eventually, 24 (7.5%) of 322 users who were suspected of having TB by the mobile app were detected as active TB cases by CXR. The system should be upscaled for a large trial. %M 35623000 %R 10.2196/37779 %U https://formative.jmir.org/2022/6/e37779 %U https://doi.org/10.2196/37779 %U http://www.ncbi.nlm.nih.gov/pubmed/35623000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34566 %T A Yoga Exercise App Designed for Patients With Axial Spondylarthritis: Development and User Experience Study %A Truong,Minh Tam %A Nwosu,Obioma Bertrand %A Gaytan Torres,Maria Elena %A Segura Vargas,Maria Paula %A Seifer,Ann-Kristin %A Nitschke,Marlies %A Ibrahim,Alzhraa A %A Knitza,Johannes %A Krusche,Martin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8543023, harriet.morf@uk-erlangen.de %K spondylarthritis %K digital health application %K yoga %K usability %K patient empowerment %K mobile health %K mHealth %K health applications %K smartphone %K physical exercise %K wellness %K mobile phone %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with axial spondyloarthritis (AS). Digital health apps (DHAs) such as the yoga app YogiTherapy could remotely empower patients to autonomously and correctly perform exercises. Objective: This study aimed to design and develop a smartphone-based app, YogiTherapy, for patients with AS. To gain additional insights into the usability of the graphical user interface (GUI) for further development of the app, this study focused exclusively on evaluating users’ interaction with the GUI. Methods: The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by engineering students, rheumatologists, and patients with AS. After the initial development process, a pilot version of the app was evaluated by 5 patients and 5 rheumatologists. The participants had to interact with the app’s GUI and complete 5 navigation tasks within the app. Subsequently, the completion rate and experience questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) were completed by the patients. Results: The results of the posttest questionnaires showed that most patients were already familiar with digital apps (4/5, 80%). The task completion rates of the usability test were 100% (5/5) for the tasks T1 and T2, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists indicated that they were even more experienced with digital devices (2/5, 40% experts; 3/5, 60% intermediates). In this case, they scored task completion rates of 100% (5/5) for all 5 usability tasks T1 to T5. The mean results from the User Experience Questionnaire range from −3 (most negative) to +3 (most positive). According to rheumatologists’ evaluations, attractiveness (mean 2.267, SD 0.401) and stimulation (mean 2.250, SD 0.354) achieved the best mean results compared with dependability (mean 2.000, SD 0.395). Patients rated attractiveness at a mean of 2.167 (SD 0.565) and stimulation at a mean of 1.950 (SD 0.873). The lowest mean score was reported for perspicuity (mean 1.250, SD 1.425). Conclusions: The newly developed and tested DHA YogiTherapy demonstrated moderate usability among rheumatologists and patients with rheumatic diseases. The app can be used by patients with AS as a complementary treatment. The initial evaluation of the GUI identified significant usability problems that need to be addressed before the start of a clinical evaluation. Prospective trials are also needed in the second step to prove the clinical benefits of the app. %M 35657655 %R 10.2196/34566 %U https://formative.jmir.org/2022/6/e34566 %U https://doi.org/10.2196/34566 %U http://www.ncbi.nlm.nih.gov/pubmed/35657655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32571 %T Antifragile Behavior Change Through Digital Health Behavior Change Interventions %A Kaveladze,Benjamin T %A Young,Sean D %A Schueller,Stephen M %+ Department of Psychological Science, University of California, 4201 Social & Behavioral Sciences Gateway, Irvine, CA, 92697-7085, United States, 1 310 984 9318, bkavelad@uci.edu %K digital health behavior change interventions %K behavior change %K digital health %K self-management %K antifragile %D 2022 %7 3.6.2022 %9 Viewpoint %J JMIR Form Res %G English %X Digital health behavior change interventions (DHBCIs) offer users accessible support, yet their promise to improve health behaviors at scale has not been met. One reason for this unmet potential may be a failure to offer users support that is tailored to their personal characteristics and goals. We apply the concept of antifragility to propose how DHBCIs could be better designed to support diverse users’ behavior change journeys. We first define antifragility as a feature of an individual’s relationship to a particular challenge such that if one is antifragile to a challenge, one is well positioned to benefit from facing that challenge. Second, we introduce antifragile behavior change to describe behavior change processes that leverage person-specific antifragilities to maximize benefits and minimize risk in the behavior change process. While most existing behavior change models focus on improving one’s motivation and ability to face challenges, antifragile behavior change complements these models by helping to select challenges that are most likely to produce desired outcomes. Next, we propose three principles by which DHBCIs can help users to develop antifragile behavior change strategies: providing personalized guidance, embracing variance and exploration in choosing behaviors, and prioritizing user agency. Finally, we offer an example of how a DHBCI could be designed to support antifragile behavior change. %M 35657665 %R 10.2196/32571 %U https://formative.jmir.org/2022/6/e32571 %U https://doi.org/10.2196/32571 %U http://www.ncbi.nlm.nih.gov/pubmed/35657665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35086 %T An Intervention to Connect Patients With Psychosis and Volunteers via Smartphone (the Phone Pal): Development Study %A Pinto da Costa,Mariana %A , %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny, London, SE58AB, United Kingdom, 44 02078480002, mariana.pintodacosta@gmail.com %K intervention %K intervention development %K digital mental health %K psychosis %K severe mental illness %K volunteering %K volunteer %K mental health %K mental illness %K development %K design %K user centered design %K smartphone %K mobile phone %K mobile health %K mHealth %K MRC framework %K Medical Research Council framework %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Intervention development is a critical stage. However, evidence indicates that the substandard reporting of intervention details is widespread. Objective: This study aimed to provide an overview of the guiding frameworks, methodology, and stages for the design and construction of a new complex intervention—the Phone Pal. Methods: The intervention development process followed the Medical Research Council framework for developing complex interventions as well as the person-based approach. The intervention was developed following the evidence synthesis of a literature review, a focus group study, and a survey after consultation and input from advisory groups with a range of stakeholders, including patients, volunteers, clinicians, and academics. Results: The developed logic model outlines the contextual factors, intervention, mechanisms of change, and short- and long-term outcomes. The operationalized intervention required matching 1 patient with 1 volunteer to communicate with each other through a smartphone via SMS text messages, WhatsApp messages or email, and audio or video calls. Each participant was encouraged to communicate with their match at least once per week for a 12-week period using informal conversation. Conclusions: The systematic process and theoretically sound strategy through which this intervention was developed can provide insights to future researchers on the reality of developing and preparing the operationalization of a digital intervention using multiple components. %M 35653171 %R 10.2196/35086 %U https://formative.jmir.org/2022/6/e35086 %U https://doi.org/10.2196/35086 %U http://www.ncbi.nlm.nih.gov/pubmed/35653171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e28059 %T Direct Outreach in Bars and Clubs to Enroll Cigarette Smokers in Mobile Cessation Services: Exploratory Study %A Chalela,Patricia %A McAlister,Alfred L %A Despres,Cliff %A Muñoz,Edgar %A Sukumaran,Pramod %A Akopian,David %A Kaghyan,Sahak %A Trujillo,Jesus %A Ramirez,Amelie G %+ Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, Suite 1000, 7411 John Smith Drive, San Antonio, TX, 78229, United States, 1 210 562 6500, ramirezag@uthscsa.edu %K smoking cessation %K young adults %K Latinos %K mobile intervention %K direct recruitment %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. Objective: The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. Methods: We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. Results: The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. Conclusions: Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates. %M 35653173 %R 10.2196/28059 %U https://formative.jmir.org/2022/6/e28059 %U https://doi.org/10.2196/28059 %U http://www.ncbi.nlm.nih.gov/pubmed/35653173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32419 %T Continuation of Teletherapy After the COVID-19 Pandemic: Survey Study of Licensed Mental Health Professionals %A Gangamma,Rashmi %A Walia,Bhavneet %A Luke,Melissa %A Lucena,Claudine %+ Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Peck Hall, 601 E Genesee Street, Syracuse, NY, 13202, United States, 1 614 325 4029, rgangamm@syr.edu %K teletherapy %K relational teletherapy %K teletherapy predictors %K postpandemic teletherapy %K mental health %K telemedicine %K COVID-19 %K telehealth %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective: In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods: Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results: A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions: Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals. %M 35584317 %R 10.2196/32419 %U https://formative.jmir.org/2022/6/e32419 %U https://doi.org/10.2196/32419 %U http://www.ncbi.nlm.nih.gov/pubmed/35584317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34279 %T Application of Spatial Risk Assessment Integrated With a Mobile App in Fighting Against the Introduction of African Swine Fever in Pig Farms in Thailand: Development Study %A Thanapongtharm,Weerapong %A Wongphruksasoong,Vilaiporn %A Sangrat,Waratida %A Thongsrimoung,Kittin %A Ratanavanichrojn,Nattavut %A Kasemsuwan,Suwicha %A Khamsiriwatchara,Amnat %A Kaewkungwal,Jaranit %A Leelahapongsathon,Kansuda %+ Faculty of Veterinary Medicine, Kasetsart University, Malaiman Rd, Kamphaeng Saen, Nakhon Pathom, 73140, Thailand, 66 34351901, fvetkul@ku.ac.th %K African swine fever %K multi-criteria decision analysis %K risk-based surveillance %K risk assessment %K spatial analysis %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: African swine fever (ASF), a highly contagious disease affecting both domestic and wild pigs, has been having a serious impact on the swine industry worldwide. This important transboundary animal disease can be spread by animals and ticks via direct transmission and by contaminated feed and fomites via indirect transmission because of the high environmental resistance of the ASF virus. Thus, the prevention of the introduction of ASF to areas free of ASF is essential. After an outbreak was reported in China, intensive import policies and biosecurity measures were implemented to prevent the introduction of ASF to pig farms in Thailand. Objective: Enhancing prevention and control, this study aims to identify the potential areas for ASF introduction and transmission in Thailand, develop a tool for farm assessment of ASF risk introduction focusing on smallholders, and develop a spatial analysis tool that is easily used by local officers for disease prevention and control planning. Methods: We applied a multi-criteria decision analysis approach with spatial and farm assessment and integrated the outputs with the necessary spatial layers to develop a spatial analysis on a web-based platform. Results: The map that referred to potential areas for ASF introduction and transmission was derived from 6 spatial risk factors; namely, the distance to the port, which had the highest relative importance, followed by the distance to the border, the number of pig farms using swill feeding, the density of small pig farms (<50 heads), the number of pigs moving in the area, and the distance to the slaughterhouse. The possible transmission areas were divided into 5 levels (very low, low, medium, high, and very high) at the subdistrict level, with 27 subdistricts in 10 provinces having very high suitability and 560 subdistricts in 34 provinces having high suitability. At the farm level, 17 biosecurity practices considered as useful and practical for smallholders were selected and developed on a mobile app platform. The outputs from the previous steps integrated with necessary geographic information system layers were added to a spatial analysis web-based platform. Conclusions: The tools developed in this study have been complemented with other strategies to fight against the introduction of ASF to pig farms in the country. The areas showing high and very high risk for disease introduction and transmission were applied for spatial information planning, for example, intensive surveillance, strict animal movement, and public awareness. In addition, farms with low biosecurity were improved in these areas, and the risk assessment developed on a mobile app in this study helped enhance this matter. The spatial analysis on a web-based platform helped facilitate disease prevention planning for the authorities. %M 35639455 %R 10.2196/34279 %U https://formative.jmir.org/2022/5/e34279/ %U https://doi.org/10.2196/34279 %U http://www.ncbi.nlm.nih.gov/pubmed/35639455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e22899 %T Telecare Service Use in Northern Ireland: Exploratory Retrospective Cohort Study %A Al-Obaidi,Hala %A Jirjees,Feras %A Al-Azzam,Sayer %A Faith,Verity %A Clarke,Mike %A Gardner,Evie %A Agus,Ashley %A McElnay,James %+ School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, United Kingdom, 44 28 9097 208, j.mcelnay@qub.ac.uk %K telecare %K Northern Ireland %K assistive technology %K elderly people %K healthcare use %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telecare is a health service that involves the home installation of a number of information technology support systems for individuals with complex needs, such as people with reduced mobility or disabilities and the elderly. It involves the use of sensors in patients’ homes to detect events, such as smoke in the kitchen, a front door left open, or a patient fall. In Northern Ireland (NI), outputs from these sensors are monitored remotely by the telecare team, who can provide assistance as required by telephone or through the emergency services. The facilitation of such rapid responses has the aim of promoting early intervention and therefore maintaining patient well-being. Objective: The aims of this study were to construct a descriptive summary of the telecare program in NI and evaluate hospital-based service use by telecare patients before and after the installation of telecare equipment. Methods: An exploratory retrospective cohort study was conducted involving more than 2000 patients. Data analysis included the evaluation of health care use before and after the telecare service was initiated for individual participants. Individuals with data for a minimum of 6 months before and after the installation of the telecare service were included in this analysis. Results: A total of 2387 patients were enrolled in the telecare service during the observation period (February 26, 2010-February 22, 2016). The mean age was 78 years (median 81 years). More women (1623/2387, 68%) were enrolled in the service. Falls detectors were the most commonly deployed detectors in the study cohort (824/1883, 43.8% of cases). The average number of communications (calls and/or alarms) between participants and the coordinating center was the highest for patients aged ≥85 years (mean 86 calls per year). These contacts were similarly distributed by gender. The mortality rate over the study period was higher in men than women (98/770, 14.4% in men compared to 107/1617, 6.6% in women). The number of nonelective hospital admissions, emergency room visits, and outpatient clinic visits and the length of hospital stays per year were significantly higher (P<.001) after the installation of the telecare equipment than during the period before installation. Conclusions: Despite the likely benefits of the telecare service in providing peace of mind for patients and their relatives, hospital-based health care use significantly increased after enrollment in the service. This likely reflects the increasing health care needs over time in an aging population. %M 35639448 %R 10.2196/22899 %U https://formative.jmir.org/2022/5/e22899 %U https://doi.org/10.2196/22899 %U http://www.ncbi.nlm.nih.gov/pubmed/35639448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30371 %T The Associations Between Racially/Ethnically Stratified COVID-19 Tweets and COVID-19 Cases and Deaths: Cross-sectional Study %A Liu,Xiaohui %A Kar,Bandana %A Montiel Ishino,Francisco Alejandro %A Onega,Tracy %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, 20892, United States, 1 8016464179, xiaohuiliugis@gmail.com %K racial/ethnic stratification %K geo-tagged COVID-19 tweets %K racial/ethnic disparity %K surveillance %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic exacerbated existing racial/ethnic health disparities in the United States. Monitoring nationwide Twitter conversations about COVID-19 and race/ethnicity could shed light on the impact of the pandemic on racial/ethnic minorities and help address health disparities. Objective: This paper aims to examine the association between COVID-19 tweet volume and COVID-19 cases and deaths, stratified by race/ethnicity, in the early onset of the pandemic. Methods: This cross-sectional study used geotagged COVID-19 tweets from within the United States posted in April 2020 on Twitter to examine the association between tweet volume, COVID-19 surveillance data (total cases and deaths in April), and population size. The studied time frame was limited to April 2020 because April was the earliest month when COVID-19 surveillance data on racial/ethnic groups were collected. Racially/ethnically stratified tweets were extracted using racial/ethnic group–related keywords (Asian, Black, Latino, and White) from COVID-19 tweets. Racially/ethnically stratified tweets, COVID-19 cases, and COVID-19 deaths were mapped to reveal their spatial distribution patterns. An ordinary least squares (OLS) regression model was applied to each stratified dataset. Results: The racially/ethnically stratified tweet volume was associated with surveillance data. Specifically, an increase of 1 Asian tweet was correlated with 288 Asian cases (P<.001) and 93.4 Asian deaths (P<.001); an increase of 1 Black tweet was linked to 47.6 Black deaths (P<.001); an increase of 1 Latino tweet was linked to 719 Latino deaths (P<.001); and an increase of 1 White tweet was linked to 60.2 White deaths (P<.001). Conclusions: Using racially/ethnically stratified Twitter data as a surveillance indicator could inform epidemiologic trends to help estimate future surges of COVID-19 cases and potential future outbreaks of a pandemic among racial/ethnic groups. %M 35537056 %R 10.2196/30371 %U https://formative.jmir.org/2022/5/e30371 %U https://doi.org/10.2196/30371 %U http://www.ncbi.nlm.nih.gov/pubmed/35537056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36068 %T Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach %A Birrell,Louise %A Furneaux-Bate,Ainsley %A Debenham,Jennifer %A Spallek,Sophia %A Newton,Nicola %A Chapman,Catherine %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, 2006, Australia, 61 286279003, louise.birrell@sydney.edu.au %K mobile health %K depression %K anxiety %K psychosocial support system %K alcohol drinking %K adolescent %K digital technology %K mobile intervention %K intervention %K social %K economic %K development %K mind your mate %K app %K application %K mHealth %K mobile phone %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. %M 35622401 %R 10.2196/36068 %U https://formative.jmir.org/2022/5/e36068 %U https://doi.org/10.2196/36068 %U http://www.ncbi.nlm.nih.gov/pubmed/35622401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35835 %T Acceptability, Adaptability, and Feasibility of a Novel Computer-Based Virtual Counselor–Delivered Alcohol Intervention: Focus Group and In-depth Interview Study Among Adults With HIV or Tuberculosis in Indian Clinical Settings %A Suryavanshi,Nishi %A Dhumal,Gauri %A Cox,Samyra R %A Sangle,Shashikala %A DeLuca,Andrea %A Santre,Manjeet %A Gupta,Amita %A Chander,Geetanjali %A Hutton,Heidi %+ Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Trials Unit, Jaiprakesh Narayan Road, Pune, 411001, India, 91 9823 248979, nishisuryavanshi@hotmail.com %K computer-based-intervention %K HIV/TB clinical setting %K alcohol use disorder (AUD) %K alcohol %K India %K HIV %K TB %K feasibility %K acceptability %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Unhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB. Objective: We assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India. Methods: We conducted 10 in-depth interviews with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis. Results: The majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program’s effectiveness by providing more flexible interaction. HCP focus group participants noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators, and activities to substitute for drinking alcohol were suggested by all focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff. Conclusions: With cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor–delivered alcohol intervention is acceptable and appears feasible to implement, particularly if coupled with person-delivered counseling. %M 35622406 %R 10.2196/35835 %U https://formative.jmir.org/2022/5/e35835 %U https://doi.org/10.2196/35835 %U http://www.ncbi.nlm.nih.gov/pubmed/35622406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e27248 %T Polar Vantage and Oura Physical Activity and Sleep Trackers: Validation and Comparison Study %A Henriksen,André %A Svartdal,Frode %A Grimsgaard,Sameline %A Hartvigsen,Gunnar %A Hopstock,Laila Arnesdatter %+ Department of Computer Science, UiT The Arctic University of Norway, Hansine Hansens veg 18, Troms, 9019, Norway, 47 77645214, andre.henriksen@uit.no %K actigraphy %K fitness trackers %K motor activity %K energy expenditure %K steps %K activity tracker %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Consumer-based activity trackers are increasingly used in research, as they have the potential to promote increased physical activity and can be used for estimating physical activity among participants. However, the accuracy of newer consumer-based devices is mostly unknown, and validation studies are needed. Objective: The objective of this study was to compare the Polar Vantage watch (Polar Electro Oy) and Oura ring (generation 2; Ōura Health Oy) activity trackers to research-based instruments for measuring physical activity, total energy expenditure, resting heart rate, and sleep duration in free-living adults. Methods: A total of 21 participants wore 2 consumer-based activity trackers (Polar watch and Oura ring), an ActiGraph accelerometer (ActiGraph LLC), and an Actiheart accelerometer and heart rate monitor (CamNtech Ltd) and completed a sleep diary for up to 7 days. We assessed Polar watch and Oura ring validity and comparability for measuring physical activity, total energy expenditure, resting heart rate (Oura), and sleep duration. We analyzed repeated measures correlations, Bland-Altman plots, and mean absolute percentage errors. Results: The Polar watch and Oura ring values strongly correlated (P<.001) with the ActiGraph values for steps (Polar: r=0.75, 95% CI 0.54-0.92; Oura: r=0.77, 95% CI 0.62-0.87), moderate-to-vigorous physical activity (Polar: r=0.76, 95% CI 0.62-0.88; Oura: r=0.70, 95% CI 0.49-0.82), and total energy expenditure (Polar: r=0.69, 95% CI 0.48-0.88; Oura: r=0.70, 95% CI 0.51-0.83) and strongly or very strongly correlated (P<.001) with the sleep diary–derived sleep durations (Polar: r=0.74, 95% CI 0.56-0.88; Oura: r=0.82, 95% CI 0.68-0.91). Oura ring–derived resting heart rates had a very strong correlation (P<.001) with the Actiheart-derived resting heart rates (r=0.9, 95% CI 0.85-0.96). However, the mean absolute percentage error was high for all variables except Oura ring–derived sleep duration (10%) and resting heart rate (3%), which the Oura ring underreported on average by 1 beat per minute. Conclusions: The Oura ring can potentially be used as an alternative to the Actiheart to measure resting heart rate. As for sleep duration, the Polar watch and Oura ring can potentially be used as replacements for a manual sleep diary, depending on the acceptable error. Neither the Polar watch nor the Oura ring can replace the ActiGraph when it comes to measuring steps, moderate-to-vigorous physical activity, and total energy expenditure, but they may be used as additional sources of physical activity measures in some settings. On average, the Polar Vantage watch reported higher outputs compared to those reported by the Oura ring for steps, moderate-to-vigorous physical activity, and total energy expenditure. %M 35622397 %R 10.2196/27248 %U https://formative.jmir.org/2022/5/e27248 %U https://doi.org/10.2196/27248 %U http://www.ncbi.nlm.nih.gov/pubmed/35622397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36824 %T Emergency Telemedicine Mobile Ultrasounds Using a 5G-Enabled Application: Development and Usability Study %A Berlet,Maximilian %A Vogel,Thomas %A Gharba,Mohamed %A Eichinger,Joseph %A Schulz,Egon %A Friess,Helmut %A Wilhelm,Dirk %A Ostler,Daniel %A Kranzfelder,Michael %+ Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr 22, Munich, 81675, Germany, 49 89 4140 ext 5088, michael.kranzfelder@tum.de %K 5G %K telemedicine %K telehealth %K eHealth %K digital health %K digital medicine %K mobile ultrasound %K ultrasound %K imaging %K digitalized medicine %K emergency care %K emergency %K ambulance %K slicing %K diagnostic %K diagnosis %K image quality %K field test %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications. Objective: The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. Methods: A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. Results: Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. Conclusions: Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive. %M 35617009 %R 10.2196/36824 %U https://formative.jmir.org/2022/5/e36824 %U https://doi.org/10.2196/36824 %U http://www.ncbi.nlm.nih.gov/pubmed/35617009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34339 %T Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale %A Agnew,Jonathon M R %A Nugent,Chris %A Hanratty,Catherine E %A Martin,Elizabeth %A Kerr,Daniel P %A McVeigh,Joseph G %+ Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 07576629548, agnew-j10@ulster.ac.uk %K mobile app %K shoulder pain %K mHealth %K Mobile App Rating Scale %K mobile phone %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed. Objective: The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale. Methods: This study included 25 free and paid apps—8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps. Results: Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the “Functionality” and “Aesthetics” sections, and apps were scored poorer in the “Engagement” and “Information” sections. The apps were also rated poorly in the “Subjective Quality” section. Conclusions: In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control. %M 35617008 %R 10.2196/34339 %U https://formative.jmir.org/2022/5/e34339 %U https://doi.org/10.2196/34339 %U http://www.ncbi.nlm.nih.gov/pubmed/35617008 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35950 %T Individuals’ Perceptions as a Substitute for Guidelines and Evidence: Interview Study Among Clinicians on How They Choose Between In-Person and Remote Consultation %A Enam,Amia %A Dreyer,Heidi C %A De Boer,Luitzen %+ Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Alfred Getz vei 3, Trondheim, 7491, Norway, 47 40617856, amia.enam@ntnu.no %K video consultation %K work routine %K outpatient care %K telemedicine %K clinician %K professional work %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Video consultation (VC) is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for health care worldwide. Therefore, the sustainable implementation of VC is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being sufficiently robust because the research settings are mostly small-scale pilot projects and are unable to reflect long-term implementation. The COVID-19 pandemic has compelled clinicians worldwide to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation. Objective: The aim of this study was to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reasons are for their choices. We posited that a deeper understanding of clinicians’ perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service. Methods: A qualitative approach was taken, in which the unit of analysis was clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which were used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed using deductive content analysis. Results: Clinicians have mixed opinions on the merits and demerits of VC and its position between in-person and telephone consultation. Totally, 6 different planning criteria were identified, and individual clinicians used different combinations of these criteria when choosing a mode of consultation. The ideals that clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. VC engenders a new ideal and endangers the existing ideals. VC causes minor changes in the tasks the clinicians perform during a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians could not identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation. Conclusions: Clinicians feel that there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and interpersonal and managerial aspects, which are crucial for consultation service. The absence of sufficient scientific evidence and a clear understanding of the merits and demerits of VC and standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify their choices regarding the consultation mode. Thus, diverse opinions emerge, including some paradoxical ones, resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service. %M 35475503 %R 10.2196/35950 %U https://formative.jmir.org/2022/5/e35950 %U https://doi.org/10.2196/35950 %U http://www.ncbi.nlm.nih.gov/pubmed/35475503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35874 %T Potential of Online Recruitment Among 15-25-Year Olds: Feasibility Randomized Controlled Trial %A Hoffmann,Sofie Have %A Paldam Folker,Anna %A Buskbjerg,Mark %A Paldam Folker,Marie %A Huber Jezek,Andrea %A Lyngsø Svarta,Durita %A Nielsen Sølvhøj,Ida %A Thygesen,Lau %+ National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen, 1455, Denmark, 45 29138049, sohh@vive.dk %K recruitment %K web based %K online %K mental health %K young people %K well-being %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Recruiting young people for health and intervention studies by traditional methods has become increasingly challenging. The widespread access to the internet may offer new strategies for online recruitment. Objective: This study aims to assess the feasibility of online recruitment for a randomized controlled trial evaluating the effectiveness of Mindhelper, an online national youth mental health promotion service. The target group was young Danes aged 15-25 in need of mental health promotion. Methods: Advertisements for recruitment were set up on Facebook and Instagram. Browser history was collected for a subsample of participants. We compared basic characteristics of participants who completed the baseline survey and those who did not, as well as of participants who completed the follow-up survey and those who were lost to follow-up. The significance of these differences was tested with the Pearson chi-square test. Results: A total of 560 Danes aged 15-25 were recruited within 1 month (ie, had completed the baseline survey). Among these participants, 356 (63.6%) were at risk of developing depression or stress. The average advertisement price per participant completing the baseline questionnaire was 31 DKK (approximately €4 [US $4.2]). The follow-up survey was sent to 545 participants, of whom 318 (58.3%) completed the survey. No statistically significant differences were observed in baseline characteristics of participants who completed the follow-up and those who were lost to follow-up in terms of gender (P=.45), age (P=.35), occupation (P=.17), cohabitation (P=.90), mental well-being (P=.26), mental illness (P=.44; impact of the illness, P=.05), or use of the internet when having a hard time (P=.92). Conclusions: We conclude that it is feasible to recruit young Danes online for a large-scale randomized controlled trial assessing the effectiveness of Mindhelper. Trial Registration: ClinicalTrials.gov NCT04650906; https://clinicaltrials.gov/ct2/show/NCT04650906 %M 35612877 %R 10.2196/35874 %U https://formative.jmir.org/2022/5/e35874 %U https://doi.org/10.2196/35874 %U http://www.ncbi.nlm.nih.gov/pubmed/35612877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30573 %T Identifying Barriers to Enrollment in Patient Pregnancy Registries: Building Evidence Through Crowdsourcing %A Pimenta,Jeanne M %A Painter,Jeffery L %A Gemzoe,Kim %A Levy,Roger Abramino %A Powell,Marcy %A Meizlik,Paige %A Powell,Gregory %+ Safety Innovation and Analytics, GlaxoSmithKline, 5 Moore Dr, Research Triangle, Durham, NC, 27709, United States, 1 919 619 3297, gregory.e.powell@gsk.com %K belimumab %K crowdsourcing %K systemic lupus erythematosus %K pregnancy %K registry %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Enrollment in pregnancy registries is challenging despite substantial awareness-raising activities, generally resulting in low recruitment owing to limited safety data. Understanding patient and physician awareness of and attitudes toward pregnancy registries is needed to facilitate enrollment. Crowdsourcing, in which services, ideas, or content are obtained by soliciting contributions from a large group of people using web-based platforms, has shown promise for improving patient engagement and obtaining patient insights. Objective: This study aimed to use web-based crowdsourcing platforms to evaluate Belimumab Pregnancy Registry (BPR) awareness among patients and physicians and to identify potential barriers to pregnancy registry enrollment with the BPR as a case study. Methods: We conducted 2 surveys using separate web-based crowdsourcing platforms: Amazon Mechanical Turk (a 14-question patient survey) and Sermo RealTime (a 11-question rheumatologist survey). Eligible patients were women, aged 18-55 years; diagnosed with systemic lupus erythematosus (SLE); and pregnant, recently pregnant (within 2 years), or planning pregnancy. Eligible rheumatologists had prescribed belimumab and treated pregnant women. Responses were descriptively analyzed. Results: Of 151 patient respondents over a 3-month period (n=88, 58.3% aged 26-35 years; n=149, 98.7% with mild or moderate SLE; and n=148, 98% from the United States), 51% (77/151) were currently or recently pregnant. Overall, 169 rheumatologists completed the survey within 48 hours, and 59.2% (100/169) were based in the United States. Belimumab exposure was reported by 41.7% (63/151) patients, whereas 51.7% (75/145) rheumatologists had prescribed belimumab to <5 patients, 25.5% (37/145) had prescribed to 5-10 patients, and 22.8% (33/145) had prescribed to >10 patients who were pregnant or trying to conceive. Of the patients exposed to belimumab, 51% (32/63) were BPR-aware, and 45.5% (77/169) of the rheumatologists were BPR-aware. Overall, 60% (38/63) of patients reported belimumab discontinuation because of pregnancy or planned pregnancy. Among the 77 BPR-aware rheumatologists, 70 (91%) referred patients to the registry. Concerns among rheumatologists who did not prescribe belimumab during pregnancy included unknown pregnancy safety profile (119/169, 70.4%), and 61.5% (104/169) reported their patients’ concerns about the unknown pregnancy safety profile. Belimumab exposure during or recently after pregnancy or while trying to conceive was reported in patients with mild (6/64, 9%), moderate (22/85, 26%), or severe (1/2, 50%) SLE. Rheumatologists more commonly recommended belimumab for moderate (84/169, 49.7%) and severe (123/169, 72.8%) SLE than for mild SLE (36/169, 21.3%) for patients trying to conceive recently or currently pregnant. Overall, 81.6% (138/169) of the rheumatologists suggested a belimumab washout period before pregnancy of 0-30 days (44/138, 31.9%), 30-60 days (64/138, 46.4%), or >60 days (30/138, 21.7%). Conclusions: In this case, crowdsourcing efficiently obtained patient and rheumatologist input, with some patients with SLE continuing to use belimumab during or while planning a pregnancy. There was moderate awareness of the BPR among patients and physicians. %M 35612888 %R 10.2196/30573 %U https://formative.jmir.org/2022/5/e30573 %U https://doi.org/10.2196/30573 %U http://www.ncbi.nlm.nih.gov/pubmed/35612888 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30294 %T A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial %A Laird,Breanne %A Puzia,Megan %A Larkey,Linda %A Ehlers,Diane %A Huberty,Jennifer %+ Arizona State University, 425 N 5th St, Phoenix, AZ, 85004, United States, 1 7046043782, bmlaird@asu.edu %K stress %K meditation %K mHealth %K COVID-19 %K mobile app %K mental health %K mindfulness %K digital intervention %K psychological outcomes %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app–based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. Trial Registration: ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138 %M 34989677 %R 10.2196/30294 %U https://formative.jmir.org/2022/5/e30294 %U https://doi.org/10.2196/30294 %U http://www.ncbi.nlm.nih.gov/pubmed/34989677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37302 %T Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis %A Sinha,Chaitali %A Cheng,Abby L %A Kadaba,Madhura %+ Wysa, 131 Dartmouth St, Boston, MA, 02116, United States, 1 7819219969, chaitali@wysa.io %K retention %K engagement %K Wysa %K chronic pain %K digital health %K digital application %K app %K mental health %K digital intervention %K health intervention %K symptom management %K user engagement %K conversational agent %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital applications are commonly used to support mental health and well-being. However, successfully retaining and engaging users to complete digital interventions is challenging, and comorbidities such as chronic pain further reduce user engagement. Digital conversational agents (CAs) may improve user engagement by applying engagement principles that have been implemented within in-person care settings. Objective: To evaluate user retention and engagement with an artificial intelligence–led digital mental health app (Wysa for Chronic Pain) that is customized for individuals managing mental health symptoms and coexisting chronic pain. Methods: In this ancillary survival analysis of a clinical trial, participants included 51 adults who presented to a tertiary care center for chronic musculoskeletal pain, who endorsed coexisting symptoms of depression or anxiety (Patient-Reported Outcomes Measurement Information System score of ≥55 for depression or anxiety), and initiated onboarding to an 8-week subscription of Wysa for Chronic Pain. The study outcomes were user retention, defined as revisiting the app each week and on the last day of engagement, and user engagement, defined by the number of sessions the user completed. Results: Users engaged in a cumulative mean of 33.3 sessions during the 8-week study period. The survival analysis depicted a median user retention period (i.e., time to complete disengagement) of 51 days, with the usage of a morning check-in feature having a significant relationship with a longer retention period (P=.001). Conclusions: Our findings suggest that user retention and engagement with a CBT-based CA built for users with chronic pain is higher than standard industry metrics. These results have clear implications for addressing issues of suboptimal engagement of digital health interventions and improving access to care for chronic pain. Future work should use these findings to inform the design of evidence-based interventions for individuals with chronic pain and to enhance user retention and engagement of digital health interventions more broadly. Trial Registration: ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090 %M 35526201 %R 10.2196/37302 %U https://formative.jmir.org/2022/5/e37302 %U https://doi.org/10.2196/37302 %U http://www.ncbi.nlm.nih.gov/pubmed/35526201 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37118 %T A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study %A Kim,Sunyoung %A Stanton,Kaitlyn %A Park,Yunoh %A Thomas,Stephen %+ Rutgers, The State University of New Jersey, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, shallyya@gmail.com %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K mHealth %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective: Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods: This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy’s usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results: All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions: This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users’ needs. %M 35604753 %R 10.2196/37118 %U https://formative.jmir.org/2022/5/e37118 %U https://doi.org/10.2196/37118 %U http://www.ncbi.nlm.nih.gov/pubmed/35604753 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29509 %T Key Drivers and Facilitators of the Choice to Use mHealth Technology in People With Neurological Conditions: Observational Study %A Simblett,Sara %A Pennington,Mark %A Quaife,Matthew %A Theochari,Evangelia %A Burke,Patrick %A Brichetto,Giampaolo %A Devonshire,Julie %A Lees,Simon %A Little,Ann %A Pullen,Angie %A Stoneman,Amanda %A Thorpe,Sarah %A Weyer,Janice %A Polhemus,Ashley %A Novak,Jan %A Dawe-Lane,Erin %A Morris,Daniel %A Mutepua,Magano %A Odoi,Clarissa %A Wilson,Emma %A Wykes,Til %+ Psychology Department, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K mobile technology %K neurological conditions %K multiple sclerosis %K epilepsy %K discrete choice experiment %K digital health %K mHealth %K wearable technology %K wearable biosensors %K health economics %K health data %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. Objective: To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. Methods: In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). Results: Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. Conclusions: For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies. %M 35604761 %R 10.2196/29509 %U https://formative.jmir.org/2022/5/e29509 %U https://doi.org/10.2196/29509 %U http://www.ncbi.nlm.nih.gov/pubmed/35604761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29469 %T Perceived Usefulness, Competency, and Associated Factors in Using District Health Information System Data Among District Health Managers in Tanzania: Cross-sectional Study %A Simba,Daudi %A Sukums,Felix %A Kumalija,Claud %A Asiimwe,Sarah Eden %A Pothepragada,Sai Kumar %A Githendu,Patrick Warui %+ Directorate of Information and Communication Technology, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, 255, United Republic of Tanzania, 255 713238473, Sukums@gmail.com %K DHIS2 %K Tanzania %K health information system %K health management information system %K perception %K competency %K usefulness %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Tanzania introduced District Health Information Software (version 2; DHIS2) in 2013 to support existing health management information systems and to improve data quality and use. However, to achieve these objectives, it is imperative to build human resource capabilities to address the challenges of new technologies, especially in resource-constrained countries. Objective: This study aimed to determine the perceived usefulness, competency, and associated factors in using DHIS2 data among district health managers (DHMs) in Tanzania. Methods: This descriptive cross-sectional study used a quantitative approach, which involved using a self-administered web-based questionnaire. This study was conducted between April and September 2019. We included all core and co-opted members of the council or district health management teams (DHMTs) from all 186 districts in the country. Frequency and bivariate analyses were conducted, and the differences among categories were measured by using a chi-square test. P values of <.05 were considered significant. Results: A total of 2667 (77.96%) of the expected 3421 DHMs responded, of which 2598 (97.41%) consented and completed the questionnaires. Overall, the DHMs were satisfied with DHIS2 (2074/2596, 79.83%) because of workload reduction (2123/2598, 81.72%), the ease of learning (1953/2598, 75.17%), and enhanced data use (2239/2598, 86.18%). Although only half of the managers had user accounts (1380/2598, 53.12%) and were trained on DHIS2 data analysis (1237/2598, 47.61%), most claimed to have average to advanced skills in data validation (1774/2598, 68.28%), data visualization (1563/2598, 60.16%), and DHIS2 data use (1321/2598, 50.85%). The biggest challenges facing DHMs included the use of a paper-based system as the primary data source (1890/2598, 72.75%) and slow internet speed (1552/2598, 59.74%). Core members were more confident in using DHIS2 compared with other members (P=.004), whereas program coordinators were found to receive more training on data analysis and use (P=.001) and were more confident in using DHIS2 data compared with other DHMT members (P=.001). Conclusions: This study showed that DHMs have appreciable competencies in using the DHIS2 and its data. However, their skill levels have not been commensurate with the duration of DHIS2 use. This study recommends improvements in the access to and use of DHIS2 data. More training on data use is required and should involve using cost-effective approaches to include both the core and noncore members of the DHMTs. Moreover, enhancing the culture and capacity of data use will ensure the better management and accountability of health system performance. %M 35604763 %R 10.2196/29469 %U https://formative.jmir.org/2022/5/e29469 %U https://doi.org/10.2196/29469 %U http://www.ncbi.nlm.nih.gov/pubmed/35604763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34509 %T Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study %A Iio,Misa %A Sato,Miori %A Narita,Masami %A Yamamoto-Hanada,Kiwako %A Oishi,Taku %A Kishino,Ai %A Kawaguchi,Takahiro %A Nishi,Rin %A Nagata,Mayumi %A Ohya,Yukihiro %+ College of Nursing, Kanto Gakuin University, 1-50-1 Mutsuurahigashi, Kanazawa-ward, Yokohama, 236-8503, Japan, 81 45 786 5641, misaiio@kanto-gakuin.ac.jp %K children %K caregivers %K asthma %K mobile app %K feasibility %K health app %K mHealth %K pediatric %K usability %K mobile phone %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. Objective: The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. Methods: We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children’s hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. Results: In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, “record” was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. Conclusions: The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. Trial Registration: UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8 %M 35594073 %R 10.2196/34509 %U https://formative.jmir.org/2022/5/e34509 %U https://doi.org/10.2196/34509 %U http://www.ncbi.nlm.nih.gov/pubmed/35594073 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33985 %T Use and Perception of Digital Health Technologies by Surgical Patients in Germany in the Pre–COVID-19 Era: Survey Study %A Korn,Sandra %A Böttcher,Maximilian David %A Busse,Theresa Sophie %A Kernebeck,Sven %A Breucha,Michael %A Ehlers,Jan %A Kahlert,Christoph %A Weitz,Jürgen %A Bork,Ulrich %+ Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307, Germany, 49 3514582742, Sandra.Korn@ukdd.de %K digital equity %K eHealth %K electronic health %K mobile health %K health apps %K mobile health apps %K eHealth literacy %K mobile phone %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: This survey study investigates surgical patients’ use and perception of digital health technologies in Germany in the pre–COVID-19 era. Objective: The objective of this study was to relate surgical patients’ characteristics to the use and perception of several digital health technologies. Methods: In this single-center, cross-sectional survey study in the outpatient department of a university hospital in Germany, 406 patients completed a questionnaire with the following three domains: general information and use of the internet, smartphones, and general digital health aspects. Analyses were stratified by age group and highest education level achieved. Results: We found significant age-based differences in most of the evaluated aspects. Younger patients were more open to using new technologies in private and medical settings but had more security concerns. Although searching for information on illnesses on the web was common, the overall acceptance of and trust in web-based consultations were rather low, with <50% of patients in each age group reporting acceptance and trust. More people with academic qualifications than without academic qualifications searched for information on the web before visiting physicians (73/121, 60.3% and 100/240, 41.7%, respectively). Patients with academic degrees were also more engaged in health-related information and communication technology use. Conclusions: These results support the need for eHealth literacy, health literacy, and available digital devices and internet access to support the active, meaningful use of information and communication technologies in health care. Uncertainties and a lack of knowledge exist, especially regarding telemedicine and the use of medical and health apps. This is especially pronounced among older patients and patients with a low education status. %M 35594072 %R 10.2196/33985 %U https://formative.jmir.org/2022/5/e33985 %U https://doi.org/10.2196/33985 %U http://www.ncbi.nlm.nih.gov/pubmed/35594072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34906 %T An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study %A Patel,Tejal %A Ivo,Jessica %A Pitre,Teresa %A Faisal,Sadaf %A Antunes,Kristen %A Oda,Kasumi %+ School of Pharmacy, University of Waterloo, 10 Victoria Street S, Kitchener, ON, N2G 1C5, Canada, 1 519 888 4567 ext 21337, t5patel@uwaterloo.ca %K smart %K medication adherence %K usability %K geriatric %K in-home %K community %K chronic diseases %K medication dispensing %K eHealth %K platform %K self management %K support tool %K chronic disease %K caregiver %K usability %K satisfaction %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients’ homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and reporting real-time medication adherence data. Objective: The objectives of this study were to examine the use of a smart medication dispenser as a medication adherence and self-management support tool for community dwelling adults over a 6-month period, in addition to usability, usefulness, satisfaction, and impact on caregiver support. Methods: This prospective, observational study invited community-dwelling adults aged 45 years and older taking at least one chronic medication and their caregivers to use this smart medication dispenser for their medication administration for 6 months. Adherence was defined as a dose intake within 2 hours post scheduled time. Real-time adherence data were collected using the smart medication dispenser and the AdhereNet platform. Usability, usefulness, and satisfaction were measured using the System Usability Scale and the Usefulness, Satisfaction, and Ease of Use questionnaire, respectively. Caregiver burden was measured on a visual analog scale at baseline and at the end of the 6-month study period. Results: A total of 58 participants were recruited, of which 55% (32/58) were female with a mean age of 66.36 (SD 11.28; range 48-90) years. Eleven caregiver participants were recruited, of whom 91% (10/11) were female. The average monthly adherence over 6 months was 98% (SD 3.1%; range 76.5%-100%). The average System Usability score was 85.74 (n=47; SD 12.7; range 47.5-100). Of the 46 participants who provided data, 44 (96%) rated the product as easy, 43 (93%) as simple to use, and 43 (93%) were satisfied with the product. Caregiver burden prior to and following smart medication dispenser use for 6 months was found to be statistically significantly different (P<.001; CI 2.11-5.98). Conclusions: Smart medication adherence products such as spencer, when connected and clinically monitored, can be a useful solution for medication management and have the potential to improve caregiver burden. %M 35587371 %R 10.2196/34906 %U https://formative.jmir.org/2022/5/e34906 %U https://doi.org/10.2196/34906 %U http://www.ncbi.nlm.nih.gov/pubmed/35587371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e38340 %T Deconstructing TikTok Videos on Mental Health: Cross-sectional, Descriptive Content Analysis %A Basch,Corey H %A Donelle,Lorie %A Fera,Joseph %A Jaime,Christie %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K TikTok %K mental health %K adolescent %K social media %K short video apps %K content analysis %K digital health %K online health %K visual media %K descriptive content analysis %K mental distress %K health professional %K health care professional %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms that are based on the creation of visual media, such as TikTok, are increasingly popular with adolescents. Online social media networks provide valuable opportunities to connect with each other to share experiences and strategies for health and wellness. Objective: The aim of this study was to describe the content of the hashtag #mentalhealth on TikTok. Methods: This cross-sectional, descriptive content analysis study included 100 videos with the hashtag #mentalhealth on TikTok. All videos that included the hashtag #mentalhealth were analyzed and coded for the presence of content categories. Additionally, the comments to each video were viewed and coded for content in the following themes: offering support or validation; mentioning experience with suicide or suicidal ideation; mentioning experience with self-harm; describing an experience with hospitalization for mental health issues; describing other mental health issues; and sharing coping strategies, experiences of healing, or ways to feel better. Results: Collectively, the 100 videos studied received 1,354,100,000 views; 266,900,000 likes; and 2,515,954 comments. On average, each video received 13,406,930.69 (SD 8,728,095.52) views; 2,657,425.74 (SD 1,449,920.45) likes; and 24,910.44 (SD 21,035.06) comments. The only content category observed in most (51/100, 51%) of the videos included in the sample was “general mental health.” The remaining content categories appeared in less than 50% of the sample. In total, 32% (32/100) of the videos sampled received more than the overall average number of likes (ie, more that 2.67 million likes). Among these 32 videos, 23 (72%) included comments offering support or validation and 20 (62%) included comments that described other mental health issues or struggles. Conclusions: With over 1 billion cumulative views, almost half of the assessed TikTok videos included in this study reported or expressed symptoms of mental distress. Future research should focus on the potential role of intervention by health care professionals on social media. %M 35588057 %R 10.2196/38340 %U https://formative.jmir.org/2022/5/e38340 %U https://doi.org/10.2196/38340 %U http://www.ncbi.nlm.nih.gov/pubmed/35588057 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e36181 %T The Associations of COVID-19 Lockdown Restrictions With Longer-Term Activity Levels of Working Adults With Type 2 Diabetes: Cohort Study %A Brakenridge,Christian John %A Salim,Agus %A Healy,Genevieve Nissa %A Grigg,Ruth %A Carver,Alison %A Rickards,Kym %A Owen,Neville %A Dunstan,David Wayne %+ Baker Heart and Diabetes Institute, 99 Commercial Rd, Melbourne, 3004, Australia, 61 385321853, christian.brakenridge@baker.edu.au %K COVID-19 %K Fitbit %K activity %K sedentary behavior %K type 2 diabetes %K digital health %K pandemic %K physical activity %K wearable %K health technology %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Lockdown restrictions reduce COVID-19 community transmission; however, they may pose challenges for noncommunicable disease management. A 112-day hard lockdown in Victoria, Australia (commencing March 23, 2020) coincided with an intervention trial of reducing and breaking up sitting time in desk workers with type 2 diabetes who were using a provided consumer-grade activity tracker (Fitbit). Objective: This study aims to compare continuously recorded activity levels preceding and during COVID-19 lockdown restrictions among working adults with type 2 diabetes participating in a sitting less and moving more intervention. Methods: A total of 11 participants (n=8 male; mean age 52.8, SD 5 years) in Melbourne, Australia had Fitbit activity tracked before (mean 122.7, SD 47.9 days) and during (mean 99.7, SD 62.5 days) citywide COVID-19 lockdown restrictions. Regression models compared device (Fitbit Inspire HR)–derived activity (steps; metabolic equivalent tasks [METs]; mean time in sedentary, lightly, fairly, and very active minutes; and usual bout durations) during restrictions to prerestrictions. Changes in activity were statistically significant when estimates (Δ%) did not intercept zero. Results: Overall, there was a decrease in mean steps (–1584 steps/day; Δ% –9%, 95% CI –11% to –7%); METs (–83 METs/day; Δ% –5%, 95% CI –6% to –5%); and lightly active (Δ% –4%, 95% CI –8% to –1%), fairly active (Δ% –8%, 95% CI –21% to –15%), and very active (Δ% –8%, 95% CI –11% to –5%) intensity minutes per day, and increases in mean sedentary minutes per day (51 mins/day; Δ% 3%, 95% CI 1%-6%). Only very active (+5.1 mins) and sedentary (+4.3 mins) bout durations changed significantly. Conclusions: In a convenience sample of adults with type 2 diabetes, COVID-19 lockdown restrictions were associated with decreases in overall activity levels and increases in very active and sedentary bout durations. A Fitbit monitor provided meaningful continuous long-term data in this context. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001159246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001159246 %M 35486904 %R 10.2196/36181 %U https://diabetes.jmir.org/2022/2/e36181 %U https://doi.org/10.2196/36181 %U http://www.ncbi.nlm.nih.gov/pubmed/35486904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e31292 %T One Hundred Years of Hypertension Research: Topic Modeling Study %A Abba,Mustapha %A Nduka,Chidozie %A Anjorin,Seun %A Mohamed,Shukri %A Agogo,Emmanuel %A Uthman,Olalekan %+ Warwick Centre for Global Health, Division of Health Sciences, University of Warwick Medical School, University of Warwick, GH5 Bustop Gibbet Hill Campus, Coventry, CV4 7AL, United Kingdom, 44 7466739753, mustapha.abba@warwick.ac.uk %K hypertension %K high blood pressure %K machine learning %K topic modeling %K latent Dirichlet allocation %K LDA %K cardiovascular %K research trends %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to scientific and technical advancements in the field, published hypertension research has developed substantially during the last decade. Given the amount of scientific material published in this field, identifying the relevant information is difficult. We used topic modeling, which is a strong approach for extracting useful information from enormous amounts of unstructured text. Objective: This study aims to use a machine learning algorithm to uncover hidden topics and subtopics from 100 years of peer-reviewed hypertension publications and identify temporal trends. Methods: The titles and abstracts of hypertension papers indexed in PubMed were examined. We used the latent Dirichlet allocation model to select 20 primary subjects and then ran a trend analysis to see how popular they were over time. Results: We gathered 581,750 hypertension-related research articles from 1900 to 2018 and divided them into 20 topics. These topics were broadly categorized as preclinical, epidemiology, complications, and therapy studies. Topic 2 (evidence review) and topic 19 (major cardiovascular events) are the key (hot topics). Most of the cardiopulmonary disease subtopics show little variation over time, and only make a small contribution in terms of proportions. The majority of the articles (414,206/581,750; 71.2%) had a negative valency, followed by positive (119, 841/581,750; 20.6%) and neutral valency (47,704/581,750; 8.2%). Between 1980 and 2000, negative sentiment articles fell somewhat, while positive and neutral sentiment articles climbed substantially. Conclusions: The number of publications has been increasing exponentially over the period. Most of the uncovered topics can be grouped into four categories (ie, preclinical, epidemiology, complications, and treatment-related studies). %M 35583933 %R 10.2196/31292 %U https://formative.jmir.org/2022/5/e31292 %U https://doi.org/10.2196/31292 %U http://www.ncbi.nlm.nih.gov/pubmed/35583933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33001 %T A Novel Digital Self-management Intervention for Symptoms of Fatigue, Pain, and Urgency in Inflammatory Bowel Disease: Describing the Process of Development %A Sweeney,Louise %A Windgassen,Sula %A Artom,Micol %A Norton,Christine %A Fawson,Sophie %A Moss-Morris,Rona %+ Health Psychology Section, King's College London, Bermondsey Wing, London, SE1 9RT, United Kingdom, 44 2071880178, rona.moss-morris@kcl.ac.uk %K inflammatory bowel disease %K symptoms %K self-management %K intervention development %K digital health %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Empirical studies and systematic reviews have demonstrated the role of biological, cognitive, behavioral, and emotional factors in fatigue, pain, and urgency in inflammatory bowel disease (IBD). Behavioral management that addresses the cognitive, behavioral, and emotional factors offered alongside medical treatment is seldom available to people with IBD. Digital interventions provide a potentially scalable and cost-effective way of providing behavioral support to patients. Objective: This paper aimed to describe the process of developing a supported digital self-management intervention for fatigue, pain, and urgency in IBD using theory and evidence-based approaches and stakeholder input. Methods: The Medical Research Council framework for complex health interventions and a person-based approach were used to guide intervention development, consulting with 87 patients with IBD and 60 nurses. These frameworks informed the selection and use of a theoretical model that subsequently guided cognitive behaviorally based intervention content. They also guided the design of tailored digital intervention pathways for individuals with IBD that matched the predominant symptoms. Results: A transsymptomatic cognitive behavioral framework of symptom perpetuation was developed for the symptoms of fatigue, pain, and urgency in IBD. A logic model was used to define the intervention techniques. Patient feedback and qualitative interviews refined the website content and functionalities, including the use of visual aids, email reminders, and graphical tracking of symptoms. Nurse focus groups informed the volume and delivery model of the therapist facilitator support. Ratings of acceptability out of 10 following feasibility testing (31/87, 36%) demonstrated accessibility (scoring 9.43, SD 1.040), ease (scoring 8.07, SD 3.205), clarity, and the relevant tone of the intervention. The final intervention comprised 12 web-based sessions (8 core and 4 symptom-specific), with one 30-minute facilitator phone call following session 1 and subsequent on-site messaging. Conclusions: The use of theory and integration of stakeholders’ views throughout informed the development of an evidence-based digital intervention for fatigue, pain, and urgency in IBD. This is the first web-based self-management intervention designed to address these multiple symptoms with the aim of improving the quality of life and reducing the symptom burden of IBD. The intervention is being tested in a large multicenter randomized controlled trial. Trial Registration: ISRCTN Registry ISRCTN71618461; https://www.isrctn.com/ISRCTN71618461 %M 35583924 %R 10.2196/33001 %U https://formative.jmir.org/2022/5/e33001 %U https://doi.org/10.2196/33001 %U http://www.ncbi.nlm.nih.gov/pubmed/35583924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35674 %T Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During the COVID-19 Pandemic: Feasibility Trial of HoloLens 2 %A Sivananthan,Arun %A Gueroult,Aurelien %A Zijlstra,Geiske %A Martin,Guy %A Baheerathan,Aravindhan %A Pratt,Philip %A Darzi,Ara %A Patel,Nisha %A Kinross,James %+ Institute of Global Health Innovation, Imperial College London, Praed Street, London, W2 1NY, United Kingdom, 44 020 3312 6666, arun.sivananthan@nhs.net %K mixed reality %K remote learning %K HoloLens %K bedside teaching %K COVID-19 %K personal protective equipment %K digital education %K medical education %K e-learning %K protection %K feasibility %K medical student %K virtual reality %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. Objective: This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching. Methods: Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected. Results: Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. Conclusions: This study is proof of principle that HoloLens can be used effectively to deliver clinical bedside teaching. This novel format confers significant advantages in terms of minimizing exposure of trainees to COVID-19, reducing PPE use, enabling larger attendance, and delivering convenient and accessible real-time clinical training. %M 35389347 %R 10.2196/35674 %U https://formative.jmir.org/2022/5/e35674 %U https://doi.org/10.2196/35674 %U http://www.ncbi.nlm.nih.gov/pubmed/35389347 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35244 %T Understanding Online and Offline Social Networks in Illness Management of Older Patients With Asthma and Chronic Obstructive Pulmonary Disease: Mixed Methods Study Using Quantitative Social Network Assessment and Qualitative Analysis %A Andreou,Andreas %A Dhand,Amar %A Vassilev,Ivaylo %A Griffiths,Chris %A Panzarasa,Pietro %A De Simoni,Anna %+ Wolfson Institute of Population Health, Asthma UK Centre of Applied Research, Queen Mary University of London, 58 Turner Street, London, E1 2AB, United Kingdom, 44 207 882 2520, a.desimoni@qmul.ac.uk %K social networks %K asthma %K COPD %K self-management %K elderly %K online health communities %K online forums %K digital health %K mobile phone %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals’ social networks and social support are fundamental determinants of self-management and self-efficacy. In chronic respiratory conditions, social support can be promoted and optimized to facilitate the self-management of breathlessness. Objective: This study aimed to identify how online and offline social networks play a role in the health management of older patients with chronic respiratory conditions, explore the role of support from online peers in patients’ self-management, and understand the barriers to and potential benefits of digital social interventions. Methods: We recruited participants from a hospital-run singing group to a workshop in London, the United Kingdom, and adapted PERSNET, a quantitative social network assessment tool. The second workshop was replaced by telephone interviews because of the COVID-19 lockdown. The transcripts were analyzed using thematic analysis. Results: A total of 7 participants (2/7, 29%, men and 5/7, 71%, women), with an age range of 64 to 81 years, produced network maps that comprised between 5 and 10 individuals, including family members, health care professionals, colleagues, activity groups, offline and online friends, and peers. The visual maps facilitated reflections and enhanced participants’ understanding of the role of offline and online social networks in the management of chronic respiratory conditions. It also highlighted the work undertaken by the networks themselves in the self-management support. Participants with small, close-knit networks received physical, health, and emotional support, whereas those with more diverse and large networks benefited from accessing alternative and complementary sources of information. Participants in the latter type of network tended to communicate more openly and comfortably about their illness, shared the impact of their illness on their day-to-day life, and demonstrated distinct traits in terms of identity and perception of chronic disease. Participants described the potential benefits of expanding their networks to include online peers as sources of novel information, motivation, and access to supportive environments. Lack of technological skills, fear of being scammed, or preference for keeping illness-related problems for themselves and immediate family were reported by some as barriers to engaging with online peer support. Conclusions: In this small-scale study, the social network assessment tool proved feasible and acceptable. These data show the value of using a social network tool as a research tool that can help assess and understand network structure and engagement in the self-management support and could be developed into an intervention to support self-management. Patients’ preferences to share illness experiences with their online peers, as well as the contexts in which this can be acceptable, should be considered when developing and offering digital social interventions. Future studies can explore the evolution of the social networks of older people with chronic illnesses to understand whether their willingness to engage with online peers can change over time. %M 35579933 %R 10.2196/35244 %U https://formative.jmir.org/2022/5/e35244 %U https://doi.org/10.2196/35244 %U http://www.ncbi.nlm.nih.gov/pubmed/35579933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33037 %T Contrasting a Mobile App With a Conversational Chatbot for Reducing Alcohol Consumption: Randomized Controlled Pilot Trial %A Dulin,Patrick %A Mertz,Robyn %A Edwards,Alexandra %A King,Diane %+ Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 99508, United States, 1 907 786 1653, aehauser@alaska.edu %K alcohol %K hazardous drinking %K smartphone app %K chatbot %K brief intervention %K effectiveness %K utilization %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps have shown considerable promise for reducing alcohol consumption among problem drinkers, but like many mobile health apps, they frequently report low utilization, which is an important limitation, as research suggests that effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility. Objective: This study aimed to develop a chatbot alcohol intervention based on an empirically supported app (Step Away) for reducing drinking and to conduct a pilot trial of the 2 interventions. Included participants met the criteria for hazardous drinking and were interested in reducing alcohol consumption. The study assessed utilization patterns and alcohol outcomes across the 2 technology conditions, and a waitlist control group. Methods: Participants were recruited using Facebook advertisements. Those who met the criteria for hazardous consumption and expressed an interest in changing their drinking habits were randomly assigned to three conditions: the Step Away app, Step Away chatbot, and waitlist control condition. Participants were assessed on the web using the Alcohol Use Disorders Identification Test, Adapted for Use in the United States, Readiness to Change Questionnaire, Short Inventory of Problems-Revised, and Timeline Followback at baseline and at 12 weeks follow-up. Results: A total of 150 participants who completed the baseline and follow-up assessments were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up, with large effect sizes noted (ie, η2=0.34 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable, with the bot group showing the greatest improvement in readiness (F2,147=5.6; P=.004; η2=0.07). The results suggested that the app group used the app for a longer duration (mean 50.71, SD 49.02 days) than the bot group (mean 27.16, SD 30.54 days; P=.02). Use of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.25, 95% CI 0.00-0.01; P=.04). Conclusions: Results indicated that all groups in this study reduced their drinking considerably from baseline to the 12-week follow-up, but no differences were found in the alcohol outcome variables between the groups, possibly because of a combination of small sample size and methodological issues. The app group reported greater use and slightly higher usability scores than the bot group, but the bot group demonstrated improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed. Trial Registration: ClinicalTrials.gov NCT04447794; https://clinicaltrials.gov/ct2/show/NCT04447794 %M 35576569 %R 10.2196/33037 %U https://formative.jmir.org/2022/5/e33037 %U https://doi.org/10.2196/33037 %U http://www.ncbi.nlm.nih.gov/pubmed/35576569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29227 %T Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial %A Gardiner,Paula %A McGonigal,Lisa %A Villa,Ariel %A Kovell,Lara C %A Rohela,Pallavi %A Cauley,Andrew %A Rinker,Diana %A Olendzki,Barbara %+ Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Benedict Building, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 781 929 6460, paula.gardiner@umassmed.edu %K hypertension %K health disparities %K teaching kitchen %K technology %K mindfulness %K low income %K medical group visits %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income $6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West). Results: Based on the Health Management Academy’s assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives). Conclusions: The increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models. %M 35323115 %R 10.2196/32819 %U https://formative.jmir.org/2022/5/e32819 %U https://doi.org/10.2196/32819 %U http://www.ncbi.nlm.nih.gov/pubmed/35323115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37736 %T A Machine Learning Approach for Detecting Digital Behavioral Patterns of Depression Using Nonintrusive Smartphone Data (Complementary Path to Patient Health Questionnaire-9 Assessment): Prospective Observational Study %A Choudhary,Soumya %A Thomas,Nikita %A Ellenberger,Janine %A Srinivasan,Girish %A Cohen,Roy %+ Research, Behavidence Inc, 99 Wall Street #4004, New York, NY, 10005, United States, 1 6372493366, soumya@behavidence.com %K mobile phone %K depression %K digital phenotyping %K digital mental health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a major global cause of morbidity, an economic burden, and the greatest health challenge leading to chronic disability. Mobile monitoring of mental conditions has long been a sought-after metric to overcome the problems associated with the screening, diagnosis, and monitoring of depression and its heterogeneous presentation. The widespread availability of smartphones has made it possible to use their data to generate digital behavioral models that can be used for both clinical and remote screening and monitoring purposes. This study is novel as it adds to the field by conducting a trial using private and nonintrusive sensors that can help detect and monitor depression in a continuous, passive manner. Objective: This study demonstrates a novel mental behavioral profiling metric (the Mental Health Similarity Score), derived from analyzing passively monitored, private, and nonintrusive smartphone use data, to identify and track depressive behavior and its progression. Methods: Smartphone data sets and self-reported Patient Health Questionnaire-9 (PHQ-9) depression assessments were collected from 558 smartphone users on the Android operating system in an observational study over an average of 10.7 (SD 23.7) days. We quantified 37 digital behavioral markers from the passive smartphone data set and explored the relationship between the digital behavioral markers and depression using correlation coefficients and random forest models. We leveraged 4 supervised machine learning classification algorithms to predict depression and its severity using PHQ-9 scores as the ground truth. We also quantified an additional 3 digital markers from gyroscope sensors and explored their feasibility in improving the model’s accuracy in detecting depression. Results: The PHQ-9 2-class model (none vs severe) achieved the following metrics: precision of 85% to 89%, recall of 85% to 89%, F1 of 87%, and accuracy of 87%. The PHQ-9 3-class model (none vs mild vs severe) achieved the following metrics: precision of 74% to 86%, recall of 76% to 83%, F1 of 75% to 84%, and accuracy of 78%. A significant positive Pearson correlation was found between PHQ-9 questions 2, 6, and 9 within the severely depressed users and the mental behavioral profiling metric (r=0.73). The PHQ-9 question-specific model achieved the following metrics: precision of 76% to 80%, recall of 75% to 81%, F1 of 78% to 89%, and accuracy of 78%. When a gyroscope sensor was added as a feature, the Pearson correlation among questions 2, 6, and 9 decreased from 0.73 to 0.46. The PHQ-9 2-class model+gyro features achieved the following metrics: precision of 74% to 78%, recall of 67% to 83%, F1 of 72% to 78%, and accuracy of 76%. Conclusions: Our results demonstrate that the Mental Health Similarity Score can be used to identify and track depressive behavior and its progression with high accuracy. %M 35420993 %R 10.2196/37736 %U https://formative.jmir.org/2022/5/e37736 %U https://doi.org/10.2196/37736 %U http://www.ncbi.nlm.nih.gov/pubmed/35420993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36821 %T Participants’ Perceptions of Essential Coaching for Every Mother—a Canadian Text Message–Based Postpartum Program: Process Evaluation of a Randomized Controlled Trial %A Dol,Justine %A Aston,Megan %A McMillan,Douglas %A Tomblin Murphy,Gail %A Campbell-Yeo,Marsha %+ Faculty of Health, Dalhousie University, 6299 South St, Halifax, NS, B3H 4J1, Canada, 1 902 470 8895, Justine.dol@dal.ca %K mHealth %K text messaging %K postpartum %K process evaluation %K mobile health %K SMS %K text message %K digital health %K randomized control trial %K postnatal %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: “Essential Coaching for Every Mother” is a Canadian text message–based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program’s effectiveness in terms of the participants’ experience to guide refinement and modification. Objective: This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality. Methods: Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program’s text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis. Results: Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement. Conclusions: Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program. Trial Registration: ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 %M 35559855 %R 10.2196/36821 %U https://formative.jmir.org/2022/5/e36821 %U https://doi.org/10.2196/36821 %U http://www.ncbi.nlm.nih.gov/pubmed/35559855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34021 %T eRegTime—Time Spent on Health Information Management in Primary Health Care Clinics Using a Digital Health Registry Versus Paper-Based Documentation: Cluster-Randomized Controlled Trial %A Venkateswaran,Mahima %A Nazzal,Zaher %A Ghanem,Buthaina %A Khraiwesh,Reham %A Abbas,Eatimad %A Abu Khader,Khadija %A Awwad,Tamara %A Hijaz,Taghreed %A Isbeih,Mervett %A Mørkrid,Kjersti %A Rose,Christopher James %A Frøen,J Frederik %+ Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway, 47 21 07 70 00, frederik.froen@fhi.no %K time-motion study %K clinical workflow %K digital health intervention %K eRegistry %K antenatal care %K cluster-randomized controlled trial %K digital health %K child health registry %K eRegistry %K primary care %K health information %K primary care %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. Trial Registration: ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445 International Registered Report Identifier (IRRID): RR2-10.2196/13653 %M 35559792 %R 10.2196/34021 %U https://formative.jmir.org/2022/5/e34021 %U https://doi.org/10.2196/34021 %U http://www.ncbi.nlm.nih.gov/pubmed/35559792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37124 %T The Acceptability of Adherence Support via Mobile Phones for Antituberculosis Treatment in South India: Exploratory Study %A Jose,Nisha K %A Vaz,Clint %A Chai,Peter R %A Rodrigues,Rashmi %+ Non Communicable Diseases Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India, 91 9717660464, cathnisha@gmail.com %K adherence %K tuberculosis %K antitubercular therapy %K mHealth %K mobile health %K digital health %K South India %K technology acceptance %K health intervention %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: India has the greatest burden of tuberculosis (TB). However, over 15% of the people on antitubercular therapy (ATT) in India are nonadherent. Several adherence monitoring techniques deployed in India to enhance ATT adherence have had modest effects. Increased adoption of mobile phones and other technologies pose potential solutions to measuring and intervening in ATT adherence. Several technology-based interventions around ATT adherence have been demonstrated in other countries. Objective: The objective of our study was to understand the acceptance of mobile phone adherence supports for ATT using self-administered quantitative measures among patients with TB in South India. Methods: This exploratory study was conducted at a TB treatment center (TTC) at a tertiary care center in Thrissur District, Kerala, India. We recruited 100 patients with TB on ATT using convenience sampling after obtaining written informed consent. Trained study staff administered the questionnaire in Malayalam, commonly spoken in Kerala, India. We used frequency, mean, median, and SD or IQR to describe the data. Results: Of the 100 participants diagnosed with TB on ATT, 90% used mobile phones routinely, and 84% owned a mobile phone. Ninety-five percent of participants knew how to use the calling function, while 65% of them did not know how to use the SMS function on their mobile phone. Overall, 89% of the participants did not consider mobile phone–based ATT adherence interventions an intrusion in their privacy, and 93% did not fear stigma if the adherence reminder was received by someone else. Most (95%) of the study participants preferred mobile phone reminders instead of directly observed treatment, short-course. Voice calls (n=80, 80%) were the more preferred reminder modality than SMS reminders (n=5, 5%). Conclusions: Mobile phones are likely an acceptable platform to deliver ATT adherence interventions among individuals with TB in South India. Preference of voice call reminders may inform the architecture of future adherence interventions surrounding ATT in South India. %M 35560021 %R 10.2196/37124 %U https://formative.jmir.org/2022/5/e37124 %U https://doi.org/10.2196/37124 %U http://www.ncbi.nlm.nih.gov/pubmed/35560021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35535 %T Clinicians’ Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study %A Zentner,Kristen %A Gaine,Graham %A Ethridge,Paige %A Surood,Shireen %A Abba-Aji,Adam %+ Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, 9942 108 St NW, Edmonton, AB, T5K 2J5, Canada, 1 780 342 7726, graham.gaine@albertahealthservices.ca %K mental health %K telepsychology %K clinician attitude %K unified theory of acceptance and use of technology %K therapeutic alliance %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. Objective: This study (1) explored clinicians’ experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians’ intentions to offer telepsychology after the COVID-19 pandemic. Methods: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. Results: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (β=0.46; P<.001) and telephone services (β=0.35; P<.001) after the pandemic. Social influence (β=0.24; P=.004) and facilitating conditions (β=0.19; P=.03) additionally predicted the intention to use telephone services. Conclusions: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities. %M 35559793 %R 10.2196/35535 %U https://formative.jmir.org/2022/5/e35535 %U https://doi.org/10.2196/35535 %U http://www.ncbi.nlm.nih.gov/pubmed/35559793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34436 %T The Value of Extracting Clinician-Recorded Affect for Advancing Clinical Research on Depression: Proof-of-Concept Study Applying Natural Language Processing to Electronic Health Records %A Panaite,Vanessa %A Devendorf,Andrew R %A Finch,Dezon %A Bouayad,Lina %A Luther,Stephen L %A Schultz,Susan K %+ Research Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 3979, vanessa.panaite2@va.gov %K depression %K affect %K natural language processing %K electronic health records %K vocabularies %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Affective characteristics are associated with depression severity, course, and prognosis. Patients’ affect captured by clinicians during sessions may provide a rich source of information that more naturally aligns with the depression course and patient-desired depression outcomes. Objective: In this paper, we propose an information extraction vocabulary used to pilot the feasibility and reliability of identifying clinician-recorded patient affective states in clinical notes from electronic health records. Methods: Affect and mood were annotated in 147 clinical notes of 109 patients by 2 independent coders across 3 pilots. Intercoder discrepancies were settled by a third coder. This reference annotation set was used to test a proof-of-concept natural language processing (NLP) system using a named entity recognition approach. Results: Concepts were frequently addressed in templated format and free text in clinical notes. Annotated data demonstrated that affective characteristics were identified in 87.8% (129/147) of the notes, while mood was identified in 97.3% (143/147) of the notes. The intercoder reliability was consistently good across the pilots (interannotator agreement [IAA] >70%). The final NLP system showed good reliability with the final reference annotation set (mood IAA=85.8%; affect IAA=80.9%). Conclusions: Affect and mood can be reliably identified in clinician reports and are good targets for NLP. We discuss several next steps to expand on this proof of concept and the value of this research for depression clinical research. %M 35551066 %R 10.2196/34436 %U https://formative.jmir.org/2022/5/e34436 %U https://doi.org/10.2196/34436 %U http://www.ncbi.nlm.nih.gov/pubmed/35551066 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e31338 %T Examining Anxiety Treatment Information Needs: Web-Based Survey Study %A Bernstein,Matthew T %A Reynolds,Kristin A %A Jakobson,Lorna S %A Stoesz,Brenda M %A Alcolado,Gillian M %A Furer,Patricia %+ Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada, 1 2044749528, matthew.bernstein@uhn.ca %K anxiety %K information needs %K anxiety treatment %K web survey %K survey methodology %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several treatments for anxiety are available, which can make treatment decisions difficult. Resources are often produced with limited knowledge of what information is of interest to consumers. This is a problem because there is limited understanding of what people want to know when considering help for anxiety. Objective: This study aimed to examine the information needs and preferences concerning treatment options for anxiety by assessing the following: what information people consider to be important when they are considering treatment options for anxiety, what information people have received on psychological and medication treatment in the past, how they received this information in the past, and whether there are any differences in information needs between specific samples and demographic groups. Methods: Using a web-based survey, we recruited participants from a peer-support association website (n=288) and clinic samples (psychology, n=113; psychiatry, n=64). Results: Participants in all samples wanted information on a broad range of topics pertaining to anxiety treatment. However, they reported that they did not receive the desired amount of information. Participants in the clinic samples rated the importance of information topics higher than did those in the self-help sample. When considering the anxiety treatment information received in the past, most respondents indicated receiving information from informational websites, family doctors, and mental health practitioners. In terms of what respondents want to learn about, high ratings of importance were given to topics concerning treatment effectiveness, how it works, advantages and disadvantages, what happens when it stops, and common side effects. Conclusions: It is challenging for individuals to obtain anxiety-related information on the range of topics they desire through currently available information sources. It is also difficult to provide comprehensive information during typical clinical visits. Providing evidence-based information on the web and in a brochure format may help consumers make informed choices and support the advice provided by health professionals. %M 35551056 %R 10.2196/31338 %U https://formative.jmir.org/2022/5/e31338 %U https://doi.org/10.2196/31338 %U http://www.ncbi.nlm.nih.gov/pubmed/35551056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34852 %T Access to and Use of Mobile Phone by Postpartum, Married Women in Punjab, India: Secondary Analysis of mHealth Intervention Pilot Data %A Pendse,Ruchita S %A El Ayadi,Alison M %A Sharma,Preetika %A Ahuja,Alka %A Hosapatna Basavarajappa,Darshan %A Duggal,Mona %A Kankaria,Ankita %A Singh,Pushpendra %A Kumar,Vijay %A Bagga,Rashmi %A Diamond-Smith,Nadia G %+ Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4154762300, nadia.diamond-smith@ucsf.edu %K pregnancy %K mothers %K postpartum period %K postnatal care %K mobile phone use %K mHealth %K mobile health %K digital health %K telemedicine %K health education %K sex factors %K gender %K India %K South Asia %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective: We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods: A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results: The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. Conclusions: These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. %M 35551059 %R 10.2196/34852 %U https://formative.jmir.org/2022/5/e34852 %U https://doi.org/10.2196/34852 %U http://www.ncbi.nlm.nih.gov/pubmed/35551059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30900 %T Exploring Use Patterns and Racial and Ethnic Differences in Real Time Affective States During Social Media Use Among a Clinical Sample of Adolescents With Depression: Prospective Cohort Study %A Nereim,Cameron %A Bickham,David %A Rich,Michael %+ Division of Adolescent Medicine, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Suite 5053, Tampa, FL, 33606, United States, 1 813 259 8695, cnereim@usf.edu %K depression %K race/ethnicity %K ecological momentary assessment %K internet %K mental health %K mood %K social media %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing youth mental health problems over time correlate with increasing rates of social media use (SMU); however, a proposed contributory relationship remains unproven. To better understand how SMU impacts mental health requires a more nuanced understanding of the relationship between different patterns of SMU and specific individual factors. Studies suggest that more active forms of SMU may offer mental health benefits when compared with more passive forms. Furthermore, the literature suggests important differences in patterns of SMU and affective states among those identifying as racial and ethnic minorities. Objective: Using ecological momentary assessment (EMA), this study aims to investigate potential differences in affective states during active and passive forms of SMU and whether such differences vary by race and ethnicity. Methods: We recruited patients seeking care at a large urban adolescent medicine clinic who exhibited at least mild depressive symptoms based on Patient Health Questionnaire-9 (PHQ-9) scores. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day, which assessed real time SMU behaviors and affective states using the Positive and Negative Affect Schedule–Expanded form subscales. To correct for nonindependent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the individual level to examine associations between EMA-reported SMU and affective states while adjusting results for age, gender, race and ethnicity, PHQ-9 score, and EMA response rate. Results: A racially and ethnically diverse group of 55 adolescents aged 14 to 19 years provided a total of 976 EMA responses, averaging 17.76 (SD 8.76) responses per participant, with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F1,215=3.86; SE 0.05; t1,215=1.96; P=.05) and lower mean levels of positive affect during passive SMU (F1,369=3.90; SE 0.09; t1,369=–1.98; P=.049). However, within different racial and ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black non-Hispanic participants: F1,81=6.31; SE 0.05; t81=2.51; P=.01). Similarly, lower levels of positive affect during passive SMU were seen only among White non-Hispanic participants (F1,295=10.52; SE 0.13; t295=–3.24; P=.001). Conclusions: Although in aggregate, adolescents with depressive symptoms experienced more negative affect during active SMU and less positive affect during passive SMU, these mean outcomes were driven solely by greater negative affect during active SMU by Black non-Hispanic participants and lower positive affect during passive SMU by White non-Hispanic participants. Differences in intentionality, content, context, and expectations of SMU among youths across racial and ethnic groups may result in different affective outcomes. Exploration of the interactions among cultural differences in SMU strategies and characteristics will be critical to furthering our understanding of the impact of SMU on youth mental health. %M 35550316 %R 10.2196/30900 %U https://formative.jmir.org/2022/5/e30900 %U https://doi.org/10.2196/30900 %U http://www.ncbi.nlm.nih.gov/pubmed/35550316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34552 %T Strengthening the Impact of Digital Cognitive Behavioral Interventions Through a Dual Intervention: Proficient Motivational Interviewing–Based Health Coaching Plus In-Application Techniques %A Serio,Catherine %A Gabarda,Amanda %A Uyar-Morency,Fatma %A Silfee,Valerie %A Ludwig,Justin %A Szigethy,Eva %A Butterworth,Susan %+ Happify Health, 51 E. 12th Street, New York, NY, 10003, United States, 1 208 861 4790, Catherine.serio@happify.com %K digital health %K mHealth %K cognitive behavioral therapy %K motivational interviewing %K COVID-19 %K mental health %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum in increasing overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight into the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes versus simply monitoring engagement metrics. Motivational interviewing (MI) is a collaborative, goal-oriented communication approach that pays particular attention to the language of change and is an effective engagement approach to help people manage mental health issues. However, this approach has been traditionally used for in-person or telephonic interventions, and less is known about the application of MI to digital interventions. Objective: We sought to provide a dual intervention approach and address multiple factors across two levels of engagement to operationalize a dCBI that combined cognitive behavioral therapy–based techniques and MI-based interactions between the digital health coach (DHC) and user. Methods: We reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions. Results: We tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a noncoached intervention (P<.001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by the DHC-to-user message exchange ratio (P<.001); (3) the DHC-to-user message exchange ratio was correlated with more engagement in app activities (r=0.28, 95% CI 0.23-0.33); (4) DHCs with demonstrated MI proficiency elicited a greater amount of “change talk” from users than did DHCs without MI proficiency (H=25.12, P<.001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (P=.02). Conclusions: To our knowledge, this pilot was the first of its kind to test the application of MI to digital coaching protocols, and it demonstrated the value of MI proficiency in digital health coaching for enhanced engagement and health improvement. Further research is needed to establish coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes. %M 35544323 %R 10.2196/34552 %U https://formative.jmir.org/2022/5/e34552 %U https://doi.org/10.2196/34552 %U http://www.ncbi.nlm.nih.gov/pubmed/35544323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37737 %T A Social Media–Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study %A Hu,Lu %A Islam,Nadia %A Trinh-Shevrin,Chau %A Wu,Bei %A Feldman,Naumi %A Tamura,Kosuke %A Jiang,Nan %A Lim,Sahnah %A Wang,Chan %A Bubu,Omonigho M %A Schoenthaler,Antoinette %A Ogedegbe,Gbenga %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyulangone.org %K diabetes %K health equity %K immigrant health %K migrant %K minority %K mobile health %K social media %K WeChat %K messaging app %K patient education %K health education %K education video %K health video %K counseling %K pilot study %K feasibility %K access to care %K diabetes education %K disease management %K self management %K low income %K immigrant population %K digital health %K health intervention %K mobile phone %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. Objective: The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media–based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. Methods: This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. Results: The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of 50 years) from local and foreign community groups completed the survey, which included items on sociodemographic and clinical characteristics, the 7-item Generalized Anxiety Disorder scale (GAD-7), and the 9-item Patient Health Questionnaire (PHQ-9). Independent t tests and a multiple linear regression analysis were used to investigate differences between anxiety and depression and the factors associated with these symptoms across the 2 groups. Results: Overall, 469 responses were received; 119 responses (25.4%) were from male participants and 202 (43.1%) were from those older than 65 years. Of the 469 responses, 245 (52.2%) were from the local community group and 224 (47.8%) from the foreign group. The mean GAD-7 (P=.003) scores were significantly higher in the local group. Anxiety was significantly more present in the local group (61/245, 24.9% compared to 35/224, 15.6% in the foreign group; P=.01). A total of 6 respondents presented severe anxiety and 2 presented severe depression. Conclusions: This study demonstrated that both community groups of older adults from the Chinese “Hometown of Longevity” presented anxiety or depressive disorders during the first months of the pandemic. Local community groups presented significantly more mental health disorders, which were associated with a history of previous psychological disorders. %M 35404834 %R 10.2196/37046 %U https://formative.jmir.org/2022/5/e37046 %U https://doi.org/10.2196/37046 %U http://www.ncbi.nlm.nih.gov/pubmed/35404834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35994 %T Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study %A Kumwichar,Ponlagrit %A Chongsuvivatwong,Virasakdi %A Prappre,Tagoon %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Rd, Hat Yai, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K app %K compliance %K usability %K remote monitoring %K therapy %K tuberculosis %K lung %K infectious disease %K user experience %K video directly observed therapy %K video-enhanced therapy %K video-observed therapy %K digital health %K health care system %K disease monitoring %K health monitoring %K video consultation %K online health %K virtual therapy %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Thailand, the health care system has struggled to cope with COVID-19, resulting in directly observed therapy for tuberculosis being de-emphasized. A video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace directly observed therapy. According to the pilot study, the system needed notifications to improve usability and user compliance. The updated version of the TH VOT system thus enabled LINE (Line Corporation) notifications. Objective: This study aimed to reassess users’ compliance with and the usability of the updated TH VOT system. Methods: This study was conducted in the Hat Yai and Mueang Songkhla districts in Songkhla Province, Southern Thailand, from September 18 to December 1, 2021. The system was used by not only patients with tuberculosis but also tuberculosis staff, who acted as observers in primary health care settings. Some of the observers used the simulated VOT system instead of the actual system due to the lack of participating patients in their jurisdiction. After 30 days of using the system, VOT session records were analyzed to determine the compliance of the patients and observers. The User Experience Questionnaire was administered to reassess the usability of the system and compare the ratings of the participants with the general benchmark scores of the User Experience Questionnaire. The results were summarized to reveal the degree of user compliance and usability in the following three groups: the patients, actual VOT observers, and simulated VOT observers. Results: Of the 19 observers, 10 used the actual VOT system, and the remaining 9 used the simulated VOT system; there were also 10 patients with tuberculosis. The patients, actual VOT observers, and simulated VOT observers exhibited about 70%, 65%, and 50% compliance, respectively, in terms of following the standard operating procedures every day. The scores of all groups on all dimensions were well above the average scores. There was no significant difference in any of the dimensional scores among the three groups. Conclusions: The updated version of the TH VOT system was deemed usable by both the patients and the health care staff. Compliance with the use of the system was high among the patients but moderate among the observers. %M 35522469 %R 10.2196/35994 %U https://formative.jmir.org/2022/5/e35994 %U https://doi.org/10.2196/35994 %U http://www.ncbi.nlm.nih.gov/pubmed/35522469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34830 %T Machine Learning Decision Support for Detecting Lipohypertrophy With Bedside Ultrasound: Proof-of-Concept Study %A Bandari,Ela %A Beuzen,Tomas %A Habashy,Lara %A Raza,Javairia %A Yang,Xudong %A Kapeluto,Jordanna %A Meneilly,Graydon %A Madden,Kenneth %+ Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 60 487 55706, Kenneth.Madden@ubc.ca %K insulin %K lipoma %K machine learning %K diagnostic ultrasound %K lipohypertrophy %K diabetes %K ultrasound images %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common dermatological complication of insulin therapy is lipohypertrophy. Objective: As a proof of concept, we built and tested an automated model using a convolutional neural network (CNN) to detect the presence of lipohypertrophy in ultrasound images. Methods: Ultrasound images were obtained in a blinded fashion using a portable GE LOGIQ e machine with an L8-18I-D probe (5-18 MHz; GE Healthcare). The data were split into train, validation, and test splits of 70%, 15%, and 15%, respectively. Given the small size of the data set, image augmentation techniques were used to expand the size of the training set and improve the model’s generalizability. To compare the performance of the different architectures, the team considered the accuracy and recall of the models when tested on our test set. Results: The DenseNet CNN architecture was found to have the highest accuracy (76%) and recall (76%) in detecting lipohypertrophy in ultrasound images compared to other CNN architectures. Additional work showed that the YOLOv5m object detection model could be used to help detect the approximate location of lipohypertrophy in ultrasound images identified as containing lipohypertrophy by the DenseNet CNN. Conclusions: We were able to demonstrate the ability of machine learning approaches to automate the process of detecting and locating lipohypertrophy. %M 35404833 %R 10.2196/34830 %U https://formative.jmir.org/2022/5/e34830 %U https://doi.org/10.2196/34830 %U http://www.ncbi.nlm.nih.gov/pubmed/35404833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34129 %T Implementation of a Personalized Digital App for Pediatric Preanesthesia Evaluation and Education: Ongoing Usability Analysis and Dynamic Improvement Scheme %A Connelly,Yaron %A Lotan,Roni %A Brzezinski Sinai,Yitzhak %A Rolls,Dan %A Beker,Amir %A Abensour,Eilone %A Neudorfer,Orit %A Stocki,Daniel %+ GistMD, Stricker St 16, Tel Aviv, 6200622, Israel, 972 8 9542573, yaron.connelly@gmail.com %K mHealth apps %K preanesthesia %K pediatric setting %K mHealth usability %K usability analysis %K mobile health %K mHealth %K pediatrics %K anesthesia %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Preanesthesia evaluation is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plans for patients, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last 2 decades, eHealth and mobile health (mHealth) settings have gradually replaced part of the face-to-face encounters as the platform for preanesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Nevertheless, there is a lack of studies examining the effectiveness of surgical mHealth apps focusing on the pediatric preanesthetic setting and addressing their usability among families. Objective: This study describes a dynamic approach for the development process of GistMD’s preanesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. Methods: The study was conducted in 4 departments at a 1500-bed quaternary, academic medical center in Tel Aviv, Israel. During the study period, the link to the preanesthesia system was sent via SMS text messages to families whose children were about to undergo surgery. The system included preanesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Continuous collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. Results: During 141 days of implementation, the link to the GistMD preanesthesia management system was sent to 769 families, and product-fit actions were implemented during this term: (1) changing text message scheduling for addressing learnability and accessibility, resulting in a significant increase of 27% (χ21=12.65, P<.001) in view rates and 27.4% (χ21=30.01, P<.001) in satisfaction rates; (2) reducing the number of screens to increase efficiency and operability, leading to a significant decrease of 8.6% in cases where users did not perform any activity on the system after logging in (χ21=6.18, P=.02); (3) conducting a patient-focused campaign in 2 departments aimed at addressing memorability, leading to significant increases in 8 of the 12 usability indicators. Conclusions: Our results indicate that mHealth product-fit decisions originating from theory-based approaches and ongoing usability data analysis allow tailoring of the most appropriate responses for usability gaps, as reflected in increased use rates and satisfaction. In the case of the preanesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains. %M 35416171 %R 10.2196/34129 %U https://formative.jmir.org/2022/5/e34129 %U https://doi.org/10.2196/34129 %U http://www.ncbi.nlm.nih.gov/pubmed/35416171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e27277 %T A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial %A Yoon,Esther S %A Hur,Scott %A Curtis,Laura M %A Wynia,Aiden H %A Zheng,Pauline %A Nair,Sumi S %A Bailey,Stacy C %A Serper,Marina %A Reese,Peter P %A Ladner,Daniela P %A Wolf,Michael S %+ Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125034948, esther.yoon@northwestern.edu %K kidney transplantation %K medication adherence %K fidelity %K digital health %K patient portal %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Inadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant recipients is common, yet interventions are needed to support patients in sustaining adequate adherence to prescribed regimens and achieving optimal transplant outcomes. Objective: We examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring strategy known as TAKE IT. Methods: The TAKE IT strategy includes: (1) routine, online, monthly patient self-report adherence assessments; (2) care alerts directed to nurses; (3) quarterly reports monitoring tacrolimus values and adherence trends; (4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at two large transplant centers (N=449). To evaluate the initial fidelity of TAKE IT, we investigated patient uptake of monthly adherence assessments during the course of a 3-month period, whether any disparities emerged, and the nature of any reported adherence concerns. Results: Among 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% (164/202) completed an adherence assessment, 73% (148/202) completed at least two, and 57% (116/202) completed all monthly assessments. Overall, 50% (82/164) of kidney transplant recipients reported at least one adherence concern over the 3-month assessment period. The most common barriers were classified as regimen-related (eg, regimen complexity), cognitive (eg, forgetfulness), and medical (eg, side effects). Higher-income participants were more likely to complete all surveys compared to lower-income participants (P=.01). Conclusions: TAKE IT demonstrated 81% (164/202) completion of an adherence assessment, 73% (148/202) completion of at least two, and 57% (116/202) completion of all monthly assessments during this brief, initial observation period. Among those that did respond to the online assessments, the majority demonstrated sustained engagement. Additional monitoring modalities could also be offered to meet patient preferences to ensure all patients’ medication use can be properly monitored. Trial Registration: ClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868 %M 35511225 %R 10.2196/27277 %U https://formative.jmir.org/2022/5/e27277 %U https://doi.org/10.2196/27277 %U http://www.ncbi.nlm.nih.gov/pubmed/35511225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37014 %T Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets %A Yamada,Yasunori %A Shinkawa,Kaoru %A Kobayashi,Masatomo %A Badal,Varsha D %A Glorioso,Danielle %A Lee,Ellen E %A Daly,Rebecca %A Nebeker,Camille %A Twamley,Elizabeth W %A Depp,Colin %A Nemoto,Miyuki %A Nemoto,Kiyotaka %A Kim,Ho-Cheol %A Arai,Tetsuaki %A Jeste,Dilip V %+ Digital Health, IBM Research, 19-21 Nihonbashi Hakozaki-cho, Chuo-ku, Tokyo, 103-8510, Japan, 81 80 6706 9381, ysnr@jp.ibm.com %K tablet %K behavior analysis %K digital biomarkers %K digital health %K motor control %K cognitive impairment %K dementia %K machine learning %K multicohort %K multination %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. Objective: The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. Methods: We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning–based regression analyses. Results: We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen’s horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001). Conclusions: This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment. %M 35511253 %R 10.2196/37014 %U https://formative.jmir.org/2022/5/e37014 %U https://doi.org/10.2196/37014 %U http://www.ncbi.nlm.nih.gov/pubmed/35511253 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e28558 %T A Platform to Develop and Apply Digital Methods for Empirical Bioethics Research: Mixed Methods Design and Development Study %A Schneider,Manuel %+ Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Hottingerstrasse 10, Zurich, 8092, Switzerland, 41 44 632 26 16, manuel.schneider@digitalmethods.ch %K digital bioethics %K digital humanities %K digital methods %K computational methods %K empirical bioethics %K research platform %K digital health %K bioethics %K digital platform %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The rise of digital methods and computational tools has opened up the possibility of collecting and analyzing data from novel sources, such as discussions on social media. At the same time, these methods and tools introduce a dependence on technology, often resulting in a need for technical skills and expertise. Researchers from various disciplines engage in empirical bioethics research, and software development and similar skills are not usually part of their background. Therefore, researchers often depend on technical experts to develop and apply digital methods, which can create a bottleneck and hinder the broad use of digital methods in empirical bioethics research. Objective: This study aimed to develop a research platform that would offer researchers the means to better leverage implemented digital methods, and that would simplify the process of developing new methods. Methods: This study used a mixed methods approach to design and develop a research platform prototype. I combined established methods from user-centered design, rapid prototyping, and agile software development to iteratively develop the platform prototype. In collaboration with two other researchers, I tested and extended the platform prototype in situ by carrying out a study using the prototype. Results: The resulting research platform prototype provides three digital methods, which are composed of functional components. This modular concept allows researchers to use existing methods for their own experiments and combine implemented components into new methods. Conclusions: The platform prototype illustrates the potential of the modular concept and empowers researchers without advanced technical skills to carry out experiments using digital methods and develop new methods. However, more work is needed to bring the prototype to a production-ready state. %M 35511234 %R 10.2196/28558 %U https://formative.jmir.org/2022/5/e28558 %U https://doi.org/10.2196/28558 %U http://www.ncbi.nlm.nih.gov/pubmed/35511234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36203 %T Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study %A Leo,Ashwin J %A Schuelke,Matthew J %A Hunt,Devyani M %A Miller,J Philip %A Areán,Patricia A %A Cheng,Abby L %+ Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, Box MSC 8233-0004-05, 660S S Euclid Ave, St Louis, MO, 63110, United States, 1 3147472823, ChengAL@wustl.edu %K digital health %K mental health %K depression %K anxiety %K chronic pain %K musculoskeletal %K orthopedic %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety frequently coexist with chronic musculoskeletal pain and can negatively impact patients’ responses to standard orthopedic treatments. Nevertheless, mental health is not routinely addressed in the orthopedic care setting. If effective, a digital mental health intervention may be a feasible and scalable method of addressing mental health in an orthopedic setting. Objective: We aimed to compare 2-month changes in mental and physical health between orthopedic patients who received a digital mental health intervention in addition to usual orthopedic care, those who received usual orthopedic care only (without a specific mental health intervention), and those who received in-person care with a psychologist as part of their orthopedic treatment plan. Methods: In this single-center retrospective cohort study involving ancillary analysis of a pilot feasibility study, 2-month self-reported health changes were compared between a cohort of orthopedic patients who received access to a digital mental health intervention (Wysa) and 2 convenience sample comparison cohorts (patients who received usual orthopedic care without a specific mental health intervention and patients who received in-person care with a psychologist as part of their orthopedic treatment plan). All patients were 18 years or older and reported elevated symptoms of depression or anxiety at an orthopedic clinic visit (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression or Anxiety score ≥55). The digital intervention was a multi-component mobile app that used chatbot technology and text-based access to human counselors to provide cognitive behavioral therapy, mindfulness training, and sleep tools, among other features, with an emphasis on behavioral activation and pain acceptance. Outcomes of interest were between-cohort differences in the 2-month longitudinal changes in PROMIS Depression and Anxiety scores (primary outcomes) and PROMIS Pain Interference and Physical Function scores (secondary outcomes). Results: Among 153 patients (mean age 55, SD 15 years; 128 [83.7%] female; 51 patients per cohort), patients who received the digital mental health intervention showed clinically meaningful improvements at the 2-month follow-up for all PROMIS measures (mean longitudinal improvement 2.8-3.7 points; P≤.02). After controlling for age and BMI, the improvements in PROMIS Depression, Pain Interference, and Physical Function were meaningfully greater than longitudinal changes shown by patients who received usual orthopedic care (mean between-group difference 2.6-4.8 points; P≤.04). Improvements in PROMIS Physical Function were also meaningfully greater than longitudinal changes shown by patients who received in-person psychological counseling (mean between-group difference 2.4 points; P=.04). Conclusions: Patients who received a digital mental health intervention as part of orthopedic care reported greater 2-month mean improvements in depression, pain interference, and physical function than patients who received usual orthopedic care. They also reported a greater mean improvement in physical function and comparable improvements in depression, anxiety, and pain interference compared with orthopedic patients who received in-person psychological counseling. %M 35507387 %R 10.2196/36203 %U https://formative.jmir.org/2022/5/e36203 %U https://doi.org/10.2196/36203 %U http://www.ncbi.nlm.nih.gov/pubmed/35507387 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37348 %T Effectiveness of an 8-Week Physical Activity Intervention Involving Wearable Activity Trackers and an eHealth App: Mixed Methods Study %A McCormack,Gavin R %A Petersen,Jennie %A Ghoneim,Dalia %A Blackstaffe,Anita %A Naish,Calli %A Doyle-Baker,Patricia K %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 220 8193, gmccorma@ucalgary.ca %K activity tracker %K technology %K eHealth %K physical activity %K intervention %K exercise %K mHealth %K fitness %K wearable %K sensor %K digital health %K COVID-19 %K health promotion %K mixed methods study %K wearable technology %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-promotion interventions incorporating wearable technology or eHealth apps can encourage participants to self-monitor and modify their physical activity and sedentary behavior. In 2020, a Calgary (Alberta, Canada) recreational facility developed and implemented a health-promotion intervention (Vivo Play Scientist program) that provided a commercially available wearable activity tracker and a customized eHealth dashboard to participants free of cost. Objective: The aim of this study was to independently evaluate the effectiveness of the Vivo Play Scientist program for modifying physical activity and sedentary behavior during the initial 8 weeks of the piloted intervention. Methods: Our concurrent mixed methods study included a single-arm repeated-measures quasiexperiment and semistructured interviews. Among the 318 eligible participants (≥18 years of age) registered for the program, 87 completed three self-administered online surveys (baseline, T0; 4 weeks, T1; and 8 weeks, T2). The survey captured physical activity, sedentary behavior, use of wearable technology and eHealth apps, and sociodemographic characteristics. Twenty-three participants were recruited using maximal-variation sampling and completed telephone-administered semistructured interviews regarding their program experiences. Self-reported physical activity and sedentary behavior outcomes were statistically compared among the three time points using Friedman tests. Thematic analysis was used to analyze the interview data. Results: The mean age of participants was 39.8 (SD 7.4) years and 75% (65/87) were women. Approximately half of all participants had previously used wearable technology (40/87, 46%) or an eHealth app (43/87, 49%) prior to the intervention. On average, participants reported wearing the activity tracker (Garmin Vivofit4) for 6.4 (SD 1.7) days in the past week at T1 and for 6.0 (SD 2.2) days in the past week at T2. On average, participants reported using the dashboard for 1.6 (SD 2.1) days in the past week at T1 and for 1.0 (SD 1.8) day in the past week at T2. The mean time spent walking at 8 weeks was significantly higher compared with that at baseline (T0 180.34 vs T2 253.79 minutes/week, P=.005), with no significant differences for other physical activity outcomes. Compared to that at baseline, the mean time spent sitting was significantly lower at 4 weeks (T0 334.26 vs T1 260.46 minutes/day, P<.001) and 8 weeks (T0 334.26 vs T2 267.13 minutes/day, P<.001). Significant differences in physical activity and sitting between time points were found among subgroups based on the household composition, history of wearable technology use, and history of eHealth app use. Participants described how wearing the Vivofit4 device was beneficial in helping them to modify physical activity and sedentary behavior. The social support, as a result of multiple members of the same household participating in the program, motivated changes in physical activity. Participants experienced improvements in their mental, physical, and social health. Conclusions: Providing individuals with free-of-cost commercially available wearable technology and an eHealth app has the potential to support increases in physical activity and reduce sedentary behavior in the short term, even under COVID-19 public health restrictions. %M 35404832 %R 10.2196/37348 %U https://formative.jmir.org/2022/5/e37348 %U https://doi.org/10.2196/37348 %U http://www.ncbi.nlm.nih.gov/pubmed/35404832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e32226 %T Feasibility of a Web-Based Intervention to Prevent Perinatal Depression and Promote Human Milk Feeding: Randomized Pilot Trial %A Pezley,Lacey %A Tussing-Humphreys,Lisa %A Koenig,Mary Dawn %A Maki,Pauline %A Odoms-Young,Angela %A Freels,Sally %A DiPiazza,Brittany %A Cann,Felicity %A Cares,Kate %A Depa,Courtney %A Klejka,Gintare %A Lima Oliveira,Manoela %A Prough,Jilian %A Roe,Taylor %A Buscemi,Joanna %A Duffecy,Jennifer %+ Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, United States, 1 312 355 5521, lwissl2@uic.edu %K breastfeeding %K chestfeeding %K perinatal %K depression %K anxiety %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mothers who identify as Black or African American are more likely to report depressed moods in late pregnancy and early postpartum and have the lowest rates of human milk feeding compared with all other racial groups in the United States. Internet interventions offer the potential to extend preventative and supportive services as they address key barriers, particularly for those navigating the complex and vulnerable early postpartum period. However, there is limited evidence on the feasibility of such interventions for preventing perinatal mental health disorders and improving human milk feeding outcomes in Black mothers. Objective: This pilot study aimed to assess the feasibility and preliminary findings of a web-based cognitive behavioral therapy–based internet intervention, with and without human milk feeding education and support, to prevent perinatal depression and promote human milk feeding in Black mothers. Methods: Participants were Black-identifying individuals between 20 and 28 weeks of pregnancy with human milk feeding intention and mild to moderate depressive symptoms (Patient Health Questionnaire scores 5-14). Participants were randomized to either Sunnyside, a 6-week cognitive behavioral therapy–based web-based intervention, or Sunnyside Plus, which included additional education and support to promote human milk feeding. Assessments occurred at baseline, third trimester (end of antenatal treatment), 6 weeks postpartum (end of postpartum treatment), and 12 weeks postpartum. The primary focus of this randomized pilot trial was the feasibility and preliminary outcomes of mental health and human milk feeding. Results: A total of 22 tertiary-educated participants were randomized. The mean number of log-ins was 7.3 (SD 5.3) for Sunnyside and 13.8 (SD 10.5) for Sunnyside Plus. Scores of depression and anxiety measures remained below the clinical threshold for referral to treatment in both groups. All the participants initiated human milk feeding (18/18, 100%). Most participants reported at least some human milk feeding at both 6 and 12 weeks postpartum (6/7, 86%; 11/11, 100%, or 10/10, 100%, for Sunnyside and Sunnyside Plus, respectively). Conclusions: The results suggest that tertiary-educated Black mothers at risk for perinatal depression and who intended to human milk feed were receptive to and satisfied with a web-based cognitive behavioral therapy–based internet intervention, with and without human milk feeding education and support. Preliminary findings indicate that both Sunnyside and Sunnyside Plus interventions have the potential to affect symptoms of depression, anxiety, and human milk feeding outcomes. Trial Registration: ClinicalTrials.gov NCT04128202; https://www.clinicaltrials.gov/ct2/show/NCT04128202 %M 35503244 %R 10.2196/32226 %U https://formative.jmir.org/2022/5/e32226 %U https://doi.org/10.2196/32226 %U http://www.ncbi.nlm.nih.gov/pubmed/35503244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35886 %T Testing a Mobile App for Participatory Research to Identify Teen-Targeted Food Marketing: Mixed Methods Study %A Truman,Emily %A Elliott,Charlene %+ Department of Communication, Media and Film, University of Calgary, 2500 University Dr NW, Social Sciences Building, Calgary, AB, T2N 1N4, Canada, 1 403 220 3180, charlene.elliott@ucalgary.ca %K mHealth %K mobile app %K teenager %K adolescent %K monitoring %K participatory research %K feasibility %K usability %K food marketing %K food advertising %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps are not only effective tools for promoting health to teenagers but are also useful for engaging teenagers in participatory research on factors that influence their health. Given the impact of food marketing messages on teenagers’ food attitudes and consumption choices, it is important to develop effective methods for capturing the food advertisements targeted at this population to assess their content. Objective: The aim of this study was to test the feasibility and usability of a mobile app, “GrabFM!” (“Grab Food Marketing!”), designed for teenagers to facilitate monitoring of self-identified targeted food marketing messaging. Methods: A mixed methods approach, including quantitative user response rates and qualitative focus group discussion feedback, was used in the evaluation process. Results: A total of 62 teenagers (ages 13-17) completed GrabFM! app pilot testing over a 7-day data collection period. Teenagers submitted a total of 339 examples of food marketing, suggesting high feasibility for the app. Participants also took part in focus group discussions about their experience, providing positive feedback on usability, including ease of use and design aesthetic appeal. Conclusions: The GrabFM! app had high feasibility and usability, suggesting its efficacy in capturing accurate data relevant to the teenage population’s experience with food marketing messaging. %M 35503652 %R 10.2196/35886 %U https://formative.jmir.org/2022/5/e35886 %U https://doi.org/10.2196/35886 %U http://www.ncbi.nlm.nih.gov/pubmed/35503652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35471 %T Assessing Engagement With Patient-Generated Health Data Recording and Its Impact on Health Behavior Changes in Multicomponent Interventions: Supplementary Analysis %A Kinouchi,Kaori %A Ohashi,Kazutomo %+ Department of Children and Women's Health, Area of integrated Health and Nursing Science, Osaka University Graduate School of Medicine, 1-7-B411, Yamadaoka, Suita, Osaka, 5650871, Japan, 81 668792537, kinouchi@sahs.med.osaka-u.ac.jp %K patient-generated health data %K engagement %K health behavior change %K postpartum women %K health data %K health informatics %K pelvic health %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients’ decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients’ health behavior changes remains unclear. Objective: This study aimed to assess patients’ engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. Methods: This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients’ engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). Results: The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). Conclusions: The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients’ engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes. %M 35503411 %R 10.2196/35471 %U https://formative.jmir.org/2022/5/e35471 %U https://doi.org/10.2196/35471 %U http://www.ncbi.nlm.nih.gov/pubmed/35503411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35699 %T Characterizing User Experiences With an SMS Text Messaging–Based mHealth Intervention: Mixed Methods Study %A King,Sayde Leya %A Lebert,Jana %A Karpisek,Lacey Anne %A Phillips,Amelia %A Neal,Tempestt %A Kosyluk,Kristin %+ Department of Computer Science and Engineering, College of Engineering, University of South Florida, 4202 East Fowler Avenue, Tampa, FL, 33620, United States, 1 813 396 9353, saydeking@usf.edu %K text messaging %K SMS %K mobile health %K mHealth %K stigma %K user perceptions %K ubiquitous sensing %K low-intensity intervention %K coping %K mental health %K cognitive restructuring %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps. Objective: We present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content? Methods: We performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced). Results: We derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001). Conclusions: Our study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most. %M 35503524 %R 10.2196/35699 %U https://formative.jmir.org/2022/5/e35699 %U https://doi.org/10.2196/35699 %U http://www.ncbi.nlm.nih.gov/pubmed/35503524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e28072 %T Effect of a Virtual Reality Contact-Based Educational Intervention on the Public Stigma of Depression: Randomized Controlled Pilot Study %A Lem,Wey Guan %A Kohyama-Koganeya,Ayako %A Saito,Toki %A Oyama,Hiroshi %+ Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan, 81 3 5841 1893, vyrolwg@m.u-tokyo.ac.jp %K major depressive disorder %K depression stigma %K virtual reality %K contact-based educational intervention %K virtual patient %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Public stigma against depression contributes to low employment rates among individuals with depression. Contact-based educational (CBE) interventions have been shown to reduce this public stigma. Objective: We investigated the ability of our Virtual Reality Antistigma (VRAS) app developed for CBE interventions to reduce the stigma of depression. Methods: Sixteen medical students were recruited and randomized 1:1 to the intervention group, who used the VRAS app (VRAS group), and the control group, who watched a video on depression. The depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD) questionnaire at pre- and postintervention. Feasibility was assessed in both groups and usability was assessed only in the VRAS group after the intervention. A qualitative study was performed on the acquisition of knowledge about stigma in both groups based on participants’ answers to open-ended questions and interviews after the intervention. Results: The feasibility score was significantly higher in the VRAS group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). However, no significant differences were apparent between the VRAS and control groups for the DSS (VRAS: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (VRAS: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease; however, the stigma-reducing effects of the VRAS app were not significant for the DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). Qualitative analysis suggested that the VRAS app facilitated perspective-taking and promoted empathy toward the patient. Conclusions: The CBE intervention using virtual reality technology (VRAS app) was as effective as the video intervention. The results of the qualitative study suggested that the virtual reality intervention was able to promote perspective-taking and empathy toward patients. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049109 %M 35499865 %R 10.2196/28072 %U https://formative.jmir.org/2022/5/e28072 %U https://doi.org/10.2196/28072 %U http://www.ncbi.nlm.nih.gov/pubmed/35499865 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e29292 %T Communicating Treatment-Related Symptoms Using Passively Collected Data and Satisfaction/Loyalty Ratings: Exploratory Study %A Kudel,Ian %A Perry,Toni %+ Varian, a Siemens Healthineers Company, 3100 Hansen Way, Palo Alto, CA, 94304, United States, 1 518 902 8554, ian.kudel@varian.com %K electronic patient-reported outcomes %K ePRO %K cancer %K symptoms %K health-related quality of life %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Electronic patient-reported outcomes’ real time communication of treatment-related symptoms is increasingly associated with better outcomes including longer survival and less health care resource use, but the primary method of collecting this information, static questionnaires, has not evolved. Objective: The aim of this paper is to describe the use of Noona’s three methods of communicating treatment-related symptoms, which are as follows: (1) Noona symptom questionnaires (NSQ), which incorporate branching logic; (2) a diary; and (3) secure messaging, the last two of which have NSQ reporting functionality. It also aims to explore, using multivariable analyses, whether patients find value using these features. Methods: Noona users (N=1081) who have an active account for more than 30 days, who responded to the satisfaction/loyalty item, and who were undergoing active cancer treatment (systemic or radiotherapy) in the United States were included in this study. All study data were collected via software embedded within Noona code. This includes metadata, patient activities (measured in clicks), and responses to a satisfaction/loyalty question (“How likely are you to recommend Noona to another patient”) displayed on the Noona home page. Results: Noona users expressed a high degree of satisfaction/loyalty when asked to rate how likely they would recommend Noona to another patient. Multivariable analyses indicate small but significant effects for some of the analyses. Use of NSQs were significantly related to satisfaction/loyalty, users of NSQs had significantly higher satisfaction/loyalty than those who did not use any, and secure communication use was significantly higher for those who rated the app highly compared to those who did not. These relationships will likely be further explicated with the use of satisfaction/loyalty questions that focus specifically on feature use. Conclusions: Noona is well liked by respondents, and exploratory multivariable analyses demonstrate the potential for using passively and minimally invasive data to demonstrate value. %M 35175206 %R 10.2196/29292 %U https://cancer.jmir.org/2022/2/e29292 %U https://doi.org/10.2196/29292 %U http://www.ncbi.nlm.nih.gov/pubmed/35175206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36043 %T A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study %A Nelson,Lyndsay A %A Pennings,Jacquelyn S %A Sommer,Evan C %A Popescu,Filoteia %A Barkin,Shari L %+ Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 450, Nashville, TN, 37203, United States, 1 6156009027, lyndsay.a.nelson@vumc.org %K digital literacy %K digital health care %K telehealth %K health equity %K scale development %K mobile phone %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with using these services. Objective: The goal of this study was to develop and validate a brief scale that assesses digital health care literacy. Methods: We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital health care use. Results: Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of .999; unguided: F1,176=0.13, P>.999). Conclusions: Both guided and unguided versions of the intervention were highly effective in reducing depressive symptoms. Follow-up data suggest that these effects could be maintained. The guided version was not superior to the unguided version. Trial Registration: German Clinical Trials Register DRKS00017191; https://tinyurl.com/2p9h5hnx International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05218-4 %M 35105536 %R 10.2196/34330 %U https://formative.jmir.org/2022/4/e34330 %U https://doi.org/10.2196/34330 %U http://www.ncbi.nlm.nih.gov/pubmed/35105536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e29566 %T Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country %A Lara,Ma. Asunción %A Patiño,Pamela %A Tiburcio,Marcela %A Navarrete,Laura %+ Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Calz. Mexico-Xochimilco 101, Col. San Lorenzo Huipulco, Del. Tlalpan, Mexico City, 14370, Mexico, 52 55 4160 5170, laracan@imp.edu.mx %K depression %K web-based intervention %K unguided intervention %K acceptability %K satisfaction %K resource-limited country %D 2022 %7 4.4.2022 %9 Early Reports %J JMIR Form Res %G English %X Background: Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective: The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. Methods: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence. %M 35377324 %R 10.2196/29566 %U https://formative.jmir.org/2022/4/e29566 %U https://doi.org/10.2196/29566 %U http://www.ncbi.nlm.nih.gov/pubmed/35377324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e28983 %T Reducing Inappropriate Urinary Catheter Use by Involving Patients Through the Participatient App: Before-and-After Study %A Bentvelsen,Robbert G %A Bruijning,Marguerite L %A Chavannes,Niels H %A Veldkamp,Karin Ellen %+ Department of Medical Microbiology, Leiden University Medical Center, Leiden University, E4-P, PO Box 9600, Leiden, 2300 RC, Netherlands, 31 715261652, rbentvelsen@gmail.com %K infection control %K catheter-associated urinary tract infections %K urinary catheter %K patient empowerment %K catheter %K urology %K infection %K urinary tract infection %K smartphone app %K surgical nursing %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The risk of urinary tract infections is increased by the inappropriate placement and unnecessary prolongation of the use of indwelling urinary catheters. Sustained behavior change in infection prevention could be promoted by empowering patients through a smartphone app. Objective: The aim of this study is to assess the feasibility and efficacy of implementation actions on patients’ use of the Participatient app on a clinical ward and to compare 3 survey methods for urinary catheter use. Methods: Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. Over a period of 3 months, the number of new app users, days of use, and sessions were recorded. In a comparison of urinary catheter use before and after the implementation of the app, 3 methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in patients’ electronic medical records, parsing a survey of checkbox items, and parsing nursing notes. Results: In all, 475 patients were admitted to the ward, 42 (8.8%) installed the app, with 1 to 5 new users per week. The actions with the most ensuing app use were the kick-off with the clinical lesson and recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter use prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% (36/96) to 27% (23/86) after app introduction (OR 0.61, 95% CI 0.32-1.14). Conclusions: The clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are also used. For surveying indwelling urinary catheter use prevalence, manual parsing is the best approach. %M 35377323 %R 10.2196/28983 %U https://formative.jmir.org/2022/4/e28983 %U https://doi.org/10.2196/28983 %U http://www.ncbi.nlm.nih.gov/pubmed/35377323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31839 %T The Impact of Web-Based Physical Activity Interventions on Depression and Anxiety Among College Students: Randomized Experimental Trial %A Murray,Andy %A Marenus,Michele %A Cahuas,Ana %A Friedman,Kathryn %A Ottensoser,Haley %A Kumaravel,Varun %A Sanowski,Julia %A Chen,Weiyun %+ Physical Activity and Health Laboratory, School of Kinesiology, University of Michigan, SKB 4250, 830 N University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 615 0376, chenwy@umich.edu %K depression %K anxiety %K college students %K mindfulness %K aerobic exercise %K resistance training %K web-based intervention %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective: This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods: The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results: The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions: College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students’ depression and anxiety during a pandemic. %M 35363151 %R 10.2196/31839 %U https://formative.jmir.org/2022/4/e31839 %U https://doi.org/10.2196/31839 %U http://www.ncbi.nlm.nih.gov/pubmed/35363151 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32357 %T Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case %A Fecho,Karamarie %A Ahalt,Stanley C %A Appold,Stephen %A Arunachalam,Saravanan %A Pfaff,Emily %A Stillwell,Lisa %A Valencia,Alejandro %A Xu,Hao %A Peden,David B %+ Renaissance Computing Institute, University of North Carolina at Chapel Hill, 100 Europa Drive, Suite 540, Chapel Hill, NC, 27517, United States, 1 919 445 9640, kfecho@copperlineprofessionalsolutions.com %K open patient data %K electronic health records %K airborne pollutant exposures %K socioeconomic exposures %K medication exposures %K asthma exacerbation %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner. Objective: This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case. Methods: We queried the ICEES open application programming interface (OpenAPI) using a functionality that supports chi-square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (α=.001). We focused on 2 primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone. Results: Of the 157,410 patients within the asthma cohort, 26,332 (16.73%) had 1 or more annual ED or inpatient visits for respiratory issues, and 17,056 (10.84%) had 1 or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of particulate matter ≤2.5 μm (PM2.5) or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural versus urban residence. Moreover, the results were largely consistent across outcome measures. Conclusions: Our results demonstrate that the open-source ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields. %M 35363149 %R 10.2196/32357 %U https://formative.jmir.org/2022/4/e32357 %U https://doi.org/10.2196/32357 %U http://www.ncbi.nlm.nih.gov/pubmed/35363149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31870 %T An Evaluation of Real-world Smart Sock–Based Temperature Monitoring Data as a Physiological Indicator of Early Diabetic Foot Injury: Case-Control Study %A Reyzelman,Alexander M %A Shih,Chia-Ding %A Tovmassian,Gregory %A Nathan,Mohan %A Ma,Ran %A Scholten,Henk Jan %A Malhotra,Kara %A Armstrong,David G %+ Siren Care Inc, 1256 Folsom Street, San Francisco, CA, 94103, United States, 1 9199176559, mo@siren.care %K diabetes %K diabetic foot ulcer %K temperature monitoring %K Charcot foot %K digital health %K wearable %K neuropathy %K remote patient monitoring %K foot ulcer %K monitoring device %K patient monitoring %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Lower extremity complications of diabetes represent major health care complications both in terms of cost and impact to quality of life for patients with diabetic peripheral neuropathy. Temperature monitoring has been shown in previous studies to provide a useful signal of inflammation that may indicate the early presence of a foot injury. Objective: In this study, we evaluated the temperature data for patients that presented with a diabetic foot injury while using a sock-based remote temperature monitoring device. Methods: The study abstracted data from patients who were enrolled in a remote temperature monitoring program (2020-2021) using a smart sock (Siren Care). In the study cohort, a total of 5 participants with a diabetes-related lower extremity injury during the study period were identified. In the second comparison cohort, a total of 26 patients met the criteria for monitoring by the same methods but did not present with a diabetes-related podiatric lower extremity injury during the same period. The 15-day temperature differential between 6 defined locations on each foot was the primary outcome measure among subjects who presented with a diagnosed foot injury. Paired t tests were used to compare the differences between the two groups. Results: A significant difference in temperature differential (temperature measured in °F) was observed in the group that presented with a podiatric injury over the course of evaluation versus the comparator group that did not present with a podiatric injury. The average difference from all 6 measured points was 1.4 °F between the injury group (mean 3.6, SD 3.0) and the comparator group (mean 2.2, SD 2.5, t=–71.4, df=39; P<.001). Conclusions: The results of this study suggest temperature monitoring in a sock form factor could be used to predict a developing foot injury. The continuous temperature monitoring system employed has implications for further algorithm development to enable early detection. The study was limited by a nonrandomized, observational design with limited injuries present in the study period. We look forward to further studies that will refine the predictive potential and confirm or refute the current promising data. %M 35363148 %R 10.2196/31870 %U https://formative.jmir.org/2022/4/e31870 %U https://doi.org/10.2196/31870 %U http://www.ncbi.nlm.nih.gov/pubmed/35363148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35069 %T A Smart Mobile App to Simplify Medical Documents and Improve Health Literacy: System Design and Feasibility Validation %A Hendawi,Rasha %A Alian,Shadi %A Li,Juan %+ North Dakota State University, 1340 Administration Ave, Fargo, ND, 58105, United States, 1 701 231 9662, j.li@ndsu.edu %K health literacy %K knowledge graph %K natural language processing %K machine learning %K medical entity recognition %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with low health literacy experience more challenges in understanding instructions given by their health providers, following prescriptions, and understanding their health care system sufficiently to obtain the maximum benefits. People with insufficient health literacy have high risk of making medical mistakes, more chances of experiencing adverse drug effects, and inferior control of chronic diseases. Objective: This study aims to design, develop, and evaluate a mobile health app, MediReader, to help individuals better understand complex medical materials and improve their health literacy. Methods: MediReader is designed and implemented through several steps, which are as follows: measure and understand an individual’s health literacy level; identify medical terminologies that the individual may not understand based on their health literacy; annotate and interpret the identified medical terminologies tailored to the individual’s reading skill levels, with meanings defined in the appropriate external knowledge sources; evaluate MediReader using task-based user study and satisfaction surveys. Results: On the basis of the comparison with a control group, user study results demonstrate that MediReader can improve users’ understanding of medical documents. This improvement is particularly significant for users with low health literacy levels. The satisfaction survey showed that users are satisfied with the tool in general. Conclusions: MediReader provides an easy-to-use interface for users to read and understand medical documents. It can effectively identify medical terms that a user may not understand, and then, annotate and interpret them with appropriate meanings using languages that the user can understand. Experimental results demonstrate the feasibility of using this tool to improve an individual’s understanding of medical materials. %M 35363142 %R 10.2196/35069 %U https://formative.jmir.org/2022/4/e35069 %U https://doi.org/10.2196/35069 %U http://www.ncbi.nlm.nih.gov/pubmed/35363142 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e33640 %T Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study %A Huma,Zil E %A Struik,Laura %A Bottorff,Joan L %A Hasan,Mohammad Khalad %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V1V7, Canada, 1 2508078000, laura.struik@ubc.ca %K qualitative research %K electronic nicotine delivery systems %K e-cigarette %K cessation %K young adults %K smartphone apps %K mHealth %K mobile phone %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults’ preferences and expectations from an e-cigarette cessation smartphone app remains unexplored. Objective: The purpose of this study was to take an initial step toward understanding young adults’ preferences and perceptions on app-based e-cigarette cessation interventions. Methods: Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software. Results: All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men. Conclusions: The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults. %M 35363140 %R 10.2196/33640 %U https://formative.jmir.org/2022/4/e33640 %U https://doi.org/10.2196/33640 %U http://www.ncbi.nlm.nih.gov/pubmed/35363140 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28379 %T Patient Experience and Satisfaction in Online Reviews of Obstetric Care: Observational Study %A Seltzer,Emily K %A Guntuku,Sharath Chandra %A Lanza,Amy L %A Tufts,Christopher %A Srinivas,Sindhu K %A Klinger,Elissa V %A Asch,David A %A Fausti,Nick %A Ungar,Lyle H %A Merchant,Raina M %+ Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19103, United States, 1 215 615 3211, sharathg@seas.upenn.edu %K patient satisfaction %K Yelp %K online reviews %K labor and delivery %K ob-gyn %K quality improvement %K machine learning %K labor %K delivery %K natural language processing %K maternal health %K ML %K patients %K obstetrics %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The quality of care in labor and delivery is traditionally measured through the Hospital Consumer Assessment of Healthcare Providers and Systems but less is known about the experiences of care reported by patients and caregivers on online sites that are more easily accessed by the public. Objective: The aim of this study was to generate insight into the labor and delivery experience using hospital reviews on Yelp. Methods: We identified all Yelp reviews of US hospitals posted online from May 2005 to March 2017. We used a machine learning tool, latent Dirichlet allocation, to identify 100 topics or themes within these reviews and used Pearson r to identify statistically significant correlations between topics and high (5-star) and low (1-star) ratings. Results: A total of 1569 hospitals listed in the American Hospital Association directory had at least one Yelp posting, contributing a total of 41,095 Yelp reviews. Among those hospitals, 919 (59%) had at least one Yelp rating for labor and delivery services (median of 9 reviews), contributing a total of 6523 labor and delivery reviews. Reviews concentrated among 5-star (n=2643, 41%) and 1-star reviews (n=1934, 30%). Themes strongly associated with favorable ratings included the following: top-notch care (r=0.45, P<.001), describing staff as comforting (r=0.52, P<.001), the delivery experience (r=0.46, P<.001), modern and clean facilities (r=0.44, P<.001), and hospital food (r=0.38, P<.001). Themes strongly correlated with 1-star labor and delivery reviews included complaints to management (r=0.30, P<.001), a lack of agency among patients (r=0.47, P<.001), and issues with discharging from the hospital (r=0.32, P<.001). Conclusions: Online review content about labor and delivery can provide meaningful information about patient satisfaction and experiences. Narratives from these reviews that are not otherwise captured in traditional surveys can direct efforts to improve the experience of obstetrical care. %M 35357310 %R 10.2196/28379 %U https://formative.jmir.org/2022/3/e28379 %U https://doi.org/10.2196/28379 %U http://www.ncbi.nlm.nih.gov/pubmed/35357310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33581 %T Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study %A Win,Hninyee %A Russell,Samantha %A Wertheim,Betsy C %A Maizes,Victoria %A Crocker,Robert %A Brooks,Audrey J %A Mesa,Ruben %A Huberty,Jennifer %A Geyer,Holly %A Eckert,Ryan %A Larsen,Ashley %A Gowin,Krisstina %+ Department of Hematology, University of Arizona, 1501 N Campbell, Tucson, AZ, 85724, United States, 1 5206260662, gowink@email.arizona.edu %K myeloproliferative neoplasm %K mobile application %K symptom burden %K wellness %K self-management %K mobile phone %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective: This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods: Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results: Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions: Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted. %M 35357315 %R 10.2196/33581 %U https://formative.jmir.org/2022/3/e33581 %U https://doi.org/10.2196/33581 %U http://www.ncbi.nlm.nih.gov/pubmed/35357315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30577 %T A Free Open-Source Bayesian Vancomycin Dosing App for Adults: Design and Evaluation Study %A Oommen,Thomas %A Thommandram,Anirudh %A Palanica,Adam %A Fossat,Yan %+ Pharmacy, Lakeridge Health, 1 Hospital Court, Oshawa, ON, L1G 2B9, Canada, 1 9055768711, toommen@lh.ca %K medical informatics %K therapeutic drug monitoring %K vancomcyin %K Bayesian prediction %K drug monitoring %K clinical data %K tool development %K digital health tools %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: It has been suggested that Bayesian dosing apps can assist in the therapeutic drug monitoring of patients receiving vancomycin. Unfortunately, Bayesian dosing tools are often unaffordable to resource-limited hospitals. Our aim was to improve vancomycin dosing in adults. We created a free and open-source dose adjustment app, VancoCalc, which uses Bayesian inference to aid clinicians in dosing and monitoring of vancomycin. Objective: The aim of this paper is to describe the design, development, usability, and evaluation of a free open-source Bayesian vancomycin dosing app, VancoCalc. Methods: The app build and model fitting process were described. Previously published pharmacokinetic models were used as priors. The ability of the app to predict vancomycin concentrations was performed using a small data set comprising of 52 patients, aged 18 years and over, who received at least 1 dose of intravenous vancomycin and had at least 2 vancomycin concentrations drawn between July 2018 and January 2021 at Lakeridge Health Corporation Ontario, Canada. With these estimated and actual concentrations, median prediction error (bias), median absolute error (accuracy), and root mean square error (precision) were calculated to evaluate the accuracy of the Bayesian estimated pharmacokinetic parameters. Results: A total of 52 unique patients’ initial vancomycin concentrations were used to predict subsequent concentration; 104 total vancomycin concentrations were assessed. The median prediction error was –0.600 ug/mL (IQR –3.06, 2.95), the median absolute error was 3.05 ug/mL (IQR 1.44, 4.50), and the root mean square error was 5.34. Conclusions: We described a free, open-source Bayesian vancomycin dosing calculator based on revisions of currently available calculators. Based on this small retrospective preliminary sample of patients, the app offers reasonable accuracy and bias, which may be used in everyday practice. By offering this free, open-source app, further prospective validation could be implemented in the near future. %M 35353046 %R 10.2196/30577 %U https://formative.jmir.org/2022/3/e30577 %U https://doi.org/10.2196/30577 %U http://www.ncbi.nlm.nih.gov/pubmed/35353046 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27158 %T Understanding Engagement and the Potential Impact of an Electronic Drug Repository: Multi-Methods Study %A Soobiah,Charlene %A Phung,Michelle %A Tadrous,Mina %A Jamieson,Trevor %A Bhatia,R Sacha %A Desveaux,Laura %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, laura.desveaux@thp.ca %K centralized drug repository %K mixed methods %K electronic survey %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Centralized drug repositories can reduce adverse events and inappropriate prescriptions by enabling access to dispensed medication data at the point of care; however, how they achieve this goal is largely unknown. Objective: This study aims to understand the perceived clinical value; the barriers to and enablers of adoption; and the clinician groups for which a provincial, centralized drug repository may provide the most benefit. Methods: A mixed methods approach, including a web-based survey and semistructured interviews, was used. Participants were clinicians (eg, nurses, physicians, and pharmacists) in Ontario who were eligible to use the digital health drug repository (DHDR), irrespective of actual use. Survey data were ranked on a 7-point adjectival scale and analyzed using descriptive statistics, and interviews were analyzed using qualitative descriptions. Results: Of the 161 survey respondents, only 40 (24.8%) actively used the DHDR. Perceptions of the utility of the DHDR were neutral (mean scores ranged from 4.11 to 4.76). Of the 75.2% (121/161) who did not use the DHDR, 97.5% (118/121) rated access to medication information (eg, dose, strength, and frequency) as important. Reasons for not using the DHDR included the cumbersome access process and the perception that available data were incomplete or inaccurate. Of the 33 interviews completed, 26 (79%) were active DHDR users. The DHDR was a satisfactory source of secondary information; however, the absence of medication instructions and prescribed medications (which were not dispensed) limited its ability to provide a comprehensive profile to meaningfully support clinical decision-making. Conclusions: Digital drug repositories must be adjusted to align with the clinician’s needs to provide value. Ensuring integration with point-of-care systems, comprehensive clinical data, and streamlined onboarding processes would optimize clinically meaningful use. The electronic provision of accessible drug information to providers across health care settings has the potential to improve efficiency and reduce medication errors. %M 35353042 %R 10.2196/27158 %U https://formative.jmir.org/2022/3/e27158 %U https://doi.org/10.2196/27158 %U http://www.ncbi.nlm.nih.gov/pubmed/35353042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32933 %T Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment %A Vilendrer,Stacie %A Sackeyfio,Sarah %A Akinbami,Eliel %A Ghosh,Roy %A Luu,Jacklyn Ha %A Pathak,Divya %A Shimada,Masahiro %A Williamson,Emmanuelle Elise %A Shieh,Lisa %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, United States, 1 952 913 8883, staciev@stanford.edu %K telemedicine %K inpatient %K patient experience %K COVID-19 %K infection control %K quality of health care %K communication %K hospital %K perspective %K qualitative %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective: We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods: We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results: Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions: Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting. %M 35147510 %R 10.2196/32933 %U https://formative.jmir.org/2022/3/e32933 %U https://doi.org/10.2196/32933 %U http://www.ncbi.nlm.nih.gov/pubmed/35147510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29955 %T eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey %A Makowsky,Mark J %A Davachi,Shahnaz %A Jones,Charlotte A %+ Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-142E Katz Group - Rexall Centre for Pharmacy & Health Research, 11361 87 Avenue, Edmonton, AB, T6G 2E1, Canada, 1 7804921735, makowsky@ualberta.ca %K eHealth literacy %K consumer health information %K ethnicity %K cross-sectional survey %K Canada %K digital health %K eHealth %K ePatient %K health technology %K cardiovascular disease %K diabetes %K sociodemographics, mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population. Objective: The aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians. Methods: We analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy. Results: The analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was “I can tell high-quality health resources from low-quality health resources on the internet” (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient –6.0, 95% CI –9.61 to –2.39). Conclusions: In our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions. %M 35353044 %R 10.2196/29955 %U https://formative.jmir.org/2022/3/e29955 %U https://doi.org/10.2196/29955 %U http://www.ncbi.nlm.nih.gov/pubmed/35353044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33919 %T Using Named Entity Recognition to Identify Substances Used in the Self-medication of Opioid Withdrawal: Natural Language Processing Study of Reddit Data %A Preiss,Alexander %A Baumgartner,Peter %A Edlund,Mark J %A Bobashev,Georgiy V %+ Center for Data Science, RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, United States, 1 9195418771, preisssa@gmail.com %K substance abuse %K opioid epidemic %K opioid use disorder %K self-medication %K social media %K Reddit %K natural language processing %K machine learning %K network analysis %K opioid %K drug withdrawal %K withdrawal %K opioid withdrawal %K mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The cessation of opioid use can cause withdrawal symptoms. People often continue opioid misuse to avoid these symptoms. Many people who use opioids self-treat withdrawal symptoms with a range of substances. Little is known about the substances that people use or their effects. Objective: The aim of this study is to validate a methodology for identifying the substances used to treat symptoms of opioid withdrawal by a community of people who use opioids on the social media site Reddit. Methods: We developed a named entity recognition model to extract substances and effects from nearly 4 million comments from the r/opiates and r/OpiatesRecovery subreddits. To identify effects that are symptoms of opioid withdrawal and substances that are potential remedies for these symptoms, we deduplicated substances and effects by using clustering and manual review, then built a network of substance and effect co-occurrence. For each of the 16 effects identified as symptoms of opioid withdrawal in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, we identified the 10 most strongly associated substances. We classified these pairs as follows: substance is a Food and Drug Administration–approved or commonly used treatment for the symptom, substance is not often used to treat the symptom but could be potentially useful given its pharmacological profile, substance is a home or natural remedy for the symptom, substance can cause the symptom, or other or unclear. We developed the Withdrawal Remedy Explorer application to facilitate the further exploration of the data. Results: Our named entity recognition model achieved F1 scores of 92.1 (substances) and 81.7 (effects) on hold-out data. We identified 458 unique substances and 235 unique effects. Of the 130 potential remedies strongly associated with withdrawal symptoms, 54 (41.5%) were Food and Drug Administration–approved or commonly used treatments for the symptom, 17 (13.1%) were not often used to treat the symptom but could be potentially useful given their pharmacological profile, 13 (10%) were natural or home remedies, 7 (5.4%) were causes of the symptom, and 39 (30%) were other or unclear. We identified both potentially promising remedies (eg, gabapentin for body aches) and potentially common but harmful remedies (eg, antihistamines for restless leg syndrome). Conclusions: Many of the withdrawal remedies discussed by Reddit users are either clinically proven or potentially useful. These results suggest that this methodology is a valid way to study the self-treatment behavior of a web-based community of people who use opioids. Our Withdrawal Remedy Explorer application provides a platform for using these data for pharmacovigilance, the identification of new treatments, and the better understanding of the needs of people undergoing opioid withdrawal. Furthermore, this approach could be applied to many other disease states for which people self-manage their symptoms and discuss their experiences on the web. %M 35353047 %R 10.2196/33919 %U https://formative.jmir.org/2022/3/e33919 %U https://doi.org/10.2196/33919 %U http://www.ncbi.nlm.nih.gov/pubmed/35353047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32537 %T A Novel Experience Sampling Method Tool Integrating Momentary Assessments of Cognitive Biases: Two Compliance, Usability, and Measurement Reactivity Studies %A Boemo,Teresa %A Socastro,Angela %A Blanco,Ivan %A Martin-Garcia,Oscar %A Pacheco-Romero,Ana Mar %A Rodríguez-Carvajal,Raquel %A Sanchez-Lopez,Alvaro %+ Complutense University of Madrid, Campus de Somosaguas, s/n, Madrid, 28223, Spain, 34 674107873, mboemo@ucm.es %K experience sampling method %K compliance %K usability %K measurement reactivity %K emotion %K cognitive biases %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Experience sampling methods (ESMs) are increasingly being used to study ecological emotion dynamics in daily functioning through repeated assessments taken over several days. However, most of these ESM approaches are only based on self-report assessments, and therefore, studies on the ecological trajectories of their underlying mechanisms are scarce (ie, cognitive biases) and require evaluation through experimental tasks. We developed a novel ESM tool that integrates self-report measures of emotion and emotion regulation with a previously validated app-based cognitive task that allows for the assessment of underlying mechanisms during daily functioning. Objective: The objective of the study is to test this new tool and study its usability and the possible factors related to compliance with it in terms of latency and missing responses. Among the compliance predictors, we considered psychological and time-related variables, as well as usability, measurement reactivity, and participants’ satisfaction with the tool. Methods: We conducted 2 extensive ESM studies—study 1 (N=84; a total of 3 assessments per day for 5 days) and study 2 (N=135; a total of 3 assessments per day for 10 days). Results: In both studies, participants found the tool highly usable (average usability score >81). By using mixed regression models, we found both common and specific results for the compliance predictors. In both study 1 and study 2, latency was significantly predicted by the day (P<.001 and P=.003, respectively). Participants showed slower responses to the notification as the days of the study progressed. In study 2 but not in study 1, latency was further predicted by individual differences in overload with the use of the app, and missing responses were accounted for by individual differences in stress reactivity to notifications (P=.04). Thus, by using a more extensive design, participants who experienced higher overload during the study were characterized by slower responses to notifications (P=.01), whereas those who experienced higher stress reactivity to the notification system were characterized by higher missing responses. Conclusions: The new tool had high levels of usability. Furthermore, the study of compliance is of enormous importance when implementing novel ESM methods, including app-based cognitive tasks. The main predictors of latency and missing responses found across studies, specifically when using extensive ESM protocols (study 2), are methodology-related variables. Future research that integrates cognitive tasks in ESM designs should take these results into consideration by performing accurate estimations of participants’ response rates to facilitate the optimal quality of novel eHealth approaches, as in this study. %M 35343900 %R 10.2196/32537 %U https://formative.jmir.org/2022/3/e32537 %U https://doi.org/10.2196/32537 %U http://www.ncbi.nlm.nih.gov/pubmed/35343900 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31342 %T Notes From the Field: A Voice-Activated Video Communication System for Nurses to Communicate With Inpatients With COVID-19 %A Dunn,Mimi %A Landman,Adam %A Cartright,Jennifer %A Bane,Anne %A Brogan,Anne %A Coy,Caroline %A Zhang,Haipeng %+ Brigham Digital Innovation Hub, Brigham and Women's Hospital, Mass General Brigham, 60 Fenwood Road, Boston, MA, 02115, United States, 1 8573075995, mdunn15@bwh.harvard.edu %K Internet of Things %K IoT %K voice assistant %K telehealth %K hospital systems %K COVID-19 %K nurses %K nursing %K public health %K virtual care %D 2022 %7 28.3.2022 %9 Notes From the Field %J JMIR Form Res %G English %X With the relaxing of telehealth regulations through the Health Insurance Portability and Accountability Act (HIPAA) waiver notification for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency, our organization had the opportunity to pilot an innovative virtual care solution using a modified consumer-grade voice-activated video communication system (Amazon Echo Show 8) within one inpatient COVID-19 unit. In this brief report, we describe our experiences with implementing the system and general feedback from clinicians, and discuss areas for future development required to enable future scaling of this solution. Our pilot demonstrates the feasibility of deploying a consumer-grade voice assistant device in COVID-19 patient rooms. We found the devices engaging due to the voice technologies and Alexa functionalities for both clinician and patient entertainment. To enable future deployment at scale, enhancements to the Echo Show and data analytics will need to be further explored. %M 35156929 %R 10.2196/31342 %U https://formative.jmir.org/2022/3/e31342 %U https://doi.org/10.2196/31342 %U http://www.ncbi.nlm.nih.gov/pubmed/35156929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29154 %T A Smartphone-Based Intervention as an Adjunct to Standard-of-Care Treatment for Schizophrenia: Randomized Controlled Trial %A Ghaemi,S Nassir %A Sverdlov,Oleksandr %A van Dam,Joris %A Campellone,Timothy %A Gerwien,Robert %+ Novaris Institutes for Biomedical Research, 220 Massachusetts Avenue, Cambridge, MA, 02139, United States, 1 857 253 8950, nassir.ghaemi@tufts.edu %K digital therapeutics %K schizophrenia %K smartphones %K randomized controlled trial %K mobile phone %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Antipsychotic medications have limited benefits in schizophrenia, and cognitive behavioral therapy may be beneficial as an adjunct. There may be potential for implementing mobile cognitive behavioral therapy–based treatment for schizophrenia in addition to standard antipsychotic medications. Objective: This study aims to determine whether PEAR-004, a smartphone-based investigational digital therapeutic, improves the symptoms of an acute psychotic exacerbation of schizophrenia when it is added to standard treatments. Methods: This was a 12-week, multicenter, randomized, sham-controlled, rater-blinded, parallel group proof‑of‑concept study of 112 participants with moderate acute psychotic exacerbation in schizophrenia. This study was conducted in 6 clinical trial research sites in the United States from December 2018 to September 2019. The primary outcome, change in Positive and Negative Syndrome Scale (PANSS) from baseline to week 12 or the last available visit, was analyzed using the mixed-effects regression model for repeated measures, applied to an intent-to-treat sample. Results: The total PANSS scores slightly decreased from baseline over the study period in both groups; the treatment difference at day 85 between PEAR-004 and sham was 2.7 points, in favor of the sham (2-sided P=.09). The secondary scales found no benefit, except for transient improvement in depressive symptoms with PEAR-004. Application engagement was good, and patient and clinical investigator satisfaction was high. No safety concerns were observed. There was some evidence of study site heterogeneity for the onboarding processes and directions on PEAR-004 product use at baseline and throughout the study. However, these differences did not affect the efficacy results. Conclusions: In the largest-to-date randomized, sham-controlled study of a digital therapeutic in schizophrenia, PEAR-004 did not demonstrate an effect on the primary outcome—total PANSS scores—when compared with a nonspecific digital sham control. The secondary and exploratory results also did not demonstrate any notable benefits, except for possible temporary improvement in depressive symptoms. This study provided many useful scientific and operational insights that can be used in the further clinical development of PEAR-004 and other investigational digital therapeutics. Trial Registration: ClinicalTrials.gov NCT03751280; https://clinicaltrials.gov/ct2/show/NCT03751280 %M 35343910 %R 10.2196/29154 %U https://formative.jmir.org/2022/3/e29154 %U https://doi.org/10.2196/29154 %U http://www.ncbi.nlm.nih.gov/pubmed/35343910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29479 %T Analyzability of Photoplethysmographic Smartwatch Data by the Preventicus Heartbeats Algorithm During Everyday Life: Feasibility Study %A Merschel,Steve %A Reinhardt,Lars %+ Preventicus GmbH, Ernst-Abbe-Straße 15, Jena, 07743, Germany, 49 3641 5598450, steve.merschel@preventicus.com %K photoplethysmography %K wearable %K smartwatch %K heart rate monitoring %K cardiac arrhythmia screening %K atrial fibrillation %K signal quality %K activity profile %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous heart rate monitoring via mobile health technologies based on photoplethysmography (PPG) has great potential for the early detection of sustained cardiac arrhythmias such as atrial fibrillation. However, PPG measurements are impaired by motion artifacts. Objective: The aim of this investigation was to evaluate the analyzability of smartwatch-derived PPG data during everyday life and to determine the relationship between the analyzability of the data and the activity level of the participant. Methods: A total of 41 (19 female and 22 male) adults in good cardiovascular health (aged 19-79 years) continuously wore a smartwatch equipped with a PPG sensor and a 3D accelerometer (Cardio Watch 287, Corsano Health BV) for a period of 24 hours that represented their individual daily routine. For each participant, smartwatch data were analyzed on a 1-minute basis by an algorithm designed for heart rhythm analysis (Preventicus Heartbeats, Preventicus GmbH). As outcomes, the percentage of analyzable data (PAD) and the mean acceleration (ACC) were calculated. To map changes of the ACC and PAD over the course of one day, the 24-hour period was divided into 8 subintervals comprising 3 hours each. Results: Univariate analysis of variance showed a large effect (ηp2> 0.6; P<.001) of time interval (phase) on the ACC and PAD. The PAD ranged between 34% and 100%, with an average of 71.5% for the whole day, which is equivalent to a period of 17.2 hours. Between midnight and 6 AM, the mean values were the highest for the PAD (>94%) and the lowest for the ACC (<6×10-3 m/s2). Regardless of the time of the day, the correlation between the PAD and ACC was strong (r=–0.64). A linear regression analysis for the averaged data resulted in an almost perfect coefficient of determination (r2=0.99). Conclusions: This study showed a large relationship between the activity level and the analyzability of smartwatch-derived PPG data. Given the high yield of analyzable data during the nighttime, continuous arrhythmia screening seems particularly effective during sleep phases. %M 35343902 %R 10.2196/29479 %U https://formative.jmir.org/2022/3/e29479 %U https://doi.org/10.2196/29479 %U http://www.ncbi.nlm.nih.gov/pubmed/35343902 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33087 %T A Physical Activity Just-in-time Adaptive Intervention Designed in Partnership With a Predominantly Black Community: Virtual, Community-Based Participatory Design Approach %A Robles,Maria Cielito %A Newman,Mark W %A Doshi,Aalap %A Bailey,Sarah %A Huang,Linde %A Choi,Soo Ji %A Kurien,Chris %A Merid,Beza %A Cowdery,Joan %A Golbus,Jessica R %A Huang,Christopher %A Dorsch,Michael P %A Nallamothu,Brahmajee %A Skolarus,Lesli E %+ Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 7349369075, lerusche@umich.edu %K just-in-time adaptive intervention %K design %K community participatory design %K health equity %K hypertension %K healthy lifestyle %K blood pressure %K physical activity %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Black people are disproportionally impacted by hypertension. New approaches for encouraging healthy lifestyles are needed to reduce hypertension and promote health equity in Black communities. Objective: In this report, we describe the early-stage, virtual design of a just-in-time adaptive intervention (JITAI) to increase physical activity in partnership with members of a low-income, predominantly Black community. Methods: The hallmark of JITAIs is highly contextualized mobile app push notifications. Thus, understanding participants' context and determinants of physical activity are critical. During the height of the COVID-19 pandemic, we conducted virtual discovery interviews and analysis guided by the Behavior Change Wheel (which focuses on participants' capacity, opportunity, and motivation to engage in physical activity), as well as empathy mapping. We then formed a community-academic participatory design team that partnered in the design sprint, storyboarding, and paper prototyping. Results: For this study, 5 community members participated in the discovery interviews, 12 stakeholders participated in the empathy mapping, 3 community members represented the community on the design team, and 10 community members provided storyboard or paper prototyping feedback. Only one community member had used videoconferencing prior to partnering with the academic team, and none had design experience. A set of 5 community-academic partner design principles were created: (1) keep users front and center, (2) tailor to the individual, (3) draw on existing motivation, (4) make physical activity feel approachable, and (5) make data collection transparent yet unobtrusive. To address community-specific barriers, the community-academic design team decided that mobile app push notifications will be tailored to participants’ baseline mobility level and community resources (eg, local parks and events). Push notifications will also be tailored based on the day (weekday versus weekend), time of day, and weather. Motivation will be enhanced via adaptive goal setting with supportive feedback and social support via community-generated notifications. Conclusions: We completed early-stage virtual design of a JITAI in partnership with community participants and a community design team with limited design and videoconferencing experience. We found that designing JITAIs with the community enables these interventions to address community-specific needs, which may lead to a more meaningful impact on users' health. %M 35343906 %R 10.2196/33087 %U https://formative.jmir.org/2022/3/e33087 %U https://doi.org/10.2196/33087 %U http://www.ncbi.nlm.nih.gov/pubmed/35343906 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33073 %T Patient- and Provider-Reported Experiences of a Mobile Novel Digital Therapeutic in People With Opioid Use Disorder (reSET-O): Feasibility and Acceptability Study %A Kawasaki,Sarah %A Mills-Huffnagle,Sara %A Aydinoglo,Nicole %A Maxin,Halley %A Nunes,Edward %+ Department of Psychiatry and Behavioral Health, Penn State Health, 500 University Drive, Box H073, Hershey, PA, 17033, United States, 1 7177826844, skawasaki@pennstatehealth.psu.edu %K reSET-O %K digital therapeutic %K opioid use disorder %K prescription digital therapeutic %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Medications for the treatment of opioid use disorder, such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management and cognitive behavioral counseling has shown promise for improving the outcomes of buprenorphine treatment but is complicated to deliver. The delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. Objective: reSET-O is a prescription digital therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. This pilot study aims to assess the feasibility and acceptability of reSET-O in a community-based opioid treatment program with a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O, were obtained from 15 individuals. Methods: English-speaking individuals aged ≥18 years with a diagnosis of current opioid use disorder were recruited after being on buprenorphine for at least 1 week of treatment. Two 12-week prescriptions for reSET-O were written for the 24-week study. Patient reports of drug use and likeability scales of reSET-O were conducted at weeks 4, 8, 12, and 24 of the study. Qualitative interviews were also conducted. A total of 4 providers were recruited and provided feedback on the acceptability and feasibility of reSET-O. Results: Of the 15 participants who participated in this pilot study, 7 (47%) completed 24 weeks, and 8 (53%) were unable to complete because of dropout after enrollment, attrition in treatment, or incarceration. An average of US $96 in contingency management rewards were earned by participants for the completion of modules for the duration of the pilot study. Participants’ subjective feedback revealed that reSET-O was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. Conclusions: reSET-O was well accepted based on patient and provider feedback in this pilot study; however, adherence and retention in treatment remain areas for improvement. Randomized control trials are needed to assess whether retention of community-based buprenorphine treatment is enhanced through the use of technology-based behavioral interventions such as reSET-O. %M 35333189 %R 10.2196/33073 %U https://formative.jmir.org/2022/3/e33073 %U https://doi.org/10.2196/33073 %U http://www.ncbi.nlm.nih.gov/pubmed/35333189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32940 %T Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study %A Humphrey,Gayl %A Chu,Joanna Ting %A Ruwhiu-Collins,Rebecca %A Erick-Peleti,Stephanie %A Dowling,Nicki %A Merkouris,Stephanie %A Newcombe,David %A Rodda,Simone %A Ho,Elsie %A Nosa,Vili %A Parag,Varsha %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, 1145, New Zealand, 64 21 1100901, g.humphrey@auckland.ac.nz %K gambling %K CBT %K mHealth %K co-design %K smartphone %K self-directed %K behavior change %K engagement %K mobile phone %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. Objective: This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. Methods: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. Results: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. Conclusions: Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness. %M 35108213 %R 10.2196/32940 %U https://formative.jmir.org/2022/3/e32940 %U https://doi.org/10.2196/32940 %U http://www.ncbi.nlm.nih.gov/pubmed/35108213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33156 %T Perspectives From French and Filipino Parents on the Adaptation of Child Health Knowledge Translation Tools: Qualitative Exploration %A Elliott,Sarah A %A Wright,Kelsey S %A Scott,Shannon D %A Hartling,Lisa %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6248, hartling@ualberta.ca %K knowledge translation %K cultural adaptation %K health evidence %K dissemination %K child health %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A number of evidence-based knowledge translation (KT) tools for parents of children with acute health conditions have been developed. These tools were created and tested with parental input and disseminated to groups proficient in English. Therefore, it is unclear whether they are useful for populations that are more diverse. To enhance the reach of our current and future KT tools, language translation and cultural adaptations may promote relevance for previously underserved knowledge users. Objective: This study aims to explore and understand considerations for the cultural and linguistic adaptation of a KT tool in French and Filipino communities. Methods: A KT tool (whiteboard animation video) describing the signs and symptoms of croup was originally developed in English to provide parents with evidence-based information couched within a narrative reflecting parents’ experiences with the condition. This KT tool was adapted (linguistics and imagery) for French- and Tagalog-speaking parents and caregivers through feedback from key stakeholders. The videos were presented to the respective language speakers for usability testing and discussion. Participants were asked to view the KT tool, complete a usability survey, and participate in semistructured interviews. Audio recordings from the interviews were transcribed verbatim, translated into English, and analyzed for relevant themes by using thematic analysis. Results: French- (n=13) and Tagalog-speaking (n=13) parents completed the usability survey and were interviewed. Although analyzed separately, both data sets produced similar findings, with key themes relating to understanding, relatability, and accessibility. Both the French and Tagalog groups reported that the video and other KT tools were useful in their adapted forms. Participants in both groups cautioned against using verbatim vocabulary and suggested that cultural competency and understanding of health languages were essential for high-quality translations. Parents also discussed their preference for videos with diverse visual representations of families, home environments, and health care workers, as such videos represent their communities more broadly. Conclusions: French and Filipino parents appreciated having KT tools in their first language; however, they were also supportive of the use of English KT products. Their suggestions for improving the relatability and communication of health messages are important considerations for the development and adaptation of future KT products. Understanding the needs of the intended end users is a crucial first step in producing relevant tools for health evidence dissemination. %M 35333185 %R 10.2196/33156 %U https://formative.jmir.org/2022/3/e33156 %U https://doi.org/10.2196/33156 %U http://www.ncbi.nlm.nih.gov/pubmed/35333185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33852 %T Effect of Information and Communication Technology–Based Self-management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial %A Kondo,Masahiro %A Okitsu,Teru %A Waki,Kayo %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 3 5800 9129, kwaki-tky@m.u-tokyo.ac.jp %K mHealth %K smartphone app %K abdominal obesity %K self-management %K telemedicine %K digital health %K app %K obesity %K overweight %K weight %K randomized controlled trial %K intervention %K lifestyle %K behavior %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated. Objective: This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA). Methods: This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes. Results: Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was −23.5 (SD 20.6) cm2 in the intervention group and +1.9 (SD 16.2) cm2 in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group. Conclusions: Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG. Trial Registration: UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53 %M 35323122 %R 10.2196/33852 %U https://formative.jmir.org/2022/3/e33852 %U https://doi.org/10.2196/33852 %U http://www.ncbi.nlm.nih.gov/pubmed/35323122 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29943 %T A Novel Diagnostic Decision Support System for Medical Professionals: Prospective Feasibility Study %A Timiliotis,Joanna %A Blümke,Bibiana %A Serfözö,Peter Daniel %A Gilbert,Stephen %A Ondrésik,Marta %A Türk,Ewelina %A Hirsch,Martin Christian %A Eckstein,Jens %+ CMIO Research Group, Digitalization & ICT Department, University Hospital Basel, Hebelstrasse, 10, Basel, 4031, Switzerland, 41 0613285489, joanna.timiliotis@usb.ch %K diagnostic decision support system %K DDSS %K probabilistic reasoning %K artificial intelligence %K dyspnea %K emergency department %K internal medicine %K symptom checker %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuously growing medical knowledge and the increasing amount of data make it difficult for medical professionals to keep track of all new information and to place it in the context of existing information. A variety of digital technologies and artificial intelligence–based methods are currently available as persuasive tools to empower physicians in clinical decision-making and improve health care quality. A novel diagnostic decision support system (DDSS) prototype developed by Ada Health GmbH with a focus on traceability, transparency, and usability will be examined more closely in this study. Objective: The aim of this study is to test the feasibility and functionality of a novel DDSS prototype, exploring its potential and performance in identifying the underlying cause of acute dyspnea in patients at the University Hospital Basel. Methods: A prospective, observational feasibility study was conducted at the emergency department (ED) and internal medicine ward of the University Hospital Basel, Switzerland. A convenience sample of 20 adult patients admitted to the ED with dyspnea as the chief complaint and a high probability of inpatient admission was selected. A study physician followed the patients admitted to the ED throughout the hospitalization without interfering with the routine clinical work. Routinely collected health-related personal data from these patients were entered into the DDSS prototype. The DDSS prototype’s resulting disease probability list was compared with the gold-standard main diagnosis provided by the treating physician. Results: The DDSS presented information with high clarity and had a user-friendly, novel, and transparent interface. The DDSS prototype was not perfectly suited for the ED as case entry was time-consuming (1.5-2 hours per case). It provided accurate decision support in the clinical inpatient setting (average of cases in which the correct diagnosis was the first diagnosis listed: 6/20, 30%, SD 2.10%; average of cases in which the correct diagnosis was listed as one of the top 3: 11/20, 55%, SD 2.39%; average of cases in which the correct diagnosis was listed as one of the top 5: 14/20, 70%, SD 2.26%) in patients with dyspnea as the main presenting complaint. Conclusions: The study of the feasibility and functionality of the tool was successful, with some limitations. Used in the right place, the DDSS has the potential to support physicians in their decision-making process by showing new pathways and unintentionally ignored diagnoses. The DDSS prototype had some limitations regarding the process of data input, diagnostic accuracy, and completeness of the integrated medical knowledge. The results of this study provide a basis for the tool’s further development. In addition, future studies should be conducted with the aim to overcome the current limitations of the tool and study design. Trial Registration: ClinicalTrials.gov NCT04827342; https://clinicaltrials.gov/ct2/show/NCT04827342 %M 35323125 %R 10.2196/29943 %U https://formative.jmir.org/2022/3/e29943 %U https://doi.org/10.2196/29943 %U http://www.ncbi.nlm.nih.gov/pubmed/35323125 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28157 %T Designing a Cancer Prevention Collaborative Goal-Setting Mobile App for Non-Hispanic Black Primary Care Patients: An Iterative, Qualitative Patient-Led Process %A Resnick,Daniel %A Kearney,Matthew D %A Smith,Jazmine M %A Bautista,Allison %A Jones,Liz %A Schapira,Marilyn M %A Aysola,Jaya %+ Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9475, jaysola@upenn.edu %K mHealth %K cancer prevention %K goal setting %K social networks %K health disparities %K primary care %K accessibility %K development %K feasibility %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. Objective: The objective of this study is to evaluate the content, usability, and acceptability of a mobile app that leverages insights from goal-setting and social network literature to facilitate cancer prevention goal setting, tracking, and sharing between non-Hispanic Black primary care patients and their social ties. Methods: We recruited eligible non-Hispanic Black primary care patients (aged ≥18 years) from 2 practice sites in West Philadelphia, using nonprobabilistic purposive sampling. We conducted semistructured interviews with 5 to 7 participants over 3 weeks to solicit feedback on paper mock-ups of the app, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta version of the app and sought acceptability and usability feedback from a different set of participants. Then, we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta version of the app. We further assessed app usability using questions derived from the System Usability Scale. Results: A total of 33 non-Hispanic Black primary care patients participated in this study. The mean age was 49 (SD 13) years, and 26 (79%) out of 33 participants identified as female. Semistructured interviews revealed three primary generalizable insights from our target population: the framing of each goal and its relevance to cancer impacted the likelihood that the goal would be chosen, participants thought that sharing health goals with others facilitates health behaviors, and most participants found it motivating to see other users’ goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants’ desire to customize and personalize the app. Usability testing revealed that 100% (33/33) of participants found the app easy to use, and 76% (25/33) of participants reported that they would like to use this app frequently. Conclusions: Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study’s iterative process led to the development of a cancer prevention mobile app that non-Hispanic Black primary care patients deemed usable and acceptable and yielded noteworthy insights about what intended end users value in setting and accomplishing health goals. %M 35323124 %R 10.2196/28157 %U https://formative.jmir.org/2022/3/e28157 %U https://doi.org/10.2196/28157 %U http://www.ncbi.nlm.nih.gov/pubmed/35323124 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28750 %T Identity Threats as a Reason for Resistance to Artificial Intelligence: Survey Study With Medical Students and Professionals %A Jussupow,Ekaterina %A Spohrer,Kai %A Heinzl,Armin %+ University of Mannheim, L15 1-6, Mannheim, 68313, Germany, 49 621 181 1691, jussupow@uni-mannheim.de %K artificial intelligence %K professional identity %K identity threat %K survey %K resistance %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Information systems based on artificial intelligence (AI) have increasingly spurred controversies among medical professionals as they start to outperform medical experts in tasks that previously required complex human reasoning. Prior research in other contexts has shown that such a technological disruption can result in professional identity threats and provoke negative attitudes and resistance to using technology. However, little is known about how AI systems evoke professional identity threats in medical professionals and under which conditions they actually provoke negative attitudes and resistance. Objective: The aim of this study is to investigate how medical professionals’ resistance to AI can be understood because of professional identity threats and temporal perceptions of AI systems. It examines the following two dimensions of medical professional identity threat: threats to physicians’ expert status (professional recognition) and threats to physicians’ role as an autonomous care provider (professional capabilities). This paper assesses whether these professional identity threats predict resistance to AI systems and change in importance under the conditions of varying professional experience and varying perceived temporal relevance of AI systems. Methods: We conducted 2 web-based surveys with 164 medical students and 42 experienced physicians across different specialties. The participants were provided with a vignette of a general medical AI system. We measured the experienced identity threats, resistance attitudes, and perceived temporal distance of AI. In a subsample, we collected additional data on the perceived identity enhancement to gain a better understanding of how the participants perceived the upcoming technological change as beyond a mere threat. Qualitative data were coded in a content analysis. Quantitative data were analyzed in regression analyses. Results: Both threats to professional recognition and threats to professional capabilities contributed to perceived self-threat and resistance to AI. Self-threat was negatively associated with resistance. Threats to professional capabilities directly affected resistance to AI, whereas the effect of threats to professional recognition was fully mediated through self-threat. Medical students experienced stronger identity threats and resistance to AI than medical professionals. The temporal distance of AI changed the importance of professional identity threats. If AI systems were perceived as relevant only in the distant future, the effect of threats to professional capabilities was weaker, whereas the effect of threats to professional recognition was stronger. The effect of threats remained robust after including perceived identity enhancement. The results show that the distinct dimensions of medical professional identity are affected by the upcoming technological change through AI. Conclusions: Our findings demonstrate that AI systems can be perceived as a threat to medical professional identity. Both threats to professional recognition and threats to professional capabilities contribute to resistance attitudes toward AI and need to be considered in the implementation of AI systems in clinical practice. %M 35319465 %R 10.2196/28750 %U https://formative.jmir.org/2022/3/e28750 %U https://doi.org/10.2196/28750 %U http://www.ncbi.nlm.nih.gov/pubmed/35319465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32403 %T The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study %A Ye,Siqin %A Anstey,D Edmund %A Grauer,Anne %A Metser,Gil %A Moise,Nathalie %A Schwartz,Joseph %A Kronish,Ian %A Abdalla,Marwah %+ Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 9-318, New York, NY, 10033, United States, 1 7737100114, sy2357@cumc.columbia.edu %K telemedicine %K hypertension %K blood pressure %K quality of care %K impact %K COVID-19 %K cohort %K cardiology %K telehealth %K retrospective %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. Objective: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare & Medicaid Services. Methods: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ≥140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ≥2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 2.3% (486/20,745) of patients with in-person visits only, 27.1% (1863/6878) of patients with 1 telemedicine visit, and 25% (1277/5104) of patients with ≥2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95% CI 1.94-2.18; P<.001; ≥2 telemedicine visits: OR 2.49, 95% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95% CI 0.83-0.95; P=.001; ≥2 telemedicine visits: OR 0.91, 95% CI 0.83-0.99; P=.03). Conclusions: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded. %M 35138254 %R 10.2196/32403 %U https://formative.jmir.org/2022/3/e32403 %U https://doi.org/10.2196/32403 %U http://www.ncbi.nlm.nih.gov/pubmed/35138254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28081 %T App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study %A Krohn,Holly %A Guintivano,Jerry %A Frische,Rachel %A Steed,Jamie %A Rackers,Hannah %A Meltzer-Brody,Samantha %+ Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, MacNider 304 CB 7160, Chapel Hill, NC, 27599, United States, 1 919 445 0218, holly_krohn@med.unc.edu %K postpartum care %K depression %K mobile health %K mHealth %K ecological momentary assessment (EMA) %K mobile apps %K personalized care %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods: This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results: Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions: Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic. %M 35319483 %R 10.2196/28081 %U https://formative.jmir.org/2022/3/e28081 %U https://doi.org/10.2196/28081 %U http://www.ncbi.nlm.nih.gov/pubmed/35319483 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25715 %T Improving Access to Behavioral Strategies to Improve Mental Well-being With an Entertaining Breakfast Show App: Feasibility Evaluation Study %A Öeren,Mariliis %A Jordan,Iain %A Coughlin,Deborah %A Turnbull,Sophie %+ Method X Studios Ltd, The Old Workshop, 1 Ecclesall Road South, Sheffield, S11 9PA, United Kingdom, 44 7722487501, mt679@cantab.ac.uk %K mental well-being %K mental health %K smartphone %K mobile app %K education %K entertainment %K psychotherapy %K feasibility %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective: The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey! Methods: The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results: In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions: This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration: ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296 %M 35319468 %R 10.2196/25715 %U https://formative.jmir.org/2022/3/e25715 %U https://doi.org/10.2196/25715 %U http://www.ncbi.nlm.nih.gov/pubmed/35319468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26122 %T Reversing the Antibiotic Resistance “Yelp Effect” Through the Use of Emotionally Framed Responses to Negative Reviews of Providers: Questionnaire Study %A Turner,Monique Mitchell %A Choung,Hyesun %A Bui,Quoc-Ha Hannah Mai %A Beck,Paige %A Ashraf,Hera %+ Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 202 994 7400, hmbui@gwu.edu %K online patient review %K antimicrobial resistance %K emotion %K health communication %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The overuse of antibiotics has rapidly made antimicrobial resistance a global public health challenge. There is an emerging trend where providers who perceive that their patients expect antibiotics are more likely to prescribe antibiotics unprompted or upon request. Particularly, health care providers have expressed concern that dissatisfied patients will provide disparaging online reviews, therefore threatening the reputation of the practice. To better deal with the negative reviews and inform patients, some health care staff directly respond to patients’ online feedback. Engaging with patients’ online reviews gives providers an opportunity to prevent reputational damage and improve patients’ understanding of the antibiotic resistance problem. Objective: We aim to test the effectiveness of different response strategies to the negative patient online reviews on the readers’ perceptions of the health care provider and their perceptions related to antibiotics resistance. Methods: Two experiments were conducted to examine the impact of message tactics (apologizing, inducing fear or guilt) that can be employed by health care providers when responding to patients’ negative online feedback related to not receiving an antibiotic. Results: Overall, our results demonstrated positive impacts of responding to patients’ online reviews. In study 1, we found apologetic messaging and use of emotional appeals in the response were effective in making readers feel more favorable toward the message. Readers also expressed a greater credibility perception toward the provider and willingness to visit the clinic when emotional appeals were used. Findings from study 2 largely supported the effectiveness of a fear-based response in improving the readers’ credibility perceptions and willingness to visit the clinic. The fear-inducing information was particularly effective among parent readers. Conclusions: This paper demonstrated that a strategic response to online patient complaints could prevent reputational damage and minimize the potential negative impacts of the review. The results also glean insight into the step toward developing a novel intervention—crafting a persuasive response to patients’ negative feedback that can help improve the understanding of antibiotic resistance problems. %M 35315787 %R 10.2196/26122 %U https://formative.jmir.org/2022/3/e26122 %U https://doi.org/10.2196/26122 %U http://www.ncbi.nlm.nih.gov/pubmed/35315787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31209 %T Optimizing Existing Mental Health Screening Methods in a Dementia Screening and Risk Factor App: Observational Machine Learning Study %A Kuleindiren,Narayan %A Rifkin-Zybutz,Raphael Paul %A Johal,Monika %A Selim,Hamzah %A Palmon,Itai %A Lin,Aaron %A Yu,Yizhou %A Alim-Marvasti,Ali %A Mahmud,Mohammad %+ Mindset Technologies Ltd, 3rd Floor, 5 Chancery Lane, London, WC2A 1LG, United Kingdom, 44 02081522341, raphael.rifkinzybutz@meetmindset.com %K depression %K anxiety %K screening %K research method %K questionnaire %K precision %K dementia %K cognition %K risk factors %K machine learning %K prediction %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindstep is an app that aims to improve dementia screening by assessing cognition and risk factors. It considers important clinical risk factors, including prodromal symptoms, mental health disorders, and differential diagnoses of dementia. The 9-item Patient Health Questionnaire for depression (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) are widely validated and commonly used scales used in screening for depression and anxiety disorders, respectively. Shortened versions of both (PHQ-2/GAD-2) have been produced. Objective: We sought to develop a method that maintained the brevity of these shorter questionnaires while maintaining the better precision of the original questionnaires. Methods: Single questions were designed to encompass symptoms covered in the original questionnaires. Answers to these questions were combined with PHQ-2/GAD-2, and anonymized risk factors were collected by Mindset4Dementia from 2235 users. Machine learning models were trained to use these single questions in combination with data already collected by the app: age, response to a joke, and reporting of functional impairment to predict binary and continuous outcomes as measured using PHQ-9/GAD-7. Our model was developed with a training data set by using 10-fold cross-validation and a holdout testing data set and compared to results from using the shorter questionnaires (PHQ-2/GAD-2) alone to benchmark performance. Results: We were able to achieve superior performance in predicting PHQ-9/GAD-7 screening cutoffs compared to PHQ-2 (difference in area under the curve 0.04, 95% CI 0.00-0.08, P=.02) but not GAD-2 (difference in area under the curve 0.00, 95% CI –0.02 to 0.03, P=.42). Regression models were able to accurately predict total questionnaire scores in PHQ-9 (R2=0.655, mean absolute error=2.267) and GAD-7 (R2=0.837, mean absolute error=1.780). Conclusions: We app-adapted PHQ-4 by adding brief summary questions about factors normally covered in the longer questionnaires. We additionally trained machine learning models that used the wide range of additional information already collected in Mindstep to make a short app-based screening tool for affective disorders, which appears to have superior or equivalent performance to well-established methods. %M 35315786 %R 10.2196/31209 %U https://formative.jmir.org/2022/3/e31209 %U https://doi.org/10.2196/31209 %U http://www.ncbi.nlm.nih.gov/pubmed/35315786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28353 %T The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study %A Duggan,Nicole M %A Hasdianda,M Adrian %A Baker,Olesya %A Jambaulikar,Guruprasad %A Goldsmith,Andrew J %A Condella,Anna %A Azizoddin,Desiree %A Landry,Adaira I %A Boyer,Edward W %A Eyre,Andrew J %+ Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, NH-2, Boston, MA, 02115, United States, 1 617 724 4068, nmduggan@partners.org %K shift work %K sleep %K sleep aid %K alertness %K earbud %K SleepBuds %K healthcare worker %K physician %K health care %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being. Objective: We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift. Methods: Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights’ sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post–overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls. Results: In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights’ sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI –0.90 to –0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI –0.81 to –0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores. Conclusions: Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions’ effect on other populations of shift workers’ post–night shift alertness, users’ long-term physical and mental health, and patient outcomes. %M 35315781 %R 10.2196/28353 %U https://formative.jmir.org/2022/3/e28353 %U https://doi.org/10.2196/28353 %U http://www.ncbi.nlm.nih.gov/pubmed/35315781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30486 %T Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data %A Bradwell,Hannah %A Baines,Rebecca %A Edwards,Katie J %A Stevens,Sebastian %A Atkinson,Kate %A Wilkinson,Ellen %A Chatterjee,Arunangsu %A Jones,Ray B %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 07975927341, hannah.bradwell@plymouth.ac.uk %K COVID-19 %K video consultations %K remote consultation %K Attend Anywhere %K patient feedback %K patient experience %K staff feedback %K outpatients %K pandemic %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Video consultations (VCs) were rapidly implemented in response to COVID-19 despite modest progress before. Objective: We aim to explore staff and patient experiences with VCs implemented during COVID-19 and use feedback insights to support quality improvement and service development. Methods: Secondary data analysis was conducted on 955 patient and 521 staff responses (from 4234 consultations; 955/4234, 22.6% and 521/4234, 12.3%, respectively) routinely collected following a VC between June and July 2020 in a rural, older adult, and outpatient care setting at a National Health Service Trust. Responses were summarized using descriptive statistics and inductive thematic analysis and presented to Trust stakeholders. Results: Most patients (890/955, 93.2%) reported having good (210/955, 22%) or very good (680/955, 71.2%) experience with VCs and felt listened to and understood (904/955, 94.7%). Most patients accessed their VC alone (806/955, 84.4%) except for those aged ≥71 years (23/58, 40%), with ease of joining VCs negatively associated with age (P<.001). Despite more difficulties joining, older adults were most likely to be satisfied with the technology (46/58, 79%). Patients and staff generally felt that patients’ needs had been met (860/955, 90.1% and 453/521, 86.9%, respectively), although staff appeared to overestimate patient dissatisfaction with VC outcomes (P=.02). Patients (848/955, 88.8%) and staff (419/521, 80.5%) felt able to communicate everything they wanted, although patients were significantly more positive than staff (P<.001). Patient satisfaction with communication was positively associated with technical performance satisfaction (P<.001). Most staff members (466/521, 89.4%) reported positive (185/521, 35.5%) or very positive (281/521, 53.9%) experiences with joining and managing VCs. Staff reported reductions in carbon footprint (380/521, 72.9%) and time (373/521, 71.6%). Most patients (880/955, 92.1%) would choose VCs again. We identified three themes in responses: barriers, including technological difficulties, patient information, and suitability concerns; potential benefits, including reduced stress, enhanced accessibility, cost, and time savings; and suggested improvements, including trial calls, turning music off, photo uploads, expanding written character limit, supporting other internet browsers, and shared online screens. This routine feedback, including evidence to suggest that patients were more satisfied than clinicians had anticipated, was presented to relevant Trust stakeholders, allowing for improved processes and supporting the development of a business case to inform the Trust decision on continuing VCs beyond COVID-19 restrictions. Conclusions: The findings highlight the importance of regularly reviewing and responding to routine feedback following digital service implementation. The feedback helped the Trust improve the VC service, challenge clinician-held assumptions about patient experience, and inform future use of VCs. It has focused improvement efforts on patient information; technological improvements such as blurred backgrounds and interactive whiteboards; and responding to the needs of patients with dementia, communication or cognitive impairment, or lack of appropriate technology. These findings have implications for other health care providers. %M 35311688 %R 10.2196/30486 %U https://formative.jmir.org/2022/3/e30486 %U https://doi.org/10.2196/30486 %U http://www.ncbi.nlm.nih.gov/pubmed/35311688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30121 %T Effectiveness of a Smartwatch App in Detecting Induced Falls: Observational Study %A Brew,Bruce %A Faux,Steven G %A Blanchard,Elizabeth %+ Department of Neurology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010, Australia, 61 2 8382 4100, Bruce.Brew@svha.org.au %K falls %K smartwatch %K app fall detection %K accelerometer %K inertial sensors %K older adult %K elderly %K old age %K smart watch %K mobile health %K threshold-based algorithm %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults are at an increased risk of falls with the consequent impacts on the health of the individual and health expenditure for the population. Smartwatch apps have been developed to detect a fall, but their sensitivity and specificity have not been subjected to blinded assessment nor have the factors that influence the effectiveness of fall detection been fully identified. Objective: This study aims to assess accuracy metrics for a novel fall detection smartwatch algorithm. Methods: We performed a cross-sectional study of 22 healthy adults comparing the detection of induced forward, side (left and right), and backward falls and near falls provided by a smartwatch threshold-based algorithm, with a video record of induced falls serving as the gold standard; a blinded assessor compared the two. Three different smartwatches with two different operating systems were used. There were 226 falls: 64 were backward, 51 forward, 55 left sided, and 56 right sided. Results: The overall smartwatch app sensitivity for falls was 77%, the specificity was 99%, the false-positive rate was 1.7%, and the false-negative rate was 16.4%. The positive and negative predictive values were 98% and 84%, respectively, while the accuracy was 89%. There were 249 near falls: the sensitivity was 89%, the specificity was 100%, there were no false positives, 11% were false negatives, the positive predictive value was 100%, the false-negative predictive value was 83%, and the accuracy was 93%. Conclusions: Falls were more likely to be detected if the fall was on the same side as the wrist with the smartwatch. There was a trend toward some smartwatches and operating systems having superior sensitivity, but these did not reach statistical significance. The effectiveness data and modifying factors pertaining to this smartwatch app can serve as a reference point for other similar smartwatch apps. %M 35311686 %R 10.2196/30121 %U https://formative.jmir.org/2022/3/e30121 %U https://doi.org/10.2196/30121 %U http://www.ncbi.nlm.nih.gov/pubmed/35311686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31727 %T Egyptian Students Open to Digital Mental Health Care: Cross-Sectional Survey %A Mamdouh,Mostafa %A Tai,Andy Man Yeung %A Westenberg,Jean Nicolas %A Shams,Farhud %A Jang,Kerry %A Badawy,Adel %A Elsawi,Houssam %A Krausz,Michael %+ Department of Psychiatry, University of British Columbia, Vancouver Campus 430-5950, University Boulevard, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada, 1 6474024088, andytai7@student.ubc.ca %K students %K youth %K eMental health %K Arab countries %K mental health care %K eHealth solutions %K youth mental health %K mental health %K youth engagement %K young adults %K EMH %K therapy %K emotional support %K barriers %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success. Objective: The objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth. Methods: A web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05. Results: Of the 707 individuals who completed the survey (90.9% response rate), 60.5% (428) were female, 62% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50%). Conclusions: EMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design. %M 35311692 %R 10.2196/31727 %U https://formative.jmir.org/2022/3/e31727 %U https://doi.org/10.2196/31727 %U http://www.ncbi.nlm.nih.gov/pubmed/35311692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30606 %T Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study %A Militello,Lisa %A Sobolev,Michael %A Okeke,Fabian %A Adler,Daniel A %A Nahum-Shani,Inbal %+ College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, United States, 1 614 688 4248, militello.14@osu.edu %K Headspace %K engagement %K mHealth %K mindfulness %K mental health %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). Conclusions: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health. %M 35311675 %R 10.2196/30606 %U https://formative.jmir.org/2022/3/e30606 %U https://doi.org/10.2196/30606 %U http://www.ncbi.nlm.nih.gov/pubmed/35311675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33329 %T Improving Outcomes Through Personalized Recommendations in a Remote Diabetes Monitoring Program: Observational Study %A Kamath,Sowmya %A Kappaganthu,Karthik %A Painter,Stefanie %A Madan,Anmol %+ Teladoc Health, 2 Manhattanville Rd, Purchase, NY, 10577, United States, 1 3123307236, spainter@teladoc.com %K personalization %K type 2 diabetes %K recommendation %K causal %K observational %K mobile health %K machine learning %K engagement %K glycemic control %K mHealth %K recommender systems %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes management is complex, and program personalization has been identified to enhance engagement and clinical outcomes in diabetes management programs. However, 50% of individuals living with diabetes are unable to achieve glycemic control, presenting a gap in the delivery of self-management education and behavior change. Machine learning and recommender systems, which have been used within the health care setting, could be a feasible application for diabetes management programs to provide a personalized user experience and improve user engagement and outcomes. Objective: This study aims to evaluate machine learning models using member-level engagements to predict improvement in estimated A1c and develop personalized action recommendations within a remote diabetes monitoring program to improve clinical outcomes. Methods: A retrospective study of Livongo for Diabetes member engagement data was analyzed within five action categories (interacting with a coach, reading education content, self-monitoring blood glucose level, tracking physical activity, and monitoring nutrition) to build a member-level model to predict if a specific type and level of engagement could lead to improved estimated A1c for members with type 2 diabetes. Engagement and improvement in estimated A1c can be correlated; therefore, the doubly robust learning method was used to model the heterogeneous treatment effect of action engagement on improvements in estimated A1c. Results: The treatment effect was successfully computed within the five action categories on estimated A1c reduction for each member. Results show interaction with coaches and self-monitoring blood glucose levels were the actions that resulted in the highest average decrease in estimated A1c (1.7% and 1.4%, respectively) and were the most recommended actions for 54% of the population. However, these were found to not be the optimal interventions for all members; 46% of members were predicted to have better outcomes with one of the other three interventions. Members who engaged with their recommended actions had on average a 0.8% larger reduction in estimated A1c than those who did not engage in recommended actions within the first 3 months of the program. Conclusions: Personalized action recommendations using heterogeneous treatment effects to compute the impact of member actions can reduce estimated A1c and be a valuable tool for diabetes management programs in encouraging members toward actions to improve clinical outcomes. %M 35311691 %R 10.2196/33329 %U https://formative.jmir.org/2022/3/e33329 %U https://doi.org/10.2196/33329 %U http://www.ncbi.nlm.nih.gov/pubmed/35311691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32342 %T User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study %A Budenz,Alexandra %A Coa,Kisha %A Grenen,Emily %A Keefe,Brian %A Sanders,Amy %A Wiseman,Kara P %A Roditis,Maria %+ ICF, 9300 Lee Hwy, Fairfax, VA, 22031, United States, 1 301 572 0369, Emily.Grenen@icfnext.com %K smoking cessation %K text messaging interventions %K qualitative research %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health strategies for smoking cessation (eg, SMS text messaging–based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program’s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non–evidence-based strategies. Conclusions: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation. %M 35302505 %R 10.2196/32342 %U https://formative.jmir.org/2022/3/e32342 %U https://doi.org/10.2196/32342 %U http://www.ncbi.nlm.nih.gov/pubmed/35302505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31135 %T Examining the Influence on Perceptions of Endometriosis via Analysis of Social Media Posts: Cross-sectional Study %A Metzler,Julian Matthias %A Kalaitzopoulos,Dimitrios Rafail %A Burla,Laurin %A Schaer,Gabriel %A Imesch,Patrick %+ Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland, 41 442551111, julian.metzler@usz.ch %K endometriosis %K social media %K Facebook %K Instagram %K influencer %K engagement %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by “influencers,” regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social media. As digital opinion leaders influence the perceptions of their followers, physicians need to be aware about ideas and beliefs that are available online, in order to address possible misconceptions and provide optimal patient care. Objective: The aim of this study was to identify and analyze frequent endometriosis-related discussion topics on social media in order to offer caregivers insight into commonly discussed subject matter and aspects. Methods: We performed a systematic search using predefined parameters. Using the term “endometriosis” in Facebook’s search function and a social media search engine, a list of Facebook pages was generated. A list of Instagram accounts was generated using the terms “endometriosis” and “endo” in Instagram’s search function. Pages and accounts in English with 5000 or more followers or likes were included. Nonpublic, unrelated, or inactive pages and accounts were excluded. For each account, the most recent 10 posts were identified and categorized by two independent examiners using qualitative content analysis. User engagement was calculated using the numbers of interactions (ie, shares, likes, and comments) for each post, stratified by the number of followers. Results: A total of 39 Facebook pages and 43 Instagram accounts with approximately 1.4 million followers were identified. Hospitals and medical centers made up 15% (6/39) of the Facebook pages and 5% (2/43) of the Instagram accounts. Top accounts had up to 111,600 (Facebook) and 41,400 (Instagram) followers. A total of 820 posts were analyzed. On Facebook, most posts were categorized as “awareness” (101/390, 25.9% of posts), “education and research” (71/390, 18.2%), and “promotion” (64/390, 16.4%). On Instagram, the top categories were “inspiration and support” (120/430, 27.9% of posts), “awareness” (72/430, 16.7%), and “personal story” (72/430, 16.7%). The frequency of most categories differed significantly between platforms. User engagement was higher on Instagram than on Facebook (3.20% vs 0.97% of followers per post). On Instagram, the highest percentage of users engaged with posts categorized as “humor” (mean 4.19%, SD 4.53%), “personal story” (mean 3.02%, SD 4.95%), and “inspiration and support” (mean 2.83%, SD 3.08%). On Facebook, posts in the categories “awareness” (mean 2.05%, SD 15.56%), “humor” (mean 0.91%, SD 1.07%), and “inspiration and support” (mean 0.56%, SD 1.37%) induced the most user engagement. Posts made by hospitals and medical centers generated higher user engagement than posts by regular accounts on Facebook (mean 1.44%, SD 1.11% vs mean 0.88%, SD 2.71% of followers per post) and Instagram (mean 3.33%, SD 1.21% vs mean 3.19%, SD 2.52% of followers per post). Conclusions: Facebook and Instagram are widely used to share endometriosis-related information among a large number of users. Most posts offer inspiration or support, spread awareness about the disease, or cover personal issues. Followers mostly engage with posts with a humoristic, supportive, and awareness-generating nature. Health care providers should be aware about the topics discussed online, as this may lead to an increased understanding of the needs and demands of digitally proficient patients with endometriosis. %M 35302501 %R 10.2196/31135 %U https://formative.jmir.org/2022/3/e31135 %U https://doi.org/10.2196/31135 %U http://www.ncbi.nlm.nih.gov/pubmed/35302501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33584 %T Paving the Way for Electronic Patient-Centered Measurement in Team-Based Primary Care: Integrated Knowledge Translation Approach %A Davis,Selena %A Antonio,Marcy %A Smith,Mindy %A Burgener,Paul %A Lavallee,Danielle C %A Price,Morgan %A Fletcher,Sarah C %A Lau,Francis %+ School of Health Information Science, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W2Y2, Canada, 1 2505057866, daviss@uvic.ca %K patient-centered measurement %K patient-centered care %K primary health care %K team-based care %K knowledge translation %K patient-oriented research %K patient portals %K patient-generated health data %K patient-reported experience measures %K patient-reported outcome measures %K rural health services %K patient data %K digital health %K electronic data %K patient portal %K mental health %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-centered measurement (PCM) aims to improve the overall quality of care through the collection and sharing of patient values, outcomes, and perspectives. However, the use of PCM in care team decisions remains limited. Integrated knowledge translation (IKT) offers a collaborative, adaptive approach to explore best practices for incorporating PCM into primary care practices by involving knowledge users, including patients and providers, in the exploratory process. Objective: This study aims to test the feasibility of using patient-generated data in team-based care; describe the use of these data for team-based mental health care; and summarize patient and provider care experiences with PCM. Methods: We conducted a multi-method exploratory study in a rural team-based primary care clinic using IKT to co-design, implement, and evaluate the use of PCM in team-based mental health care. Care pathways, workflows, and quality improvement activities were adjusted iteratively to improve integration efforts. Patient and provider experiences were evaluated using individual interviews relating to the use of PCM and patient portals in practice. All meeting notes, interview summaries, and emails were analyzed to create a narrative evaluation. Results: During co-design, a care workflow was developed to incorporate electronically collected patient-generated data from the patient portal into the electronic medical record, and customized educational tools and resources were added. During implementation, care pathways and patient workflows for PCM were developed. Patients found portal use easy, educational, and validating, but data entries were not used during care visits. Providers saw the portal as extra work, and the lack of portal and electronic medical record integration was a major barrier. The IKT approach was invaluable for addressing workflow changes and understanding the ongoing barriers to PCM use and quality improvement. Conclusions: Although the culture toward using PCM is changing, the use of PCM during care has not been successful. Patients felt validated and supported through portal use and could be empowered to bring these data to their visits. Training, modeling, and adaptable PCM methods are required before PCM can be integrated into routine care. %M 35302508 %R 10.2196/33584 %U https://formative.jmir.org/2022/3/e33584 %U https://doi.org/10.2196/33584 %U http://www.ncbi.nlm.nih.gov/pubmed/35302508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34758 %T An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study %A Gelbman,Brian D %A Reed,Carol R %+ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, 635 Madison Avenue, Suite 1101, New York, NY, 10022, United States, 1 212 628 6611, Brg9001@med.cornell.edu %K COPD %K patient engagement %K mHealth %K digital health %K mobile phone %K telemedicine %K mobile apps %K remote monitoring %K spirometry %K pulse oximetry %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective: In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods: A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results: Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management. %M 35142291 %R 10.2196/34758 %U https://formative.jmir.org/2022/3/e34758 %U https://doi.org/10.2196/34758 %U http://www.ncbi.nlm.nih.gov/pubmed/35142291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31894 %T Testing Digital Methods of Patient-Reported Outcomes Data Collection: Prospective Cluster Randomized Trial to Test SMS Text Messaging and Mobile Surveys %A Agarwal,Anish K %A Ali,Zarina S %A Shofer,Frances %A Xiong,Ruiying %A Hemmons,Jessica %A Spencer,Evan %A Abdel-Rahman,Dina %A Sennett,Brian %A Delgado,Mucio K %+ Department of Emergency Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, United States, 1 6103042318, anish.agarwal@pennmedicine.upenn.edu %K patient-reported outcomes %K mobile surveys %K research methods %K text messaging %K mobile survey %K data collection %K patient engagement %K response rate %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care delivery continues to evolve, with an effort being made to create patient-centered care models using patient-reported outcomes (PROs) data. Collecting PROs has remained challenging and an expanding landscape of digital health offers a variety of methods to engage patients. Objective: The aim of this study is to prospectively investigate two common methods of remote PRO data collection. The study sought to compare response and engagement rates for bidirectional SMS text messaging and mobile surveys following orthopedic surgery. Methods: The study was a prospective, block randomized trial of adults undergoing elective orthopedic procedures over 6 weeks. The primary objective was to determine if the method of digital patient engagement would impact response and completion rates. The primary outcome was response rate and total completion of PRO questionnaires. Results: A total of 127 participants were block randomized into receiving a mobile survey (n=63) delivered as a hyperlink or responding to the same questions through an automated bidirectional SMS text messaging system (n=64). Gender, age, number of comorbidities, and opioid prescriptions were similar across messaging arms. Patients receiving the mobile survey were more likely to have had a knee-related surgery (n=50, 83.3% vs n=40, 62.5%; P=.02) but less likely to have had an invasive procedure (n=26, 41.3% vs n=39, 60.9%; P=.03). Overall engagement over the immediate postoperative period was similar. Prolonged engagement for patients taking opioids past postoperative day 4 was higher in the mobile survey arm at day 7 (18/19, 94.7% vs 9/16, 56.3%). Patients with more invasive procedures showed a trend toward being responsive at day 4 as compared to not responding (n=41, 59.4% vs n=24, 41.4%; P=.05). Conclusions: As mobile patient engagement becomes more common in health care, testing the various options to engage patients to gather data is crucial to inform future care and research. We found that bidirectional SMS text messaging and mobile surveys were comparable in response and engagement rates; however, mobile surveys may trend toward higher response rates over longer periods of time. Trial Registration: ClinicalTrials.gov NCT03532256; https://clinicaltrials.gov/ct2/show/NCT03532256 %M 35298394 %R 10.2196/31894 %U https://formative.jmir.org/2022/3/e31894 %U https://doi.org/10.2196/31894 %U http://www.ncbi.nlm.nih.gov/pubmed/35298394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31229 %T Predicting Acceptance of e–Mental Health Interventions in Patients With Obesity by Using an Extended Unified Theory of Acceptance Model: Cross-sectional Study %A Rentrop,Vanessa %A Damerau,Mirjam %A Schweda,Adam %A Steinbach,Jasmin %A Schüren,Lynik Chantal %A Niedergethmann,Marco %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, Essen, 45147, Germany, 49 201438755101, vanessa.rentrop@uni-due.de %K e–mental health %K UTAUT %K obesity %K acceptance %K mobile phone %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid increase in the number of people who are overweight and obese is a worldwide health problem. Obesity is often associated with physiological and mental health burdens. Owing to several barriers to face-to-face psychotherapy, a promising approach is to exploit recent developments and implement innovative e–mental health interventions that offer various benefits to patients with obesity and to the health care system. Objective: This study aims to assess the acceptance of e–mental health interventions in patients with obesity and explore its influencing predictors. In addition, the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) model is compared with an extended UTAUT model in terms of variance explanation of acceptance. Methods: A cross-sectional web-based survey study was conducted from July 2020 to January 2021 in Germany. Eligibility requirements were adult age (≥18 years), internet access, good command of the German language, and BMI >30 kg/m2 (obesity). A total of 448 patients with obesity (grades I, II, and III) were recruited via specialized social media platforms. The impact of various sociodemographic, medical, and mental health characteristics was assessed. eHealth-related data and acceptance of e–mental health interventions were examined using a modified questionnaire based on the UTAUT. Results: Overall, the acceptance of e–mental health interventions in patients with obesity was moderate (mean 3.18, SD 1.11). Significant differences in the acceptance of e–mental health interventions among patients with obesity exist, depending on the grade of obesity, age, sex, occupational status, and mental health status. In an extended UTAUT regression model, acceptance was significantly predicted by the depression score (Patient Health Questionnaire-8; β=.07; P=.03), stress owing to constant availability via mobile phone or email (β=.06; P=.02), and confidence in using digital media (β=−0.058; P=.04) and by the UTAUT core predictors performance expectancy (β=.45; P<.001), effort expectancy (β=.22; P<.001), and social influence (β=.27; P<.001). The comparison between an extended UTAUT model (16 predictors) and the restrictive UTAUT model (performance expectancy, effort expectancy, and social influence) revealed a significant difference in explained variance (F13,431=2.366; P=.005). Conclusions: The UTAUT model has proven to be a valuable instrument to predict the acceptance of e–mental health interventions in patients with obesity. The extended UTAUT model explained a significantly high percentage of variance in acceptance (in total 73.6%). On the basis of the strong association between acceptance and future use, new interventions should focus on these UTAUT predictors to promote the establishment of effective e–mental health interventions for patients with obesity who experience mental health burdens. %M 35297769 %R 10.2196/31229 %U https://formative.jmir.org/2022/3/e31229 %U https://doi.org/10.2196/31229 %U http://www.ncbi.nlm.nih.gov/pubmed/35297769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35503 %T Blood Pressure Control in Individuals With Hypertension Who Used a Digital, Personalized Nutrition Platform: Longitudinal Study %A Bakre,Shivani %A Shea,Benjamin %A Langheier,Jason %A Hu,Emily A %+ Foodsmart, 595 Pacific Ave, Floor 4, San Francisco, CA, 94133, United States, 1 781 866 9200, emily.hu@foodsmart.com %K blood pressure %K hypertension %K systolic %K diastolic %K digital %K nutrition %K meal planning %K food environment %K food ordering %K food purchasing %K cardiology %K digital health %K digital platform %K health technology %K platform usability %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: While there is a strong association between adhering to a healthy dietary pattern and reductions in blood pressure, adherence remains low. New technologies aimed to help facilitate behavior change may have an effect on reducing blood pressure among individuals with hypertension. Objective: This study aims to evaluate characteristics of participants with stage 2 hypertension who used Foodsmart and to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: We analyzed demographic, dietary, and clinical characteristics collected from 11,934 adults with at least two blood pressure readings who used the Foodsmart platform. Stage 2 hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg. We calculated mean changes in blood pressure among participants with stage 2 hypertension and stratified by length of follow-up and the covariates associated with achieving blood pressure levels below stage 2 hypertension. We compared changes in diet quality and weight between participants with stage 2 hypertension at baseline who achieved stage 1 hypertension or below and those who did not. Results: We found that 10.63% (1269/11,934) of participants had stage 2 hypertension at baseline. Among Foodsmart participants with stage 2 hypertension at baseline, SBP and DBP decreased, on average, by 5.7 and 4.0 mmHg, respectively; 33.02% (419/1269) of participants with stage 2 hypertension at baseline achieved blood pressure levels below stage 2 hypertension (SBP <140 mmHg and DBP <90 mmHg). Using a multivariable ordinal logistic regression model, changes in Nutriscore (P=.001) and weight (P=.04) were statistically significantly associated with changes in blood pressure categories for users with stage 2 hypertension at baseline. Using a multivariable logistic regression model, we found that baseline Nutriscore, change in Nutriscore, and change in weight were associated with greater likelihood of users with stage 2 hypertension at baseline achieving a lower blood pressure category. Conclusions: This study evaluated changes in SBP and DBP among users (with hypertension) of the Foodsmart platform and found that those with stage 2 hypertension, on average, improved their blood pressure levels over time. %M 35297775 %R 10.2196/35503 %U https://formative.jmir.org/2022/3/e35503 %U https://doi.org/10.2196/35503 %U http://www.ncbi.nlm.nih.gov/pubmed/35297775 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35181 %T Impact of a Conformité Européenne (CE) Certification–Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods %A Limingoja,Leevi %A Antila,Kari %A Jormanainen,Vesa %A Röntynen,Joel %A Jägerroos,Vilma %A Soininen,Leena %A Nordlund,Hanna %A Vepsäläinen,Kristian %A Kaikkonen,Risto %A Lallukka,Tea %+ Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), Helsinki, FIN-00014, Finland, 358 400344644, leevi.limingoja@helsinki.fi %K health care %K health technology assessment %K machine learning %K COVID-19 %K COVID-19 forecasting %K pandemic %K health technology %K digital health %K online symptom checker %K health data %K admission data %K viral spread %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the current COVID-19 and any future pandemic, we need robust, real-time, and population-scale collection and analysis of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into the progression of viral spread, and helps to predict the needs and timing of professional health care. Objective: The objective of this study was to use a Conformité Européenne (CE)-marked medical online symptom checker service, Omaolo, and validate the data against the national demand for COVID-19–related care to predict the pandemic progression in Finland. Methods: Our data comprised real-time Omaolo COVID-19 symptom checker responses (414,477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare from March 16 to June 15, 2020 (the first wave of the pandemic in Finland). The symptom checker responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having COVID-19, and provides graded recommendations for further actions. We trained linear regression and extreme gradient boosting (XGBoost) models together with F-score and mutual information feature preselectors to predict the admissions once a week, 1 week in advance. Results: Our models reached a mean absolute percentage error between 24.2% and 36.4% in predicting the national daily patient admissions. The best result was achieved by combining both Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the feature preselector. Conclusions: Accurate short-term predictions of COVID-19 patient admissions can be made, and both symptom check questionnaires and daily admissions data contribute to the accuracy of the predictions. Thus, symptom checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic. %M 35179497 %R 10.2196/35181 %U https://formative.jmir.org/2022/3/e35181 %U https://doi.org/10.2196/35181 %U http://www.ncbi.nlm.nih.gov/pubmed/35179497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32725 %T Patients’ Perspectives About the Treatment They Receive for Cardiovascular Diseases and Mental Disorders: Web-Based Survey Study %A Courtet,Philippe %A Pecout,Catherine %A Lainé-Pellet,Anne-Félice %A Chekroun,Michael %A Avril,Charlotte %A Mourad,Jean-Jacques %+ Service d’Urgence et Post-Urgence Psychiatrique, Centre Hospitalier Universitaire de Montpellier, 371 avenue du Doyen Gaston Giraud, Montpellier, 34295, France, 33 0467336733, philippe.courtet@univ-montp1.fr %K medication adherence %K iatrogenic risk %K online patient community %K patient experience %K chronic disease %K cardiovascular disease %K mental disorder %K noncommunicable disease %K adherence %K risk %K community %K experience %K cardiovascular %K mental health %K perspective %K treatment %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable disease (NCD)–related deaths account for 71% of deaths worldwide. The World Health Organization recently developed a global action plan to address the impact of NCDs, with the goal of reducing the number of premature NCD-related deaths to 25% by the year 2025. Appropriate therapeutic adherence is critical for effective disease management; however, approximately 30%-50% of patients with an NCD do not comply with disease management activities as prescribed. Web-based patient communities can represent platforms from which specific information on patients’ perception of treatment adherence can be gathered outside of a clinical trial setting. Objective: This study aims to better understand patients’ perspectives regarding therapeutic adherence and iatrogenic risk in 2 major groups of NCDs for which poor disease management can have fatal consequences: cardiovascular diseases and mental disorders. Therapeutic adherence, motivational factors, patients’ awareness and perception of iatrogenesis, and treatment tools used by patients were assessed. Methods: A web-based survey was performed among patients with cardiovascular diseases or mental disorders or both conditions who were registered on the French Carenity platform, a web-based community in which patients with an NCD can share experiences and receive support and information. The study inclusion criteria were defined as follows: diagnosis of cardiovascular disease or mental disorder or both conditions (self-declared), age ≥18 years, residence in France, registration on the French Carenity platform, and ongoing pharmaceutical treatment for the condition. Patients who met the inclusion criteria were then invited to complete a self-administered web-based questionnaire that included questions addressing therapeutic adherence and iatrogenic risk. Results: A total of 820 patients were enrolled in the study, including patients with cardiovascular diseases (403/820, 49.2%), patients with mental disorders (292/820, 35.6%), and patients with both cardiovascular diseases and mental disorders (125/820, 15.2%). The mean age of the participants was 55.2 (SD 12.7) years. We found that 82.8% (679/820) of patients experienced adverse effects of medication. Patients tended to perceive themselves to be more adherent than they actually were; a significant number of patients disregarded their prescription and stopped or interrupted medication without consulting with a doctor. Patients with cardiovascular diseases were nearly twice as adherent as patients with a mental disorder (P≤.001). Adherence was significantly associated with gender (P≤.001), age (P≤.001), and treatment complexity (P≤.001). Finally, for each disease type, 3 patient profiles were identified, which provide interesting insight for improving therapeutic adherence and adjustment strategies specifically according to patient behavior. Conclusions: This study provides insight into the perspectives of patients receiving therapy for cardiovascular diseases or mental disorders or both conditions, which could help improve the management of NCDs and prevent premature death. Our study also shows that web-based patient platforms provide new opportunities to improve disease management by understanding patients’ experiences. %M 35293869 %R 10.2196/32725 %U https://formative.jmir.org/2022/3/e32725 %U https://doi.org/10.2196/32725 %U http://www.ncbi.nlm.nih.gov/pubmed/35293869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32302 %T Media Source Characteristics Regarding Food Fraud Misinformation According to the Health Information National Trends Survey (HINTS) in China: Comparative Study %A Chang,Angela %A Schulz,Peter Johannes %A Jiao,Wen %A Yu,Guoming %A Yang,Ya %+ School of Journalism and Communication, Beijing Normal University, #15 Xinjiekouwai Street, Haidian District, Beijing, 100875, China, 86 18810305219, yangya@bnu.edu.cn %K risk assessment %K food rumor %K risk management %K conspiracy narratives %K population health %K food safety %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda. Objective: This study explored the issue of food fraud and the effect of misinformation. Further, it assessed whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate fraud misinformation. Methods: The Health Information National Trends Survey (HINTS) was adopted for a collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults in May 2017. Based on 4 government surveillance reports on food rumors and safety incidents, a descriptive analysis, correlation analysis, and analysis of variance were performed on the data. Results: A total of 3090 results were gathered and analyzed. Among the respondents, 83.6% (2584/3090) heard at least one food rumor. Learning about food fraud was correlated with interpersonal connections (eg, doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with a statistical difference (P<.001). Interpersonal connection was the most frequent communication source (698/1253, 55.7%), followed by traditional media (325/1253, 25.9%) and internet portals (144/1253, 11.5%). There was a significant relationship between media use and media category in Beijing (P<.001) and Hefei (P<.001). Overall, responses to food fraud and incident risks were lower in Beijing than in Hefei (P=.006). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differed in terms of perceiving different levels of food risks from different media sources. The food rumor narratives that examined the conspiracy belief showed that social media played more important roles in influencing attitudes against misinformation for users in Hefei than in Beijing. Conclusions: This study shows that consumers have to be on guard against not only fake food, but also spreading fake information and rumors, as well as conspiracy beliefs involving fake food. This study focused on characterizing media sources, types of food fraud misinformation, and risk perceptions of food safety, which mix urgency and suspicion, and attempted to provide evidence-based interventions for risk management guidance, with the hypothesis of significant correlations between media types and sources, and consumer exposure and perception levels of food rumors and risks. %M 34939565 %R 10.2196/32302 %U https://formative.jmir.org/2022/3/e32302 %U https://doi.org/10.2196/32302 %U http://www.ncbi.nlm.nih.gov/pubmed/34939565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e36446 %T Culturally Tailored Social Media Content to Reach Latinx Immigrant Sexual Minority Men for HIV Prevention: Web-Based Feasibility Study %A Lee,Jane J %A Aguirre Herrera,Joel %A Cardona,José %A Cruz,Loren Yesenia %A Munguía,Lésster %A Leyva Vera,Christopher A %A Robles,Gabriel %+ School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, United States, 1 2066168984, janejlee@uw.edu %K social media %K eHealth %K feasibility %K Latinx %K immigrant %K sexual minorities %K gay %K homosexual %K bisexual %K pre-exposure prophylaxis %K HIV prevention %K HIV %K prevention %K web-based %K internet-based %K sexual minority %K sexual health %K digital health %K health technology %K web-based health %K web-based prevention %K health information %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx gay, bisexual, and other sexual minority men are disproportionately affected by HIV in the United States. As Latinx sexual minority men, particularly those who are foreign-born, experience inequitable access to health services, tailored strategies to engage them for HIV prevention are urgently needed. Objective: Our study seeks to address the need for enhanced access to HIV prevention among Latinx immigrant sexual minority men. We developed and piloted a culturally sensitive technology-based campaign focused on HIV testing and pre-exposure prophylaxis (PrEP) uptake. Methods: We used a two-phase approach to assess the feasibility of community-informed social media content in engaging Latinx immigrant sexual minority men for HIV testing and PrEP use. First, we conducted three iterative focus groups with 15 Latinx immigrant sexual minority men to refine the HIV prevention content to be piloted on social media platforms. The finalized content was placed on Instagram and Facebook for 9 days in July and September 2021 to individuals who were in Washington State. Individuals who clicked on the content were directed to a website with additional HIV prevention information. Second, we conducted online surveys (n=60) with website visitors that assessed sociodemographic characteristics, barriers to HIV prevention, and HIV-related transmission risk and prevention behaviors. We conducted descriptive analyses to examine the overall profile of survey respondents and determine the feasibility of culturally informed social media content in reaching Latinx immigrant sexual minority men. Results: Overall, 739 unique users visited the website during the 9-day period when the social media content was posted on Instagram and Facebook. Our sample included 60 Latinx immigrant sexual minority men who completed the online survey. Participants’ mean age was 30.8 years and more than half (n=34, 57%) completed the survey in Spanish. A quarter of participants indicated that they were unauthorized immigrants and 57% (n=34) reported not having medical insurance. Participants reported, on average, having 6 different sexual partners in the last 6 months. Nearly a third of respondents had not tested for HIV in the last 6 months. Only about half (n=32, 53%) of respondents had used PrEP in the last 12 months. Conclusions: Community-driven social media and web-based strategies are feasible ways to engage Latinx immigrant sexual minority men who may traditionally lack access to HIV prevention information and services due to structural and social barriers. The results highlight that culturally relevant social media and web-based outreach strategies that are informed and developed by the community can reach Latinx immigrant sexual minority men for HIV prevention. Findings underscore the need to examine the effectiveness of social media content in promoting HIV testing and PrEP uptake in marginalized Latinx populations. %M 35182416 %R 10.2196/36446 %U https://formative.jmir.org/2022/3/e36446 %U https://doi.org/10.2196/36446 %U http://www.ncbi.nlm.nih.gov/pubmed/35182416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34458 %T Patients’ Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study %A Eiken,Anne-Grethe %A Nordanger,Dag Ø %A Solberg Nes,Lise %A Varsi,Cecilie %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Trondheimsveien 235, Oslo, 0424, Norway, 47 90856339, cecilie.varsi@usn.no %K chronic pain %K psychomotor physiotherapy %K EPIO %K self-management %K telemedicine %K mHealth %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is a major health challenge to those affected. Blended care with psychomotor physiotherapy (PMP) combined with eHealth self-management might be beneficial. Objective: This study aims to explore how patients with chronic pain experience the combination of PMP and the use of EPIO, an eHealth self-management intervention for chronic pain. Methods: Individual semistructured interviews were conducted with 5 adult patients with chronic pain (ie, participants) who used EPIO in combination with PMP over a period of 10 to 15 weeks. Interviews explored participants’ experiences using this treatment combination in relation to their pain and analyzed their experiences using systematic text condensation. Results: Participants described having benefited from using EPIO in combination with PMP in terms of increased awareness of bodily signals and how pain was related to stress and activity. They also described changes in the relationship to themselves in terms of increased self-acceptance, self-assertion, and hope and their relationship to their pain in terms of seeing pain as less harmful and engaging in more active coping strategies. Conclusions: Results indicate that a blended care approach combining eHealth self-management interventions such as EPIO with PMP may be of value to patients living with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 %M 35293866 %R 10.2196/34458 %U https://formative.jmir.org/2022/3/e34458 %U https://doi.org/10.2196/34458 %U http://www.ncbi.nlm.nih.gov/pubmed/35293866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32722 %T Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Keetile,Mpho %A Kadimo,Khutsafalo %A Senyatso,Refilwe Yvonne %A Ntebela,Davies %A Valela,Buthugwashe %A Murambi,Clement %+ Department of Computer Science, Faculty of Science, University of Botswana, Private Bag UB 0022, Plot 4775 Notwane Rd, Gaborone, 00267, Botswana, 267 3555700 ext 5700, ndlovuk@ub.ac.bw %K malaria case-based surveillance %K district health information system %K eHealth %K technology acceptance model %K Botswana %K DHIS2 %K malaria %K surveillance %K public health %K technology adoption %K user acceptance %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. Objective: We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. Methods: The study’s design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. Results: Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants’ survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. Conclusions: Participants’ responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana. %M 35289760 %R 10.2196/32722 %U https://formative.jmir.org/2022/3/e32722 %U https://doi.org/10.2196/32722 %U http://www.ncbi.nlm.nih.gov/pubmed/35289760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29967 %T Machine-Aided Self-diagnostic Prediction Models for Polycystic Ovary Syndrome: Observational Study %A Zigarelli,Angela %A Jia,Ziyang %A Lee,Hyunsun %+ Department of Mathematics and Statistics, University of Massachusetts Amherst, 100 Carlson Ave, Newton, MA, 02459, United States, 1 6172431886, hyunsunlee@umass.edu %K Polycystic Ovary Syndrome (PCOS) %K prediction %K machine learning %K self-diagnosis %K principal component analysis %K clustering %K CatBoost %K SHAP values %K subgroup study %D 2022 %7 15.3.2022 %9 Early Reports %J JMIR Form Res %G English %X Background: Artificial intelligence and digital health care have substantially advanced to improve and enhance medical diagnosis and treatment during the prolonged period of the COVID-19 global pandemic. In this study, we discuss the development of prediction models for the self-diagnosis of polycystic ovary syndrome (PCOS) using machine learning techniques. Objective: We aim to develop self-diagnostic prediction models for PCOS in potential patients and clinical providers. For potential patients, the prediction is based only on noninvasive measures such as anthropomorphic measures, symptoms, age, and other lifestyle factors so that the proposed prediction tool can be conveniently used without any laboratory or ultrasound test results. For clinical providers who can access patients’ medical test results, prediction models using all predictor variables can be adopted to help health providers diagnose patients with PCOS. We compare both prediction models using various error metrics. We call the former model the patient model and the latter, the provider model throughout this paper. Methods: In this retrospective study, a publicly available data set of 541 women’s health information collected from 10 different hospitals in Kerala, India, including PCOS status, was acquired and used for analysis. We adopted the CatBoost method for classification, K-fold cross-validation for estimating the performance of models, and SHAP (Shapley Additive Explanations) values to explain the importance of each variable. In our subgroup study, we used k-means clustering and Principal Component Analysis to split the data set into 2 distinct BMI subgroups and compared the prediction results as well as the feature importance between the 2 subgroups. Results: We achieved 81% to 82.5% prediction accuracy of PCOS status without any invasive measures in the patient models and achieved 87.5% to 90.1% prediction accuracy using both noninvasive and invasive predictor variables in the provider models. Among noninvasive measures, variables including acanthosis nigricans, acne, hirsutism, irregular menstrual cycle, length of menstrual cycle, weight gain, fast food consumption, and age were more important in the models. In medical test results, the numbers of follicles in the right and left ovaries and anti-Müllerian hormone were ranked highly in feature importance. We also reported more detailed results in a subgroup study. Conclusions: The proposed prediction models are ultimately expected to serve as a convenient digital platform with which users can acquire pre- or self-diagnosis and counsel for the risk of PCOS, with or without obtaining medical test results. It will enable women to conveniently access the platform at home without delay before they seek further medical care. Clinical providers can also use the proposed prediction tool to help diagnose PCOS in women. %M 35289757 %R 10.2196/29967 %U https://formative.jmir.org/2022/3/e29967 %U https://doi.org/10.2196/29967 %U http://www.ncbi.nlm.nih.gov/pubmed/35289757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31972 %T Ascertaining Medication Use and Patient-Reported Outcomes via an App and Exploring Gamification in Patients With Multiple Sclerosis Treated With Interferon β-1b: Observational Study %A Limmroth,Volker %A Bayer-Gersmann,Kirsten %A Mueller,Christian %A Schürks,Markus %+ Bayer Vital GmbH, Medical Affairs, Neurology, Immunology & Ophthalmology, Leverkusen, 51368, Germany, 49 214 30 51455, markus.schuerks@bayer.com %K digital observational study %K BETACONNECT %K app %K interferon β-1b %K multiple sclerosis %K medication adherence %K medication compliance %K medication persistence %K health-related quality of life %K gamification %K mobile phone %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The BETACONNECT autoinjector and myBETAapp app were designed to support patients with multiple sclerosis receiving interferon β-1b and are an ideal platform for digital observational studies. A recent pilot study in Germany demonstrated the feasibility of using the app to recruit patients, obtain informed consent, and evaluate medication-taking behavior over 6 months. Objective: This study aims to describe medication-taking behavior for 1 year in patients with multiple sclerosis receiving interferon β-1b based on data collected from the app and to provide information on patient-reported outcomes (PROs). The optional use of the cognitive training tool PEAK (Peak, formerly Brainbow Ltd) is included to test the feasibility of gamification in this setting. Methods: A prospective and retrospective, exploratory, digital, observational cohort study was conducted among users of the app in Germany. Invitations to participate were sent to patients’ apps between February and May 2019. Participants provided electronic informed consent. Injection-related data from consenting patients’ devices were collected prospectively for 1 year following the consent date and retrospectively for ≤1 year from the first day of use (if historical data were available). Participants also completed three electronic PRO instruments every 3 months: the EuroQol 5-Dimension, 5-Level questionnaire (EQ-5D-5L); the Treatment Satisfaction Questionnaire for Medication (TSQM; version II); and a questionnaire on satisfaction with treatment support (on a server accessed via an emailed hyperlink). All patients were offered optional access to the professional version of PEAK. Results: Of 1778 registered app accounts (May 2019), 79 patients (4.44%) provided informed consent; 62 (3.49%) were eligible for inclusion in the prospective analysis, of whom, 60 (97%) also had retrospective data. The mean age of the 62 participants was 43.2 (SD 11.5) years and 41 (66%) were women. Compliance over the 1-year prospective observational period (primary end point) was high (median 98.9%, IQR 94.3%-100%) and similar among men and women. Persistence and adherence (coprimary end points) decreased from 85% (53/62) and 74% (46/62), respectively, at 6 months to 76% (47/62) and 65% (40/62), respectively, at 12 months; both were higher in men than in women. A retrospective analysis showed similar patterns. The PRO questionnaires were answered by 79% (49/62) of the participants at baseline and 50% (31/62) of them at month 12. Women had more severe problems in some EQ-5D-5L dimensions (mobility, usual activities, and pain/discomfort) and lower median convenience scores on the TSQM (version II) than men. At month 12, 84% (26/31) of the patients were satisfied or very satisfied with the app. PEAK was used by 67% (14/21) of men and 49% (20/41) of women. Conclusions: This study showed high compliance and decreasing persistence and adherence over 1 year and demonstrated the feasibility of including remotely completed electronic PRO instruments in digital observational studies. %M 35285806 %R 10.2196/31972 %U https://formative.jmir.org/2022/3/e31972 %U https://doi.org/10.2196/31972 %U http://www.ncbi.nlm.nih.gov/pubmed/35285806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35092 %T Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study %A Hopstock,Laila Arnesdatter %A Medin,Anine Christine %A Skeie,Guri %A Henriksen,André %A Lundblad,Marie Wasmuth %+ Department of Community Medicine, UiT The Arctic University of Norway, Hansine Hansens vei, Tromsø, 9037, Norway, 47 77644000, laila.hopstock@uit.no %K system usability score %K older adults %K measurements %K nutrition %K dietary intake %K digital health %K web tool %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A healthy diet throughout the life course improves health and reduces the risk of disease. There is a need for new knowledge of the relation between diet and health, but existing methods to collect information on food and nutrient intake have their limitations. Evaluations of new tools to assess dietary intake are needed, especially in old people, where the introduction of new technology might impose challenges. Objective: We aimed to examine the usability of a new web-based dietary assessment tool in older adult women and men. Methods: A total of 60 women and men (participation 83%, 57% women) aged 60-74 years recruited by convenience and snowball sampling completed a 24-hour web-based dietary recall using the newly developed Norwegian version of Measure Your Food On One Day (myfood24). Total energy and nutrient intakes were calculated in myfood24, primarily on the basis of the Norwegian Food Composition Table. No guidance or support was provided to complete the recall. Usability was assessed using the system usability scale (SUS), where an SUS score of ≥68 was considered satisfactory. We examined the responses to single SUS items and the mean (SD) SUS score in groups stratified by sex, age, educational level, and device used to complete the recall (smartphone, tablet device, or computer). Results: The mean total energy intake was 5815 (SD 3093) kJ. A total of 14% of participants had an energy intake of <2100 kJ (ie, 500 kilocalories) and none had an intake of >16,800 kJ (ie, 4000 kilocalories). Mean energy proportions from carbohydrates, fat, protein, alcohol, and fiber was within the national recommendations. The mean SUS score was 55.5 (SD 18.6), and 27% of participants had SUS scores above the satisfactory product cut-off. Higher SUS scores were associated with younger age and lower education, but not with the type of device used. Conclusions: We found the overall usability of a new web-based dietary assessment tool to be less than satisfactory in accordance with standard usability criteria in a sample of 60-74–year-old Norwegians. The observed total energy intakes suggest that several of the participants underreported their intake during the completion of the dietary recall. Implementing web-based dietary assessment tools in older adults is feasible, but guidance and support might be needed to ensure valid completion. %M 35275079 %R 10.2196/35092 %U https://formative.jmir.org/2022/3/e35092 %U https://doi.org/10.2196/35092 %U http://www.ncbi.nlm.nih.gov/pubmed/35275079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30946 %T Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers %A Bentley,Kate H %A Zuromski,Kelly L %A Fortgang,Rebecca G %A Madsen,Emily M %A Kessler,Daniel %A Lee,Hyunjoon %A Nock,Matthew K %A Reis,Ben Y %A Castro,Victor M %A Smoller,Jordan W %+ Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, United States, 1 6177247741, kbentley@mgh.harvard.edu %K suicide %K machine learning %K implementation %K mobile phone %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in developing machine learning models that use electronic health record data to predict patients’ risk of suicidal behavior has recently proliferated. However, whether and how such models might be implemented and useful in clinical practice remain unknown. To ultimately make automated suicide risk–prediction models useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders, including the frontline providers who will be using such tools, at each stage of the implementation process. Objective: The aim of this focus group study is to inform ongoing and future efforts to deploy suicide risk–prediction models in clinical practice. The specific goals are to better understand hospital providers’ current practices for assessing and managing suicide risk; determine providers’ perspectives on using automated suicide risk–prediction models in practice; and identify barriers, facilitators, recommendations, and factors to consider. Methods: We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by 2 independent study staff members. All coded text was reviewed and discrepancies were resolved in consensus meetings with doctoral-level staff. Results: Although most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers’ general attitudes toward the practical use of automated suicide risk–prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the health care system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider training. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings. Conclusions: Providers were dissatisfied with current suicide risk assessment methods and were open to the use of a machine learning–based risk-prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of these new approaches in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk. %M 35275075 %R 10.2196/30946 %U https://formative.jmir.org/2022/3/e30946 %U https://doi.org/10.2196/30946 %U http://www.ncbi.nlm.nih.gov/pubmed/35275075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27654 %T Thematic Analysis on User Reviews for Depression and Anxiety Chatbot Apps: Machine Learning Approach %A Ahmed,Arfan %A Aziz,Sarah %A Khalifa,Mohamed %A Shah,Uzair %A Hassan,Asma %A Abd-Alrazaq,Alaa %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Liberal Arts and Sciences Building, Education City, Doha Al Luqta St, Ar-Rayyan, Doha, PO Box 5825, Qatar, 974 33223401, mhouseh@hbku.edu.qa %K anxiety %K depression %K chatbots %K conversational agents %K topic modeling %K latent Dirichlet allocation %K thematic analysis %K mobile phone %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and depression are among the most commonly prevalent mental health disorders worldwide. Chatbot apps can play an important role in relieving anxiety and depression. Users’ reviews of chatbot apps are considered an important source of data for exploring users’ opinions and satisfaction. Objective: This study aims to explore users’ opinions, satisfaction, and attitudes toward anxiety and depression chatbot apps by conducting a thematic analysis of users’ reviews of 11 anxiety and depression chatbot apps collected from the Google Play Store and Apple App Store. In addition, we propose a workflow to provide a methodological approach for future analysis of app review comments. Methods: We analyzed 205,581 user review comments from chatbots designed for users with anxiety and depression symptoms. Using scraper tools and Google Play Scraper and App Store Scraper Python libraries, we extracted the text and metadata. The reviews were divided into positive and negative meta-themes based on users’ rating per review. We analyzed the reviews using word frequencies of bigrams and words in pairs. A topic modeling technique, latent Dirichlet allocation, was applied to identify topics in the reviews and analyzed to detect themes and subthemes. Results: Thematic analysis was conducted on 5 topics for each sentimental set. Reviews were categorized as positive or negative. For positive reviews, the main themes were confidence and affirmation building, adequate analysis, and consultation, caring as a friend, and ease of use. For negative reviews, the results revealed the following themes: usability issues, update issues, privacy, and noncreative conversations. Conclusions: Using a machine learning approach, we were able to analyze ≥200,000 comments and categorize them into themes, allowing us to observe users’ expectations effectively despite some negative factors. A methodological workflow is provided for the future analysis of review comments. %M 35275069 %R 10.2196/27654 %U https://formative.jmir.org/2022/3/e27654 %U https://doi.org/10.2196/27654 %U http://www.ncbi.nlm.nih.gov/pubmed/35275069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e23589 %T CoGNIT Automated Tablet Computer Cognitive Testing in Patients With Mild Cognitive Impairment: Feasibility Study %A Behrens,Anders %A Berglund,Johan Sanmartin %A Anderberg,Peter %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Sweden, 46 734223736, pan@bth.se %K internet %K cognitive testing %K software %K testing %K impairment %K cognition %K feasibility %K diagnosis %K app %K assessment %K cognitive impairment %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression). Objective: The aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI). Methods: Patients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented. Results: The test battery was completed by all 36 patients. One test, the four-finger–tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified. Conclusions: The overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger–tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic. %M 35275064 %R 10.2196/23589 %U https://formative.jmir.org/2022/3/e23589 %U https://doi.org/10.2196/23589 %U http://www.ncbi.nlm.nih.gov/pubmed/35275064 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32205 %T Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study %A Chacornac,Mathieu %A Faoro,Aurélien %A Texereau,Joëlle %A Billoet,Catherine %A Hominal,Stéphane %+ Department of Cardiology, Centre Hospitalier Annecy-Genevois, 1, avenue de l’Hôpital, Pringy, 74374, France, 33 450636749, mchacornac@ch-annecygenevois.fr %K multimorbidity %K telehealth %K telemonitoring %K chronic disease %K chronic heart failure %K chronic obstructive pulmonary disease %K diabetes %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Management of patients with multiple chronic diseases is a growing public health challenge, especially in rural sectors where access to physicians may be limited. Connected medical devices monitoring vital signs, associated with eHealth program and structured telephone support, may improve complex patient management through early detection of disease complications, positive impact on patients’ health, and health resources consumption optimization. Objective: The aim of this study was to evaluate the technical performance and user experience of the NOMHAD eHealth system in patients with multimorbidity. Methods: This was a pilot, single-arm, interventional study. Patients with multimorbidity with any combination of chronic heart failure (CHF), chronic obstructive pulmonary disease, and diabetes were followed for 80-100 days using the NOMHAD eHealth system. This system used connected devices telemonitoring symptoms and vital signs (eg, body weight, oxygen saturation, pulse rate, blood pressure, and blood glucose), associated with structured telecoaching and educational support by call center nurses. An overall risk indicator (ORI) was automatically computed after each data teletransmission. The ORI was color coded; green indicated no action required; yellow, orange, and red (low to high priority, respectively) generated telenotifications and indicated to the nurses the need for a telecoaching action. Each ORI was calculated by combining 7 clinical stability system indicators based on symptom questionnaires and vital signs. Technical accuracy of the system was assessed by comparing system-generated ORIs with ORIs recalculated from raw data. Ease of use, usefulness, satisfaction, and acceptability of the system were assessed through patient adherence to self-assessments, and through self-administered questionnaires to patients, call center nurses, and physicians. Results: A total of 23 patients were enrolled in this study and participated between April 2016 and March 2017 at 5 study centers in France. All patients were successfully equipped and evaluable for analysis. Mean age was 68.5 (SD 10.4) years and most patients were men (n=20). The most common multimorbidity was CHF + diabetes (n=15), followed by patients with all 3 diseases (n=5). Mean effective follow-up was 78.7 (SD 24.2) days. The system generated 6263 ORIs, as several ORIs could be generated on a single day for any patient. Overall system sensitivity was 99.2% (95% CI 98.9-99.4) and overall specificity was 91.3% (95% CI 87.7-94.1). Most patients (20/23, 87%) were satisfied with the system and agreed that it helped them to better understand and manage their diseases, and 19/23 (83%) valued the nurse regular contacts. Nurses and physicians were generally satisfied with the system and considered it useful. All users indicated they would agree to long-term use of the system. Conclusions: This study provides evidence that the NOMHAD eHealth system is accurate, acceptable, informative, and feasible for patients with multimorbidity, supporting further investigation of its clinical benefits. Trial Registration: Agence Nationale de Sécurité du Médicament et des Produits de Santé 2015-A01106-43; https://ictaxercb.ansm.sante.fr/Public/index.php %M 35275068 %R 10.2196/32205 %U https://formative.jmir.org/2022/3/e32205 %U https://doi.org/10.2196/32205 %U http://www.ncbi.nlm.nih.gov/pubmed/35275068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29819 %T Searching for HIV and AIDS Health Information in South Africa, 2004-2019: Analysis of Google and Wikipedia Search Trends %A Okunoye,Babatunde %A Ning,Shaoyang %A Jemielniak,Dariusz %+ Berkman Klein Centre for Internet and Society, Harvard University, 2nd Floor, 23 Everett Street, Cambridge, MA, 02138, United States, 1 (617) 495 7547, bokunoye@cyber.harvard.edu %K HIV/AIDS %K web search %K big data %K public health %K Wikipedia %K information seeking behavior %K online behavior %K online health information %K Google Trends %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: AIDS, caused by HIV, is a leading cause of mortality in Africa. HIV/AIDS is among the greatest public health challenges confronting health authorities, with South Africa having the greatest prevalence of the disease in the world. There is little research into how Africans meet their health information needs on HIV/AIDS online, and this research gap impacts programming and educational responses to the HIV/AIDS pandemic. Objective: This paper reports on how, in general, interest in the search terms “HIV” and “AIDS” mirrors the increase in people living with HIV and the decline in AIDS cases in South Africa. Methods: Data on search trends for HIV and AIDS for South Africa were found using the search terms “HIV” and “AIDS” (categories: health, web search) on Google Trends. This was compared with data on estimated adults and children living with HIV, and AIDS-related deaths in South Africa, from the Joint United Nations Programme on HIV/AIDS, and also with search interest in the topics “HIV” and “AIDS” on Wikipedia Afrikaans, the most developed local language Wikipedia service in South Africa. Nonparametric statistical tests were conducted to support the trends and associations identified in the data. Results: Google Trends shows a statistically significant decline (P<.001) in search interest for AIDS relative to HIV in South Africa. This trend mirrors progress on the ground in South Africa and is significantly associated (P<.001) with a decline in AIDS-related deaths and people living longer with HIV. This trend was also replicated on Wikipedia Afrikaans, where there was a greater interest in HIV than AIDS. Conclusions: This statistically significant (P<.001) association between interest in the search terms “HIV” and “AIDS” in South Africa (2004-2019) and the number of people living with HIV and AIDS in the country (2004-2019) might be an indicator that multilateral efforts at combating HIV/AIDS—particularly through awareness raising and behavioral interventions in South Africa—are bearing fruit, and this is not only evident on the ground, but is also reflected in the online information seeking on the HIV/AIDS pandemic. We acknowledge the limitation that in studying the association between Google search interests on HIV/AIDS and cases/deaths, causal relationships should not be drawn due to the limitations of the data. %M 35275080 %R 10.2196/29819 %U https://formative.jmir.org/2022/3/e29819 %U https://doi.org/10.2196/29819 %U http://www.ncbi.nlm.nih.gov/pubmed/35275080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29196 %T Barriers and Facilitators to HIV Testing Among Adolescents and Young Adults in Washington, District of Columbia: Formative Research to Inform the Development of an mHealth Intervention %A Wilbourn,Brittany %A Howard-Howell,Tyriesa %A Castel,Amanda %A D'Angelo,Lawrence %A Trexler,Constance %A Carr,Rashida %A Greenberg,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 500, Washington, DC, 20052, United States, 1 2029944392, blewis1@gwu.edu %K youth %K HIV %K knowledge %K testing %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults (AYA) in the United States, and in Washington, District of Columbia (DC), specifically, are disproportionately affected by HIV. Both the national Ending the HIV Epidemic initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed. Objective: The purpose of this study is to identify sexual behaviors, HIV knowledge, HIV perceptions (eg, susceptibility and severity), and perceived barriers and facilitators to HIV testing among AYA at risk for HIV in DC. Methods: This study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys stratified by self-reported sexual orientation were conducted among, and administered to, AYA aged 13-24 years in DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed. Results: Of the 46 AYA who participated in the focus groups, 30 (65%) identified as heterosexual and 16 (35%) as lesbian, gay, bisexual, transgender, or queer. A higher proportion of lesbian, gay, bisexual, transgender, or queer AYA reported sexual activity (12/16, 75%, vs 18/30, 60%), condomless sex (11/12, 92%, vs 15/18, 83%), and HIV testing (13/16, 81%, vs 17/29, 58%) than heterosexual AYA. HIV prevention (“condoms” and “...PrEP”) and transmission (“exchange of fluids”) knowledge was high, and most (34/44, 77%) of the AYA perceived HIV testing as beneficial. However, the AYA also demonstrated some misinformation concerning HIV: an average of 67% (31/46; SD 0.474) of the participants believed that an HIV test could deliver accurate results 1 week after a potential exposure and an average of 72% (33/46; SD 0.455) believed that an HIV vaccine exists. The AYA also identified individual (“...people...are scared”), interpersonal (“it’s an awkward conversation”), and structural (“...people don’t...know where they can go”) barriers to testing. Most of the AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, IQR 2.0-3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood) and strongly agreed that the game was interesting (median 5.0, IQR 5.0-5.0), fun (median 5.0, IQR 4.0-5.0), and easy to learn (median 5.0, IQR 5.0-5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement). Conclusions: These results suggest a need for multilevel HIV testing interventions and informed the development of a mobile health intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic. %M 35275083 %R 10.2196/29196 %U https://formative.jmir.org/2022/3/e29196 %U https://doi.org/10.2196/29196 %U http://www.ncbi.nlm.nih.gov/pubmed/35275083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33883 %T The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial %A Imamura,Kotaro %A Sasaki,Natsu %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Sakuraya,Asuka %A Matsuyama,Yutaka %A Nishi,Daisuke %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K COVID-19 %K education %K internet-based intervention %K occupational groups %K psychological distress %K mental health %K digital health %K health intervention %K psychoeducation %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prolonged COVID-19 pandemic has affected mental health among workers. Psychoeducational intervention via a website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. Objective: The aim of this randomized controlled trial is to examine the effect of a newly developed online psychoeducational website named Imacoco Care on reducing psychological distress and fear about COVID-19 infection among workers. Methods: Participants in the study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to the intervention or control group. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. The Kessler Psychological Distress Scale (K6) and the Fear of COVID-19 Scale (FCV-19S) scores were obtained at baseline and at 1- and 3-month follow-ups. Results: A total of 1200 workers were randomly allocated to the intervention and control groups (n=600 [50%] per group). The Imacoco Care intervention group showed a significant favorable effect on K6 scores (P=.03) with a small effect size (ES; Cohen d=–0.14) and an adverse effect on FCV-19S scores (P=.01) with a small ES (Cohen d=0.16) at 3-month follow-up. In the per protocol analysis (including only participants who had read the Imacoco Care content at least 1 time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 scores (P=.03), while an adverse effect on FCV-19S scores was not significant (P=.06) in the intervention group at 3-month follow-up. Conclusions: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042556; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548 %M 35133972 %R 10.2196/33883 %U https://formative.jmir.org/2022/3/e33883 %U https://doi.org/10.2196/33883 %U http://www.ncbi.nlm.nih.gov/pubmed/35133972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34088 %T System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic %A Sharma,Anjana E %A Khoong,Elaine C %A Sierra,Maribel %A Rivadeneira,Natalie A %A Nijagal,Malini A %A Su,George %A Lyles,Courtney R %A DeFries,Triveni %A Tuot,Delphine S %A Sarkar,Urmimala %+ Department of Family & Community Medicine, University of California San Francisco, 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, United States, 1 4155708619, anjana.sharma@ucsf.edu %K telemedicine %K safety-net hospitals %K health care delivery %K ambulatory care %K vulnerable populations %K COVID-19 %K survey %K vulnerable %K telehealth %K hospital %K safety %K delivery %K video %K implementation %K health system %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. %M 35148271 %R 10.2196/34088 %U https://formative.jmir.org/2022/3/e34088 %U https://doi.org/10.2196/34088 %U http://www.ncbi.nlm.nih.gov/pubmed/35148271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26764 %T Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App %A Jackson,Devlon N %A Sehgal,Neil %A Baur,Cynthia %+ Department of Behavioral and Community Health, Center for Health Literacy, Center for Health Equity, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, United States, 1 3014051464, djacks04@umd.edu %K mHealth app design %K health literacy %K health disparities %K health equity %K African Americans %K Hispanics %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants’ experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1—community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2—community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3—interactive design sessions uncover participants’ needs and development opportunities for mHealth tools. Lesson 4—multiple design sessions with different methods provide an in-depth understanding of participants’ mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. %M 35262496 %R 10.2196/26764 %U https://formative.jmir.org/2022/3/e26764 %U https://doi.org/10.2196/26764 %U http://www.ncbi.nlm.nih.gov/pubmed/35262496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26374 %T Weight Loss Trajectories in Healthy Weight Coaching: Cohort Study %A Kupila,Sakris K E %A Venäläinen,Mikko S %A Suojanen,Laura-Unnukka %A Rosengård-Bärlund,Milla %A Ahola,Aila J %A Elo,Laura L %A Pietiläinen,Kirsi H %+ Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, P.O. Box 63, University of Helsinki, Helsinki, FI-00014, Finland, 358 02941911, sakris.kupila@helsinki.fi %K acceptance and commitment therapy %K body weight %K eHealth %K obesity management %K real-life intervention %K web-based %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As global obesity prevalence continues to increase, there is a need for accessible and affordable weight management interventions, such as web-based programs. Objective: This paper aims to assess the outcomes of healthy weight coaching (HWC), a web-based obesity management program integrated into standard Finnish clinical care. Methods: HWC is an ongoing, structured digital 12-month program based on acceptance and commitment therapy. It includes weekly training sessions focused on lifestyle, general health, and psychological factors. Participants received remote one-on-one support from a personal coach. In this real-life, single-arm, prospective cohort study, we examined the total weight loss, weight loss profiles, and variables associated with weight loss success and program retention in 1189 adults (963 women) with a BMI >25 kg/m² among participants of the program between October 2016 and March 2019. Absolute (kg) and relative (%) weight loss from the baseline were the primary outcomes. We also examined the weight loss profiles, clustered based on the dynamic time-warping distance, and the possible variables associated with greater weight loss success and program retention. We compared different groups using the Mann-Whitney test or Kruskal-Wallis test for continuous variables and the chi-squared test for categorical variables. We analyzed changes in medication using the McNemar test. Results: Among those having reached the 12-month time point (n=173), the mean weight loss was 4.6% (SE 0.5%), with 43% (n=75) achieving clinically relevant weight loss (≥5%). Baseline BMI ≥40 kg/m² was associated with a greater weight loss than a lower BMI (mean 6.6%, SE 0.9%, vs mean 3.2%, SE 0.6%; P=.02). In addition, more frequent weight reporting was associated with greater weight loss. No significant differences in weight loss were observed according to sex, age, baseline disease, or medication use. The total dropout rate was 29.1%. Dropouts were slightly younger than continuers (47.2, SE 0.6 years vs 49.2, SE 0.4 years; P=.01) and reported their weight less frequently (3.0, SE 0.1 entries per month vs 3.3, SE 0.1 entries per month; P<.001). Conclusions: A comprehensive web-based program such as HWC is a potential addition to the repertoire of obesity management in a clinical setting. Heavier patients lost more weight, but weight loss success was otherwise independent of baseline characteristics. %M 35262494 %R 10.2196/26374 %U https://formative.jmir.org/2022/3/e26374 %U https://doi.org/10.2196/26374 %U http://www.ncbi.nlm.nih.gov/pubmed/35262494 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33488 %T Evaluation of a Web-Based Medication Reconciliation Application Within a Primary Care Setting: Cluster-Randomized Controlled Trial %A Gionfriddo,Michael R %A Hu,Yirui %A Maddineni,Bhumika %A Kern,Melissa %A Hayduk,Vanessa %A Kaledas,William R %A Elder,Nevan %A Border,Jeffrey %A Frusciante,Katie %A Kobylinski,Maria %A Wright,Eric A %+ Center for Pharmacy Innovation and Outcomes, Geisinger Health, 100 N Academy Ave Danville, Danville, PA, 17822, United States, 1 570 714 6633, ewright2@geisinger.edu %K medication %K reconciliation %K electronic health record %K information technology %K medication safety %K primary care %K EHR %K safety %K app %K randomized controlled trial %K drug %K interoperability %K information source %K mixed method %K effectiveness %K satisfaction %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. Objective: We aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT). Methods: We conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews. Results: Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement. Conclusions: The use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application. %M 35023836 %R 10.2196/33488 %U https://formative.jmir.org/2022/3/e33488 %U https://doi.org/10.2196/33488 %U http://www.ncbi.nlm.nih.gov/pubmed/35023836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27677 %T Smartphone App–Based Noncontact Ecological Momentary Assessment With Experienced and Naïve Older Participants: Feasibility Study %A Burke,Louise %A Naylor,Graham %+ Hearing Sciences - Scottish Section, School of Medicine, University of Nottingham, New Lister Building Level 3, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom, 44 0141 242 9666, graham.naylor@nottingham.ac.uk %K ecological momentary assessment %K EMA %K smartphone %K mobile phone %K mHealth %K app %K noncontact EMA %K remote EMA %K hearing %K hearing loss %K feasibility %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone app–based ecological momentary assessment (EMA) without face-to-face contact between researcher and participant (app-based noncontact EMA) potentially provides a valuable data collection tool when geographic, time, and situational factors (eg, COVID-19 restrictions) place constraints on in-person research. Nevertheless, little is known about the feasibility of this method, particularly in older and naïve EMA participants. Objective: This study aims to assess the feasibility of app-based noncontact EMA as a function of previous EMA experience, by recruiting and comparing a group of participants who had never participated in EMA before against a group of participants who had been part of an earlier in-person EMA study, and age, by recruiting middle-aged to older adults. Methods: Overall, 151 potential participants were invited via email; 46.4% (70/151) enrolled in the study by completing the baseline questionnaire set and were emailed instructions for the EMA phase. Of these participants, 67% (47/70) downloaded an EMA app and ran the survey sequence for 1 week. In total, 5 daytime surveys and 1 evening survey, each day, assessed participants’ listening environment, social activity, and conversational engagement. A semistructured exit telephone interview probed the acceptability of the method. As markers of feasibility, we assessed the enrollment rate, study completion rate, reason for noncompletion, EMA survey response rate, and likelihood of reporting an issue with survey alerts and requested assistance from researchers, family, or friends. Results: Enrollment rates among invitees (63.3% vs 38.2%; P=.004) and completion rates among enrollees (83.9% vs 53.8%; P<.001) were higher in the experienced than in the naïve EMA group. On average, experienced participants responded to 64.1% (SD 30.2%) of the daytime EMA surveys, and naïve participants responded to 54.3% (SD 29.5%) of the daytime EMA surveys (P=.27). Among participants who retrospectively reported issues with survey alerts, only 19% (3/16) requested researcher assistance during data collection. Older participants were more likely to report not being alerted to EMA surveys (P=.008), but age was unrelated to all other markers of feasibility. Post hoc analyses of the effect of the phone operating system on markers of feasibility revealed that response rates were higher among iOS users (mean 74.8%, SD 20.25%) than among Android users (mean 48.5%, SD 31.35%; P=.002). Conclusions: Smartphone app–based noncontact EMA appears to be feasible, although participants with previous EMA experience, younger participants, and iOS users performed better on certain markers of feasibility. Measures to increase feasibility may include extensive testing of the app with different phone types, encouraging participants to seek timely assistance for any issues experienced, and recruiting participants who have some previous EMA experience where possible. The limitations of this study include participants’ varying levels of existing relationship with the researcher and the implications of collecting data during the COVID-19 social restrictions. %M 35258471 %R 10.2196/27677 %U https://formative.jmir.org/2022/3/e27677 %U https://doi.org/10.2196/27677 %U http://www.ncbi.nlm.nih.gov/pubmed/35258471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25055 %T Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study %A Sui,Wuyou %A Rush,Jonathan %A Rhodes,Ryan E %+ Exercise and Health Psychology Lab, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 5196612111 ext 81189, yoahsui@gmail.com %K eHealth %K physical activity %K adults %K adherence %K COVID-19 %K fitness %K video %K YouTube %K Instagram %K social media %K longitudinal %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown. Objective: We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics. Methods: An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels’ videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables. Results: Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI –44,400 to –11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, “virality,” and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement. Conclusions: Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important. %M 35258459 %R 10.2196/25055 %U https://formative.jmir.org/2022/3/e25055 %U https://doi.org/10.2196/25055 %U http://www.ncbi.nlm.nih.gov/pubmed/35258459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32669 %T A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change %A Berry,Alice %A McClellan,Carey %A Wanless,Ben %A Walsh,Nicola %+ University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom, 44 117 32 87802, alice.berry@uwe.ac.uk %K musculoskeletal %K supported self-management %K behavior change %K digital health intervention %K behavior change wheel %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey. Objective: The aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines. Methods: A range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented. Results: The content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders. Conclusions: This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations. %M 35258462 %R 10.2196/32669 %U https://formative.jmir.org/2022/3/e32669 %U https://doi.org/10.2196/32669 %U http://www.ncbi.nlm.nih.gov/pubmed/35258462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32752 %T Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter %A Gabarron,Elia %A Dechsling,Anders %A Skafle,Ingjerd %A Nordahl-Hansen,Anders %+ Department of Education, ICT and Learning, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 94863460, egabarron@gmail.com %K social media %K autism spectrum disorder %K health literacy %K famous persons %K Asperger %K Elon Musk %K twitter %K tweets %K mental health %K autism %K sentiment analysis %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk's disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition. Objective: The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure. Methods: We extracted tweets that were published 1 week before and after Musk's disclosure that had received >30 likes and included the terms “Aspergers” or “Aspie.” The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool. Results: We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement. Conclusions: The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition. %M 35254265 %R 10.2196/32752 %U https://formative.jmir.org/2022/3/e32752 %U https://doi.org/10.2196/32752 %U http://www.ncbi.nlm.nih.gov/pubmed/35254265 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e28332 %T mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial %A Ranjit,Yerina S %A Krishnan,Archana %A Ghosh,Debarchana %A Cravero,Claire %A Zhou,Xin %A Altice,Frederick L %+ Department of Communication, University of Missouri, 108 Switzler Hall, Columbia, MO, 65211, United States, 1 573 822 0881, ranjity@missouri.edu %K smart pillbox %K smartphone %K mHealth intervention %K people with HIV %K cocaine use %K antiretroviral therapy %K description of feasibility and acceptability %K mobile phone %D 2022 %7 7.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antiretroviral therapy is effective in reducing HIV-related morbidity, mortality, and transmission among people with HIV. However, adherence and persistence to antiretroviral therapy are crucial for successful HIV treatment outcomes. People with HIV who use cocaine have poor access to HIV services and lower retention in care. Objective: The primary goal of this paper is to provide a detailed description of a mobile health intervention. This study is designed to improve medication adherence among people with HIV who use cocaine. A secondary goal is to list the important challenges and adaptations incorporated in the study design. Methods: This study, titled Project SMART, used a wireless technology–based intervention, including cellular-enabled electronic pillboxes called TowerView Health and smartphones, to provide reminders and feedback on adherence behavior. The intervention design was based on the theoretical frameworks provided by the self-determination theory and the Motivation Technology Model. The 12-week pilot randomized controlled trial with four arms provided three types of feedback: automated feedback, automated+clinician feedback, and automated feedback+social network feedback. Results: The study was funded by the National Institute of Drug Abuse (R21DA039842) on August 1, 2016. The institutional review board for the study was approved by Yale University on March 21, 2017. Data collection lasted from June 2017 to January 2020. The final enrollment was 71 participants, of whom 57 (80%) completed the study. The data are currently undergoing analysis, and the manuscript is being developed for publication in early 2022. Conclusions: Implementing complex mobile health interventions for high-risk and marginalized populations with multicomponent interventions poses certain challenges, such as finding companies with adequate technology for clients and financial stability and minimizing the research-related burden for the study population. Conducting feasibility studies is important to recognize these challenges and the opportunity to address these challenges with solutions while keeping the design of a randomized controlled trial as true as possible. Trial Registration: Clinicaltrials.gov NCT04418076; https://clinicaltrials.gov/ct2/show/NCT04418076 International Registered Report Identifier (IRRID): DERR1-10.2196/28332 %M 35254270 %R 10.2196/28332 %U https://www.researchprotocols.org/2022/3/e28332 %U https://doi.org/10.2196/28332 %U http://www.ncbi.nlm.nih.gov/pubmed/35254270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34901 %T Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study %A Sifat,Munjireen S %A Saperstein,Sandra L %A Tasnim,Naima %A Green,Kerry M %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052716872 ext 50477, Munjireen-sifat@ouhsc.edu %K digital health %K mental health %K Bangladesh %K university students %K mental health service use %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low. Objective: The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH. Methods: This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH. Results: Social influence (adjusted odds ratio [aOR] 1.68, 95% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non–stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95% CI 1.10-3.80; P=.02). Conclusions: Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health. %M 35254267 %R 10.2196/34901 %U https://formative.jmir.org/2022/3/e34901 %U https://doi.org/10.2196/34901 %U http://www.ncbi.nlm.nih.gov/pubmed/35254267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33314 %T Public Perception of the Use of Digital Contact-Tracing Tools After the COVID-19 Lockdown: Sentiment Analysis and Opinion Mining %A Huang,Zhilian %A Tay,Evonne %A Wee,Dillon %A Guo,Huiling %A Lim,Hannah Yee-Fen %A Chow,Angela %+ Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, Angela_Chow@ttsh.com.sg %K infectious disease %K sentiment analysis %K opinion mining %K COVID-19 %K contact tracing %K public health %K opinion %K data mining %K survey %K cross-sectional %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s national digital contact-tracing (DCT) tool—TraceTogether—attained an above 70% uptake by December 2020 after a slew of measures. Sentiment analysis can help policymakers to assess public sentiments on the implementation of new policy measures in a short time, but there is a paucity of sentiment analysis studies on the usage of DCT tools. Objective: We sought to understand the public’s knowledge of, concerns with, and sentiments on the use of TraceTogether over time and their preferences for the type of TraceTogether tool. Methods: We conducted a cross-sectional survey at a large public hospital in Singapore after the COVID-19 lockdown, from July 2020 through February 2021. In total, 4097 respondents aged 21-80 years were sampled proportionately by sex and 4 age groups. The open-ended responses were processed and analyzed using natural language processing tools. We manually corrected the language and logic errors and replaced phrases with words available in the syuzhet sentiment library without altering the original meaning of the phrases. The sentiment scores were computed by summing the scores of all the tokens (phrases split into smaller units) in the phrase. Stopwords (prepositions and connectors) were removed, followed by implementing the bag-of-words model to calculate the bigram and trigram occurrence in the data set. Demographic and time filters were applied to segment the responses. Results: Respondents’ knowledge of and concerns with TraceTogether changed from a focus on contact tracing and Bluetooth activation in July-August 2020 to QR code scanning and location check-ins in January-February 2021. Younger males had the highest TraceTogether uptake (24/40, 60%), while older females had the lowest uptake (8/34, 24%) in the first half of July 2020. This trend was reversed in mid-October after the announcement on mandatory TraceTogether check-ins at public venues. Although their TraceTogether uptake increased over time, older females continued to have lower sentiment scores. The mean sentiment scores were the lowest in January 2021 when the media reported that data collected by TraceTogether were used for criminal investigations. Smartphone apps were initially preferred over tokens, but the preference for the type of TraceTogether tool equalized over time as tokens became accessible to the whole population. The sentiments on token-related comments became more positive as the preference for tokens increased. Conclusions: The public’s knowledge of and concerns with the use of a mandatory DCT tool varied with the national regulations and public communications over time with the evolution of the COVID-19 pandemic. Effective communications tailored to subpopulations and greater transparency in data handling will help allay public concerns with data misuse and improve trust in the authorities. Having alternative forms of the DCT tool can increase the uptake of and positive sentiments on DCT. %M 35120017 %R 10.2196/33314 %U https://formative.jmir.org/2022/3/e33314 %U https://doi.org/10.2196/33314 %U http://www.ncbi.nlm.nih.gov/pubmed/35120017 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28877 %T Token Economy–Based Hospital Bed Allocation to Mitigate Information Asymmetry: Proof-of-Concept Study Through Simulation Implementation %A Hiragi,Shusuke %A Hatanaka,Jun %A Sugiyama,Osamu %A Saito,Kenichi %A Nambu,Masayuki %A Kuroda,Tomohiro %+ Division of Health Science, Tazuke Kofukai Medical Research Institute, 2-4-10 Ohgimachi Kita-ku, Osaka, 5308480, Japan, 81 6 6312 1221, shiragi@kuhp.kyoto-u.ac.jp %K hospital administration %K resource allocation %K token economy %K bed occupancy %K hospital management %K simulation %K decision-making %K organization %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospital bed management is an important resource allocation task in hospital management, but currently, it is a challenging task. However, acquiring an optimal solution is also difficult because intraorganizational information asymmetry exists. Signaling, as defined in the fields of economics, can be used to mitigate this problem. Objective: We aimed to develop an assignment process that is based on a token economy as signaling intermediary. Methods: We implemented a game-like simulation, representing token economy–based bed assignments, in which 3 players act as ward managers of 3 inpatient wards (1 each). As a preliminary evaluation, we recruited 9 nurse managers to play and then participate in a survey about qualitative perceptions for current and proposed methods (7-point Likert scale). We also asked them about preferred rewards for collected tokens. In addition, we quantitatively recorded participant pricing behavior. Results: Participants scored the token economy–method positively in staff satisfaction (3.89 points vs 2.67 points) and patient safety (4.38 points vs 3.50 points) compared to the current method, but they scored the proposed method negatively for managerial rivalry, staff employee development, and benefit for patients. The majority of participants (7 out of 9) listed human resources as the preferred reward for tokens. There were slight associations between workload information and pricing. Conclusions: Survey results indicate that the proposed method can improve staff satisfaction and patient safety by increasing the decision-making autonomy of staff but may also increase managerial rivalry, as expected from existing criticism for decentralized decision-making. Participant behavior indicated that token-based pricing can act as a signaling intermediary. Given responses related to rewards, a token system that is designed to incorporate human resource allocation is a promising method. Based on aforementioned discussion, we concluded that a token economy–based bed allocation system has the potential to be an optimal method by mitigating information asymmetry. %M 35254264 %R 10.2196/28877 %U https://formative.jmir.org/2022/3/e28877 %U https://doi.org/10.2196/28877 %U http://www.ncbi.nlm.nih.gov/pubmed/35254264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33701 %T Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study %A Banerjee,Rahul %A Huang,Chiung-Yu %A Dunn,Lisa %A Knoche,Jennifer %A Ryan,Chloe %A Brassil,Kelly %A Jackson,Lindsey %A Patel,Dhiren %A Lo,Mimi %A Arora,Shagun %A Wong,Sandy W %A Wolf,Jeffrey %A Martin III,Thomas %A Dhruva,Anand %A Shah,Nina %+ Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94158, United States, 1 415 353 8000, rahul.banerjee.md@gmail.com %K digital health %K life coaching %K multiple myeloma %K stem cell transplantation %K stem cell therapy %K cancer %K high-dose chemotherapy %K patient engagement %K feasibility %K digital life coaching %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized well-being–related support via phone calls and SMS text messaging, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period, which is generally characterized by symptomatic exacerbations and 2-week hospitalizations. Objective: We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period. Methods: We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning on day −5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to well-being. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every 4 weeks during the study period. Secondary endpoints were electronic patient-reported outcome assessments of QOL, distress, and sleep disturbances. Results: Of the 20 patients who were screened, 17 (85%) chose to enroll and 15 (75%) underwent SCT as planned. Of these 15 patients (median age 65 years, range 50-81 years), 11 (73%) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once every 6.2 days (range 3.9-28 days). During index hospitalizations with median lengths of stay of 16 days (range 14-31 days), the median frequency of conversations was once every 5.3 days (range 2.7-15 days). Electronic patient-reported outcome assessments (94% adherence) demonstrated an expected QOL nadir during the second week after SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress on day −5 and on day +2. Conclusions: DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous SCT for multiple myeloma. The limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC use. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is underway to investigate the efficacy of DLC with regard to patient well-being. Trial Registration: ClinicalTrials.gov NCT04432818; https://clinicaltrials.gov/ct2/show/NCT04432818. %M 35039279 %R 10.2196/33701 %U https://formative.jmir.org/2022/3/e33701 %U https://doi.org/10.2196/33701 %U http://www.ncbi.nlm.nih.gov/pubmed/35039279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34032 %T Feasibility and Preliminary Efficacy of Web-Based and Mobile Interventions for Common Mental Health Problems in Working Adults: Multi-Arm Randomized Pilot Trial %A Economides,Marcos %A Bolton,Heather %A Male,Rhian %A Cavanagh,Kate %+ Unmind Ltd, 180 Borough High St, London, SE1 1LB, United Kingdom, 44 2078664050, marcos.economides@unmind.com %K mHealth %K workplace %K CBT %K ACT %K feasibility %K stress %K anxiety %K depression %K resilience %K mobile phone %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing interest in digital platforms as a means of implementing scalable, accessible, and cost-effective mental health interventions in the workplace. However, little is known about the efficacy of such interventions when delivered to employee groups. Objective: This study aims to evaluate the feasibility and preliminary efficacy of a digital mental health platform for the workplace, which incorporates evidence-based practices such as cognitive behavioral therapy and acceptance and commitment therapy. A total of 3 brief, unguided interventions designed to address stress, anxiety, and resilience, respectively, are evaluated. The primary aim is to determine the feasibility of the study methods and interventions in preparation for a definitive randomized controlled trial. Methods: The study used a fully remote, parallel, multi-arm, external pilot randomized controlled trial, with 3 intervention arms and a no-intervention control group. Participants were working adults representative of the general UK population with respect to age, sex, and ethnicity who were recruited from a web-based participant platform. Primary outcomes included objective and self-report measures of feasibility, acceptability, engagement, transferability, relevance, and negative effects. Secondary outcomes included 4 self-report measures of mental health and well-being, completed at baseline (time point 0 [t0]), postintervention (time point 1 [t1]), and the 1-month follow-up (time point 2 [t2]). Secondary outcomes were analyzed via linear mixed-effects models using intention-to-treat principles. Preregistered criteria for progression to a definitive trial were evaluated. Results: Data were collected between January and March of 2021. A total of 383 working adult participants meeting trial eligibility were randomized, of whom 356 (93%) were retained at t2. Objective engagement data showed that 67.8% (196/289) of participants randomized to an intervention arm completed their intervention. Overall, 87.1% (203/233) of participants reported being satisfied or very satisfied with their intervention and rated the quality of their intervention as good or excellent. All intervention groups reported significantly greater improvements than the control group on at least one secondary outcome at t1, with between-group Hedges g effect sizes for the pooled interventions ranging from 0.25 (95% CI 0.05-0.46) to 0.43 (95% CI 0.23-0.64). All the improvements were maintained at t2. Conclusions: The study methods were feasible, and all preregistered criteria for progression to a definitive trial were met. Several minor protocol amendments were noted. Preliminary efficacy findings suggest that the study interventions may result in improved mental health outcomes when offered to working adults. Trial Registration: ISRCTN Registry 80309011; http://www.isrctn.com/ISRCTN80309011 %M 35238794 %R 10.2196/34032 %U https://formative.jmir.org/2022/3/e34032 %U https://doi.org/10.2196/34032 %U http://www.ncbi.nlm.nih.gov/pubmed/35238794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29832 %T A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study %A Dietvorst,Evelien %A Aukes,Michelle A %A Legerstee,Jeroen S %A Vreeker,Annabel %A Hrehovcsik,Micah M %A Keijsers,Loes %A Hillegers,Manon H J %+ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Wytemaweg 8, Rotterdam, 3015 CN, Netherlands, 31 (0)107040209, m.hillegers@erasmusmc.nl %K ecological momentary assessment %K EMA %K serious game %K CBT %K depression %K internalizing problems %K adolescents %K high risk %K digital health %K mobile health %K mHealth %K game design %K app development %K mobile phone %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. Objective: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy–based challenges to promote adaptive coping. Methods: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. Results: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64% boys) completed 31.5% (13.2/42) to 49.5% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7% to 32.5/105, 30.9%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6% (278/383) to 75.6% (487/644) would recommend the app to friends. Conclusions: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy–based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles. %M 35238795 %R 10.2196/29832 %U https://formative.jmir.org/2022/3/e29832 %U https://doi.org/10.2196/29832 %U http://www.ncbi.nlm.nih.gov/pubmed/35238795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30085 %T Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %A Cho,Yoon Jeong %+ Department of Family Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K health literacy %K readability %K public health %K health equity %K consumer health information %K information dissemination %K health education %K eHealth %K online %K social media %K pandemic %K infodemic %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. %M 35072633 %R 10.2196/30085 %U https://formative.jmir.org/2022/3/e30085 %U https://doi.org/10.2196/30085 %U http://www.ncbi.nlm.nih.gov/pubmed/35072633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32640 %T Internet-Based Information Behavior After Pregnancy Loss: Interview Study %A Andalibi,Nazanin %A Bowen,Kristen %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48109, United States, 1 (734) 763 2285, andalibi@umich.edu %K pregnancy loss %K miscarriage %K reproductive health %K stigma %K information behavior %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Information behavior describes all human behaviors in relation to information. Individuals experiencing disruption or stigma often use internet-based tools and spaces to meet their associated information needs. One such context is pregnancy loss, which, although impactful and common, has been absent from much of feminist and reproductive health and information behavior scholarship. By understanding information behavior after pregnancy loss and accounting for it in designing internet-based information spaces, we can take a meaningful step toward countering the stigma and silence that many who experience such loss endure, facilitate coping, and make space for diverse pregnancy narratives in our society. Objective: This study’s objective is to provide a characterization of internet-based information behavior after pregnancy loss. Methods: We examined internet-based information behavior after pregnancy loss through 9 in-depth interviews with individuals residing in the United States. We analyzed the data by using open and axial coding. Results: We identified the following three themes in relation to participants’ information behavior in internet-based spaces: needed information types, information-related concerns, and information outcomes. We drew from information behavior frameworks to interpret the processes and concerns described by participants as they moved from recognizing information needs to searching for information and to using information and experiencing outcomes. Specifically, we aligned these themes with information use concepts from the information behavior literature—information search, knowledge construction, information production, information application, and information effects. Participants’ main concerns centered on being able to easily find information (ie, searchability), particularly on topics that had already been covered (ie, persistence), and, once found, being able to assess the information for its relevance, helpfulness, and credibility (ie, assessability). We suggest the following design implications that support health information behavior: assessability, persistence, and searchability. Conclusions: We examined internet-based information behavior in the context of pregnancy loss, an important yet silenced reproductive health experience. Owing to the prevalence of information seeking during pregnancy, we advocate that generic pregnancy-related information spaces should address the needs related to pregnancy loss that we identified in addition to spaces dedicated to pregnancy loss. Such a shift could not only support those who use these spaces to manage pregnancies and then experience a loss but also help combat the silence and stigma associated with loss and the linear and normative narrative by which pregnancies are often represented. %M 35234656 %R 10.2196/32640 %U https://formative.jmir.org/2022/3/e32640 %U https://doi.org/10.2196/32640 %U http://www.ncbi.nlm.nih.gov/pubmed/35234656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30052 %T eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study %A Kerckhove,Nicolas %A Delage,Noémie %A Cambier,Sébastien %A Cantagrel,Nathalie %A Serra,Eric %A Marcaillou,Fabienne %A Maindet,Caroline %A Picard,Pascale %A Martiné,Gaelle %A Deleens,Rodrigue %A Trouvin,Anne-Priscille %A Fourel,Lauriane %A Espagne-Dubreuilh,Gaelle %A Douay,Ludovic %A Foulon,Stéphane %A Dufraisse,Bénédicte %A Gov,Christian %A Viel,Eric %A Jedryka,François %A Pouplin,Sophie %A Lestrade,Cécile %A Combe,Emmanuel %A Perrot,Serge %A Perocheau,Dominique %A De Brisson,Valentine %A Vergne-Salle,Pascale %A Mertens,Patrick %A Pereira,Bruno %A Djiberou Mahamadou,Abdoul Jalil %A Antoine,Violaine %A Corteval,Alice %A Eschalier,Alain %A Dualé,Christian %A Attal,Nadine %A Authier,Nicolas %+ Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, 29 boulevard Joseph Girod, Clermont-Ferrand, 63000, France, 33 0473178414, nkerckhove@chu-clermontferrand.fr %K mHealth %K chronic pain %K feasibility study %K eHealth %K self-monitoring %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective: We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods: We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results: Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions: This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration: ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694 %M 35234654 %R 10.2196/30052 %U https://formative.jmir.org/2022/3/e30052 %U https://doi.org/10.2196/30052 %U http://www.ncbi.nlm.nih.gov/pubmed/35234654 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26525 %T Supporting Behavior Change in Sedentary Adults via Real-time Multidimensional Physical Activity Feedback: Mixed Methods Randomized Controlled Trial %A Western,Max James %A Standage,Martyn %A Peacock,Oliver James %A Nightingale,Tom %A Thompson,Dylan %+ Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 383732, M.J.Western@bath.ac.uk %K physical activity %K feedback %K wearables %K behavior change %K sedentary time %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing physical activity (PA) behavior remains a public health priority, and wearable technology is increasingly being used to support behavior change efforts. Using wearables to capture and provide comprehensive, visually persuasive, multidimensional feedback with real-time support may be a promising way of increasing PA in inactive individuals. Objective: This study aims to explore whether a 6-week self-monitoring intervention using composite web-based multidimensional PA feedback with real-time daily feedback supports increased PA in adults. Methods: A 6-week, mixed methods, 2-armed exploratory randomized controlled trial with 6-week follow-up was used, whereby low to moderately active (PA level [PAL] <2.0) adults (mean age 51.3 years, SD 8.4 years; women 28/51, 55%) were randomly assigned to receive the self-monitoring intervention (36/51, 71%) or waiting list control (15/51, 29%). Assessment of PA across multiple health-harnessing PA dimensions (eg, PAL, weekly moderate to vigorous intensity PA, sedentary time, and steps), psychosocial cognitions (eg, behavioral regulation, barrier self-efficacy, and habit strength), and health were made at the prerandomization baseline at 6 and 12 weeks. An exploratory analysis of the mean difference and CIs was conducted using the analysis of covariance model. After the 12-week assessment, intervention participants were interviewed to explore their views on the program. Results: There were no notable differences in any PA outcome immediately after the intervention; however, at 12 weeks, moderate-to-large effects were observed with a mean difference in PAL of 0.09 (95% CI 0.02-0.15; effect size [Hedges g] 0.8), daily moderate-intensity PA of 24 (95% CI 0-45; Hedges g=0.6) minutes, weekly moderate-to-vigorous intensity PA of 195 (95% CI 58-331; Hedges g=0.8) minutes, and steps of 1545 (95% CI 581-2553; Hedges g=0.7). Descriptive analyses suggested that the differences in PA at 12 weeks were more pronounced in women and participants with lower baseline PA levels. Immediately after the intervention, there were favorable differences in autonomous motivation, controlled motivation, perceived competence for PA, and barrier self-efficacy, with the latter sustained at follow-up. Qualitative data implied that the intervention was highly informative for participants and that the real-time feedback element was particularly useful in providing tangible, day-to-day behavioral support. Conclusions: Using wearable trackers to capture and present sophisticated multidimensional PA feedback combined with discrete real-time support may be a useful way of facilitating changes in behavior. Further investigation into the ways of optimizing the use of wearables in inactive participants and testing the efficacy of this approach via a robust study design is warranted. Trial Registration: ClinicalTrials.gov NCT02432924; https://clinicaltrials.gov/ct2/show/NCT02432924 %M 35234658 %R 10.2196/26525 %U https://formative.jmir.org/2022/3/e26525 %U https://doi.org/10.2196/26525 %U http://www.ncbi.nlm.nih.gov/pubmed/35234658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31615 %T Performance of a Computational Phenotyping Algorithm for Sarcoidosis Using Diagnostic Codes in Electronic Medical Records: Case Validation Study From 2 Veterans Affairs Medical Centers %A Seedahmed,Mohamed I %A Mogilnicka,Izabella %A Zeng,Siyang %A Luo,Gang %A Whooley,Mary A %A McCulloch,Charles E %A Koth,Laura %A Arjomandi,Mehrdad %+ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, Department of Medicine, University of California San Francisco, 513 Parnassus Ave, HSE 1314, Box 0111, San Francisco, CA, 94143, United States, 1 (415) 476 0735, mohamed.seedahmed@ucsf.edu %K sarcoidosis %K electronic medical records %K EMRs %K computational phenotype %K diagnostic codes %K Veterans Affairs %K VA %K practice guidelines %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic medical records (EMRs) offer the promise of computationally identifying sarcoidosis cases. However, the accuracy of identifying these cases in the EMR is unknown. Objective: The aim of this study is to determine the statistical performance of using the International Classification of Diseases (ICD) diagnostic codes to identify patients with sarcoidosis in the EMR. Methods: We used the ICD diagnostic codes to identify sarcoidosis cases by searching the EMRs of the San Francisco and Palo Alto Veterans Affairs medical centers and randomly selecting 200 patients. To improve the diagnostic accuracy of the computational algorithm in cases where histopathological data are unavailable, we developed an index of suspicion to identify cases with a high index of suspicion for sarcoidosis (confirmed and probable) based on clinical and radiographic features alone using the American Thoracic Society practice guideline. Through medical record review, we determined the positive predictive value (PPV) of diagnosing sarcoidosis by two computational methods: using ICD codes alone and using ICD codes plus the high index of suspicion. Results: Among the 200 patients, 158 (79%) had a high index of suspicion for sarcoidosis. Of these 158 patients, 142 (89.9%) had documentation of nonnecrotizing granuloma, confirming biopsy-proven sarcoidosis. The PPV of using ICD codes alone was 79% (95% CI 78.6%-80.5%) for identifying sarcoidosis cases and 71% (95% CI 64.7%-77.3%) for identifying histopathologically confirmed sarcoidosis in the EMRs. The inclusion of the generated high index of suspicion to identify confirmed sarcoidosis cases increased the PPV significantly to 100% (95% CI 96.5%-100%). Histopathology documentation alone was 90% sensitive compared with high index of suspicion. Conclusions: ICD codes are reasonable classifiers for identifying sarcoidosis cases within EMRs with a PPV of 79%. Using a computational algorithm to capture index of suspicion data elements could significantly improve the case-identification accuracy. %M 35081036 %R 10.2196/31615 %U https://formative.jmir.org/2022/3/e31615 %U https://doi.org/10.2196/31615 %U http://www.ncbi.nlm.nih.gov/pubmed/35081036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32934 %T Utilization of a Smart Sock for the Remote Monitoring of Patients With Peripheral Neuropathy: Cross-sectional Study of a Real-world Registry %A Scholten,Henk Jan %A Shih,Chia-Ding %A Ma,Ran %A Malhotra,Kara %A Reyzelman,Alexander M %+ Siren Care, Inc, 1256 Folsom Street, San Francisco, CA, 94103, United States, 1 6284449603, henkjan.scholten@siren.care %K diabetes %K diabetic foot ulcer %K temperature monitoring %K digital health %K wearable %K neuropathy %K remote patient monitoring %K ulcer %K foot %K temperature %K monitoring %K medical device %K utilization %K risk %K complication %K registry %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote patient monitoring (RPM) devices are increasingly being used in caring for patients to reduce risks of complications. Temperature monitoring specifically has been shown in previous studies to provide a useful signal of inflammation that may help prevent foot ulcers. Objective: In this cross-sectional study, we evaluated utilization data for patients who were prescribed smart socks as remote temperature monitoring devices. Methods: This study evaluated data from a patient registry from January to July 2021. The utilization data, which were collected starting from the first full month since patients were prescribed the smart socks, were evaluated along with retention over time, the average time that the socks were worn, and the number of days that the socks were worn per month and per week. Results: A total of 160 patients wore the smart sock RPM device for 22 to 25 days per month on average. The retention rate was 91.9% (147/160) at the end of the 7-month period; a total of 13 patients were lost to follow-up during this period. The average number of days that the socks were worn per week was 5.8. The percentage of patients with a utilization rate of >15 days ranged from 79.7% (106/133) to 91.9% (125/136) each month. Conclusions: This study shows a high level of utilization for a smart sock RPM device and a high compliance rate. A future prospective study on the clinical outcomes after the use of the smart socks may further solidify the idea of conducting temperature monitoring for foot ulcer prevention. %M 35230248 %R 10.2196/32934 %U https://formative.jmir.org/2022/3/e32934 %U https://doi.org/10.2196/32934 %U http://www.ncbi.nlm.nih.gov/pubmed/35230248 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32704 %T Barriers to and Facilitators of Using a One Button Tracker and Web-Based Data Analytics Tool for Personal Science: Exploratory Study %A van de Belt,Tom H %A de Croon,Aimee %A Freriks,Faye %A Blomseth Christiansen,Thomas %A Eg Larsen,Jakob %A de Groot,Martijn %+ Health Innovation Labs, Radboud University Medical Center, Geert Grooteplein Noord 15, Nijmegen, 6525 EZ, Netherlands, 31 613424584, martijn.degroot@radboudumc.nl %K self-tracking %K personal science %K one-button-tracker %K barriers %K facilitators %K quantified self %K health promotion %K button tracker %K usability testing %K One Button Tracker %K health technology %K system usability %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals’ self-tracking of subjectively experienced phenomena related to health can be challenging, as current options for instrumentation often involve too much effort in the moment or rely on retrospective self-reporting, which is likely to impair accuracy and compliance. Objective: This study aims to assess the usability and perceived usefulness of low-effort, in-the-moment self-tracking using simple instrumentation and to establish the amount of support needed when using this approach. Methods: In this exploratory study, the One Button Tracker—a press-button device that records time stamps and durations of button presses—was used for self-tracking. A total of 13 employees of an academic medical center chose a personal research question and used the One Button Tracker to actively track specific subjectively experienced phenomena for 2 to 4 weeks. To assess usability and usefulness, we combined qualitative data from semistructured interviews with quantitative results from the System Usability Scale. Results: In total, 29 barriers and 15 facilitators for using the One Button Tracker were found. Ease of use was the most frequently mentioned facilitator. The One Button Tracker’s usability received a median System Usability Scale score of 75.0 (IQR 42.50), which is considered as good usability. Participants experienced effects such as an increased awareness of the tracked phenomenon, a confirmation of personal knowledge, a gain of insight, and behavior change. Support and guidance during all stages of the self-tracking process were judged as valuable. Conclusions: The low-effort, in-the-moment self-tracking of subjectively experienced phenomena has been shown to support personal knowledge gain and health behavior change for people with an interest in health promotion. After addressing barriers and formally validating the collected data, self-tracking devices may well be helpful for additional user types or health questions. %M 35230247 %R 10.2196/32704 %U https://formative.jmir.org/2022/3/e32704 %U https://doi.org/10.2196/32704 %U http://www.ncbi.nlm.nih.gov/pubmed/35230247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33635 %T Heart Rate Measurement Accuracy of Fitbit Charge 4 and Samsung Galaxy Watch Active2: Device Evaluation Study %A Nissen,Michael %A Slim,Syrine %A Jäger,Katharina %A Flaucher,Madeleine %A Huebner,Hanna %A Danzberger,Nina %A Fasching,Peter A %A Beckmann,Matthias W %A Gradl,Stefan %A Eskofier,Bjoern M %+ Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Schlossplatz 4, Erlangen, 91054, Germany, 49 913185 28990, michael.nissen@fau.de %K wearable validation %K heart rate validation %K Fitbit Charge 4 %K Samsung Galaxy Watch Active2 %K heart rate accuracy %K fitness tracker accuracy %K wearable accuracy %K wearable %K Fitbit %K heart rate %K fitness tracker %K fitness %K cardiovascular %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Fitness trackers and smart watches are frequently used to collect data in longitudinal medical studies. They allow continuous recording in real-life settings, potentially revealing previously uncaptured variabilities of biophysiological parameters and diseases. Adequate device accuracy is a prerequisite for meaningful research. Objective: This study aims to assess the heart rate recording accuracy in two previously unvalidated devices: Fitbit Charge 4 and Samsung Galaxy Watch Active2. Methods: Participants performed a study protocol comprising 5 resting and sedentary, 2 low-intensity, and 3 high-intensity exercise phases, lasting an average of 19 minutes 27 seconds. Participants wore two wearables simultaneously during all activities: Fitbit Charge 4 and Samsung Galaxy Watch Active2. Reference heart rate data were recorded using a medically certified Holter electrocardiogram. The data of the reference and evaluated devices were synchronized and compared at 1-second intervals. The mean, mean absolute error, mean absolute percentage error, Lin concordance correlation coefficient, Pearson correlation coefficient, and Bland-Altman plots were analyzed. Results: A total of 23 healthy adults (mean age 24.2, SD 4.6 years) participated in our study. Overall, and across all activities, the Fitbit Charge 4 slightly underestimated the heart rate, whereas the Samsung Galaxy Watch Active2 overestimated it (−1.66 beats per minute [bpm]/3.84 bpm). The Fitbit Charge 4 achieved a lower mean absolute error during resting and sedentary activities (seated rest: 7.8 vs 9.4; typing: 8.1 vs 11.6; laying down [left]: 7.2 vs 9.4; laying down [back]: 6.0 vs 8.6; and walking slowly: 6.8 vs 7.7 bpm), whereas the Samsung Galaxy Watch Active2 performed better during and after low- and high-intensity activities (standing up: 12.3 vs 9.0; walking fast: 6.1 vs 5.8; stairs: 8.8 vs 6.9; squats: 15.7 vs 6.1; resting: 9.6 vs 5.6 bpm). Conclusions: Device accuracy varied with activity. Overall, both devices achieved a mean absolute percentage error of just <10%. Thus, they were considered to produce valid results based on the limits established by previous work in the field. Neither device reached sufficient accuracy during seated rest or keyboard typing. Thus, both devices may be eligible for use in respective studies; however, researchers should consider their individual study requirements. %M 35230250 %R 10.2196/33635 %U https://formative.jmir.org/2022/3/e33635 %U https://doi.org/10.2196/33635 %U http://www.ncbi.nlm.nih.gov/pubmed/35230250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32230 %T Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study %A Zhang,Nasen Jonathan %A Rameau,Philippe %A Julemis,Marsophia %A Liu,Yan %A Solomon,Jeffrey %A Khan,Sundas %A McGinn,Thomas %A Richardson,Safiya %+ Northwell Health, 600 Community Dr, Manhasset, NY, 11020, United States, 1 (516) 470 3377, nasenz@gmail.com %K health informatics %K pulmonary embolism %K electronic health record %K quality improvement %K clinical decision support systems %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for the diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy. Objective: We aimed to create an automated process to calculate the Wells score for pulmonary embolism for patients in the ED, which could potentially reduce unnecessary CTPA testing. Methods: We designed an automated process using electronic health records data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Wells scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at 2 tertiary care hospitals in New York, over a 2-month period. To validate the automated process, the scores were compared to those derived from a 2-clinician chart review. Results: A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as “PE likely” by the automated process (126/202, 62%) had a PE prevalence of 15.9%, whereas those classified as “PE unlikely” (76/202, 38%; Wells score >4) had a PE prevalence of 7.9%. With respect to classification of the patient as “PE likely,” the automated process achieved an accuracy of 92.1% when compared with the chart review, with sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 90.5%, 94.4%, and 88.2%, respectively. Conclusions: This was a successful development and validation of an automated process using electronic health records data elements, including free-text fields, to classify risk for PE in ED visits. %M 35225812 %R 10.2196/32230 %U https://formative.jmir.org/2022/2/e32230 %U https://doi.org/10.2196/32230 %U http://www.ncbi.nlm.nih.gov/pubmed/35225812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32138 %T Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns %A Wrobel,Julia %A Silvasstar,Joshva %A Peterson,Roger %A Sumbundu,Kanku %A Kelley,Allyson %A Stephens,David %A Craig Rushing,Stephanie %A Bull,Sheana %+ Colorado School of Public Health, University of Colorado, 13001 East 17th Place, Mail Stop B119, Aurora, CO, 80045, United States, 1 307 724 4585, JULIA.WROBEL@cuanschutz.edu %K American Indian %K Alaska Native %K adolescent %K mental health %K help-seeking skills, text messaging %K mHealth, behavioral intervention %K user engagement %K feasibility %K engagement %K low-touch %K intervention %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods: The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results: Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions: This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 %M 35212633 %R 10.2196/32138 %U https://formative.jmir.org/2022/2/e32138 %U https://doi.org/10.2196/32138 %U http://www.ncbi.nlm.nih.gov/pubmed/35212633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35027 %T Identifying Health-Related Discussions of Cannabis Use on Twitter by Using a Medical Dictionary: Content Analysis of Tweets %A Allem,Jon-Patrick %A Majmundar,Anuja %A Dormanesh,Allison %A Donaldson,Scott I %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto Street, SSB 312D, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K cannabis %K marijuana %K Twitter %K social media %K adverse event %K cannabis safety %K dictionary %K rule-based classifier %K medical %K health-related %K conversation %K codebook %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The cannabis product and regulatory landscape is changing in the United States. Against the backdrop of these changes, there have been increasing reports on health-related motives for cannabis use and adverse events from its use. The use of social media data in monitoring cannabis-related health conversations may be useful to state- and federal-level regulatory agencies as they grapple with identifying cannabis safety signals in a comprehensive and scalable fashion. Objective: This study attempted to determine the extent to which a medical dictionary—the Unified Medical Language System Consumer Health Vocabulary—could identify cannabis-related motivations for use and health consequences of cannabis use based on Twitter posts in 2020. Methods: Twitter posts containing cannabis-related terms were obtained from January 1 to August 31, 2020. Each post from the sample (N=353,353) was classified into at least 1 of 17 a priori categories of common health-related topics by using a rule-based classifier. Each category was defined by the terms in the medical dictionary. A subsample of posts (n=1092) was then manually annotated to help validate the rule-based classifier and determine if each post pertained to health-related motivations for cannabis use, perceived adverse health effects from its use, or neither. Results: The validation process indicated that the medical dictionary could identify health-related conversations in 31.2% (341/1092) of posts. Specifically, 20.4% (223/1092) of posts were accurately identified as posts related to a health-related motivation for cannabis use, while 10.8% (118/1092) of posts were accurately identified as posts related to a health-related consequence from cannabis use. The health-related conversations about cannabis use included those about issues with the respiratory system, stress to the immune system, and gastrointestinal issues, among others. Conclusions: The mining of social media data may prove helpful in improving the surveillance of cannabis products and their adverse health effects. However, future research needs to develop and validate a dictionary and codebook that capture cannabis use–specific health conversations on Twitter. %M 35212637 %R 10.2196/35027 %U https://formative.jmir.org/2022/2/e35027 %U https://doi.org/10.2196/35027 %U http://www.ncbi.nlm.nih.gov/pubmed/35212637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34477 %T Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study %A Ben-Yehuda,Ofri %A Dreazen,Efrat %A Koren,Danny %A Peleg,Mor %+ Department of Information Systems, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 048288509, morpeleg@is.haifa.ac.il %K mobile health %K mHealth %K eHealth %K telehealth %K mental health %K mental resilience %K participatory design %K mobile phone %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app’s content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others. %M 35212631 %R 10.2196/34477 %U https://formative.jmir.org/2022/2/e34477 %U https://doi.org/10.2196/34477 %U http://www.ncbi.nlm.nih.gov/pubmed/35212631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32664 %T Patient Digital Health Technologies to Support Primary Care Across Clinical Contexts: Survey of Primary Care Providers, Behavioral Health Consultants, and Nurses %A Zaslavsky,Oleg %A Chu,Frances %A Renn,Brenna N %+ School of Nursing, University of Washington, 1959 Pacific Ave, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K survey %K primary care %K acceptance %K nurses %K primary care providers %K behavioral health consultants %K mobile health %K technology %K health promotion %K attitudes %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored. Objective: The purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations. Methods: We surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients’ health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research. Results: Most of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type). Conclusions: The survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations. %M 35212642 %R 10.2196/32664 %U https://formative.jmir.org/2022/2/e32664 %U https://doi.org/10.2196/32664 %U http://www.ncbi.nlm.nih.gov/pubmed/35212642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33636 %T A Smartphone-Based Information Communication Technology Solution for Primary Modifiable Risk Factors for Noncommunicable Diseases: Pilot and Feasibility Study in Norway %A Gram,Inger Torhild %A Skeie,Guri %A Oyeyemi,Sunday Oluwafemi %A Borch,Kristin Benjaminsen %A Hopstock,Laila Arnesdatter %A Løchen,Maja-Lisa %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Forskningsparken i Breivika, 3rd floor, Sykehusvn. 23, Tromsø, 9019, Norway, 47 92401177, inger.gram@ehealthresearch.no %K eHealth %K feasibility study %K modifiable risk factor %K noncommunicable disease %K pilot study %K smartphone-based information communication technology solution %K short text message service %K feasibility %K risk %K factor %K information communication technology %K smartphone %K development %K monitoring %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the 4 main noncommunicable diseases. These noncommunicable diseases share 4 modifiable risk factors (tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet). Short smartphone surveys have the potential to identify modifiable risk factors for individuals to monitor trends. Objective: We aimed to pilot a smartphone-based information communication technology solution to collect nationally representative data, annually, on 4 modifiable risk factors. Methods: We developed an information communication technology solution with functionalities for capturing sensitive data from smartphones, receiving, and handling data in accordance with general data protection regulations. The main survey comprised 26 questions: 8 on socioeconomic factors, 17 on the 4 risk factors, and 1 about current or previous noncommunicable diseases. For answers to the continuous questions, a keyboard was displayed for entering numbers; there were preset upper and lower limits for acceptable response values. For categorical questions, pull-down menus with response options were displayed. The second survey comprised 9 yes-or-no questions. For both surveys, we used SMS text messaging. For the main survey, we invited 11,000 individuals, aged 16 to 69 years, selected randomly from the Norwegian National Population Registry (1000 from each of the 11 counties). For the second survey, we invited a random sample of 100 individuals from each county who had not responded to the main survey. All data, except county of residence, were self-reported. We calculated the distribution for socioeconomic background, tobacco use, diet, physical activity, and health condition factors overall and by sex. Results: The response rate was 21.9% (2303/11,000; women: 1397/2263; 61.7%, men: 866/2263, 38.3%; missing: 40/2303, 1.7%). The median age for men was 52 years (IQR 40-61); the median age for women was 48 years (IQR 35-58). The main reported reason for nonparticipation in the main survey was that the sender of the initial SMS was unknown. Conclusions: We successfully developed and piloted a smartphone-based information communication technology solution for collecting data on the 4 modifiable risk factors for the 4 main noncommunicable diseases. Approximately 1 in 5 invitees responded; thus, these data may not be nationally representative. The smartphone-based information communication technology solution should be further developed with the long-term goal to reduce premature mortality from the 4 main noncommunicable diseases. %M 35212636 %R 10.2196/33636 %U https://formative.jmir.org/2022/2/e33636 %U https://doi.org/10.2196/33636 %U http://www.ncbi.nlm.nih.gov/pubmed/35212636 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32428 %T Understanding the Needs of a Mobile Phone–Based Telemonitoring Program for Pregnant Women at High Risk for Pre-Eclampsia: Interpretive Qualitative Description Study %A Feroz,Anam Shahil %A De Vera,Kristina %A D Bragagnolo,Nadia %A Saleem,Sarah %A Bhutta,Zulfiqar %A Seto,Emily %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 6478676702, anam.shahil@mail.utoronto.ca %K telemonitoring %K pre-eclampsia %K qualitative study %K Pakistan %K pregnant women at high risk %K low- to middle-income country %K pregnant %K pregnancy %K women %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan. Objective: This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone–based TM program. Methods: An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone–based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique. Results: The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one’s health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding the adoption of a TM program, including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives. Conclusions: Our findings highlight the perceived feasibility of a mobile phone–based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs. %M 35200152 %R 10.2196/32428 %U https://formative.jmir.org/2022/2/e32428 %U https://doi.org/10.2196/32428 %U http://www.ncbi.nlm.nih.gov/pubmed/35200152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27501 %T Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study %A Stocks,Jacob %A Choi,Yujung %A Ibrahim,Saduma %A Huchko,Megan %+ Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 681 7760, jacob_stocks@med.unc.edu %K mHealth %K cervical cancer screening %K Kenya %K HPV testing %K user-testing %K community health volunteers %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs. %M 35200151 %R 10.2196/27501 %U https://formative.jmir.org/2022/2/e27501 %U https://doi.org/10.2196/27501 %U http://www.ncbi.nlm.nih.gov/pubmed/35200151 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32613 %T Persuasive Technologies and Social Interactions in Professional Environments: Embedded Qualitative Case Study %A Marcolin,Barb %A Saunders,Chad %A Aubert,Benoit %+ Faculty of Management, The University of British Columbia, Okanagan Campus, 1137 Alumni Avenue, EME4113, Kelowna, BC, V1V 1V7, Canada, 1 250 300 9731, barb.marcolin@ubc.ca %K persuasive technology %K patient experience platforms %K group effects %K professional work management %K services co-design %K self-management %K health and wellness outcomes %K social environments %K work influence %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although previous studies have highlighted the impact of interactions on the web in the context of patient–health care professional (HCP) dyads, this paper extends that context to a triad that includes the role of employers and associated settings with social groups. Objective: This study aims to evaluate how the interactions between individuals and the social use of the platform affect individuals’ use of persuasive technology and, in turn, their work environment actions and responses, by implementing a persuasive technology health and wellness platform in a work environment. Methods: For 8 months, we deployed a persuasive technology platform with different combinations of health-related features and content in 1 embedded case design with 8 fire stations for a small Canadian city (total number of participant firefighters, n=141) assigned to 1 of 2 treatments—interactive or static webpages. We used text-based content analysis techniques for outcome measures, drawn from a total of 29 participant exit interviews. In addition, medical assessments were conducted at baseline, midpoint, and end point by 7 HCPs and 1 researcher (BM), who also served as the data steward and managed the study. Results: Our results reveal that group, social, and work influences introduce new elements to the use of persuasive technology, which interact to foster higher levels of individual success. The platform in our study served as part of a larger social system, providing information that facilitated new behaviors at work and home. The 8-month group programs centered on exercise, nutrition, and smoking cessation. Groups of participants coached by certified professionals showed significant increases in sodium awareness, levels of actual exercise, and consistency of activities. As a result of the study, of 141 people, 15 (10.6%) were notified of serious medical health issues and 29 (20.6%) underwent blood work assessments and a privacy shield (protected by federal law) was enacted to protect employees from losing their employment based on any health concerns disclosed. Conclusions: The persuasive technology platform, in combination with self-management and professional management and social interactions, significantly altered work management behaviors. Interactions among individual outcomes, group influences, and social situations strongly influenced individuals’ behaviors in their work and home environments. Three things further improved the positive results that we observed: privacy shields (which allowed employees to reveal health concerns without fear of professional consequences), individual private activities aligned with group activities, and integration between HCP work with localized, organizational work roles. %M 35195527 %R 10.2196/32613 %U https://formative.jmir.org/2022/2/e32613 %U https://doi.org/10.2196/32613 %U http://www.ncbi.nlm.nih.gov/pubmed/35195527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31807 %T Importance of Getting Enough Sleep and Daily Activity Data to Assess Variability: Longitudinal Observational Study %A Óskarsdóttir,María %A Islind,Anna Sigridur %A August,Elias %A Arnardóttir,Erna Sif %A Patou,François %A Maier,Anja M %+ Department of Computer Science, Reykjavík University, Menntavegur 1, Reykjavík, 102, Iceland, 354 5996326, mariaoskars@ru.is %K wearable technology %K nearable technology %K internet of health care things %K sleep %K Withings %K study duration %K establishing standards %K seasonality %K mHealth %K digital health %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The gold standard measurement for recording sleep is polysomnography performed in a hospital environment for 1 night. This requires individuals to sleep with a device and several sensors attached to their face, scalp, and body, which is both cumbersome and expensive. Self-trackers, such as wearable sensors (eg, smartwatch) and nearable sensors (eg, sleep mattress), can measure a broad range of physiological parameters related to free-living sleep conditions; however, the optimal duration of such a self-tracker measurement is not known. For such free-living sleep studies with actigraphy, 3 to 14 days of data collection are typically used. Objective: The primary goal of this study is to investigate if 3 to 14 days of sleep data collection is sufficient while using self-trackers. The secondary goal is to investigate whether there is a relationship among sleep quality, physical activity, and heart rate. Specifically, we study whether individuals who exhibit similar activity can be clustered together and to what extent the sleep patterns of individuals in relation to seasonality vary. Methods: Data on sleep, physical activity, and heart rate were collected over 6 months from 54 individuals aged 52 to 86 years. The Withings Aura sleep mattress (nearable; Withings Inc) and Withings Steel HR smartwatch (wearable; Withings Inc) were used. At the individual level, we investigated the consistency of various physical activities and sleep metrics over different time spans to illustrate how sensor data from self-trackers can be used to illuminate trends. We used exploratory data analysis and unsupervised machine learning at both the cohort and individual levels. Results: Significant variability in standard metrics of sleep quality was found between different periods throughout the study. We showed specifically that to obtain more robust individual assessments of sleep and physical activity patterns through self-trackers, an evaluation period of >3 to 14 days is necessary. In addition, we found seasonal patterns in sleep data related to the changing of the clock for daylight saving time. Conclusions: We demonstrate that >2 months’ worth of self-tracking data are needed to provide a representative summary of daily activity and sleep patterns. By doing so, we challenge the current standard of 3 to 14 days for sleep quality assessment and call for the rethinking of standards when collecting data for research purposes. Seasonal patterns and daylight saving time clock change are also important aspects that need to be taken into consideration when choosing a period for collecting data and designing studies on sleep. Furthermore, we suggest using self-trackers (wearable and nearable ones) to support longer-term evaluations of sleep and physical activity for research purposes and, possibly, clinical purposes in the future. %M 35191850 %R 10.2196/31807 %U https://formative.jmir.org/2022/2/e31807 %U https://doi.org/10.2196/31807 %U http://www.ncbi.nlm.nih.gov/pubmed/35191850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30527 %T Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study %A Frennert,Susanne %A Erlingsdóttir,Gudbjörg %A Muhic,Mirella %A Rydenfält,Christofer %A Milos Nymberg,Veronica %A Ekman,Björn %+ Department of Design Sciences, Lund University, Ingvar Kamprad Designcentrum, Sölvegatan 26, Lund, 223 62, Sweden, 46 2220195, susanne.frennert@design.lth.se %K digital patient management platform %K primary care %K normalization process theory coherence %K cognitive participation %K collective action %K reflexive monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input. Objective: This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods: HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis. Results: The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures. Conclusions: Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice. %M 35191845 %R 10.2196/30527 %U https://formative.jmir.org/2022/2/e30527 %U https://doi.org/10.2196/30527 %U http://www.ncbi.nlm.nih.gov/pubmed/35191845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31089 %T Exploring Deeper Causes Linking Adolescents’ Mental Disorders to Mobile Phone Use Problems: Grounded Theory Approach %A Sun,Zeyuan %A Zhou,Yue %A Zhang,Yinan %A Gui,Bing %A Liu,Zhenmi %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 18116636482, zhenmiliu@scu.edu.cn %K mobile phone use %K adolescent health %K mental disorder %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence from a variety of studies link mobile phone use with an increase in mental health problems, with the situation being particularly prevalent in China and exacerbated by the COVID-19 quarantine. Objective: This study aims to reveal underlying connections between mobile phone use and mental disorders of adolescents, and to develop a theory to help parents and counseling psychologists better understand and intervene in future cases. Methods: A total of 37 teenagers having both mental health and mobile phone use problems, along with their parents, were included for individual interviews. These interviews were transcribed, coded, and analyzed using qualitative methods of grounded theory. Results: The grades-ranking-first mentality is one of the main factors causing problems such as defective family bonding and peer influences, pushing teenagers with mental disorders to seek comfort in the virtual world through their cellphones. Conclusions: The idea proposed in this study is not only inspiring for psychological counseling and therapy on adolescents with mental problems but also beneficial for school educators and parents to better understand the adolescents. The findings of the study are also particularly noteworthy in the postpandemic age, where parents whose work locations and schedules are substantially affected due to any emergencies should try to build a relaxing and cozy atmosphere at home to avoid possible conflicts with adolescents. %M 35188470 %R 10.2196/31089 %U https://formative.jmir.org/2022/2/e31089 %U https://doi.org/10.2196/31089 %U http://www.ncbi.nlm.nih.gov/pubmed/35188470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30974 %T Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study %A Williams,Victoria %A Brown,Nashira %A Moore,Justin Xavier %A Farrell,David %A Perumean-Chaney,Suzanne %A Schleicher,Erica %A Fontaine,Kevin %A Demark-Wahnefried,Wendy %A Pekmezi,Dori %+ Department of Health Behavior, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35233, United States, 1 205 934 4993, contact@drvaw.com %K cancer survivors %K diet %K exercise %K lifestyle %K internet %K physical activity %K web-based %K website %K weight management %K digital health %K cancer %K online health %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. Objective: The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. Methods: A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants’ gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann–Whitney U tests were used to compare demographic factors on website use. Results: Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). Conclusions: Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity. %M 35188468 %R 10.2196/30974 %U https://formative.jmir.org/2022/2/e30974 %U https://doi.org/10.2196/30974 %U http://www.ncbi.nlm.nih.gov/pubmed/35188468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34889 %T A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study %A Leo,Ashwin J %A Schuelke,Matthew J %A Hunt,Devyani M %A Metzler,John P %A Miller,J Philip %A Areán,Patricia A %A Armbrecht,Melissa A %A Cheng,Abby L %+ Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Washington University in St Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO, 63110, United States, 1 3147472823, chengal@wustl.edu %K digital health %K mental health %K depression %K anxiety %K chronic pain %K musculoskeletal %K orthopedic %K pain management %K health intervention %K mobile phone %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms of depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. However, mental health intervention is not yet a routine part of standard orthopedic treatment, in part because of access-related barriers. Digital mental health intervention is a potential scalable resource that could be feasibly incorporated into orthopedic care. Objective: This study’s primary purpose was to assess the feasibility of introducing a digital mental health intervention (Wysa) in an outpatient orthopedic setting to patients with coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. Methods: In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a nonsurgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression and/or Anxiety score ≥55). Face-to-face enrollment was performed by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided 2 months of access to a mobile app called Wysa, which is an established, multicomponent digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation–based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engagement with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at 2-month follow-up between high and low Wysa users, defined by a median split. Results: The recruitment rate was 29.3% (61/208), retention rate was 84% (51/61), and engagement rate was 72% (44/61). Compared to low users, high users reported greater improvement in PROMIS Anxiety scores (between-group difference −4.2 points, 95% CI −8.1 to −0.2; P=.04) at the 2-month follow-up. Between-group differences in PROMIS Depression (−3.2 points, 95% CI −7.5 to 1.2; P=.15) and Pain Interference scores (−2.3 points, 95% CI −6.3 to 1.7; P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function scores were comparable between groups. Conclusions: Delivery of a digital mental health intervention within the context of orthopedic care is feasible and has the potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. Trial Registration: ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090 %M 35039278 %R 10.2196/34889 %U https://formative.jmir.org/2022/2/e34889 %U https://doi.org/10.2196/34889 %U http://www.ncbi.nlm.nih.gov/pubmed/35039278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30973 %T Use of Live Community Events on Facebook to Share Health and Clinical Research Information With a Minnesota Statewide Community: Exploratory Study %A Cha,Jinhee %A West,Ian W %A Brockman,Tabetha A %A Soto,Miguel Valdez %A Balls-Berry,Joyce E %A Eder,Milton %A Patten,Christi A %A Cohen,Elisia L %+ Clinical and Translational Science Institute, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, United States, 1 612 625 2874, cha00003@umn.edu %K social media %K virtual %K digital %K community engagement %K engagement %K retention %K Facebook %K health information %K information sharing %K communication %K participation %K retention %K eHealth %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Community engagement can make a substantial difference in health outcomes and strengthen the capacity to deal with disruptive public health events such as the COVID-19 pandemic. Social media platforms such as Facebook are a promising avenue to reach the broader public and enhance access to clinical and translational science, and require further evaluation from the scientific community. Objective: This study aims to describe the use of live community events to enhance communication about clinical and health research through a Facebook platform case study (Minnesota [MN] Research Link) with a Minnesota statewide community. We examined variables associated with video engagement including video length and type of posting. Methods: From June 2019 to February 2021, MN Research Link streamed 38 live community events on its public Facebook page, MN Research Link. Live community events highlighted different investigators’ clinical and health research in the areas of mental health, health and wellness, chronic diseases, and immunology/infectious diseases. Facebook analytics were used to determine the number of views, total minutes viewed, engagement metrics, and audience retention. An engagement rate was calculated by the total number of interactions (likes, shares, and comments) divided by the total length of the live event by the type of live community event. Results: The 38 live community events averaged 23 minutes and 1 second in duration. The total time viewed for all 38 videos was 10 hours, 44 minutes, and 40 seconds. Viewers’ watch time averaged 23 seconds of content per video. After adjusting for video length, promotional videos and research presentations had the highest engagement and retention rates. Events that included audience participation did not have higher retention rates compared to events without audience participation. Conclusions: The use of live community events showed adequate levels of engagement from participants. A view time of 23 seconds on average per video suggests that short informational videos engage viewers of clinical and translational science content. Live community events on Facebook can be an effective method of advancing health promotion and clinical and translational science content; however, certain types of events have more impact on engagement than others. %M 35179514 %R 10.2196/30973 %U https://formative.jmir.org/2022/2/e30973 %U https://doi.org/10.2196/30973 %U http://www.ncbi.nlm.nih.gov/pubmed/35179514 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30108 %T The Attitudes of Egyptian Web-Based Health Information Seekers Toward Health Information Provided Through the Internet: Qualitative Study %A Ghweeba,Mayada %A Lindenmeyer,Antje %A Shishi,Sobhi %A Waheed,Amani %A Kofi,Mostafa %A Amer,Shaymaa %+ Institute of Clinical Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 (0)121 414 5390, a.lindenmeyer@bham.ac.uk %K Egyptian internet users %K online health information %K doctor–patient relationship %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet has become an established source of health information for many Egyptian internet users. Understanding users’ attitudes toward the benefits and limitations of web-based health information will explain the influence of this information on users’ health-related behavior and decisions. Objective: This qualitative study aims to understand the attitude of Egyptian internet users toward internet health information and to explore the impact of obtained health information on users’ behavior and on their physician-patient relationship. Methods: For this qualitative study, semistructured interviews were conducted with a total of 49 participants (41/49, 84% Egyptian internet users and 8/49, 16% physicians) who participated in focus groups or individual interviews. We used a thematic analysis approach to explain and demonstrate participants’ views, thoughts, and experiences in using web-based health information. Results: The internet has become an important source of health information in comparison with other health information sources and is the central theme that has emerged across the thematic analysis. The attitude toward the use of internet health was classified into three main themes: feeling toward web-based health information (with subthemes: favoring, disliking, neutral, or having ambivalence feelings), motivators to seek internet health information, and behavioral changes using internet health information (subthemes: confidence, satisfaction, and improved knowledge). Themes that emerged from physicians’ interviews included the accessibility of the internet health information, good communication, and coordination of care between patients and their physicians, and the active engagement of patients with their management plan. Conclusions: The internet has become an essential source of health information for Egyptian adults. Internet health information can improve the patient-physician relationship, especially when users discuss the obtained health information with their physician. Internet health information provided seekers with social support and self-confidence when making health decisions. %M 35179505 %R 10.2196/30108 %U https://formative.jmir.org/2022/2/e30108 %U https://doi.org/10.2196/30108 %U http://www.ncbi.nlm.nih.gov/pubmed/35179505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28979 %T Telehealth Adoption and Discontinuation by US Hospitals: Results From 2 Quasi-Natural Experiments %A Baird,Aaron %A Cheng,Yichen %A Xia,Yusen %+ Institute of Health Administration, Georgia State University, 35 Broad Street, Suite 805, Atlanta, GA, 30303-3083, United States, 1 4044137639, abaird@gsu.edu %K telehealth %K hospitals %K adoption %K discontinuation %K health information system %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. To our knowledge, a larger-scale, national-level (US) study has yet to be conducted on the causal impacts of hospital telehealth adoption as well as discontinuation. Objective: The aim of this study is to understand the causal impact of US hospital telehealth adoption or discontinuation on hospital performance from 2016 to 2018. Methods: We analyzed impacts of telehealth adoption or discontinuation by US hospitals on emergency department visits, total ambulatory visits (minus emergency department visits), outpatient services revenue, total facility expenses, and total hospital revenue for the 2016-2018 period. We specifically focused on performance effects for hospitals that switched from not having telehealth to adopting telehealth, or vice versa, during the 2016-2018 period, thus exploiting 2 quasi-natural experiments. We applied a difference-in-differences research design to each of the 2 main analyses. We compared hospitals that have made a telehealth change to groups of hospitals with similar characteristics that did not make a telehealth change, which established a counterfactual. To appropriately match hospitals between treatment and control groups, we applied propensity score matching. Our primary data were from the American Hospital Association Annual Survey and the Healthcare Cost Report Information System data. Several control variables were obtained from additional sources, including the Area Health Resource File and the Federal Communications Commission. Results: We found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P<.001), and increased hospital revenue (P=.004) compared with the control group. We found that telehealth discontinuation during the same period resulted in, on average, decreased outpatient services revenue (P=.02) compared with the control group. Conclusions: Our findings suggest that telehealth adoption increases use but has mixed impacts on performance, given that cost and revenue increase. However, once telehealth is offered, removing it can have a negative impact on performance, implying that returning to prior performance levels, if telehealth is removed, may be challenging. %M 35179503 %R 10.2196/28979 %U https://formative.jmir.org/2022/2/e28979 %U https://doi.org/10.2196/28979 %U http://www.ncbi.nlm.nih.gov/pubmed/35179503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28342 %T Determining Priorities in the Aboriginal and Islander Mental Health Initiative for Youth App Second Phase Participatory Design Project: Qualitative Study and Narrative Literature Review %A Povey,Josie %A Sweet,Michelle %A Nagel,Tricia %A Lowell,Anne %A Shand,Fiona %A Vigona,Jahdai %A Dingwall,Kylie M %+ Menzies School of Health Research, Charles Darwin University, Red 9 CDU Campus, Casuarina, 0820, Australia, 61 8 8946 8487, josie.povey@menzies.edu.au %K Aboriginal and Torres Strait Islander %K young people %K digital mental health %K app %K participatory design %K decision-making %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health tools can promote access to culturally safe early intervention mental health services for Aboriginal and Torres Strait Islander young people. Participatory design methodology facilitates user engagement in the co-design of digital resources. However, several challenges have been identified that limit the methodological rigor of this approach. Objective: This paper aims to present an in-depth account of the second phase of participatory design in the development of the Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app. Methods: A first idea storyboard, generated from a formative phase of the AIMhi-Y project, was refined through a series of youth co-design workshops and meetings. A narrative review of the literature, 6 service provider interviews, and engagement with an expert reference group also informed the design process. Generative design activities, storyboarding, discussions, and voting strategies were used. Results: The participatory design process identified the app features preferred by young people and service providers and assessed their alignment with current recommendations from the scientific literature. Findings from the co-design process are presented across 9 app characteristic domains. Integration of findings into app design proved complex. Although most preferred features identified by young people were included to some degree, other inclusions were restricted by budget, time, and the need to integrate best practice recommendations. A process of prioritization was required. Conclusions: Participatory design is often cited in the development of digital mental health resources; however, methods are diverse and often lack detailed descriptions. This study reports the outcomes and strategies used to determine priorities in the second phase of the development of the AIMhi-Y app. We provide an example and the key learnings to inform others seeking to use participatory design with a similar cohort. %M 35179498 %R 10.2196/28342 %U https://formative.jmir.org/2022/2/e28342 %U https://doi.org/10.2196/28342 %U http://www.ncbi.nlm.nih.gov/pubmed/35179498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34237 %T Asynchronous Remote Assessment for Cognitive Impairment: Reliability Verification of the Neurotrack Cognitive Battery %A Myers,Jennifer Rae %A Glenn,Jordan M %A Madero,Erica N %A Anderson,John %A Mak-McCully,Rachel %A Gray,Michelle %A Gills,Joshua L %A Harrison,John E %+ Neurotrack Technologies Inc, 399 Bradford St. #101, Redwood City, CA, 21216, United States, 1 650 549 8566, jennifer@neurotrack.com %K cognition %K screening %K remote testing %K psychometric %K challenge %K validation %K assessment %K impairment %K access %K reliability %K stability %K testing %K utility %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As evidenced by the further reduction in access to testing during the COVID-19 pandemic, there is an urgent, growing need for remote cognitive assessment for individuals with cognitive impairment. The Neurotrack Cognitive Battery (NCB), our response to this need, was evaluated for its temporal reliability and stability as part of ongoing validation testing. Objective: The aim of this study is to assess the temporal reliability of the NCB tests (5 total) across a 1-week period and to determine the temporal stability of these measures across 3 consecutive administrations in a single day. Methods: For test-retest reliability, a range of 29-66 cognitively healthy participants (ages 18-68 years) completed each cognitive assessment twice, 1 week apart. In a separate study, temporal stability was assessed using data collected from 31 different cognitively healthy participants at 3 consecutive timepoints in a single day. Results: Correlations for the assessments were between 0.72 and 0.83, exceeding the standard acceptable threshold of 0.70 for temporal reliability. Intraclass correlations ranged from 0.60 to 0.84, indicating moderate to good temporal stability. Conclusions: These results highlight the NCB as a brief, easy-to-administer, and reliable assessment for remote cognitive testing. Additional validation research is underway to determine the full magnitude of the clinical utility of the NCB. %M 35179511 %R 10.2196/34237 %U https://formative.jmir.org/2022/2/e34237 %U https://doi.org/10.2196/34237 %U http://www.ncbi.nlm.nih.gov/pubmed/35179511 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33603 %T Consistency With and Disengagement From Self-monitoring of Weight, Dietary Intake, and Physical Activity in a Technology-Based Weight Loss Program: Exploratory Study %A Carpenter,Chelsea A %A Eastman,Abraham %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 (352) 294 8433, kmross@phhp.ufl.edu %K self-monitoring %K adherence %K weight loss %K digital tools %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant consistency and disengagement with these tools. Objective: This study characterizes the consistency of use and time to disengagement with digital self-monitoring tools during a 6-month weight loss intervention and investigates whether the provision of phone-based intervention improved self-monitoring adherence. Methods: Participants were 54 adults with overweight or obesity (mean age 49.6 years, SD 12.4 years; mean BMI 32.6 kg/m2, SD 3.2 kg/m2) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone app), with and without additional interventionist contact, on weight loss. All participants received weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants adhered to self-monitoring recommendations (7 out of 7 days). Disengagement was defined as the first of 2 consecutive weeks that the 7-day self-monitoring adherence goal was not met. Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral targets. t tests (2-tailed) and Cox proportional hazards models were used to examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss. Results: Participants consistently self-monitored physical activity for more weeks (mean 17.4 weeks, SD 8.5 weeks) than weight (mean 11.1 weeks, SD 8.5 weeks) or dietary intake (mean 10.8 weeks, SD 8.7 weeks; P<.05). Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks; P<.001). Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared with participants who did not (P=.006); however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity (P=.24 and P=.25, respectively). Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake (P<.001 and P=.004, respectively) but not for physical activity (P=.57). Conclusions: Results demonstrated that self-monitoring adherence differed by behavioral target, with greater consistency and longer time to disengagement associated with lower-burden tools (ie, self-monitoring of physical activity). Consistent with supportive accountability theory, additional interventionist contact improved consistency and lengthened time to disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools. %M 35179513 %R 10.2196/33603 %U https://formative.jmir.org/2022/2/e33603 %U https://doi.org/10.2196/33603 %U http://www.ncbi.nlm.nih.gov/pubmed/35179513 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28913 %T The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial %A Sassenberg,Kai %A Roesel,Inka %A Sudeck,Gorden %A Bernecker,Katharina %A Durst,Jennifer %A Krauss,Inga %+ Social Processes Lab, Leibniz-Institut für Wissensmedien, Schleichstrasse 6, Tübingen, 72076, Germany, 49 7071 979 220, k.sassenberg@iwm-tuebingen.de %K mobile app %K exercise %K mastery experience %K self-efficacy %K attitudes toward technology %K osteoarthritis %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise. Objective: This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment. Methods: Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session. Results: In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology. Conclusions: The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments. Trial Registration: German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759 %M 35179500 %R 10.2196/28913 %U https://formative.jmir.org/2022/2/e28913 %U https://doi.org/10.2196/28913 %U http://www.ncbi.nlm.nih.gov/pubmed/35179500 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32716 %T Think-Aloud Testing of a Novel Safer Drinking App for College Students During COVID-19: Usability Study %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Biegger,Grace %A Frederick,Christina %A Halbert,Jennifer P %A Ingersoll,Karen S %+ Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K app development %K college binge drinking %K think aloud testing %K formative research %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption, and binge drinking in particular, continues to be common among college students, posing the greatest risk for their health and safety. Despite widespread exposure to evidence-based preventive interventions among US undergraduates, only modest and temporary effects on risky drinking occur. Formative studies have demonstrated that students want a more engaging intervention tool for risky drinking that can be used just in time. Objective: The purpose of this study is to test the appeal, relevance, and perceived utility of a draft mobile app for safer student drinking at a public university in Virginia. Methods: Undergraduate student participants tested the draft mobile app via a web-based prototype that tailors to individual feedback with hot spots that responded to their taps to mimic app functionality. They narrated their impressions, navigation, and comments in a standardized think-aloud procedure. After each round of think-aloud interviews, researchers debriefed the investigators and developers to discuss findings and brainstorm app modifications. Results: Minor changes to the functionality and aesthetics would improve usability of the app (eg, option for light mode in app settings). Student testers recommended tailoring the app to the needs of college students and to aspects of the local university’s drinking culture. Conclusions: Findings from this study will be synthesized with information gained from other formative work to determine the final app features. We will test the app in a pilot randomized trial to assess app use and the impact of the app on college student drinking behavior over several months. %M 35175210 %R 10.2196/32716 %U https://formative.jmir.org/2022/2/e32716 %U https://doi.org/10.2196/32716 %U http://www.ncbi.nlm.nih.gov/pubmed/35175210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30489 %T Online Cognitive Behavioral Therapy (CBT) Life Skills Program for Depression: Pilot Randomized Controlled Trial %A Williams,Christopher %A McClay,Carrie-Anne %A Martinez,Rebeca %A Morrison,Jill %A Haig,Caroline %A Jones,Ray %A Farrand,Paul %+ Institute of Health and Wellbeing, University of Glasgow, Mental Health and Wellbeing, Gartnavel Royal Hospital, Administration building, 1st floor, General Office, Glasgow, G12 0XH, United Kingdom, 44 141 330 3299, chris.williams@glasgow.ac.uk %K pilot study %K depression %K low mood %K iCBT %K guided self-help %K online %K psychotherapy %K LLTTF %K RCT %K treatment gap %K bibliotherapy %K life skills %K anxiety %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a common mental health problem with significant personal and social consequences. Studies have suggested that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety when delivered one-to-one by an expert practitioner, but access to this talking therapy is often limited, and waiting lists can be long. However, a range of low-intensity interventions that can increase access to services are available including guided CBT self-help materials delivered via books, classes, and online packages. Objective: This project aimed to pilot a randomized controlled trial (RCT) of an online CBT-based life skills course with community-based individuals experiencing depression. Methods: Individuals with symptoms of depression were recruited directly from the community via newspaper advertisements. Participants were remotely randomized to receive either immediate access (IA) or delayed access (DA) to a research version of the Living Life to the Full online CBT-based life skills package (3rd edition) with telephone support provided by nonspecialist, charity-based workers while they used the online intervention. The primary end point was at 3 months postrandomization, at which point, the DA group were offered the intervention. Levels of depression, anxiety, social functioning, and satisfaction were assessed. Results: There were effective recruitment, randomization, and uptake, with 19 IA and 17 DA control participants entering the pilot study via newspaper advertisements and 13 of the 19 participants taking up the intervention. Overall, 72% (26/36) were not currently under the care of their general practitioner. The online package was acceptable to participants; the mean satisfaction score on the Client Satisfaction Questionnaire was 21 out of 32 (SD 8.89). At 3 months, data collection was achieved from 78% (28/36) of the participants. The efficacy and retention data were used for a power calculation indicating that 72 participants in total will be required for a future substantive RCT. Conclusions: The research design successfully tested the recruitment, data collection, and intervention delivery. The pilot study has provided data for the required sample size for the full RCT. Trial Registration: ISRCTN registry ISRCTN12890709; https://doi.org/10.1186/ISRCTN12890709 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1336-y %M 35175203 %R 10.2196/30489 %U https://formative.jmir.org/2022/2/e30489 %U https://doi.org/10.2196/30489 %U http://www.ncbi.nlm.nih.gov/pubmed/35175203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32312 %T Digital Companion Choice to Support Teachers’ Stress Self-management: Systematic Approach Through Taxonomy Creation %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %+ Interaction Centre, Department of Computer Science, University College London, 2nd Floor, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 07973312358, j.manning.17@ucl.ac.uk %K digital technology %K digital health %K psychological treatment %K stress %K self-management %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies. Objective: The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers’ stress self-management. Methods: We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3. Results: First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions’ mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop. Conclusions: The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context. %M 35171106 %R 10.2196/32312 %U https://formative.jmir.org/2022/2/e32312 %U https://doi.org/10.2196/32312 %U http://www.ncbi.nlm.nih.gov/pubmed/35171106 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29179 %T Effects of Game Mode in Multiplayer Video Games on Intergenerational Social Interaction: Randomized Field Study %A Zahn,Carmen %A Leisner,David %A Niederhauser,Mario %A Roos,Anna-Lena %A Iseli,Tabea %A Soldati,Marco %+ School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, CH-4600, Switzerland, 41 (0)629572473, carmen.zahn@fhnw.ch %K video games %K computer games %K older adults %K game mode %K serious game %K social interaction %K video analysis methods %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining social relationships is a basic human need and particularly essential in old age, including when living in a retirement home. Multiplayer video games can promote positive social interactions among players from different generations while playing. Yet, such facilitation of positive social interactions depends on specific game design. To systematically investigate the effects of game design on social interaction between seniors and their coplayers, the game Myosotis FoodPlanet was developed in this study, and the impacts of 3 different game modes on social interaction were compared in a controlled field trial. Objective: This study aims to compare the effects of 3 different game modes (competitive, cooperative, and creative) on social interactions (verbal and nonverbal communication) between seniors and their younger coplayers. Methods: This study was conducted in a Swiss retirement home as a controlled field trial. Participants were residents of the retirement home (N=10; mean age 84.8 years, SD 5.9 years) and played in pairs with their caregivers. Each pair played 3 game modes in random order. This resulted in 30 game sequences of 20 minutes each. A within-subject design was applied with game mode as the within-factor and social interaction as the outcome variable. To assess the quality of social interaction, 30 video-recorded game sequences were analyzed based on an event sampling method. Results: Analysis of variance for repeated measurements revealed significant effects: there was significantly more verbal communication in the creative mode than in the cooperative mode (P=.04) with a strong effect size (Cohen f=0.611). An examination of verbal communication revealed more game-related communication in the creative mode than in the cooperative mode (P=.01) and the competitive mode (P=.09) with marginally significant effects and strong effect sizes (Cohen f=0.841). In addition, significantly more biography-related communication occurred in the creative mode than in the cooperative mode (P=.03), with a strong effect size (r=0.707). Regarding nonverbal communication (eg, laughing together), analysis of variance for repeated measurements showed significant differences among the game modes (P=.02) with a strong effect size (Cohen f=0.758). Results showed that there was significantly more laughing together in the competitive mode (competitive>cooperative>creative). Conclusions: The results show that game mode can be an important factor for shaping the social interactions of players playing together. Compared with other modes, creative game modes can increase verbal communication. In contrast, competitive modes may stimulate more laughing together. This has important implications for game design and the use of computer games to promote social interaction between seniors and their coplayers in practice. %M 35171097 %R 10.2196/29179 %U https://formative.jmir.org/2022/2/e29179 %U https://doi.org/10.2196/29179 %U http://www.ncbi.nlm.nih.gov/pubmed/35171097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33356 %T Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey %A Wright,Julie A %A Volkman,Julie E %A Leveille,Suzanne G %A Amante,Daniel J %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 5088568480, daniel.amante@umassmed.edu %K internet %K patient portal %K emerging adults %K portal %K predictor %K prediction %K sample %K cross-sectional %K survey %K usage %K young adult %K eHealth %K literacy %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. Objective: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. Methods: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. Results: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). Conclusions: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management. %M 35166686 %R 10.2196/33356 %U https://formative.jmir.org/2022/2/e33356 %U https://doi.org/10.2196/33356 %U http://www.ncbi.nlm.nih.gov/pubmed/35166686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32443 %T Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis %A Bachu,Vismaya S %A Mahjoub,Heba %A Holler,Albert E %A Crihalmeanu,Tudor %A Bachu,Dheevena M %A Ayyaswami,Varun %A Parker,Pearman D %A Prabhu,Arpan V %+ Department of Radiation Oncology, University of Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, 4130 Shuffield Dr, Little Rock, AR, 72205, United States, 1 5016644568, avprabhu@uams.edu %K COVID-19 %K COVID-19 pandemic %K health literacy %K readability %K QUEST %K online health information %K cross-sectional %K trend %K internet %K spread %K symptom %K quality %K United States %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. Objective: Our purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. Methods: We used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. Results: Exactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P<.05). The average reading level was 11.7 (SD 1.9, range 5.4-16.9). Only 3 (1.6%) articles were written at the recommended sixth grade level. Conclusions: COVID-19–related articles are vastly varied in their attributes and levels of bias, and would benefit from revisions for increased readability. %M 34995206 %R 10.2196/32443 %U https://formative.jmir.org/2022/2/e32443 %U https://doi.org/10.2196/32443 %U http://www.ncbi.nlm.nih.gov/pubmed/34995206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27866 %T Perceptions on the Use of Wearable Sensors and Continuous Monitoring in Surgical Patients: Interview Study Among Surgical Staff %A Joshi,Meera %A Archer,Stephanie %A Morbi,Abigail %A Ashrafian,Hutan %A Arora,Sonal %A Khan,Sadia %A Cooke,Graham %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 020 3312 6666, meera.joshi03@imperial.ac.uk %K staff feedback %K interview %K sensors %K continuous monitoring %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous vital sign monitoring by using wearable sensors may result in the earlier detection of patient deterioration and sepsis. Few studies have explored the perspectives of surgical team members on the use of such sensors in surgical patients. Objective: This study aims to understand the views of surgical team members regarding novel wearable sensors for surgical patients. Methods: Wearable sensors that monitor vital signs (heart rate, respiratory rate, and temperature) continuously were used by acute surgical patients. The opinions of surgical staff who were treating patients with these sensors were collated through in-depth semistructured interviews to thematic saturation. Interviews were audio recorded, transcribed, and analyzed via thematic analysis. Results: A total of 48 interviews were performed with senior and junior surgeons and senior and junior nurses. The main themes of interest that emerged from the interviews were (1) problems with current monitoring, (2) the anticipated impact of wearables on patient safety, (3) the impact on staff, (4) the impact on patients overall, (5) potential new changes, and (6) the future and views on technology. Conclusions: Overall, the feedback from staff who were continuously monitoring surgical patients via wearable sensors was positive, and relatively few concerns were raised. Surgical staff members identify problems with current monitoring and anticipate that sensors will both improve patient safety and be the future of monitoring. %M 35147503 %R 10.2196/27866 %U https://formative.jmir.org/2022/2/e27866 %U https://doi.org/10.2196/27866 %U http://www.ncbi.nlm.nih.gov/pubmed/35147503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29922 %T Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study %A Sharma,Shreya %A Gergen Barnett,Katherine %A Maypole,John (Jack) %A Grochow Mishuris,Rebecca %+ Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, United States, 1 (617)358 9600, sshreya@bu.edu %K mobile health application %K apps %K mobile health %K diverse %K low-income %K mHealth %K framework %K chronic disease %K condition %K smoking cessation %K diabetes %K medication adherence %K safety net hospital %K personal %K self-management %K usability test %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US $30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable. Objective: This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations. Methods: Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps. Results: The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence. Conclusions: We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities. %M 35147502 %R 10.2196/29922 %U https://formative.jmir.org/2022/2/e29922 %U https://doi.org/10.2196/29922 %U http://www.ncbi.nlm.nih.gov/pubmed/35147502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27500 %T Early Development of a Virtual Coach for Healthy Coping Interventions in Type 2 Diabetes Mellitus: Validation Study %A Bassi,Giulia %A Donadello,Ivan %A Gabrielli,Silvia %A Salcuni,Silvia %A Giuliano,Claudio %A Forti,Stefano %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3477334405, giulia.bassi@phd.unipd.it %K virtual coach %K early development %K type 2 diabetes mellitus %K healthy coping %K Wizard of Oz %K ORBIT model %K pilot study %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients’ health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients’ self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective. Objective: This study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients’ (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users’ role-playing is further analyzed. Methods: This preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs’ profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development. Results: Both quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs’ profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols. Conclusions: This study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing. %M 35147505 %R 10.2196/27500 %U https://formative.jmir.org/2022/2/e27500 %U https://doi.org/10.2196/27500 %U http://www.ncbi.nlm.nih.gov/pubmed/35147505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31131 %T An Association of Influenza Epidemics in Children With Mobile App Data: Population-Based Observational Study in Osaka, Japan %A Katayama,Yusuke %A Kiyohara,Kosuke %A Hirose,Tomoya %A Ishida,Kenichiro %A Tachino,Jotaro %A Nakao,Shunichiro %A Noda,Tomohiro %A Ojima,Masahiro %A Kiguchi,Takeyuki %A Matsuyama,Tasuku %A Kitamura,Tetsuhisa %+ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Japan, 81 6 6879 5707, orion13@hp-emerg.med.osaka-u.ac.jp %K syndromic surveillance %K mobile app %K influenza %K epidemic %K children %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early surveillance to prevent the spread of influenza is a major public health concern. If there is an association of influenza epidemics with mobile app data, it may be possible to forecast influenza earlier and more easily. Objective: We aimed to assess the relationship between seasonal influenza and the frequency of mobile app use among children in Osaka Prefecture, Japan. Methods: This was a retrospective observational study that was performed over a three-year period from January 2017 to December 2019. Using a linear regression model, we calculated the R2 value of the regression model to evaluate the relationship between the number of “fever” events selected in the mobile app and the number of influenza patients ≤14 years of age. We conducted three-fold cross-validation using data from two years as the training data set and the data of the remaining year as the test data set to evaluate the validity of the regression model. And we calculated Spearman correlation coefficients between the calculated number of influenza patients estimated using the regression model and the number of influenza patients, limited to the period from December to April when influenza is prevalent in Japan. Results: We included 29,392 mobile app users. The R2 value for the linear regression model was 0.944, and the adjusted R2 value was 0.915. The mean Spearman correlation coefficient for the three regression models was 0.804. During the influenza season (December–April), the Spearman correlation coefficient between the number of influenza patients and the calculated number estimated using the linear regression model was 0.946 (P<.001). Conclusions: In this study, the number of times that mobile apps were used was positively associated with the number of influenza patients. In particular, there was a good association of the number of influenza patients with the number of “fever” events selected in the mobile app during the influenza epidemic season. %M 35142628 %R 10.2196/31131 %U https://formative.jmir.org/2022/2/e31131 %U https://doi.org/10.2196/31131 %U http://www.ncbi.nlm.nih.gov/pubmed/35142628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32772 %T Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results %A Ponnada,Aditya %A Wang,Shirlene %A Chu,Daniel %A Do,Bridgette %A Dunton,Genevieve %A Intille,Stephen %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02130, United States, 1 6173061610, ponnada.a@northeastern.edu %K intensive longitudinal data %K ecological momentary assessment %K experience sampling %K microinteractions %K smartwatch %K health behavior research %K mobile phone %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual’s behaviors and states. A new approach, microinteraction EMA (μEMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using μEMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated. Objective: This paper describes the μEMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the μEMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the μEMA app, changes made to the main TIME Study μEMA protocol and app based on the pilot feedback, and preliminary μEMA results from a subset of active participants in the TIME Study. Methods: The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non–EMA burst days, participants answer μEMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and μEMA in a semistructured interview. A pilot study was used to test and refine the μEMA protocol before the main study. Results: Changes made to the μEMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 μEMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%). Conclusions: The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that μEMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives. %M 35138253 %R 10.2196/32772 %U https://formative.jmir.org/2022/2/e32772 %U https://doi.org/10.2196/32772 %U http://www.ncbi.nlm.nih.gov/pubmed/35138253 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29393 %T Home-Based Spirometry Telemonitoring After Allogeneic Hematopoietic Cell Transplantation: Mixed Methods Evaluation of Acceptability and Usability %A Sheshadri,Ajay %A Makhnoon,Sukh %A Alousi,Amin M %A Bashoura,Lara %A Andrade,Rene %A Miller,Christopher J %A Stolar,Karen R %A Arain,Muhammad Hasan %A Noor,Laila %A Balagani,Amulya %A Jain,Akash %A Blanco,David %A Ortiz,Abel %A Taylor,Michael S %A Stenzler,Alex %A Mehta,Rohtesh %A Popat,Uday R %A Hosing,Chitra %A Ost,David E %A Champlin,Richard E %A Dickey,Burton F %A Peterson,Susan K %+ Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Unit 1462, Houston, TX, 77030, United States, 1 7135631987, asheshadri@mdanderson.org %K allogeneic hematopoietic cell transplantation %K home-based spirometry %K acceptability %K usability %K mixed methods evaluation %K patient perspectives %K spirometry %K feasibility %K mHealth %K home-based %K remote care %K respirology %K pulmonary medicine %K mobile phone %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Home-based spirometry (HS) allows for the early detection of lung complications in recipients of an allogeneic hematopoietic cell transplant (AHCT). Although the usability and acceptability of HS are critical for adherence, patient-reported outcomes of HS use remain poorly understood in this setting. Objective: The aim of this study is to design a longitudinal, mixed methods study to understand the usability and acceptability of HS among recipients of AHCT. Methods: Study participants performed HS using a Bluetooth-capable spirometer that transmitted spirometry data to the study team in real time. In addition, participants completed usability questionnaires and in-depth interviews and reported their experiences with HS. Analysis of interview data was guided by the constructs of performance expectancy, effort expectancy, and social influence from the Unified Theory of Acceptance and Use of Technology model. Results: Recipients of AHCT found HS to be highly acceptable despite modest technological barriers. On average, participants believed that the HS was helpful in managing symptoms related to AHCT (scores ranging from 2.22 to 2.68 on a scale of 0-4) and for early detection of health-related problems (score range: 2.88-3.12). Participants viewed HS favorably and were generally supportive of continued use. No significant barriers to implementation were identified from the patient’s perspective. Age and gender were not associated with the patient perception of HS. Conclusions: Study participants found HS acceptable and easy to use. Some modifiable technical barriers to performing HS were identified; however, wider implementation of pulmonary screening is feasible from the patient’s perspective. %M 35129455 %R 10.2196/29393 %U https://formative.jmir.org/2022/2/e29393 %U https://doi.org/10.2196/29393 %U http://www.ncbi.nlm.nih.gov/pubmed/35129455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27675 %T A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study %A Drissi,Nidal %A Ouhbi,Sofia %A Amiri,Leena %A Al Mugaddam,Fadwa %A Jan,Reem K %A Isomursu,Minna %+ Department of Computer Science & Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates, 971 37135568, sofia.ouhbi@uaeu.ac.ae %K mental health %K digital health %K eHealth %K connected health %K mHealth %K perceptions %K attitudes %K framework %K design %K UAE %K mental health care professionals %K Arab culture %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Connected mental health (CMH) is a field presenting information and communications technology–based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people’s attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption. Objective: The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature. Methods: A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework. Results: On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users’ health and data safety considerations, including users’ suitability testing, confidentiality, and ensuring MHP integrity. Conclusions: CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects. %M 35129458 %R 10.2196/27675 %U https://formative.jmir.org/2022/2/e27675 %U https://doi.org/10.2196/27675 %U http://www.ncbi.nlm.nih.gov/pubmed/35129458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32000 %T Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study %A Grens,Hilde %A de Bruin,Jan Peter %A Huppelschoten,Aleida %A Kremer,Jan A M %+ Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 's-Hertogenbosch, 5223 GZ, Netherlands, 31 073 5538660, h.grens@jbz.nl %K COVID-19 %K patient centeredness %K video consultation %K fertility care %K telemedicine %K shared decision making %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the COVID-19 pandemic, major parts of elective health care in the Netherlands, such as reproductive medicine, were paused. When health care was resumed, video consultation was used as a new solution to continue consultations with the new governmental rules of social distancing. Prior to this COVID-19 situation, video consultation was not used extensively in the Netherlands; therefore, physicians and patients are not familiar with this way of consultation. Objective: The purpose of this study was to measure the level of patient centeredness and shared decision making in infertile couples who have undergone fertility workup through video consultation. Methods: This is a questionnaire study with an additional qualitative part for a more in depth understanding. Infertile couples (ie, male and female partners with an unfulfilled wish for a child after 1 year of unprotected intercourse) were referred to a fertility center and underwent fertility workup through video consultation. The fertility workup consisted of 2 separate video consultations, with diagnostic tests according to a protocol. After the last video consultation couples received a digital questionnaire, which consisted of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) and CollaboRATE questionnaire. Fifty-three eligible infertile couples were approached, and of these, 22 participated. Four women were approached for a semistructured interview. Results: The median score on the modified PCQ-I (scale of 0 to 3) was 2.64. The highest rating was for the subscale communication and information, and the lowest rating was for the subscale organization of care. The median score on the CollaboRATE questionnaire (scale of 1 to 9) was 8 for all 3 subquestions. Patients mentioned privacy, less travel time, and easy use of the program as possible benefits of video consultation. However, patients preferred the first consultation with their physician to be face-to-face consultation as video consultation was considered less personal. Conclusions: The high levels of patient centeredness and shared decision making show that video consultation is a promising way of providing care remotely, although attention has to be payed to mitigate the more impersonal setting of video consultation when compared with face-to-face consultation. %M 34936981 %R 10.2196/32000 %U https://formative.jmir.org/2022/2/e32000 %U https://doi.org/10.2196/32000 %U http://www.ncbi.nlm.nih.gov/pubmed/34936981 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28199 %T Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study %A Scheder-Bieschin,Justus %A Blümke,Bibiana %A de Buijzer,Erwin %A Cotte,Fabienne %A Echterdiek,Fabian %A Nacsa,Júlia %A Ondresik,Marta %A Ott,Matthias %A Paul,Gregor %A Schilling,Tobias %A Schmitt,Anne %A Wicks,Paul %A Gilbert,Stephen %+ The Else Kröner Fresenius Center for Digital Health, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Postfach 151 Fetscherstraße 74, Dresden, 01307, Germany, 49 17680396015, stephen.gilbert@mailbox.tu-dresden.de %K symptom assessment application %K anamnesis %K health care system %K patient history taking %K diagnosis %K emergency department %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED). Objective: We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning–based techniques to gather relevant symptoms and history for handover to clinicians. Methods: A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool’s performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion. Results: Respondents strongly endorsed the tool for facilitating conversation (61/81, 75% of patients, 57/78, 73% of physician ratings, and 10/10, 100% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool’s questions. The tool was recommended by most patients (63/81, 78%), in 53% (41/77) of physician ratings, and in 76% (61/80) of nurse ratings. Questionnaire completion rates were 100% (81/81) by patients and 96% (78/81 enrolled patients) by physicians. Conclusions: This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient–health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility. Trial Registration: German Clinical Trials Register DRKS00024115; https://drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115 %M 35129452 %R 10.2196/28199 %U https://formative.jmir.org/2022/2/e28199 %U https://doi.org/10.2196/28199 %U http://www.ncbi.nlm.nih.gov/pubmed/35129452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29537 %T Preferences for Technology-Mediated Behavioral Lifestyle Interventions With Different Levels of Coach and Peer Support Among Latino Men: Comparative Study Within One Arm of a Randomized Controlled Trial %A Rosas,Lisa G %A Lv,Nan %A Xiao,Lan %A Azar,Kristen MJ %A Hooker,Steven P %A Venditti,Elizabeth M %A Lewis,Megan A %A Zavella,Patricia %A Ma,Jun %+ Department of Epidemiology and Population Health, Stanford University, 1701 Page Mill Rd., 2nd Floor, Palo Alto, CA, 94304, United States, 1 6505759519, lgrosas@stanford.edu %K Latino men’s health %K technology-mediated behavioral interventions %K weight management %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although Latino men have the highest prevalence (45%) of obesity among all men in the United States, traditional weight loss interventions have not effectively engaged this hard-to-reach and diverse group. Offering choices among technology-mediated weight loss interventions may offer advantages. Objective: The aim of this study is to examine Latino men’s preferences among 3 weight loss intervention options. We also examined whether attendance in group sessions (videoconference and in person) and weight loss differed according to intervention choice. Methods: Latino men (n=200; mean age 47.3, SD 11.8 years) participated in a comparative effectiveness trial based on primary care and were randomized to receive the 1-year HOMBRE (Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Crónicas; English translation: Men With Options to Improve Their Well-being and Reduce Chronic Disease) intervention. HOMBRE is a weight loss intervention that offers 3 delivery options. During an orientation session, a trained bilingual coach helped men select 1 of the 3 intervention options that differed in coach, peer support, and available language. We used canonical discriminant analysis to assess multivariate associations of demographic, clinical, employment, cultural, and technology use and access factors with men’s intervention choices. We used generalized linear models to estimate weight loss at 6, 12, and 18 months for men in each intervention option. Results: Among Latino men, 28% (56/200) chose videoconference groups, 31% (62/200) chose web-based videos, and 41% (82/200) chose in-person groups. The canonical discriminant analysis identified 1 orthogonal dimension that distinguished between men who chose an in-person group and men who chose web-based videos. Men who were older, spoke Spanish, and did not use a computer frequently had a higher probability of choosing in-person groups versus web-based videos. For men who selected a group delivery option, 86.9% (107/123) attended ≥25% of the sessions, 83.7% (103/123) attended ≥50% of the sessions, and 73.2% (90/123) attended ≥75% of the sessions, with no differences by type of group (videoconference or in person). Men who chose videoconference and in-person group sessions lost significantly more weight at 6 months (both P<.001) and 18 months (P=.02 and P=.04, respectively) than those who chose web-based videos. Men who chose in-person group sessions also lost significantly more weight at 12 months (P=.008) than those who chose web-based videos. Conclusions: There were significant differences according to demographic, employment, cultural, and technology use factors between men who chose 1 of the 3 intervention options. Men who chose one of the group-based options (videoconference or in person) lost significantly more weight than those who chose web-based videos. Providing options that accommodate the diversity of Latino men’s preferences is important for increasing engagement in behavioral interventions. Trial Registration: ClinicalTrials.gov NCT03092960; https://clinicaltrials.gov/ct2/show/NCT03092960 %M 35119377 %R 10.2196/29537 %U https://formative.jmir.org/2022/2/e29537 %U https://doi.org/10.2196/29537 %U http://www.ncbi.nlm.nih.gov/pubmed/35119377 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31841 %T Intervention for a Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity Study: Protocol for a Randomized Controlled Trial %A Gray,Michelle %A Madero,Erica N %A Gills,Joshua L %A Paulson,Sally %A Jones,Megan D %A Campitelli,Anthony %A Myers,Jennifer %A Bott,Nicholas T %A Glenn,Jordan M %+ Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, 1 University of Arkansas, Fayetteville, AR, 72701, United States, 1 4795756713, rgray@uark.edu %K health coaching %K Alzheimer risk %K digital health %K mobile phone %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, more than 6 million adults live with Alzheimer disease (AD) that affects 1 out of every 3 older adults. Although there is no cure for AD currently, lifestyle-based interventions aimed at slowing the rate of cognitive decline or delaying the onset of AD have shown promising results. However, most studies primarily focus on older adults (>55 years) and use in-person interventions. Objective: The aim of this study is to determine the effects of a 2-year digital lifestyle intervention on AD risk among at-risk middle-aged and older adults (45-75 years) compared with a health education control. Methods: The lifestyle intervention consists of a digitally delivered, personalized health coaching program that directly targets the modifiable risk factors for AD. The primary outcome measure is AD risk as determined by the Australian National University-Alzheimer Disease Risk Index; secondary outcome measures are functional fitness, blood biomarkers (inflammation, glucose, cholesterol, and triglycerides), and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status and Neurotrack Cognitive Battery). Screening commenced in January 2021 and was completed in June 2021. Results: Baseline characteristics indicate no difference between the intervention and control groups for AD risk (mean −1.68, SD 7.31; P=.90). Conclusions: The intervention in the Digital, Cognitive, Multi-domain Alzheimer Risk Velocity is uniquely designed to reduce the risk of AD through a web-based health coaching experience that addresses the modifiable lifestyle-based risk factors. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): DERR1-10.2196/31841 %M 35119374 %R 10.2196/31841 %U https://www.researchprotocols.org/2022/2/e31841 %U https://doi.org/10.2196/31841 %U http://www.ncbi.nlm.nih.gov/pubmed/35119374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30295 %T Use of a Smartphone App Versus Motivational Interviewing to Increase Walking Distance and Weight Loss in Overweight/Obese Adults With Peripheral Artery Disease: Pilot Randomized Trial %A Collins,Tracie %A Geana,Mugur %A Overton,Kathryn %A Benton,Mary %A Lu,Liuqiang %A Khan,Faarina %A Rohleder,Mason %A Ahluwalia,Jasjit %A Resnicow,Ken %A Zhu,Yiliang %+ College of Population Health, University of New Mexico, MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, United States, 1 505 272 4979, tccollins@salud.unm.edu %K mobile health %K smartphone app %K peripheral artery disease %K motivational interviewing %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking therapy improves functional outcomes in patients with peripheral artery disease (PAD). Less is known about the additive benefit of a dietary intervention. Objective: Our objectives were to develop a smartphone app and, as a pilot, explore its potential efficacy as compared to motivational interviewing (MI) to increase walking distance and promote weight loss in overweight/obese adults with PAD. Methods: We conducted a 3-month, 2-arm randomized pilot study at the University of Kansas. Inclusion criteria were BMI >27 kg/m2 and symptomatic PAD, defined by an ankle-brachial index <0.9. Patients were randomized into 2 groups: MI, delivered through in-person and telephone counseling, and app, a mobile smartphone app. Both interventions encouraged walking for exercise and healthy dietary habits (increasing fruits and vegetables and whole grains while reducing fat and sugary drinks). We assessed medical history at baseline. At baseline and 3 months, participants completed an assessment of 6-minute walking distance, weight, quality of life, exercise behaviors, and dietary habits. The primary outcome was 3-month change in walking distance. Secondary outcomes were changes in weight, quality of life, exercise behaviors, and dietary habits. We used a Wilcoxon rank-sum test to analyze the primary and secondary outcomes at 3 months within the MI and app groups and to compare the changes between the groups with adjustment for baseline. Results: We randomized 29 participants with a mean age of 66.03 (SD 8.12) years; 25 participants completed the trial. At baseline, mean walking distance among completers was 260.40 (SD 94.32) meters and 326.15 (SD 69.28) meters for MI and app participants, respectively. At 3 months, the mean walking distance was 298.67 (SD 101.20) meters and 331.19 (SD 58.63) meters for MI and app participants, respectively (group difference P=.03, adjusting for baseline). Increase in walking distance at 3 months was 40.5 meters (95% CI 6.77 to 61.34; P=.02) in MI group. At baseline, mean body weight was 253.10 (SD 59.45) lbs and 225.13 (SD 58.93) lbs for MI and app participants, respectively. At 3 months, mean body weight was 242.14 (SD 58.54) lbs and 223.44 (SD 59.54) lbs for MI and app, respectively (group difference P=.006, adjusting for baseline). Pre-post study decrease in weight was 10.1 lbs (95% CI –17.9 to –3.0) and 2.3 lbs (95% CI –3.4 to –0.7) in MI and app group, respectively. Comparing baseline to 3 months, there were no statistically significant differences in quality of life, exercise behaviors, or dietary habits. Conclusions: Our study demonstrates that MI can promote walking and weight loss in overweight/obese adults with PAD. The smartphone app showed a small weight loss but no statistically significant increase in walking distance. As this was a pilot study, future large-scale studies are needed to replicate the efficacy of MI to promote weight loss in overweight or obese adults with PAD. Trial Registration: ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652 %M 35113020 %R 10.2196/30295 %U https://formative.jmir.org/2022/2/e30295 %U https://doi.org/10.2196/30295 %U http://www.ncbi.nlm.nih.gov/pubmed/35113020 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30989 %T Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study %A Jaffar,Aida %A Mohd-Sidik,Sherina %A Foo,Chai Nien %A Admodisastro,Novia %A Abdul Salam,Sobihatun Nur %A Ismail,Noor Diana %+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 3 9769 2541, sherina@upm.edu.my %K User-centered design %K mHealth app %K Digital intervention %K mHealth Development and Evaluation Framework %K Usability %K Acceptability %K Pelvic Floor Muscle Training %K Urinary incontinence %K Pregnancy %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design–11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. %M 35113025 %R 10.2196/30989 %U https://humanfactors.jmir.org/2022/1/e30989 %U https://doi.org/10.2196/30989 %U http://www.ncbi.nlm.nih.gov/pubmed/35113025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30811 %T Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing %A O'Connor,Cara %A Leyritana,Katerina %A Doyle,Aoife M %A Lewis,James J %A Gill,Randeep %A Salvaña,Edsel Maurice %+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com %K mHealth %K adherence %K HIV %K antiretroviral therapy %K intervention development %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. Objective: This study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines. Methods: A mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. Results: Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed. Conclusions: The mobile phone–based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance. %M 35113030 %R 10.2196/30811 %U https://formative.jmir.org/2022/2/e30811 %U https://doi.org/10.2196/30811 %U http://www.ncbi.nlm.nih.gov/pubmed/35113030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e23965 %T Consistency and Sensitivity Evaluation of the Saudi Arabia Mental Health Surveillance System (MHSS): Hypothesis Generation and Testing %A Althumiri,Nora A %A Basyouni,Mada H %A BinDhim,Nasser F %+ Sharik Association for Research and Studies, Alyasmin, Abi Baker Rd, Riyadh, 13313, Saudi Arabia, 966 580033299, nd@idm.sa %K mental health %K evaluation %K screening %K surveillance %K data quality %K surveillance system quality %K surveillance system evaluation %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Public health surveillance systems should be evaluated periodically, and the evaluation should include recommendations for improving the system’s quality and efficiency. Each surveillance system may have a unique situation in which evaluating its quality depends on its methodology, aims, and other factors, such as the frequency of repeating the survey in the case of survey-based surveillance. Objective: As the consistency of the surveillance system to capture demographic data and its sensitivity to monitor the intended health-related event are important indicators of the quality of the surveillance system, the aim of this article is to evaluate the Saudi Arabia Mental Health Surveillance System (MHSS) in terms of consistency and sensitivity via the scientific hypothesis testing process. Methods: The quality of the MHSS was assessed by examining (1) the consistency of the main demographic variables and (2) the sensitivity to changes in score between the 2 mental health screening tools used in the MHSS and between the 3 waves collected in 3 consecutive months. The assessment uses all data collected via the MHSS between May 2020 and July 2020. The first null hypothesis predicted there were differences between the distributions of the demographic variables between the 3 waves. The second predicted there were no differences between the scores of the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7) between the 3 waves. Results: In terms of sampling variables (age, gender, and region), there were no significant differences between the 3 waves in age, using one-way ANOVA, nor in gender and region, using the chi-square test. In addition, there were no significant differences between the 3 waves in all other demographic variables, except in the income variable. However, in terms of the PHQ-9 score, the one-way ANOVA (F2,12334=8.05; P<.001) showed significant differences between waves. Similarly, significant differences between waves were found in the GAD-7 score (F2,12334=7.09; P=.001). Conclusions: The MHSS showed a consistent distribution of the sample demographic variables, while being sensitive to the changes in mental health scores across waves. The MHSS can generate an acceptable level of consistency and sensitivity to monitor mental health trends. International Registered Report Identifier (IRRID): RR2-10.2196/23748 %M 35113027 %R 10.2196/23965 %U https://formative.jmir.org/2022/2/e23965 %U https://doi.org/10.2196/23965 %U http://www.ncbi.nlm.nih.gov/pubmed/35113027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32982 %T A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study %A McGinnis,Ellen %A O'Leary,Aisling %A Gurchiek,Reed %A Copeland,William E %A McGinnis,Ryan %+ M-Sense Research Group, University of Vermont, 33 Colchester Avenue, Burlington, VT, 05401, United States, 1 2025095783, ryan.mcginnis@uvm.edu %K mental health %K mHealth %K biofeedback %K panic attack %K digital medicine %K app %K mobile health %K application %K biofeedback %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Panic attacks (PAs) are an impairing mental health problem that affects >11% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate–based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs. %M 35113031 %R 10.2196/32982 %U https://formative.jmir.org/2022/2/e32982 %U https://doi.org/10.2196/32982 %U http://www.ncbi.nlm.nih.gov/pubmed/35113031 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32360 %T Quantifying the Quality of Web-Based Health Information on Student Health Center Websites Using a Software Tool: Design and Development Study %A Kulkarni,Anagha %A Wong,Mike %A Belsare,Tejasvi %A Shah,Risha %A Yu Yu,Diana %A Coskun,Bera %A Holschuh,Carrie %A Kakar,Venoo %A Modrek,Sepideh %A Smirnova,Anastasia %+ Department of Computer Science, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, United States, 1 4153381008, ak@sfsu.edu %K online health information quality %K information quality metrics %K automated quantification tool %K student health center websites %K digital health %K health information %K health information websites %K adolescents %K online health %K infodemiology %K public health %K health websites %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet has become a major source of health information, especially for adolescents and young adults. Unfortunately, inaccurate, incomplete, or outdated health information is widespread on the web. Often adolescents and young adults turn to authoritative websites such as the student health center (SHC) website of the university they attend to obtain reliable health information. Although most on-campus SHC clinics comply with the American College Health Association standards, their websites are not subject to any standards or code of conduct. In the absence of quality standards or guidelines, monitoring and compliance processes do not exist for SHC websites. Thus, there is no oversight of the health information published on SHC websites by any central governing body. Objective: The aim of this study is to develop, describe, and validate an open-source software that can effectively and efficiently assess the quality of health information on SHC websites in the United States. Methods: Our cross-functional team designed and developed an open-source software, QMOHI (Quantitative Measures of Online Health Information), that assesses information quality for a specified health topic from all SHC websites belonging to a predetermined list of universities. The tool was designed to compute 8 different quality metrics that quantify various aspects of information quality based on the retrieved text. We conducted and reported results from 3 experiments that assessed the QMOHI tool in terms of its scalability, generalizability in health topics, and robustness to changes in universities’ website structure. Results: Empirical evaluation has shown the QMOHI tool to be highly scalable and substantially more efficient than manually assessing web-based information quality. The tool’s runtime was dominated by network-related tasks (98%), whereas the metric computations take <2 seconds. QMOHI demonstrated topical versatility, evaluating SHC website information quality for four disparate and broad health topics (COVID, cancer, long-acting reversible contraceptives, and condoms) and two narrowly focused topics (hormonal intrauterine device and copper intrauterine device). The tool exhibited robustness, correctly measuring information quality despite changes in SHC website structure. QMOHI can support longitudinal studies by being robust to such website changes. Conclusions: QMOHI allows public health researchers and practitioners to conduct large-scale studies of SHC websites that were previously too time- and cost-intensive. The capability to generalize broadly or focus narrowly allows a wide range of applications of QMOHI, allowing researchers to study both mainstream and underexplored health topics. QMOHI’s ability to robustly analyze SHC websites periodically promotes longitudinal investigations and allows QMOHI to be used as a monitoring tool. QMOHI serves as a launching pad for our future work that aims to develop a broadly applicable public health tool for web-based health information studies with potential applications far beyond SHC websites. %M 35107423 %R 10.2196/32360 %U https://formative.jmir.org/2022/2/e32360 %U https://doi.org/10.2196/32360 %U http://www.ncbi.nlm.nih.gov/pubmed/35107423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e26891 %T An Android-Based Mobile App (ARVPredictor) for the Detection of HIV Drug-Resistance Mutations and Treatment at the Point of Care: Development Study %A Ongadi,Beatrice %A Lihana,Raphael %A Kiiru,John %A Ngayo,Musa %A Obiero,George %+ Centre for Biotechnology and Bioinformatics, University of Nairobi, Department of Biochemistry - CEBIB, P.O. Box 30197, Nairobi, 00100, Kenya, 254 728324324, betongadi@gmail.com %K database %K mobile Android app %K HIV/AIDS %K mutation %K pol gene %K protease %K reverse transcriptase %K integrase %K ARVPredictor %K mobile app %K mHealth %K HIV %K Android %K digital health %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV/AIDS remains one of the major global human health challenges, especially in resource-limited environments. By 2017, over 77.3 million people were infected with the disease, and approximately 35.4 million individuals had already died from AIDS-related illnesses. Approximately 21.7 million people were accessing ART with significant clinical outcomes. However, numerous challenges are experienced in the delivery and accurate interpretation of data on patients with HIV data by various health care providers at different care levels. Mobile health (mHealth) technology is progressively making inroads into the health sector as well as medical research. Different mobile devices have become common in health care settings, leading to rapid growth in the development of downloadable software specifically designed to fulfill particular health-related purposes. Objective: We developed a mobile-based app called ARVPredictor and demonstrated that it can accurately define HIV-1 drug-resistance mutations in the HIV pol gene for use at the point of care. Methods: ARVPredictor was designed using Android Studio with Java as the programming language and is compatible with both Android and iOS. The app system is hosted on Nginx Server, and network calls are built on PHP’s Laravel framework handled by the Retrofit Library. The DigitalOcean offers a high-performance and stable cloud computing platform for ARVPredictor. This mobile app is enlisted in the Google Play Store as an “ARVPredictor” and the source code is available under MIT permissive license at a GitHub repository. To test for agreement between the ARVPredictor and Stanford HIV Database in detecting HIV subtype and NNRT and NRTI mutations, a total of 100 known HIV sequences were evaluated. Results: The mobile-based app (ARVPredictor) takes in a set of sequences or known mutations (protease, reverse transcriptase and integrase). It then returns inferred levels of resistance to selected nucleoside, nonnucleoside protease, and integrase inhibitors for accurate HIV/AIDS management at the point of care. The ARVPredictor identified similar HIV subtypes in 98/100 sequences compared with the Stanford HIV Database (κ=0.98, indicating near perfect agreement). There were 89/100 major NNRTI and NRTI mutations identified by ARVPredictor, similar to the Stanford HIV Database (κ=0.89, indicating near perfect agreement). Eight mutations classified as major by the Stanford HIV Database were classified as others by ARVPredictor. Conclusions: The ARVPredictor largely agrees with the Stanford HIV Database in identifying both major and minor proteases, reverse transcriptase, and integrase mutations. The app can be conveniently used robustly at the point of care by HIV/AIDS care providers to improve the management of HIV infection. %M 35107425 %R 10.2196/26891 %U https://formative.jmir.org/2022/2/e26891 %U https://doi.org/10.2196/26891 %U http://www.ncbi.nlm.nih.gov/pubmed/35107425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33941 %T Exploring Relationships Between Tweet Numbers and Over-the-counter Drug Sales for Allergic Rhinitis: Retrospective Analysis %A Wakamiya,Shoko %A Morimoto,Osamu %A Omichi,Katsuhiro %A Hara,Hideyuki %A Kawase,Ichiro %A Koshiba,Ryuji %A Aramaki,Eiji %+ Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, Nara, 6300192, Japan, 81 743 72 5250, wakamiya@is.naist.jp %K infoveillance %K social media %K Twitter %K over-the-counter drugs %K allergic rhinitis %K hay fever %K drug %K treatment %K allergy %K immunology %K surveillance %K monitoring %K prevalence %K motivation %K Japan %K symptom %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-related social media data are increasingly being used in disease surveillance studies. In particular, surveillance of infectious diseases such as influenza has demonstrated high correlations between the number of social media posts mentioning the disease and the number of patients who went to the hospital and were diagnosed with the disease. However, the prevalence of some diseases, such as allergic rhinitis, cannot be estimated based on the number of patients alone. Specifically, individuals with allergic rhinitis typically self-medicate by taking over-the-counter (OTC) medications without going to the hospital. Although allergic rhinitis is not a life-threatening disease, it represents a major social problem because it reduces people’s quality of life, making it essential to understand its prevalence and people’s motives for self-medication behavior. Objective: This study aims to explore the relationship between the number of social media posts mentioning the main symptoms of allergic rhinitis and the sales volume of OTC rhinitis medications in Japan. Methods: We collected tweets over 4 years (from 2017 to 2020) that included keywords corresponding to the main nasal symptoms of allergic rhinitis: “sneezing,” “runny nose,” and “stuffy nose.” We also obtained the sales volume of OTC drugs, including oral medications and nasal sprays, for the same period. We then calculated the Pearson correlation coefficient between time series data on the number of tweets per week and time series data on the sales volume of OTC drugs per week. Results: The results showed a much higher correlation (r=0.8432) between the time series data on the number of tweets mentioning “stuffy nose” and the time series data on the sales volume of nasal sprays than for the other two symptoms. There was also a high correlation (r=0.9317) between the seasonal components of these time series data. Conclusions: We investigated the relationships between social media data and behavioral patterns, such as OTC drug sales volume. Exploring these relationships can help us understand the prevalence of allergic rhinitis and the motives for self-care treatment using social media data, which would be useful as a marketing indicator to reduce the number of out-of-stocks in stores, provide (sell) rhinitis medicines to consumers in a stable manner, and reduce the loss of sales opportunities. In the future, in-depth investigations are required to estimate sales volume using social media data, and future research could investigate other diseases and countries. %M 35107434 %R 10.2196/33941 %U https://formative.jmir.org/2022/2/e33941 %U https://doi.org/10.2196/33941 %U http://www.ncbi.nlm.nih.gov/pubmed/35107434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30410 %T Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study %A Eastman,Jennifer A %A Kaup,Allison R %A Bahorik,Amber L %A Butcher,Xochitl %A Attarha,Mouna %A Marcus,Gregory M %A Pletcher,Mark J %A Olgin,Jeffrey E %A Barnes,Deborah E %A Yaffe,Kristine %+ San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA, 94121, United States, 1 951 760 6711, jennifer.eastman@ucsf.edu %K mHealth %K internet %K mobile health %K digital health %K eHealth %K cardiovascular %K risk factors %K cognition %K cognitive impairment %K remote cognitive assessment %K aging %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations. Objective: We conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment. Methods: We recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function. Results: CVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance. Conclusions: Self-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation. %M 35107430 %R 10.2196/30410 %U https://formative.jmir.org/2022/2/e30410 %U https://doi.org/10.2196/30410 %U http://www.ncbi.nlm.nih.gov/pubmed/35107430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e26033 %T Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study %A Lalla-Edward,Samanta Tresha %A Mashabane,Nonkululeko %A Stewart-Isherwood,Lynsey %A Scott,Lesley %A Fyvie,Kyle %A Duncan,Dana %A Haile,Betiel %A Chugh,Kamal %A Zhou,Yiyong %A Reimers,Jacob %A Pan,Matteus %A Venkatraman,Maya %A Stevens,Wendy %+ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, 32 Princess of Wales Terrace, Parktown, 2193, South Africa, 27 0826172490, slallaedward@ezintsha.org %K HIV %K virological suppression %K mHealth %K digital health %K South Africa %K patient-centric %K disease management %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants’ phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. %M 35107427 %R 10.2196/26033 %U https://formative.jmir.org/2022/2/e26033 %U https://doi.org/10.2196/26033 %U http://www.ncbi.nlm.nih.gov/pubmed/35107427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33374 %T An Internet-Based Cognitive Behavioral Therapy Program for Anxiety and Depression (Tranquility): Adaptation Co-design and Fidelity Evaluation Study %A Patterson,Victoria C %A Rossi,Meghan A %A Pencer,Alissa %A Wozney,Lori %+ Department of Psychology and Neuroscience, Dalhousie University, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada, 1 9024944466, alissa.pencer@dal.ca %K cognitive behavioral therapy %K anxiety %K depression %K fidelity %K usability %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is a necessary step toward increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to the therapeutic principles of cognitive behavioral therapy (CBT) or usability standards. In addition, many existing iCBT programs do not include treatments targeting both anxiety and depression, which are commonly co-occurring conditions. Objective: This study aims to evaluate the usability of Tranquility—a novel iCBT program for anxiety—and its fidelity to CBT principles. This study also aims to engage in a co-design process to adapt Tranquility to include treatment elements for depression. Methods: CBT experts (n=6) and mental health–informed peers (n=6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression by using 2 simulated client case examples. Mental health–informed peers engaged in 2 co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed web-based surveys assessing the usability of Tranquility and the likelihood that they would recommend the program. Results: The CBT experts’ mean rating of Tranquility’s fidelity to CBT principles was 91%, indicating a high fidelity to CBT. Further, 5 out of 6 CBT experts and all mental health–informed peers (all participants: 11/12, 88%) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (mean 76.56, SD 14.07). Mental health–informed peers provided suggestions on how to leverage engagement with Tranquility (eg, adding incentives and notification control). Conclusions: This preliminary study demonstrated the strong fidelity of Tranquility to CBT and usability standards. The results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement. %M 34910660 %R 10.2196/33374 %U https://formative.jmir.org/2022/2/e33374 %U https://doi.org/10.2196/33374 %U http://www.ncbi.nlm.nih.gov/pubmed/34910660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29073 %T Peer Support Specialists’ Perspectives of a Standard Online Research Ethics Training: Qualitative Study %A Fortuna,Karen L %A Marceau,Skyla R %A Kadakia,Arya %A Pratt,Sarah I %A Varney,Joy %A Walker,Robert %A Myers,Amanda L %A Thompson,Shavon %A Carter,Katina %A Greene,Kaycie %A Pringle,Willie %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 6037225727, karen.l.fortuna@dartmouth.edu %K peer support specialists %K community engagement %K research ethics %K mental health %K peer support %K codebook %K online health %K online training %K education %K ethics %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for people who, unlike CPS, have had exposure to prior formal research training. Objective: The aim of this study is to explore the perspectives of CPS in completing the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training. Methods: A total of 5 CPS were recruited using a convenience sample framework through the parent study, a patient-centered outcomes research study that examined the comparative effectiveness of two chronic health disease management programs for people with serious mental illness. Participants independently completed the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training. All participants completed 15 online modules in approximately 7-9 hours and also filled out a self-report measure of executive functioning (the Adult Executive Functioning Inventory [ADEXI]). Qualitative data were collected from a 1-hour focus group and qualitative analysis was informed by the grounded theory approach. The codebook consisted of codes inductively derived from the data. Codes were independently assigned to text, grouped, and checked for themes. Thematic analysis was used to organize themes. Results: Passing scores for each module ranged from 81%-89%, with an average of 85.4% and a median of 86%. The two themes that emerged from the focus group were the following: comprehension (barrier) and opportunity (facilitator). Participants had a mean score of 27.4 on the ADEXI. Conclusions: The CPS perceived the research ethics online training as an opportunity to share their lived experience expertise to enhance current research efforts by nonpeer scientists. Although the CPS completed the online research ethics training, the findings indicate CPS experienced difficulty with comprehension of the research ethics online training materials. Adaptations may be needed to facilitate uptake of research ethics online training by CPS and create a workforce of CPS to offer their lived experience expertise alongside peer and nonpeer researchers. %M 35103606 %R 10.2196/29073 %U https://formative.jmir.org/2022/2/e29073 %U https://doi.org/10.2196/29073 %U http://www.ncbi.nlm.nih.gov/pubmed/35103606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29012 %T The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study %A Bin,Kaio Jia %A Melo,Adler Araujo Ribeiro %A da Rocha,José Guilherme Moraes Franco %A de Almeida,Renata Pivi %A Cobello Junior,Vilson %A Maia,Fernando Liebhart %A de Faria,Elizabeth %A Pereira,Antonio José %A Battistella,Linamara Rizzo %A Ono,Suzane Kioko %+ Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovidio Pires de Campos 225, Sao Paulo, 05403-110, Brazil, 55 1126616208, kaiobin@gmail.com %K COVID-19 %K artificial intelligence %K robotic process automation %K digital health %K health care management %K pandemic %K waiting time %K queue %K nonvalue-added activities %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic. Objective: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses’ time required for screening and the waiting time for patients to receive medical care. Methods: This was a single-center, comparative, prospective study designed according to the Public Health England guide “Evaluating Digital Products for Health.” A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. Results: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. Conclusions: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic. %M 35103611 %R 10.2196/29012 %U https://formative.jmir.org/2022/2/e29012 %U https://doi.org/10.2196/29012 %U http://www.ncbi.nlm.nih.gov/pubmed/35103611 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31623 %T Governing Data and Artificial Intelligence for Health Care: Developing an International Understanding %A Morley,Jessica %A Murphy,Lisa %A Mishra,Abhishek %A Joshi,Indra %A Karpathakis,Kassandra %+ Oxford Internet Institute, University of Oxford, 1 St. Giles', Oxford, OX1 3JS, United Kingdom, 44 (0)1865 287210, jessica.morley@phc.ox.ac.uk %K digital health %K artificial intelligence %K health policy %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although advanced analytical techniques falling under the umbrella heading of artificial intelligence (AI) may improve health care, the use of AI in health raises safety and ethical concerns. There are currently no internationally recognized governance mechanisms (policies, ethical standards, evaluation, and regulation) for developing and using AI technologies in health care. A lack of international consensus creates technical and social barriers to the use of health AI while potentially hampering market competition. Objective: The aim of this study is to review current health data and AI governance mechanisms being developed or used by Global Digital Health Partnership (GDHP) member countries that commissioned this research, identify commonalities and gaps in approaches, identify examples of best practices, and understand the rationale for policies. Methods: Data were collected through a scoping review of academic literature and a thematic analysis of policy documents published by selected GDHP member countries. The findings from this data collection and the literature were used to inform semistructured interviews with key senior policy makers from GDHP member countries exploring their countries’ experience of AI-driven technologies in health care and associated governance and inform a focus group with professionals working in international health and technology to discuss the themes and proposed policy recommendations. Policy recommendations were developed based on the aggregated research findings. Results: As this is an empirical research paper, we primarily focused on reporting the results of the interviews and the focus group. Semistructured interviews (n=10) and a focus group (n=6) revealed 4 core areas for international collaborations: leadership and oversight, a whole systems approach covering the entire AI pipeline from data collection to model deployment and use, standards and regulatory processes, and engagement with stakeholders and the public. There was a broad range of maturity in health AI activity among the participants, with varying data infrastructure, application of standards across the AI life cycle, and strategic approaches to both development and deployment. A demand for further consistency at the international level and policies was identified to support a robust innovation pipeline. In total, 13 policy recommendations were developed to support GDHP member countries in overcoming core AI governance barriers and establishing common ground for international collaboration. Conclusions: AI-driven technology research and development for health care outpaces the creation of supporting AI governance globally. International collaboration and coordination on AI governance for health care is needed to ensure coherent solutions and allow countries to support and benefit from each other’s work. International bodies and initiatives have a leading role to play in the international conversation, including the production of tools and sharing of practical approaches to the use of AI-driven technologies for health care. %M 35099403 %R 10.2196/31623 %U https://formative.jmir.org/2022/1/e31623 %U https://doi.org/10.2196/31623 %U http://www.ncbi.nlm.nih.gov/pubmed/35099403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e21341 %T Collaborative Research and Development of a Novel, Patient-Centered Digital Platform (MyEyeSite) for Rare Inherited Retinal Disease Data: Acceptability and Feasibility Study %A Gilbert,Rose M %A Sumodhee,Dayyanah %A Pontikos,Nikolas %A Hollyhead,Catherine %A Patrick,Angus %A Scarles,Samuel %A Van Der Smissen,Sabrina %A Young,Rodrigo M %A Nettleton,Nick %A Webster,Andrew R %A Cammack,Jocelyn %+ NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 2/12 Wolfson Building, 11-43 Bath Street, London, EC1V 9EL, United Kingdom, 44 020 7608 6800, rose.gilbert@gmail.com %K MyEyeSite %K inherited retinal diseases (IRD) %K rare diseases %K genetics %K ophthalmology %K digital health %K eye data %K GDPR %K subject access request (SAR) %K mobile phone %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Inherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care. Objective: This study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study. Methods: Qualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases. Results: Our IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom’s NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app. Conclusions: This study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases. %M 35099396 %R 10.2196/21341 %U https://formative.jmir.org/2022/1/e21341 %U https://doi.org/10.2196/21341 %U http://www.ncbi.nlm.nih.gov/pubmed/35099396 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19967 %T Perceptions of Digital Technology Experiences and Development Among Family Caregivers and Technology Researchers: Qualitative Study %A Xiong,Chen %A D'Souza,Andrea %A El-Khechen-Richandi,Graziella %A Mihailidis,Alex %A Cameron,Jill I %A Astell,Arlene %A Nalder,Emily %A Colantonio,Angela %+ Acquired Brain Injury Research Lab, University of Toronto, Suite 260, 500 University Ave, Toronto, ON, M5G1V7, Canada, 1 6477708366, chen.xiong@mail.utoronto.ca %K caregiving %K digital technologies %K sex %K gender %K diversity %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiving is highly stressful and is associated with poor mental and physical health. Various technologies, including mobile and eHealth apps, have been developed to address caregiver needs. However, there is still a paucity of research examining the technology perceptions of informal caregivers, especially from the perspectives of sex, gender, and diversity. Objective: To address the research gap and inform the development of future caregiving technologies, this study aims to examine how family caregivers perceive using technology to assist with their caregiving routines; identify the sex, gender, and diversity factors that shape these perceptions; and understand how these perceptions and needs are reflected within the current technology development process. Methods: Semistructured interviews were conducted with 16 informal caregivers of individuals with a range of chronic medical conditions and 8 technology researchers involved in caregiving technology projects. Results: Three main themes with subthemes were developed. The first main theme is that caregivers see a need for technology in their lives, and it comprises the following 3 subthemes: caregiving is a challenging endeavor, technology is multifaceted, and caregiver preferences facilitate technology use. The second main theme is that relationships play a vital role in mediating technology uptake, and it comprises the following 2 subthemes: the caregiver-care recipient dynamic shapes technology perceptions and caregivers rely on external sources for technology information. Finally, the third main theme is that barriers are present in the use and adoption of technology, and it comprises the following 2 subthemes: technology may not be compatible with personal values and abilities and technology that is not tailored toward caregivers lacks adoption. Conclusions: The findings highlight the multifaceted role that technology can play in aiding caregiving while drawing attention to the perceived drawbacks of these technologies among caregivers. The inclusion of technology researchers in this study provides a more holistic understanding of technologies in caregiving from their initial development to their eventual uptake by caregivers. %M 35089150 %R 10.2196/19967 %U https://formative.jmir.org/2022/1/e19967 %U https://doi.org/10.2196/19967 %U http://www.ncbi.nlm.nih.gov/pubmed/35089150 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32764 %T Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally %A Wray,Charlie %A Tang,Janet %A Byers,Amy %A Keyhani,Salomeh %+ Section of Hospital Medicine, San Francisco Department of Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA, 94121, United States, 1 415 595 9662, charlie.wray@ucsf.edu %K digital health literacy %K Veterans Health Administration %K health care %K telemedicine %K veterans %K digital tools %K social risk factors %K digital uptake %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective: The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods: We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results: Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3% [95% CI 30.7-36.0] vs 24.2% [95% CI 21.9-26.5], P<.01), were more often female (34.7% [95% CI 32.0-37.3] vs 6.6% [95% CI 5.5-7.6], P<.01) and identified as Black (13.1% [95% CI 11.2-15.0] vs 10.2% [95% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3% [95% CI 6.9-9.8] vs 5.5% [95% CI 4.6-6.5], P<.01) and social isolation (42.6% [95% CI 40.3-44.9] vs 35.4% [95% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [95% CI 49.2-54.4] vs 45.0% [95% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2% [95% CI 14.5-18.0] vs 11.3% [95% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1% [95% CI 12.4-15.8] vs 11.6% [95% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0% [95% CI 16.1-19.8] vs 13.3% [95% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95% CI 1.12-1.65) of being digitally prepared. Conclusions: Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort. %M 35089147 %R 10.2196/32764 %U https://formative.jmir.org/2022/1/e32764 %U https://doi.org/10.2196/32764 %U http://www.ncbi.nlm.nih.gov/pubmed/35089147 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e25752 %T Development of a Quality Assurance Score for the Nigeria AIDS Indicator and Impact Survey (NAIIS) Database: Validation Study %A Salihu,Hamisu M %A Yusuf,Zenab %A Dongarwar,Deepa %A Aliyu,Sani H %A Yusuf,Rafeek A %A Aliyu,Muktar H %A Aliyu,Gambo %+ Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, 3701, Kirby Drive, Houston, TX, 77030, United States, 1 8327908353, deepa.dongarwar@bcm.edu %K database quality assurance %K Delphi method %K quality assurance tool %K Nigeria AIDS Indicator and Impact Survey %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2018, Nigeria implemented the world’s largest HIV survey, the Nigeria AIDS Indicator and Impact Survey (NAIIS), with the overarching goal of obtaining more reliable metrics regarding the national scope of HIV epidemic control in Nigeria. Objective: This study aimed to (1) describe the processes involved in the development of a new database evaluation tool (Database Quality Assurance Score [dQAS]) and (2) assess the application of the dQAS in the evaluation and validation of the NAIIS database. Methods: The dQAS tool was created using an online, electronic Delphi (e-Delphi) methodology with the assistance of expert review panelists. Thematic categories were developed to form superordinate categories that grouped themes together. Subordinate categories were then created that decomposed themes for more specificity. A validation score using dQAS was employed to assess the technical performance of the NAIIS database. Results: The finalized dQAS tool was composed of 34 items, with a total score of 81. The tool had 2 sections: validation item section, which contains 5 subsections, and quality assessment score section, with a score of “1” for “Yes” to indicate that the performance measure item was present and “0” for “No” to indicate that the measure was absent. There were also additional scaling scores ranging from “0” to a maximum of “4” depending on the measure. The NAIIS database achieved 78 out of the maximum total score of 81, yielding an overall technical performance score of 96.3%, which placed it in the highest category denoted as “Exceptional.” Conclusions: This study showed the feasibility of remote internet-based collaboration for the development of dQAS—a tool to assess the validity of a locally created database infrastructure for a resource-limited setting. Using dQAS, the NAIIS database was found to be valid, reliable, and a valuable source of data for future population-based, HIV-related studies. %M 35089143 %R 10.2196/25752 %U https://formative.jmir.org/2022/1/e25752 %U https://doi.org/10.2196/25752 %U http://www.ncbi.nlm.nih.gov/pubmed/35089143 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29333 %T The Applied Data Analytics in Medicine Program: Lessons Learned From Four Years’ Experience With Personalizing Health Care in an Academic Teaching Hospital %A Haitjema,Saskia %A Prescott,Timothy R %A van Solinge,Wouter W %+ Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Room #G.03.551, Utrecht, 3584 CX, Netherlands, 31 088 7550759, s.haitjema@umcutrecht.nl %K digital health %K data-driven care %K multidisciplinarity %K lessons learned %K eHealth %K personalized medicine %K data analytics %K implementation %K collaboration %K hospital %D 2022 %7 28.1.2022 %9 Viewpoint %J JMIR Form Res %G English %X The University Medical Center (UMC) Utrecht piloted a hospital-wide innovation data analytics program over the past 4 years. The goal was, based on available data and innovative data analytics methodologies, to answer clinical questions to improve patient care. In this viewpoint, we aimed to support and inspire others pursuing similar efforts by sharing the three principles of the program: the data analytics value chain (data, insight, action, value), the innovation funnel (structured innovation approach with phases and gates), and the multidisciplinary team (patients, clinicians, and data scientists). We also discussed our most important lessons learned: the importance of a clinical question, collaboration challenges between health care professionals and different types of data scientists, the win-win result of our collaboration with external partners, the prerequisite of available meaningful data, the (legal) complexity of implementation, organizational power, and the embedding of collaborative efforts in the health care system as a whole. %M 35089145 %R 10.2196/29333 %U https://formative.jmir.org/2022/1/e29333 %U https://doi.org/10.2196/29333 %U http://www.ncbi.nlm.nih.gov/pubmed/35089145 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30360 %T Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study %A Trang,Kathy %A Le,Lam X %A Brown,Carolyn A %A To,Margaret Q %A Sullivan,Patrick S %A Jovanovic,Tanja %A Worthman,Carol M %A Giang,Le Minh %+ Global TIES for Children, New York University, 627 Broadway, New York City, NY, 10012, United States, 1 212 998 1212, kathytrang.kt@gmail.com %K men who have sex with men %K HIV %K mental disorder %K ecological momentary assessment %K mobile phone %K mHealth %K sexual minorities %K pilot projects %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. %M 35084340 %R 10.2196/30360 %U https://formative.jmir.org/2022/1/e30360 %U https://doi.org/10.2196/30360 %U http://www.ncbi.nlm.nih.gov/pubmed/35084340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32136 %T Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial %A Vahabi,Mandana %A Pui-Hing Wong,Josephine %A Moosapoor,Masoomeh %A Akbarian,Abdolreza %A Fung,Kenneth %+ Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 552725, mvahabi@ryerson.ca %K migrant live-in caregiver %K women %K mental health %K acceptance and commitment therapy %K depression %K anxiety %K stress %K psychological inflexibility %K resilience %K social identity %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Temporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population. Objective: Our pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area. Methods: A pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms. Results: Average age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively). Conclusions: WE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.31211 %M 35084337 %R 10.2196/32136 %U https://formative.jmir.org/2022/1/e32136 %U https://doi.org/10.2196/32136 %U http://www.ncbi.nlm.nih.gov/pubmed/35084337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29647 %T Accessing Patient Electronic Health Record Portals Safely Using Social Credentials: Demonstration Pilot Study %A SooHoo,Spencer %A Keller,Michelle S %A Moyse,Harold %A Robbins,Benjamin %A McLaughlin,Matthew %A Arora,Ajay %A Burger,Abigail %A Huang,Lilith %A Huang,Shao-Chi %A Goud,Anil %A Truong,Lyna %A Rodriguez,Donaldo %A Roberts,Pamela %+ Enterprise Information Systems, Cedars-Sinai Medical Center, 6500 Wilshire Bl, Suite 200, Los Angeles, CA, 90048, United States, 1 310 678 3640, spencer.soohoo@csmc.edu %K patient portal access %K single sign-on %K federated identity %K social credentials %K social identity %K patient portal %K electronic health records %K EHR %K credentials %K patient communication %K communication %K clinical support %K feasibility %K acceptability %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals allow communication with clinicians, access to test results, appointments, etc, and generally requires another set of log-ins and passwords, which can become cumbersome, as patients often have records at multiple institutions. Social credentials (eg, Google and Facebook) are increasingly used as a federated identity to allow access and reduce the password burden. Single Federated Identity Log-in for Electronic health records (Single-FILE) is a real-world test of the feasibility and acceptability of federated social credentials for patients to access their electronic health records (EHRs) at multiple organizations with a single sign-on (SSO). Objective: This study aims to deploy a federated identity system for health care in a real-world environment so patients can safely use a social identity to access their EHR data at multiple organizations. This will help identify barriers and inform guidance for the deployment of such systems. Methods: Single-FILE allowed patients to pick a social identity (such as Google or Facebook) as a federated identity for multisite EHR patient portal access with an SSO. Binding the identity to the patient’s EHR records was performed by confirming that the patient had a valid portal log-in and sending a one-time passcode to a telephone (SMS text message or voice) number retrieved from the EHR. This reduced the risk of stolen EHR portal credentials. For a real-world test, we recruited 8 patients and (or) their caregivers who had EHR data at 2 independent health care facilities, enrolled them into Single-FILE, and allowed them to use their social identity credentials to access their patient records. We used a short qualitative interview to assess their interest and use of a federated identity for SSO. Single-FILE was implemented as a web-based patient portal, although the concept can be readily implemented on a variety of mobile platforms. Results: We interviewed the patients and their caregivers to assess their comfort levels with using a social identity for access. Patients noted that they appreciated only having to remember 1 log-in as part of Single-FILE and being able to sign up through Facebook. Conclusions: Our results indicate that from a technical perspective, a social identity can be used as a federated identity that is bound to a patient’s EHR data. The one-time passcode sent to the patient’s EHR phone number provided assurance that the binding is valid. The patients indicated that they were comfortable with using their social credentials instead of having to remember the log-in credentials for their EHR portal. Our experience will help inform the implementation of federated identity systems in health care in the United States. %M 34762594 %R 10.2196/29647 %U https://formative.jmir.org/2022/1/e29647 %U https://doi.org/10.2196/29647 %U http://www.ncbi.nlm.nih.gov/pubmed/34762594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34309 %T Design and Evaluation of a Just-in-Time Adaptive Intervention (JITAI) to Reduce Sedentary Behavior at Work: Experimental Study %A Ismail,Tasnim %A Al Thani,Dena %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar, 974 44546374, tasnim.ismail95@gmail.com %K sedentary behavior %K persuasive technology %K behavior change %K physical activity %K adaptive intervention %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in sedentary occupations tend to spend prolonged hours physically inactive. Physical inactivity is a main factor in the increase in the risks of a wide range of chronic diseases, including obesity, diabetes, hypertension, and heart disease. This has drawn researchers’ attention to investigate methods of increasing the level of activity of employees during working hours and in their daily lifestyle. Objective: The objective of this paper is to investigate the effectiveness of using personalized messages that include user information, user goals, daily routine, and the surrounding environment to increase the level of activity among employees. In this study, we hypothesize that sending context-aware motivational messages to workers in sedentary occupations after sitting for 40 minutes can break sedentary behavior and increase daily active time compared to static reminder messages. Methods: A 66-day between-group study using a mixed methods design approach was conducted with employees who are located in Qatar and spend most of their working day sedentary. The 58 participants used 2 different interventions: The control group (n=29, 50%) used a mobile app that only sends a static message after prolonged sitting (MotiFit Lite), and the intervention group (n=29, 50%) used a mobile app that sends context-aware personalized messages to promote physical activity (PA; MotiFit). Both apps log the received messages, the step count before and after the messages are sent, and the user response to the messages to obtain an idea of the impact of the messages. The study received approval from the Qatar Biomedical Research Institute’s institutional review board (IRB application #2019-10-037). Results: The questionnaires showed satisfaction of the designed apps’ subjective quality and perceived impact. The quantitative analysis showed a high level of engagement in the intervention group compared to the control group (P<.001). The results support the original hypothesis that using context-aware motivational messages can increase PA at work compared to static messages (P<.001). However, the analysis showed no significant impact of the message type on the overall activity level during the day (P=.06). Conclusions: Context-aware motivational messages motivate employees to increase their PA in the workplace. However, future research will further develop the analysis to investigate the impact on increasing the overall activity level during the day. %M 35080498 %R 10.2196/34309 %U https://formative.jmir.org/2022/1/e34309 %U https://doi.org/10.2196/34309 %U http://www.ncbi.nlm.nih.gov/pubmed/35080498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33697 %T Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study %A Yue,Han %A Mail,Victoria %A DiSalvo,Maura %A Borba,Christina %A Piechniczek-Buczek,Joanna %A Yule,Amy M %+ Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 915, Boston, MA, 02118, United States, 1 2402719122, han.yue@bmc.org %K patient portal %K telemedicine %K telepsychiatry %K COVID-19 %K portal %K mental health %K psychiatry %K engagement %K behavior %K video %K hospital %K urban %K outreach %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to use telepsychiatry services. Objective: As an extension to a clinic’s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal–based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods: Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results: A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions: Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults. %M 34932497 %R 10.2196/33697 %U https://formative.jmir.org/2022/1/e33697 %U https://doi.org/10.2196/33697 %U http://www.ncbi.nlm.nih.gov/pubmed/34932497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30387 %T Using Mobile Phone Apps to Deliver Rural General Practitioner Services: Critical Review Using the Walkthrough Method %A O'Sullivan,Belinda %A Couch,Danielle %A Naik,Ishani %+ The Rural Clinical School, Faculty of Medicine, University of Queensland, Locked Bag 9009, Toowoomba, 4350, Australia, 61 0427405030, belinda.osullivan@uq.edu.au %K rural health %K mHealth %K general practice %K cell phone %K rural health services %K mobile applications %K primary health care %K morbidity %K mobile phone %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread use of mobile phones represents new frontiers for improving access to health care. This includes using mobile apps to deliver general practitioner (GP) services in rural areas. However, the wider adoption of apps for increasing access to rural GP services relies on understanding how they might intersect with the rural health system context. Objective: This research aims to critically review mobile apps for delivering GP services in a rural health service context using the walkthrough method. Methods: The sample comprised 3 GP service apps under the top 100 list in the medical category in the Apple App Store (also available via the Google Play Store) in Australia as of June 2020. The walkthrough method was applied to extract data and critique the explicit factors, such as the app interface elements, and implicit factors, such as the embedded cultural features related to use for people in rural settings. Data analysis was undertaken between 3 researchers over 6 months applying the walkthrough method and using critical reflection. Results: There were 3 main themes: improving rural access, addressing rural health care needs, and providing quality of care. App-based GP services may improve rural GP service availability. However, this may be at a relatively superficial level that does not encompass the scope and intensity of the services needed in rural areas (including relevant chronic and emergency care) at a cost that rural patients can afford. The apps showed signs of limited tailoring to the cultural dimensions of rural health care as a barrier to rural use. Patients generally self-selected to use GP service apps with limited support, potentially leading to inappropriate uptake especially by disadvantaged groups with lower health literacy. Although the apps claimed to avail most GP services (70%-80% in some cases), it emerged after enrollment that emergency, complex, and serious conditions might be excluded, potentially imposing more complex caseloads on in-person rural GPs. Apps provided limited information about continuity and coordination of care and sharing information with rural GPs, potentially leading to fragmented and low-quality care. There was commonly no assurance of rural skills and experience of physicians staffing apps despite the wider scope of skills needed to be effective in rural general practice. Conclusions: GP apps may increase the availability of GP services, but they may require clearer exclusions, appropriate use through decision-making tools, more rural-tailored interfaces, and capacity to align appointment times and costs with patients with complex needs to engage and be useful in a rural context. It is also important to consider how these app-based services could share information with local health care staff for safety and continuity of rural primary care. Finally, information about the physicians’ rural training and experience is critical for quality. %M 35076401 %R 10.2196/30387 %U https://formative.jmir.org/2022/1/e30387 %U https://doi.org/10.2196/30387 %U http://www.ncbi.nlm.nih.gov/pubmed/35076401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33265 %T Remote Monitoring of Patients With Hematologic Malignancies at High Risk of Febrile Neutropenia: Exploratory Study %A Kroloff,Maxwell %A Ramezani,Ramin %A Wilhalme,Holly %A Naeim,Arash %+ UCLA Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, 10911 Weyburn Ave, Suite 300, Los Angeles, CA, 90024, United States, 1 310 794 8788, anaeim@mednet.ucla.edu %K remote monitoring %K febrile neutropenia %K temperature %K heart rate %K oxygen saturation %K mobile health %K mHealth %K hematologic malignancies %K hematology %K malignancies %K digital health %K clinical outcomes %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Febrile neutropenia is one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. Most patients who experience a febrile neutropenia episode are hospitalized, resulting in significant economic cost. Objective: This exploratory study implemented a remote monitoring system comprising a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real time of abnormalities in vital signs that could suggest early clinical deterioration and thereby improve clinical outcomes. Methods: The remote monitoring system was implemented and compared to standard-of-care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess the feasibility and validity of the system. Statistical analysis was performed using the intraclass correlation coefficient (ICC) to assess the consistency between the measurements taken using traditional methods and those taken with the remote monitoring system for each of the vital sign parameters (temperature, heart rate, and oxygen saturation). A linear mixed-effects model with a random subject effect was used to estimate the variance components. Bland-Altman plots were created for the parameters to further delineate the direction of any occurring bias. Results: A total of 23 patients were enrolled in the study (mean age 56, SD 23-75 years; male patients: n=11, 47.8%). ICC analysis confirmed the high repeatability and accuracy of the heart rate assessment (ICC=0.856), acting as a supplement to remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 bpm were excellent (88% and 97%, respectively), the sensitivity of the remote monitoring system in capturing temperatures >37.8 °C and oxygen saturation <92% was 45% and 50%, respectively. Conclusions: Overall, this novel approach using temperature, heart rate, and oxygen saturation assessments successfully provided real-time, clinically valuable feedback to providers. While temperature and oxygen saturation assessments lagged in terms of sensitivity compared to a standard in-hospital system, the heart rate assessment provided highly accurate complementary data. As a whole, the system provided additional information that can be applied to a clinically vulnerable population. By transitioning its application to high-risk patients in the outpatient setting, this system can help prevent additional use of health care services through early provider intervention and potentially improve outcomes. %M 35076403 %R 10.2196/33265 %U https://formative.jmir.org/2022/1/e33265 %U https://doi.org/10.2196/33265 %U http://www.ncbi.nlm.nih.gov/pubmed/35076403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29644 %T Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study %A Zhang,Puhong %A Chen,Huan %A Shang,Jie %A Ge,Jun %A Zhang,Huichen %A Xu,Mingjun %A Bian,Cui %A Zhao,Yang %A Chen,Minyuan %A Hirst,Jane Elizabeth %+ The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building, No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, China, 86 13691270366, zpuhong@georgeinstitute.org.cn %K maternal and child health %K mHealth %K mobile apps %K retrospective study %K pregnancy outcomes %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal and child health (MCH)–related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks’ gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women’s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. %M 35076402 %R 10.2196/29644 %U https://formative.jmir.org/2022/1/e29644 %U https://doi.org/10.2196/29644 %U http://www.ncbi.nlm.nih.gov/pubmed/35076402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33798 %T Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study %A Gorny,Alexander Wilhelm %A Chee,Wei Chian Douglas %A Müller-Riemenschneider,Falk %+ Centre of Excellence for Soldier Performance, Singapore Armed Forces, Pasir Laba Camp, Blk 130 #03-09, Singapore, 637901, Singapore, 65 81337238, alexander_gorny@u.nus.edu %K mHealth %K physical activity %K health promoting financial incentives %K weight loss maintenance %K young men %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings. Objective: To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program. Methods: A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior. Results: Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors. Conclusions: Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change. %M 35076399 %R 10.2196/33798 %U https://formative.jmir.org/2022/1/e33798 %U https://doi.org/10.2196/33798 %U http://www.ncbi.nlm.nih.gov/pubmed/35076399 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32400 %T Evaluation of an AIDS Educational Mobile Game (AIDS Fighter · Health Defense) for Young Students to Improve AIDS-Related Knowledge, Stigma, and Attitude Linked to High-Risk Behaviors in China: Randomized Controlled Trial %A Tang,Jian %A Zheng,Yu %A Zhang,Daiying %A Yu,Xingli %A Ren,Jianlan %A Li,Mei %A Luo,Yue %A Tian,Min %A Chen,Yanhua %+ Department of Nursing, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang District, Luzhou, 646000, China, 86 18982765016, chen_yanhua25@163.com %K young students %K AIDS education %K educational game %K game-based intervention %K serious games %K public health %K HIV %K AIDS epidemic %K stigma %K health defense %K health knowledge %K digital health %K digital health intervention %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter · Health Defense. Objective: In this study, we tested the effect of AIDS Fighter · Health Defense on young students in improving AIDS-related knowledge, stigma, and attitude related to high-risk behaviors in Southwest China. Methods: A randomized controlled trial was conducted from September 14 to 27, 2020. In total, 96 students from 2 classes in a middle school were selected by stratified cluster sampling in Luzhou City, Southwest China. The students were randomly divided into the intervention group (n=50, 52%) and the control group (n=46, 48%). The intervention group played the AIDS educational game AIDS Fighter · Health Defense; the control group learned AIDS-related knowledge through independent learning on the QQ chat group. An AIDS-related knowledge questionnaire, a stigma scale, and an attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of the AIDS educational game via face-to-face interviews. The user experience of the game was assessed using the Educational Game User Experience Evaluation Scale. The difference was statistically significant at P≤.05. Results: After the intervention, the AIDS knowledge awareness rate (X̅ [SD], %) of the intervention and control groups were 70.09 (SD 11.58) and 57.49 (SD 16.58), with t=4.282 and P<.001. The stigma scores of the 2 groups were 2.44 (SD 0.57) and 2.48 (SD 0.47), with t=0.373 and P=0.71. The positive rate (X̅ [SD], %) of attitudes of high-risk AIDS behaviors of the 2 groups were 82.00 (SD 23.44) and 79.62 (SD 17.94), with t=0.555 and P=0.58. The mean percentage of the game evaluation was 54.73% as excellent, 31.45% as good, 13.09% as medium, and 0.73% as poor. Conclusions: AIDS Fighter · Health Defense could increase AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors was not seen. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038230; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2000038230 %M 34870603 %R 10.2196/32400 %U https://games.jmir.org/2022/1/e32400 %U https://doi.org/10.2196/32400 %U http://www.ncbi.nlm.nih.gov/pubmed/34870603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e26276 %T Facial and Vocal Markers of Schizophrenia Measured Using Remote Smartphone Assessments: Observational Study %A Abbas,Anzar %A Hansen,Bryan J %A Koesmahargyo,Vidya %A Yadav,Vijay %A Rosenfield,Paul J %A Patil,Omkar %A Dockendorf,Marissa F %A Moyer,Matthew %A Shipley,Lisa A %A Perez-Rodriguez,M Mercedez %A Galatzer-Levy,Isaac R %+ AiCure, 214 Sullivan Street 6C, New York, NY, 10012, United States, 1 8005700448, anzar@anzarabbas.com %K digital biomarkers %K phenotyping %K computer vision %K facial expressivity %K negative symptoms %K vocal acoustics %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning–based facial and vocal measurements have demonstrated relationships with schizophrenia diagnosis and severity. Demonstrating utility and validity of remote and automated assessments conducted outside of controlled experimental or clinical settings can facilitate scaling such measurement tools to aid in risk assessment and tracking of treatment response in populations that are difficult to engage. Objective: This study aimed to determine the accuracy of machine learning–based facial and vocal measurements acquired through automated assessments conducted remotely through smartphones. Methods: Measurements of facial and vocal characteristics including facial expressivity, vocal acoustics, and speech prevalence were assessed in 20 patients with schizophrenia over the course of 2 weeks in response to two classes of prompts previously utilized in experimental laboratory assessments: evoked prompts, where subjects are guided to produce specific facial expressions and speech; and spontaneous prompts, where subjects are presented stimuli in the form of emotionally evocative imagery and asked to freely respond. Facial and vocal measurements were assessed in relation to schizophrenia symptom severity using the Positive and Negative Syndrome Scale. Results: Vocal markers including speech prevalence, vocal jitter, fundamental frequency, and vocal intensity demonstrated specificity as markers of negative symptom severity, while measurement of facial expressivity demonstrated itself as a robust marker of overall schizophrenia symptom severity. Conclusions: Established facial and vocal measurements, collected remotely in schizophrenia patients via smartphones in response to automated task prompts, demonstrated accuracy as markers of schizophrenia symptom severity. Clinical implications are discussed. %M 35060906 %R 10.2196/26276 %U https://formative.jmir.org/2022/1/e26276 %U https://doi.org/10.2196/26276 %U http://www.ncbi.nlm.nih.gov/pubmed/35060906 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32404 %T Exploring Children’s Engagement in Monitoring Indoor Air Quality: Longitudinal Study %A Kim,Sunyoung %A Sohanchyk,Gregory %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sunyoung.kim@rutgers.edu %K children %K indoor air quality %K mobile app %K awareness %K longitudinal deployment %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is harmful to everyone, but children are of particular concern, as they are more vulnerable to its adverse health effects from air pollutants. Although mobile technology is increasingly being designed to support monitoring and improving air quality indoors, little attention has been paid to its use by and for children. Previously, we created inAirKids, a child-friendly device to promote children’s engagement with monitoring indoor air quality through a participatory design process. The next step is to evaluate its usability in the real world. Objective: The aim of this study is to investigate how inAirKids affects children’s understanding of and engagement with indoor air quality through a longitudinal field deployment study. Methods: We deployed inAirKids in the homes of 9 children aged between 6 and 7 years, and investigated their use for up to 16 weeks by conducting semistructured, biweekly interviews. Results: The results show that participants promptly engaged with inAirKids but quickly lost interest in it owing to the lack of engaging factors to sustain engagement. In addition, we identified 2 design considerations that can foster sustained engagement of children with monitoring indoor air quality: design interactivity for engaging in continuity and corporate hands-on activities as part of indoor air quality monitoring for experiential learning. Conclusions: Our findings shed light on the potential to promote the engagement of children in indoor air quality as well as considerations for designing a child-friendly digital device. To the best of our knowledge, this is the first longitudinal field deployment to investigate how to engage children in monitoring indoor air quality. %M 35060916 %R 10.2196/32404 %U https://formative.jmir.org/2022/1/e32404 %U https://doi.org/10.2196/32404 %U http://www.ncbi.nlm.nih.gov/pubmed/35060916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33449 %T An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A White,Paul %A Gwyther,Holly %A Williamson,Heidi %A , %+ Health and Applied Sciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom, 44 7816449143, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K mixed methods %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective: In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods: To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results: In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions: An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation. %M 35060908 %R 10.2196/33449 %U https://formative.jmir.org/2022/1/e33449 %U https://doi.org/10.2196/33449 %U http://www.ncbi.nlm.nih.gov/pubmed/35060908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33716 %T Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation %A Hogan,Timothy P %A Etingen,Bella %A McMahon,Nicholas %A Bixler,Felicia R %A Am,Linda %A Wacks,Rachel E %A Shimada,Stephanie L %A Reilly,Erin D %A Frisbee,Kathleen L %A Smith,Bridget M %+ eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, United States, 1 781 687 3181, Timothy.Hogan@va.gov %K mobile health applications %K pain %K veterans %K usability %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. %M 35049515 %R 10.2196/33716 %U https://formative.jmir.org/2022/1/e33716 %U https://doi.org/10.2196/33716 %U http://www.ncbi.nlm.nih.gov/pubmed/35049515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27805 %T Prediction of Age-Adjusted Mortality From Stroke in Japanese Prefectures: Ecological Study Using Search Engine Queries %A Taira,Kazuya %A Fujita,Sumio %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 75 751 3927, taira.kazuya.5m@kyoto-u.ac.jp %K stroke %K age-adjusted mortality %K search engine query %K Japan %K random forest %K generalized linear mixed model %K search engine %K GLMM %K information-seeking behavior %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is a major cause of death and the need for nursing care in Japan, with large regional disparities. Objective: The purpose of this study was to clarify the association between stroke-related information retrieval behavior and age-adjusted mortality in each prefecture in Japan. Methods: Age-adjusted mortality from stroke and aging rates were obtained from publicly available Japanese government statistics. A total of 9476 abstracts of Japanese articles related to symptoms and signs of stroke were identified in Ichushi-Web, a Japanese web-based database of biomedical articles, and 100 highly frequent words (hereafter referred to as the Stroke 100) were extracted. Using data from 2014 to 2019, a random forest analysis was carried out using the age-adjusted mortality from stroke in 47 prefectures as the outcome variable and the standardized retrieval numbers of the Stroke 100 words in the log data of Yahoo! JAPAN Search as predictive variables. Regression analysis was performed using a generalized linear mixed model (GLMM) with the number of standardized searches for Stroke 100 words with high importance scores in the random forest model as the predictive variable. In the GLMM, the aging rate and data year were used as control variables, and the random slope of data year and random intercept were calculated by prefecture. Results: The mean age-adjusted mortality from stroke was 28.07 (SD 4.55) deaths per 100,000 for all prefectures in all data years. The accuracy score of the random forest analysis was 89.94%, the average error was 2.79 degrees, and the mean squared error was 13.57 degrees. The following 9 variables with high importance scores in the random forest analysis were selected as predictive variables for the regression analysis: male, age, hospitalization, enforcement, progress, stroke, abnormal, use, and change. As a result of the regression analysis with GLMM, the standardized partial regression coefficients (β) and 95% confidence intervals showed that the following internet search terms were significantly associated with age-adjusted mortality from stroke: male (β=−5.83, 95% CI −8.67 to −3.29), age (β=−5.83, 95% CI −8.67 to −3.29), hospitalization (β=−5.83, 95% CI −8.67 to −3.29), and abnormal (β=3.83, 95% CI 1.14 to 6.56). Conclusions: Stroke-related search behavior was associated with age-adjusted mortality from stroke in each prefecture in Japan. Query terms that were strongly associated with age-adjusted mortality rates of stroke suggested the possibility that individual characteristics, such as sex and age, have an impact on stroke-associated mortality and that it is important to receive medical care early after stroke onset. Further studies on the criteria and timing of alerting are needed by monitoring information-seeking behavior to identify queries that are strongly associated with stroke mortality. %M 35049512 %R 10.2196/27805 %U https://formative.jmir.org/2022/1/e27805 %U https://doi.org/10.2196/27805 %U http://www.ncbi.nlm.nih.gov/pubmed/35049512 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29987 %T Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic %A Muñoz,John %A Mehrabi,Samira %A Li,Yirou %A Basharat,Aysha %A Middleton,Laura E %A Cao,Shi %A Barnett-Cowan,Michael %A Boger,Jennifer %+ Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, john.munoz.hci@uwaterloo.ca %K virtual reality %K exergames %K persons living with dementia %K physical activity %K head mounted displays %K participatory design %K co-development %K gaming %K older adults %K elderly %K design %K dementia %K VR %K user-centered %K physical activity %K exercise %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. %M 35044320 %R 10.2196/29987 %U https://games.jmir.org/2022/1/e29987 %U https://doi.org/10.2196/29987 %U http://www.ncbi.nlm.nih.gov/pubmed/35044320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31989 %T A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study %A Smart,Mary H %A Nabulsi,Nadia A %A Gerber,Ben S %A Gupta,Itika %A Di Eugenio,Barbara %A Ziebart,Brian %A Sharp,Lisa K %+ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, 833 South Wood St, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K mHealth %K Fitbit %K SMART goals %K texting %K health coach %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. %M 35044308 %R 10.2196/31989 %U https://formative.jmir.org/2022/1/e31989 %U https://doi.org/10.2196/31989 %U http://www.ncbi.nlm.nih.gov/pubmed/35044308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28300 %T A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned %A Moltrecht,Bettina %A Patalay,Praveetha %A Bear,Holly Alice %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, 4-8 Rodney Street, London, N19JH, United Kingdom, 44 0207794 ext 2313, bettina.moltrecht.16@ucl.ac.uk %K mHealth %K participatory design %K emotion regulation %K interdisciplinary development %K child mental health %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient–clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children’s mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. %M 35044312 %R 10.2196/28300 %U https://formative.jmir.org/2022/1/e28300 %U https://doi.org/10.2196/28300 %U http://www.ncbi.nlm.nih.gov/pubmed/35044312 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27550 %T Toward Data-Driven Radiation Oncology Using Standardized Terminology as a Starting Point: Cross-sectional Study %A Cihoric,Nikola %A Badra,Eugenia Vlaskou %A Stenger-Weisser,Anna %A Aebersold,Daniel M %A Pavic,Matea %+ Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland, 41 31 632 26 32, nikola.cihoric@gmail.com %K terminology %K semantic interoperability %K radiation oncology %K informatics %K medical informatics %K oncology %K lexical analysis %K eHealth %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The inability to seamlessly exchange information across radiation therapy ecosystems is a limiting factor in the pursuit of data-driven clinical practice. The implementation of semantic interoperability is a prerequisite for achieving the full capacity of the latest developments in personalized and precision medicine, such as mathematical modeling, advanced algorithmic information processing, and artificial intelligence approaches. Objective: This study aims to evaluate the state of terminology resources (TRs) dedicated to radiation oncology as a prerequisite for an oncology semantic ecosystem. The goal of this cross-sectional analysis is to quantify the state of the art in radiation therapy specific terminology. Methods: The Unified Medical Language System (UMLS) was searched for the following terms: radio oncology, radiation oncology, radiation therapy, and radiotherapy. We extracted 6509 unique concepts for further analysis. We conducted a quantitative analysis of available source vocabularies (SVs) and analyzed all UMLS SVs according to the route source, number, author, location of authors, license type, the lexical density of TR, and semantic types. Descriptive data are presented as numbers and percentages. Results: The concepts were distributed across 35 SVs. The median number of unique concepts per SV was 5 (range 1-5479), with 14% (5/35) of SVs containing 94.59% (6157/6509) of the concepts. The SVs were created by 29 authors, predominantly legal entities registered in the United States (25/35, 71%), followed by international organizations (6/35, 17%), legal entities registered in Australia (2/35, 6%), and the Netherlands and the United Kingdom with 3% (1/35) of authors each. Of the total 35 SVs, 16 (46%) did not have any restrictions on use, whereas for 19 (54%) of SVs, some level of restriction was required. Overall, 57% (20/35) of SVs were updated within the last 5 years. All concepts found within radiation therapy SVs were labeled with one of the 29 semantic types represented within UMLS. After removing the stop words, the total number of words for all SVs together was 56,219, with a median of 25 unique words per SV (range 3-50,682). The total number of unique words in all SVs was 1048, with a median of 19 unique words per vocabulary (range 3-406). The lexical density for all concepts within all SVs was 0 (0.02 rounded to 2 decimals). Median lexical density per unique SV was 0.7 (range 0.0-1.0). There were no dedicated radiation therapy SVs. Conclusions: We did not identify any dedicated TRs for radiation oncology. Current terminologies are not sufficient to cover the need of modern radiation oncology practice and research. To achieve a sufficient level of interoperability, of the creation of a new, standardized, universally accepted TR dedicated to modern radiation therapy is required. %M 35044315 %R 10.2196/27550 %U https://formative.jmir.org/2022/1/e27550 %U https://doi.org/10.2196/27550 %U http://www.ncbi.nlm.nih.gov/pubmed/35044315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28003 %T The Challenges in Designing a Prevention Chatbot for Eating Disorders: Observational Study %A Chan,William W %A Fitzsimmons-Craft,Ellen E %A Smith,Arielle C %A Firebaugh,Marie-Laure %A Fowler,Lauren A %A DePietro,Bianca %A Topooco,Naira %A Wilfley,Denise E %A Taylor,C Barr %A Jacobson,Nicholas C %+ Center for m2Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA, 94022, United States, 1 650 667 7193, wchan@paloaltou.edu %K chatbot %K eating disorders %K digital mental health %K prevention %K intervention development %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots have the potential to provide cost-effective mental health prevention programs at scale and increase interactivity, ease of use, and accessibility of intervention programs. Objective: The development of chatbot prevention for eating disorders (EDs) is still in its infancy. Our aim is to present examples of and solutions to challenges in designing and refining a rule-based prevention chatbot program for EDs, targeted at adult women at risk for developing an ED. Methods: Participants were 2409 individuals who at least began to use an EDs prevention chatbot in response to social media advertising. Over 6 months, the research team reviewed up to 52,129 comments from these users to identify inappropriate responses that negatively impacted users’ experience and technical glitches. Problems identified by reviewers were then presented to the entire research team, who then generated possible solutions and implemented new responses. Results: The most common problem with the chatbot was a general limitation in understanding and responding appropriately to unanticipated user responses. We developed several workarounds to limit these problems while retaining some interactivity. Conclusions: Rule-based chatbots have the potential to reach large populations at low cost but are limited in understanding and responding appropriately to unanticipated user responses. They can be most effective in providing information and simple conversations. Workarounds can reduce conversation errors. %M 35044314 %R 10.2196/28003 %U https://formative.jmir.org/2022/1/e28003 %U https://doi.org/10.2196/28003 %U http://www.ncbi.nlm.nih.gov/pubmed/35044314 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e24239 %T A Digital Intervention for Respiratory Tract Infections (Internet Dr): Process Evaluation to Understand How to Support Self-care for Minor Ailments %A Miller,Sascha %A Yardley,Lucy %A Smith,Peter %A Weal,Mark %A Anderson,Alexander %A Stuart,Beth %A Little,Paul %A Morrison,Leanne %+ Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 02380595000, S.Miller@soton.ac.uk %K illness behavior %K self-care %K internet %K evaluation studies %K respiratory tract infection %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 57 million physician appointments annually in the United Kingdom are for minor ailments. These illnesses could be self-cared for, which would potentially lower patients’ anxiety, increase their confidence, and be more convenient. In a randomized controlled trial of the Internet Dr digital intervention, patients with access to the intervention had fewer consultations for respiratory tract infections (RTIs). Having established intervention efficacy, further examination of trial data is required to understand how the intervention works. Objective: This paper reports a process evaluation of Internet Dr usage by the intervention group. The evaluation aims to demonstrate how meaningful usage metrics (ie, interactions that are specific and relevant to the intervention) can be derived from the theoretical principles underlying the intervention, then applied to examine whether these interactions are effective in supporting self-care for RTIs, for whom, and at what time. Methods: The Internet Dr trial recorded patients’ characteristics and usage data over 24 weeks. At follow-up, users reported whether their levels of enablement to cope with their illness changed over the trial period. The Medical Research Council process evaluation guidance and checklists from the framework for Analyzing and Measuring Usage and Engagement Data were applied to structure research questions examining associations between usage and enablement. Results: Viewing pages containing advice on caring for RTIs were identified as a meaningful metric for measuring intervention usage. Almost half of the users (616/1491, 42.31%) viewed at least one advice page, with most people (478/616, 77.6%) accessing them when they initially enrolled in the study. Users who viewed an advice page reported increased enablement to cope with their illness as a result of having participated in the study compared with users who did not (mean 2.12, SD 2.92 vs mean 1.65, SD 3.10; mean difference 0.469, 95% CI 0.082-0.856). The target population was users who had visited their general practitioners for an RTI in the year before the trial, and analyses revealed that this group was more likely to access advice pages (odds ratio 1.35, 95% CI 1.159-1.571; P<.001). Conclusions: The process evaluation identifies viewing advice pages as associated with increased enablement to self-care, even when accessed in the absence of a RTI, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was effective at reaching the target population of users who had previously consulted their general practitioners. However, attrition before reaching advice pages was high, highlighting the necessity of prioritizing access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated and have wider implications for minor ailment interventions. %M 35044317 %R 10.2196/24239 %U https://formative.jmir.org/2022/1/e24239 %U https://doi.org/10.2196/24239 %U http://www.ncbi.nlm.nih.gov/pubmed/35044317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22586 %T Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors %A Hoang,Victor %A Parekh,Amit %A Sagers,Kevin %A Call,Trevor %A Howard,Shain %A Hoffman,Jason %A Lee,Daniel %+ Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV, 89106, United States, 1 7148374577, hoangorthopedics@gmail.com %K orthopedics %K practice management %K physician selection %K internet reviews %K patient decision %K practice %K patient online review %K social media %K physician perception %K patient choice %K health literacy %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons. Objective: The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level. Methods: This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information. Results: Patient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups. Conclusions: This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors. %M 35044319 %R 10.2196/22586 %U https://formative.jmir.org/2022/1/e22586 %U https://doi.org/10.2196/22586 %U http://www.ncbi.nlm.nih.gov/pubmed/35044319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19448 %T Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews With Institutional Stakeholders %A Chen,Nuoya %+ Faculty of Global Studies, Justice and Rights, University of Macerata, Crescimbeni 30-32, Macerata, 62100, Italy, 39 3913385558, cny0824@gmail.com %K aging %K telehealth implementation %K stakeholder mapping and power analysis %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Facing COVID 19, the use of telehealth solutions grows exponentially. However, despite the large investments made into telehealth solutions, the implementation process remains slow and sluggish. Moreover, during COVID-19, older people experienced difficulties and had the highest mortality rates, and those lucky enough to survive faced tremendous pressure to use QR code-based health monitoring systems. Objective: This paper aims to determine the barriers and incentives for the implementation of telehealth solutions via a case study about telehealth implementation in China. Methods: We conducted 8 semi-structured interviews following the design of the interactive learning framework (research question defining, participant recruitment, exploratory stage, consultation stage, integration stage, and follow-up interview). One interview with a government official from the National Health Commission and another interview with a government official from the China Center for Disease Control and Prevention was conducted in the exploratory stage. The consultation stage comprised one interview with a business manager from the Huawei Wearable Unit, one interview with a business manager from Alibaba Health Brain Unit, and one interview with a business manager from Xiaomi. Two interviews with doctors from Fudan University-affiliated Huashan Hospital and Fudan University-affiliated Zhongshan hospital were conducted in the integration stage. In addition, 8 focus group studies with 64 participants from rural and urban Beijing were conducted. Finally, another telephone interview with a business manager of the Xiaomi Wearable Unit was conducted in the follow-up stage. Results: Telehealth solutions are designed to assist health care providers in realizing the quadruple aim of better health outcomes, lowering health care costs, improved health care quality, and improved doctor and patient experiences. Governments have high incentives to improve health care efficiency via telehealth solutions. However, they have limited resources to make the necessary infrastructure transformation. Conclusions: To fully realize the potential of telehealth devices, heavy infrastructure investment in the telecommunication network is required beforehand to resolve the interoperability issue occurring during the data collection process for telehealth solutions. The industry also demands a mature business model incorporating collaboration between various stakeholders and industrial partners to invest in infrastructure. Governments have high interest and significant influence on building the necessary infrastructure for telehealth solution implementation in China. Industrial actors have a high interest and a medium level of power for telehealth solution implementation. Users have high interest but a lower level of power for the usage of telehealth solutions, and doctors have low interest and a medium level of power for telehealth solutions implementation. %M 35044321 %R 10.2196/19448 %U https://formative.jmir.org/2022/1/e19448 %U https://doi.org/10.2196/19448 %U http://www.ncbi.nlm.nih.gov/pubmed/35044321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29889 %T Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians %A Doyle,Sarah %A Pavlos,Rebecca %A Carlson,Samantha J %A Barton,Katherine %A Bhuiyan,Mejbah %A Boeing,Bernadett %A Borland,Meredith L %A Hoober,Steven %A Blyth,Christopher C %+ Emergency Department, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Perth, 6009, Australia, 61 64562222, sarahkdoyle@me.com %K usability testing %K REDCap %K discharge instructions %K acute respiratory infection %K digital health technology %K mobile technology %K semistructured interview %K pediatric acute respiratory infection %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective: The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods: Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results: Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions: Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting. %M 35037889 %R 10.2196/29889 %U https://formative.jmir.org/2022/1/e29889 %U https://doi.org/10.2196/29889 %U http://www.ncbi.nlm.nih.gov/pubmed/35037889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e17568 %T A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready): Formative Evaluation %A Dannapfel,Petra %A Thomas,Kristin %A Chakhunashvili,Alexander %A Melin,Jeanette %A Trolle Lagerros,Ylva %+ Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Building 511-001, 14th Floor, Linköping, 58183, Sweden, 46 727 174370, petra.dannapfel@regionostergotland.se %K implementation science %K health care sector %K telemedicine %K organizational readiness for change %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings. Objective: The aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care. Methods: A first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated. Results: The E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87). Conclusions: E-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample. %M 35037884 %R 10.2196/17568 %U https://formative.jmir.org/2022/1/e17568 %U https://doi.org/10.2196/17568 %U http://www.ncbi.nlm.nih.gov/pubmed/35037884 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e24483 %T Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study %A Fox,Sarah %A Brown,Laura J E %A Antrobus,Steven %A Brough,David %A Drake,Richard J %A Jury,Francine %A Leroi,Iracema %A Parry-Jones,Adrian R %A Machin,Matthew %+ Division of Informatics, Imaging & Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)7917 520637, matthew.machin@manchester.ac.uk %K agile %K dementia %K co-design %K cognition %K mHealth %K patient public involvement %K software development %K mobile phone %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner–led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. %M 35029539 %R 10.2196/24483 %U https://mhealth.jmir.org/2022/1/e24483 %U https://doi.org/10.2196/24483 %U http://www.ncbi.nlm.nih.gov/pubmed/35029539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32458 %T Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study %A Huberty,Jennifer %A Bhuiyan,Nishat %A Neher,Taylor %A Joeman,Lynda %A Mesa,Ruben %A Larkey,Linda %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K cancer patients/survivors %K meditation %K mHealth %K app development %K qualitative research %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients’/survivors’ needs. Objective: The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods: Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results: A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions: Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype’s form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study. %M 35029528 %R 10.2196/32458 %U https://formative.jmir.org/2022/1/e32458 %U https://doi.org/10.2196/32458 %U http://www.ncbi.nlm.nih.gov/pubmed/35029528 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34429 %T Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis %A Struik,Laura %A Khan,Shaheer %A Assoiants,Artem %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079972, laura.struik@ubc.ca %K qualitative research %K smoking cessation %K social media %K social support %K smoking %K tobacco use %K tobacco %K online forum %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms. Objective: The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts. Methods: A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software. Results: Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time. Conclusions: The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation. %M 35023834 %R 10.2196/34429 %U https://formative.jmir.org/2022/1/e34429 %U https://doi.org/10.2196/34429 %U http://www.ncbi.nlm.nih.gov/pubmed/35023834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32610 %T A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina %A Sanchez Antelo,Victoria %A Szwarc,Lucila %A Paolino,Melisa %A Saimovici,Diana %A Massaccesi,Silvia %A Viswanath,Kasisomayajula %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante, 27, Ciudad Autónoma de Buenos Aires, C1173 AAA, Argentina, 54 11 4865 1707, silviarrossi@cedes.org %K mHealth %K mobile application %K counseling %K HPV test %K cervical cancer %K health belief model %K integrated behavioral model %K patient education %K Argentina %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective: This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions: Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women. %M 35023843 %R 10.2196/32610 %U https://formative.jmir.org/2022/1/e32610 %U https://doi.org/10.2196/32610 %U http://www.ncbi.nlm.nih.gov/pubmed/35023843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32273 %T A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study %A Feldman,Amy G %A Moore,Susan %A Bull,Sheana %A Morris,Megan A %A Wilson,Kumanan %A Bell,Cameron %A Collins,Margaret M %A Denize,Kathryn M %A Kempe,Allison %+ Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 720 777 5354, amy.feldman@childrenscolorado.org %K vaccinations %K transplantation %K mobile app %K agile development %K immunization %K mHealth %K mobile health %K children %K transplant recipients %K pediatric transplant recipients %K pediatrics %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. %M 35023840 %R 10.2196/32273 %U https://formative.jmir.org/2022/1/e32273 %U https://doi.org/10.2196/32273 %U http://www.ncbi.nlm.nih.gov/pubmed/35023840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32126 %T Evaluating the Quality of Asynchronous Versus Synchronous Virtual Care in Patients With Erectile Dysfunction: Retrospective Cohort Study %A Broffman,Lauren %A Barnes,Melynda %A Stern,Kevin %A Westergren,Amy %+ Ro, 116 West 23rd Street, New York, NY, 10011, United States, 1 888 798 8686, lauren.broffman@ro.co %K telehealth %K medical informatics %K side effect %K virtual health %K platform %K medication %K sync %K outcome %K adverse event %K drug %K electronic health record %K treatment %K erectile dysfunction %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Asynchronous health care encounters are becoming an increasingly mainstream form of telehealth. While synchronous phone or video visits have become more widely accepted, US policymakers and other key health care stakeholders have been hesitant to fully embrace asynchronous diagnosis and treatment. This is particularly true in the context of direct-to-consumer (DTC) platforms, where encounters are patient-initiated and there is no preestablished relationship with a provider. This hesitation is compounded by limited research comparing outcomes between asynchronous and synchronous care, especially in the DTC context. Objective: The purpose of this study was to explore whether asynchronous care leads to different patient outcomes in the form of medication-related adverse events when compared to synchronous virtual care. Methods: Using 10,000 randomly sampled patient records from a prominent US-based DTC platform, we analyzed the rates of patient-reported side effects from commonly prescribed erectile dysfunction medications and compared these rates across modalities of treatment. Results: Asynchronous care resulted in lower but nonsignificant differences in the rates of the reported drug-related side effects compared to synchronous treatment. Conclusions: In some circumstances, such as treatment for erectile dysfunction, asynchronous care can offer the same level of safety in prescribing when compared to synchronous care. More research is needed to evaluate the safety of asynchronous care across a wider set of conditions and measures. %M 34905499 %R 10.2196/32126 %U https://formative.jmir.org/2022/1/e32126 %U https://doi.org/10.2196/32126 %U http://www.ncbi.nlm.nih.gov/pubmed/34905499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30640 %T Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study %A Chaudhry,Beenish Moalla %A Islam,Ashraful %A Matthieu,Monica %+ University of Louisiana at Lafayette, School of Computing and Informatics, 104 E University Circle, Lafayette, LA, 70508, United States, 1 4134616440, Beenish.chaudhry@louisiana.edu %K mental health %K stress %K mHealth %K frontline health worker %K design requirements %K pandemic %K COVID-19 %K design %K intervention %K burnout %K perspective %K need %K user design %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. %M 34806985 %R 10.2196/30640 %U https://formative.jmir.org/2022/1/e30640 %U https://doi.org/10.2196/30640 %U http://www.ncbi.nlm.nih.gov/pubmed/34806985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29153 %T Internet Search Results for Older Adult Physical Activity Guidelines: Scoping Review %A Harden,Samantha M %A Murphy,Anna %A Ratliff,Kathryn %A Balis,Laura E %+ Physical Activity Research and Community Implementation Laboratory, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, Blacksburg, VA, 24060, United States, 1 540 231 9960, harden.samantha@vt.edu %K dissemination %K information seeking %K health communication %K elderly %D 2022 %7 13.1.2022 %9 Review %J JMIR Form Res %G English %X Background: Older adults seek health-related information through casual internet searches. Yet, researchers focus on peer-reviewed journals and conference presentations as primary dissemination strategies. Representatives of mass media are alerted (passive diffusion) of new studies or recommendations, but the veracity of the information shared is not often analyzed, and when it is, the analysis is often not comprehensive. However, most older adults do not have access to peer-reviewed journal articles or paid subscription services for more reputable media outlets. Objective: We aimed to determine what information was readily available (ie, open access) to older adults who may casually search the internet for physical activity recommendations. Methods: We performed a 6-part scoping review to determine the research question and available evidence, and extract data within open-access top hits using popular online search engines. Results were categorized by a dissemination model that has categories of sources, channels, audience, and messages. Results: After the iterative search process, 92 unique articles were included and coded. Only 5 (5%) cited physical activity guidelines, and most were coded as promoting healthy aging (82/92, 89%) and positive framing (84/92, 91%). Most articles were posed as educational, but the authors’ credentials were rarely reported (ie, 22% of the time). Muscle strengthening and balance components of the physical activity guidelines for older adults were rarely reported (72/92, 78% and 80/92, 87%, respectively) or inaccurately reported (3/92, 3% and 3/92, 3%, respectively). Conclusions: Inconsistent messages lead to mistrust of science and public health representatives. This work highlights the lack of evidence within existing open-access resources. Further efforts are needed to ensure evidence-based public health messages are in the sources and channels older adults are using to inform their knowledge and behaviors. %M 35023847 %R 10.2196/29153 %U https://formative.jmir.org/2022/1/e29153 %U https://doi.org/10.2196/29153 %U http://www.ncbi.nlm.nih.gov/pubmed/35023847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31759 %T Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study %A Farr,Deeonna E %A Battle,Darian A %A Hall,Marla B %+ Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G Belk Building, Mail Stop 529, Greenville, NC, 27858, United States, 1 2527375392, farrd17@ecu.edu %K social media %K surveys %K questionnaires %K advertising %K patient selection %K methodology %K ethnic groups %K health research %K healthcare %K health care %K women’s health %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective: A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods: Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results: In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions: Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations. %M 35019843 %R 10.2196/31759 %U https://formative.jmir.org/2022/1/e31759 %U https://doi.org/10.2196/31759 %U http://www.ncbi.nlm.nih.gov/pubmed/35019843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31698 %T Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study %A Kumar,Shefali %A Rudie,Emma %A Dorsey,Cynthia %A Blase,Amy %A Benjafield,Adam V %A Sullivan,Shannon S %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 6502530000, shefalikumar@verily.com %K obstructive sleep apnea %K virtual care %K remote care %K OSA diagnosis %K sleep apnea %K OSA %K underdiagnosed %K feasibility %K patient-centered %K treatment pathway %K diagnostic %K eHealth %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway. Objective: This prospective, single-arm, multistate feasibility pilot study aimed to understand the journey in a nonreferred sample of participants through the fully remote OSA screening and diagnostic and treatment pathway, using the Primasun Sleep Apnea Program (formally, Verily Sleep Apnea Program). Methods: Participants were recruited online from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician who could order a home sleep apnea test (HSAT) to be delivered to the participant's home. The results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. The participants who were diagnosed with OSA during the study and prescribed a positive airway pressure (PAP) device were instructed to download an app that provides educational and support-related content and access to personalized coaching support during the study’s 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program. Results: For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 (SD 2.6) days and median 7.1 days (IQR 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 (SD 9.6) days and median 11.7 days (IQR 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from the first televisit appointment to receiving an OSA diagnosis was 21.4 (SD 9.6) days and 18.9 days (IQR 9.2), respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 (SD 9.3) days and median 6.0 days (IQR 4.0) from OSA diagnosis to PAP therapy initiation. Conclusions: These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost. The program’s ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic, as the United States shifted to remote care models and may sustain this direction. The potential economic and clinical impact of the program’s short and efficient journey time and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and adherence. Trial Registration: ClinicalTrials.gov NCT04599803; https://clinicaltrials.gov/ct2/show/NCT04599803 %M 34792470 %R 10.2196/31698 %U https://formative.jmir.org/2022/1/e31698 %U https://doi.org/10.2196/31698 %U http://www.ncbi.nlm.nih.gov/pubmed/34792470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33438 %T Patients’ Expectations and Experiences With a Mental Health–Focused Supportive Text Messaging Program: Mixed Methods Evaluation %A Shalaby,Reham %A Vuong,Wesley %A Eboreime,Ejemai %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 17807144315, vincent.agyapong@nshealth.ca %K supportive text messages %K patients’ experience %K mental health %K mixed methods %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. Objective: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers’ experiences. Methods: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). Results: Out of 89 participants, 36 (40%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber’s sex at birth or primary diagnosis. The patients’ initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. Conclusions: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services. %M 35014972 %R 10.2196/33438 %U https://formative.jmir.org/2022/1/e33438 %U https://doi.org/10.2196/33438 %U http://www.ncbi.nlm.nih.gov/pubmed/35014972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e25444 %T An Open-Source Privacy-Preserving Large-Scale Mobile Framework for Cardiovascular Health Monitoring and Intervention Planning With an Urban African American Population of Young Adults: User-Centered Design Approach %A Clifford,Gari %A Nguyen,Tony %A Shaw,Corey %A Newton,Brittney %A Francis,Sherilyn %A Salari,Mohsen %A Evans,Chad %A Jones,Camara %A Akintobi,Tabia Henry %A Taylor Jr,Herman %+ Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, United States, 1 404 752 1545, htaylor@msm.edu %K agile design %K cardiovascular disease %K community-based participatory research %K exposome %K user-centered design %K minority health %K African American %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide and are increasingly affecting younger populations, particularly African Americans in the southern United States. Access to preventive and therapeutic services, biological factors, and social determinants of health (ie, structural racism, resource limitation, residential segregation, and discriminatory practices) all combine to exacerbate health inequities and their resultant disparities in morbidity and mortality. These factors manifest early in life and have been shown to impact health trajectories into adulthood. Early detection of and intervention in emerging risk offers the best hope for preventing race-based differences in adult diseases. However, young-adult populations are notoriously difficult to recruit and retain, often because of a lack of knowledge of personal risk and a low level of concern for long-term health outcomes. Objective: This study aims to develop a system design for the MOYO mobile platform. Further, we seek to addresses the challenge of primordial prevention in a young, at-risk population (ie, Southern-urban African Americans). Methods: Urban African Americans, aged 18 to 29 years (n=505), participated in a series of co-design sessions to develop MOYO prototypes (ie, HealthTech Events). During the sessions, participants were orientated to the issues of CVD risk health disparities and then tasked with wireframing prototype screens depicting app features that they considered desirable. All 297 prototype screens were subsequently analyzed using NVivo 12 (QSR International), a qualitative analysis software. Using the grounded theory approach, an open-coding method was applied to a subset of data, approximately 20% (5/25), or 5 complete prototypes, to identify the dominant themes among the prototypes. To ensure intercoder reliability, 2 research team members analyzed the same subset of data. Results: Overall, 9 dominant design requirements emerged from the qualitative analysis: customization, incentive motivation, social engagement, awareness, education, or recommendations, behavior tracking, location services, access to health professionals, data user agreements, and health assessment. This led to the development of a cross-platform app through an agile design process to collect standardized health surveys, narratives, geolocated pollution, weather, food desert exposure data, physical activity, social networks, and physiology through point-of-care devices. A Health Insurance Portability and Accountability Act–compliant cloud infrastructure was developed to collect, process, and review data, as well as generate alerts to allow automated signal processing and machine learning on the data to produce critical alerts. Integration with wearables and electronic health records via fast health care interoperability resources was implemented. Conclusions: The MOYO mobile platform provides a comprehensive health and exposure monitoring system that allows for a broad range of compliance, from passive background monitoring to active self-reporting. These study findings support the notion that African Americans should be meaningfully involved in designing technologies that are developed to improve CVD outcomes in African American communities. %M 35014970 %R 10.2196/25444 %U https://formative.jmir.org/2022/1/e25444 %U https://doi.org/10.2196/25444 %U http://www.ncbi.nlm.nih.gov/pubmed/35014970 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31875 %T Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study %A Sasaki,Yuki %A Sato,Koryu %A Kobayashi,Satomi %A Asakura,Keiko %+ Link & Communication Inc, Kioicho 4-1, Chiyoda-ku, Tokyo, 102-0094, Japan, 81 3 5210 2721, y.sasaki@linkncom.co.jp %K health app %K image recognition %K automatic calculation %K nutrient and food contents %K validity %K mobile phone %K mHealth %K validation %K nutrition %K diet %K food %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A smartphone image recognition app is expected to be a novel tool for measuring nutrients and food intake, but its performance has not been well evaluated. Objective: We assessed the accuracy of the performance of an image recognition app called CALO mama in terms of the nutrient and food group contents automatically estimated by the app. Methods: We prepared 120 meal samples for which the nutrients and food groups were calculated. Next, we predicted the nutrients and food groups included in the meals from their photographs by using (1) automated image recognition only and (2) manual modification after automatic identification. Results: Predictions generated using only image recognition were similar to the actual data on the weight of meals and were accurate for 11 out of 30 nutrients and 4 out of 15 food groups. The app underestimated energy, 19 nutrients, and 9 food groups, while it overestimated dairy products and confectioneries. After manual modification, the predictions were similar for energy, accurately capturing the nutrients for 29 out of 30 of meals and the food groups for 10 out of 15 meals. The app underestimated pulses, fruits, and meats, while it overestimated weight, vitamin C, vegetables, and confectioneries. Conclusions: The results of this study suggest that manual modification after prediction using image recognition improves the performance of the app in assessing the nutrients and food groups of meals. Our findings suggest that image recognition has the potential to achieve a description of the dietary intakes of populations by using “precision nutrition” (a comprehensive and dynamic approach to developing tailored nutritional recommendations) for individuals. %M 35006077 %R 10.2196/31875 %U https://formative.jmir.org/2022/1/e31875 %U https://doi.org/10.2196/31875 %U http://www.ncbi.nlm.nih.gov/pubmed/35006077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30565 %T Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study %A Burn,Anne-Marie %A Ford,Tamsin J %A Stochl,Jan %A Jones,Peter B %A Perez,Jesus %A Anderson,Joanna K %+ Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, , Cambridge, CB2 0SZ, United Kingdom, 44 1223 465 192, amb278@medschl.cam.ac.uk %K mental health %K assessment %K young people %K youth %K schools %K computerized adaptive testing %K mobile apps %K user-centered design %K coproduction %K qualitative study %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles—an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. %M 35006079 %R 10.2196/30565 %U https://formative.jmir.org/2022/1/e30565 %U https://doi.org/10.2196/30565 %U http://www.ncbi.nlm.nih.gov/pubmed/35006079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e26526 %T Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %A Bhandari,Aparajita %A Chapman,Julia %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K randomized controlled trial %K mobile app %K peer support %K urges %K digital intervention %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration: Open Science Foundation; https://osf.io/3uay9 %M 35006076 %R 10.2196/26526 %U https://formative.jmir.org/2022/1/e26526 %U https://doi.org/10.2196/26526 %U http://www.ncbi.nlm.nih.gov/pubmed/35006076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31801 %T Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach %A Richards,Rebecca %A Jones,Rebecca A %A Whittle,Fiona %A Hughes,Carly A %A Hill,Andrew J %A Lawlor,Emma R %A Bostock,Jennifer %A Bates,Sarah %A Breeze,Penny R %A Brennan,Alan %A Thomas,Chloe V %A Stubbings,Marie %A Woolston,Jennifer %A Griffin,Simon J %A Ahern,Amy L %+ Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Level 3 Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 769129, Rebecca.richards@mrc-epid.cam.ac.uk %K weight management %K eHealth %K acceptance and commitment therapy %K third-wave cognitive behavioral therapy %K guided self-help %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective: The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results: This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions: This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial. %M 34994698 %R 10.2196/31801 %U https://formative.jmir.org/2022/1/e31801 %U https://doi.org/10.2196/31801 %U http://www.ncbi.nlm.nih.gov/pubmed/34994698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30863 %T Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study %A Haveman,Marjolein E %A van Rossum,Mathilde C %A Vaseur,Roswita M E %A van der Riet,Claire %A Schuurmann,Richte C L %A Hermens,Hermie J %A de Vries,Jean-Paul P M %A Tabak,Monique %+ Department of Surgery, University Medical Center Groningen, University of Groningen, BA60, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 625646832, m.e.haveman@umcg.nl %K wearable sensors %K telemonitoring %K continuous monitoring %K vital signs %K mHealth %K wearable %K biosensor %K validity %K accuracy %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients’ baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making. Objective: The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment. Methods: Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA). Results: A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (−0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of −39.0 to 28.3) bpm and 11.4 (LoA of −53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (−10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C. Conclusions: Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring. %M 34994703 %R 10.2196/30863 %U https://formative.jmir.org/2022/1/e30863 %U https://doi.org/10.2196/30863 %U http://www.ncbi.nlm.nih.gov/pubmed/34994703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30027 %T Feasibility of Monitoring Health and Well-being in Emerging Adults: Pilot Longitudinal Cohort Study %A Lystad,Reidar P %A Fajardo Pulido,Diana %A Peters,Lorna %A Johnstone,Melissa %A Ellis,Louise A %A Braithwaite,Jeffrey %A Wuthrich,Viviana %A Amin,Janaki %A Cameron,Cate M %A Mitchell,Rebecca J %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, 2109, Australia, 61 298502464, reidar.lystad@mq.edu.au %K young adult %K emerging adulthood %K health %K well-being %K health-related quality of life %K feasibility %K monitoring %K pilot study %K longitudinal %K cohort %K youth %K acceptability %K survey %K quality of life %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging adulthood is a distinct segment of an individual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. Objective: The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. Methods: This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the sample, completeness of the survey responses, and data linkage characteristics. Results: Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). Conclusions: The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12618001364268; https://tinyurl.com/teec8wh International Registered Report Identifier (IRRID): RR2-10.2196/16108 %M 34989696 %R 10.2196/30027 %U https://formative.jmir.org/2022/1/e30027 %U https://doi.org/10.2196/30027 %U http://www.ncbi.nlm.nih.gov/pubmed/34989696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27418 %T The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration %A Kenny,Lorna %A Moore,Kevin %A O' Riordan,Clíona %A Fox,Siobhan %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr's Hospital, Douglas Road, Cork, T12 XH60, Ireland, 353 851085070, lorna.kenny@ucc.ie %K Parkinson disease %K wearable devices %K technology %K mixed method %K focus group %K survey %K mobile phone %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. %M 34989693 %R 10.2196/27418 %U https://formative.jmir.org/2022/1/e27418 %U https://doi.org/10.2196/27418 %U http://www.ncbi.nlm.nih.gov/pubmed/34989693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30408 %T Game Plan—a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis %A Wray,Tyler B %A Chan,Philip A %A Guigayoma,John P %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 S. Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K HIV %K pre-exposure prophylaxis %K alcohol use %K mHealth %K eHealth %K intervention %K mobile phone %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective: We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods: Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results: In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions: Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult. %M 34989679 %R 10.2196/30408 %U https://formative.jmir.org/2022/1/e30408 %U https://doi.org/10.2196/30408 %U http://www.ncbi.nlm.nih.gov/pubmed/34989679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28895 %T Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study %A Tennant,Ryan %A Allana,Sana %A Mercer,Kate %A Burns,Catherine M %+ Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, ryan.tennant@uwaterloo.ca %K children %K caregiver %K digital health %K home care %K qualitative research %K technology %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child’s health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child’s health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. Objective: The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. Methods: This research is part of a broader study to explore caregivers’ perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. Results: We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child’s status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children’s educators. Beyond the scope of managing their child’s health information, family caregivers also navigated bureaucratic processes for their child’s home care. Conclusions: Family caregivers’ experiences of caring for CSHCN differ contextually and evolve as their child’s condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child’s health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings. %M 34989692 %R 10.2196/28895 %U https://formative.jmir.org/2022/1/e28895 %U https://doi.org/10.2196/28895 %U http://www.ncbi.nlm.nih.gov/pubmed/34989692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30286 %T Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review %A Ademiluyi,Adesoji %A Li,Chuqin %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, apark11@uncc.edu %K cyberbullying %K cybervictimization %K cyberaggression %K bullying %K mental health %K social isolation %K social media %K mobile phone %D 2022 %7 4.1.2022 %9 Review %J JMIR Form Res %G English %X Background: The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective: This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods: Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results: Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions: Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention. %M 34982712 %R 10.2196/30286 %U https://formative.jmir.org/2022/1/e30286 %U https://doi.org/10.2196/30286 %U http://www.ncbi.nlm.nih.gov/pubmed/34982712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e23236 %T The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach %A Ogundaini,Oluwamayowa %A de la Harpe,Retha %+ Department of Information Technology, Cape Peninsula University of Technology, Engineering Building, 2nd Floor, Hanover Street, Zonnebloem, Cape Town, 8000, South Africa, 27 0735989341, ogundainio@cput.ac.za %K agency %K health care professionals %K technology performativity %K sub-Saharan Africa %K service design %K work activities %K mobile phone %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants’ data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. %M 34982713 %R 10.2196/23236 %U https://formative.jmir.org/2022/1/e23236 %U https://doi.org/10.2196/23236 %U http://www.ncbi.nlm.nih.gov/pubmed/34982713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22582 %T A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study %A Choo,Carol C %A Tan,Yi Zhuang %A Zhang,Melvyn W B %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18 Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attentional bias retraining %K smartphone app %K mixed methods %K smoking %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. %M 34982037 %R 10.2196/22582 %U https://formative.jmir.org/2022/1/e22582 %U https://doi.org/10.2196/22582 %U http://www.ncbi.nlm.nih.gov/pubmed/34982037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25748 %T Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study %A Hsu,Wan-Yu %A Rowles,William %A Anguera,Joaquin A %A Anderson,Annika %A Younger,Jessica W %A Friedman,Samuel %A Gazzaley,Adam %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 595 2795, Riley.Bove@ucsf.edu %K cognition %K digital health %K mHealth %K multiple sclerosis %K cognitive assessment %D 2021 %7 30.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective: To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods: In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results: Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions: These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618 %M 34967751 %R 10.2196/25748 %U https://www.jmir.org/2021/12/e25748 %U https://doi.org/10.2196/25748 %U http://www.ncbi.nlm.nih.gov/pubmed/34967751 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e32575 %T A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study %A Wang,Tianyu %A Stanforth,Philip R %A Fleming,R Y Declan %A Wolf Jr,J Stuart %A Stanforth,Dixie %A Tanaka,Hirofumi %+ Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, United States, 1 5122324801, htanaka@austin.utexas.edu %K mobile app %K prehabilitation %K perioperative care %K rehabilitation %K surgery %K perioperative %K elective surgery %K mobile health %K health applications %K health apps %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective: This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods: The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. Results: We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions: This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future. %M 34967752 %R 10.2196/32575 %U https://periop.jmir.org/2021/2/e32575 %U https://doi.org/10.2196/32575 %U http://www.ncbi.nlm.nih.gov/pubmed/34967752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31890 %T Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial %A Elzinga,Willem O %A Prins,Samantha %A Borghans,Laura G J M %A Gal,Pim %A Vargas,Gabriel A %A Groeneveld,Geert J %A Doll,Robert J %+ Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333CL, Netherlands, 31 715246400, rjdoll@chdr.nl %K photoplethysmography %K smartwatch %K wearable %K at-home %K heart rate %K RCT %K wearable device %K digital health %K cardiovascular %K cardiology %K sensors %K heart rate sensor %K smart technology %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 %M 34967757 %R 10.2196/31890 %U https://formative.jmir.org/2021/12/e31890 %U https://doi.org/10.2196/31890 %U http://www.ncbi.nlm.nih.gov/pubmed/34967757 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30767 %T Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study %A Wang,Elizabeth Y %A Breyer,Benjamin N %A Lee,Austin W %A Rios,Natalie %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Kenfield,Stacey A %A Bauer,Scott R %+ University of California San Francisco, 550 16th St, 6th floor, Box 1695, San Francisco, CA, 94121, United States, 1 4152214810 ext 24322, Scott.Bauer@ucsf.edu %K BPH %K mobile health %K mHealth %K telehealth %K telemedicine %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. %M 34951599 %R 10.2196/30767 %U https://humanfactors.jmir.org/2021/4/e30767 %U https://doi.org/10.2196/30767 %U http://www.ncbi.nlm.nih.gov/pubmed/34951599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32932 %T A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Protocol Development for an Expert System to Provide Adaptive User Feedback %A Goulding,Evan H %A Dopke,Cynthia A %A Michaels,Tania %A Martin,Clair R %A Khiani,Monika A %A Garborg,Christopher %A Karr,Chris %A Begale,Mark %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Suite 7-102, 303 East Chicago Ave, Chicago, IL, 60611, United States, 1 312 503 1189, e-goulding@fsm.northwestern.edu %K adaptive %K personalized %K self-management %K smartphone %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K mania %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Bipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can improve outcomes. However, access to therapy is limited. Smartphones and other technologies can increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as alerts to providers to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions. Objective: To contribute to and support the improvement and dissemination of technology-based mental health interventions, we provide a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder. Methods: Information from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system. Results: Decision points determining the timing of intervention option adaptation were selected to occur daily and weekly based on self-report data for medication adherence, sleep duration, routine, and wellness levels. These data were selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable thresholds were developed based on existing literature regarding bipolar disorder clinical status and psychiatrist feedback. To address the need for treatment adaptation with varying clinical statuses, decision rules for a clinical status state machine were developed using self-reported wellness rating data. Clinical status from this state machine was incorporated into hierarchal decision tables that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building and utilizing support, and keeping a regular routine, as well as determinants underlying engagement in these target behaviors as follows: attitudes and perceptions, knowledge, support, evaluation, and planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms, and engaging with psychiatric providers. Conclusions: Adaptive mental health technologies have the potential to enhance the self-management of mental health disorders. The need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems. %M 34951598 %R 10.2196/32932 %U https://formative.jmir.org/2021/12/e32932 %U https://doi.org/10.2196/32932 %U http://www.ncbi.nlm.nih.gov/pubmed/34951598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30578 %T A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial %A Krukowski,Rebecca %A Johnson,Brandi %A Kim,Hyeonju %A Sen,Saunak %A Homsi,Riad %+ Department of Public Health Science, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, United States, 1 434 924 1000, bkrukowski@virginia.edu %K pregnancy %K weight %K physical activity %K self-weighing %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine’s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks’ gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive–based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive–based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 %M 34951594 %R 10.2196/30578 %U https://formative.jmir.org/2021/12/e30578 %U https://doi.org/10.2196/30578 %U http://www.ncbi.nlm.nih.gov/pubmed/34951594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28709 %T Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study %A Wilson-Howard,Danyell %A Vilaro,Melissa J %A Neil,Jordan M %A Cooks,Eric J %A Griffin,Lauren N %A Ashley,Taylor T %A Tavassoli,Fatemeh %A Zalake,Mohan S %A Lok,Benjamin C %A Odedina,Folakemi T %A Modave,Francois %A Carek,Peter J %A George,Thomas J %A Krieger,Janice L %+ Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, FL, 32114, United States, 1 3864812687, wilsonda@cookman.edu %K telehealth %K digital health %K eHealth %K colorectal cancer %K Black men %K virtual human %K technology %K cancer screening %K app %K cancer %K prevention %K development %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. %M 34780346 %R 10.2196/28709 %U https://formative.jmir.org/2021/12/e28709 %U https://doi.org/10.2196/28709 %U http://www.ncbi.nlm.nih.gov/pubmed/34780346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30558 %T A Digital Health Fall Prevention Program for Older Adults: Feasibility Study %A Jacobson,Claire L %A Foster,Lauren C %A Arul,Hari %A Rees,Amanda %A Stafford,Randall S %+ Age Bold Inc, Los Angeles, CA, United States, 1 6503811395, lauren@agebold.com %K older adults %K accidental falls %K fall prevention %K digital health %K technology %K exercise %K longevity and healthy aging %K program evaluation %K aging %K elderly %K health strategy %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective: We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. Methods: Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results: The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. Conclusions: The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults. %M 34837492 %R 10.2196/30558 %U https://formative.jmir.org/2021/12/e30558 %U https://doi.org/10.2196/30558 %U http://www.ncbi.nlm.nih.gov/pubmed/34837492 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27852 %T Understanding Adolescents’ Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study %A Jee,Muhammad %A Khan,Alsa %A Nazneen,Nazneen %+ Twinbits, 1201 Big Falls Dr, Flower Mound, TX, 75028, United States, 1 214 972 8988, muhammadjee1@gmail.com %K adolescents’ perceptions %K personal technology %K technology relationship %K adolescents as technology users %K adolescents as technology bystanders %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others’ relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: "Essential,” “Distractive,” and “Addictive” were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1%; distractive: 105/619, 17%; addictive: 88/619, 14.2% ) and others’ relationship as well (essential: 96/619, 15.6%; distractive: 88/619, 14.3%; addictive: 90/619, 14.5%). Adolescents selected “Provides an escape” more to describe their own relationship with technology. Whereas, they selected “It's just a tool” and “Creates Barrier” more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was “best friend”, 16 to 17-year olds’ top choice was “I don't believe in personal connection with mobile technology,” and 18 to 19-year olds’ top choice was “My personal assistant.” Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. %M 34941556 %R 10.2196/27852 %U https://formative.jmir.org/2021/12/e27852 %U https://doi.org/10.2196/27852 %U http://www.ncbi.nlm.nih.gov/pubmed/34941556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28958 %T Implementation of Fingerprint Technology for Unique Patient Matching and Identification at an HIV Care and Treatment Facility in Western Kenya: Cross-sectional Study %A Jaafa,Noah Kasiiti %A Mokaya,Benard %A Savai,Simon Muhindi %A Yeung,Ada %A Siika,Abraham Mosigisi %A Were,Martin %+ Institute of Biomedical Informatics, Moi University, Nandi Road, Eldoret, PO Box 3900-30100, Kenya, 256 753764102, kasiitinoah@gmail.com %K biometrics %K patient matching %K fingerprints %K unique patient identification %K electronic medical record systems %K low- and middle-income countries (LMICs) %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Unique patient identification remains a challenge in many health care settings in low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on demographic-based approaches that have proven suboptimal. Affordable biometrics-based approaches, implemented with consideration of contextual ethical, legal, and social implications, have the potential to address this challenge and improve patient safety and reporting accuracy. However, limited studies exist to evaluate the actual performance of biometric approaches and perceptions of these systems in LMICs. Objective: The aim of this study is to evaluate the performance and acceptability of fingerprint technology for unique patient matching and identification in the LMIC setting of Kenya. Methods: In this cross-sectional study conducted at an HIV care and treatment facility in Western Kenya, an open source fingerprint application was integrated within an implementation of the Open Medical Record System, an open source electronic medical record system (EMRS) that is nationally endorsed and deployed for HIV care in Kenya and in more than 40 other countries; hence, it has potential to translate the findings across multiple countries. Participants aged >18 years were conveniently sampled and enrolled into the study. Participants’ left thumbprints were captured and later used to retrieve and match records. The technology’s performance was evaluated using standard measures: sensitivity, false acceptance rate, false rejection rate, and failure to enroll rate. The Wald test was used to compare the accuracy of the technology with the probabilistic patient-matching technique of the EMRS. Time to retrieval and matching of records were compared using the independent samples 2-tailed t test. A survey was administered to evaluate patient acceptance and satisfaction with use of the technology. Results: In all, 300 participants were enrolled; their mean age was 36.3 (SD 12.2) years, and 58% (174/300) were women. The relevant values for the technology’s performance were sensitivity 89.3%, false acceptance rate 0%, false rejection rate 11%, and failure to enroll rate 2.3%. The technology’s mean record retrieval speed was 3.2 (SD 1.1) seconds versus 9.5 (SD 1.9) seconds with demographic-based record retrieval in the EMRS (P<.001). The survey results revealed that 96.3% (289/300) of the participants were comfortable with the technology and 90.3% (271/300) were willing to use it. Participants who had previously used fingerprint biometric systems for identification were estimated to have more than thrice increased odds of accepting the technology (odds ratio 3.57, 95% CI 1.0-11.92). Conclusions: Fingerprint technology performed very well in identifying adult patients in an LMIC setting. Patients reported a high level of satisfaction and acceptance. Serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues. %M 34941557 %R 10.2196/28958 %U https://www.jmir.org/2021/12/e28958 %U https://doi.org/10.2196/28958 %U http://www.ncbi.nlm.nih.gov/pubmed/34941557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30368 %T The Successful Synchronized Orchestration of an Investigator-Initiated Multicenter Trial Using a Clinical Trial Management System and Team Approach: Design and Utility Study %A Mudaranthakam,Dinesh Pal %A Brown,Alexandra %A Kerling,Elizabeth %A Carlson,Susan E %A Valentine,Christina J %A Gajewski,Byron %+ University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 9139456922, dmudaranthakam@kumc.edu %K data management %K data quality %K metrics %K trial execution %K clinical trials %K cost %K accrual %K accrual inequality %K rare diseases %K healthcare %K health care %K health operations %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the cost of clinical trials continues to rise, novel approaches are required to ensure ethical allocation of resources. Multisite trials have been increasingly utilized in phase 1 trials for rare diseases and in phase 2 and 3 trials to meet accrual needs. The benefits of multisite trials include easier patient recruitment, expanded generalizability, and more robust statistical analyses. However, there are several problems more likely to arise in multisite trials, including accrual inequality, protocol nonadherence, data entry mistakes, and data integration difficulties. Objective: The Biostatistics & Data Science department at the University of Kansas Medical Center developed a clinical trial management system (comprehensive research information system [CRIS]) specifically designed to streamline multisite clinical trial management. Methods: A National Institute of Child Health and Human Development–funded phase 3 trial, the ADORE (assessment of docosahexaenoic acid [DHA] on reducing early preterm birth) trial fully utilized CRIS to provide automated accrual reports, centralize data capture, automate trial completion reports, and streamline data harmonization. Results: Using the ADORE trial as an example, we describe the utility of CRIS in database design, regulatory compliance, training standardization, study management, and automated reporting. Our goal is to continue to build a CRIS through use in subsequent multisite trials. Reports generated to suit the needs of future studies will be available as templates. Conclusions: The implementation of similar tools and systems could provide significant cost-saving and operational benefit to multisite trials. Trial Registration: ClinicalTrials.gov NCT02626299; https://tinyurl.com/j6erphcj %M 34941552 %R 10.2196/30368 %U https://formative.jmir.org/2021/12/e30368 %U https://doi.org/10.2196/30368 %U http://www.ncbi.nlm.nih.gov/pubmed/34941552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31232 %T A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients %A Pronk,Yvette %A Pilot,Peter %A van der Weegen,Walter %A Brinkman,Justus-Martijn %A Schreurs,Berend Willem %+ Research Department, Kliniek ViaSana, Hoogveldseweg 1, Mill, 5451 AA, Netherlands, 31 485476330, y.pronk@viasana.nl %K PROMs %K total hip arthroplasty %K triage tool %K video consultation %K telemedicine %K digital transformation %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. Objective: This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. Methods: A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. Results: The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4%) patients in the test cohort who needed a hospital consultation (P=.19). Conclusions: A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70% of THA patients could safely have a video consultation, and 30% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure. %M 34931989 %R 10.2196/31232 %U https://formative.jmir.org/2021/12/e31232 %U https://doi.org/10.2196/31232 %U http://www.ncbi.nlm.nih.gov/pubmed/34931989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33452 %T Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study %A Wu,Monica S %A Wickham,Robert E %A Chen,Shih-Yin %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, United States, 1 877 505 7147, mwu@lyrahealth.com %K blended care %K cognitive-behavioral therapy %K depression %K anxiety %K digital %K phase %K mental health %K digital health %K digital therapy %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. Objective: The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. Methods: This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. Results: On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. Conclusions: Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care. %M 34927591 %R 10.2196/33452 %U https://formative.jmir.org/2021/12/e33452 %U https://doi.org/10.2196/33452 %U http://www.ncbi.nlm.nih.gov/pubmed/34927591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27521 %T An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study %A Mbiine,Ronald %A Nakanwagi,Cephas %A Lekuya,Herve Monka %A Aine,Joan %A Hakim,Kawesi %A Nabunya,Lilian %A Tomusange,Henry %+ Makerere University College of Health Sciences, Mulago Hill Road, Kampala, 7072, Uganda, 256 774338585, mbiineron@gmail.com %K mHealth %K risk score for Covid-19 %K Africa %K mobile health %K digital health %K pandemic %K COVID-19 %K COVID %K screening tool %K healthcare workers %K transmission %K warning system %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. %M 34793321 %R 10.2196/27521 %U https://formative.jmir.org/2021/12/e27521 %U https://doi.org/10.2196/27521 %U http://www.ncbi.nlm.nih.gov/pubmed/34793321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25498 %T The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study %A Tossaint-Schoenmakers,Rosian %A Kasteleyn,Marise %A Goedhart,Annelijn %A Versluis,Anke %A Talboom-Kamp,Esther %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 302361136, rtossaint@saltro.nl %K patient portal %K eHealth impact questionnaire %K laboratory test results %K self-efficacy %K usability %K age %K gender %K chronic disease %K education %K patient characteristics %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups. Objective: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results. Methods: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale “information and presentation” of the eHIQ assessed the usability of the patient portal and the subscale “motivation and confidence to act” assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes. Results: The questionnaire was completed by 748 respondents, of which 428 (57.2%) were female, 423 (56.6%) were highly educated, and 509 (68%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95% CI -1147 to 0.042 (P<.001); b=-2.512, 95% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95% CI -6.469 to -0.572; P=.02). Other determinants were not significant. Conclusions: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient’s perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor. %M 34927593 %R 10.2196/25498 %U https://formative.jmir.org/2021/12/e25498 %U https://doi.org/10.2196/25498 %U http://www.ncbi.nlm.nih.gov/pubmed/34927593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28311 %T Privacy and Confidentiality Concerns Related to the Use of mHealth Apps for HIV Prevention Efforts Among Malaysian Men Who Have Sex With Men: Cross-sectional Survey Study %A Shrestha,Roman %A Fisher,Celia %A Wickersham,Jeffrey A %A Khati,Antoine %A Kim,Rayne %A Azwa,Iskandar %A Mistler,Colleen %A Goldsamt,Lloyd %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 860 486 2446, roman.shrestha@uconn.edu %K HIV %K men who have sex with men %K mHealth %K ethics %K Malaysia %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs. Objective: Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts. Methods: A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program. Results: Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app–based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate. Conclusions: Overall, our results indicate that mHealth app–based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical–legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake. %M 34924355 %R 10.2196/28311 %U https://formative.jmir.org/2021/12/e28311 %U https://doi.org/10.2196/28311 %U http://www.ncbi.nlm.nih.gov/pubmed/34924355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e17062 %T User Reviews of Depression App Features: Sentiment Analysis %A Meyer,Julien %A Okuboyejo,Senanu %+ School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria Street, Office: TRS 3-081, Toronto, ON, M4T 1G6, Canada, 1 4169795000 ext 6296, julien.meyer@ryerson.ca %K mHealth %K depression %K app reviews %K natural language processing %K app features %K emotions %K use %K linguistic inquiry word count %K mobile phone %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health in general, and depression in particular, remain undertreated conditions. Mobile health (mHealth) apps offer tremendous potential to overcome the barriers to accessing mental health care and millions of depression apps have been installed and used. However, little is known about the effect of these apps on a potentially vulnerable user population and the emotional reactions that they generate, even though emotions are a key component of mental health. App reviews, spontaneously posted by the users on app stores, offer up-to-date insights into the experiences and emotions of this population and are increasingly decisive in influencing mHealth app adoption. Objective: This study aims to investigate the emotional reactions of depression app users to different app features by systematically analyzing the sentiments expressed in app reviews. Methods: We extracted 3261 user reviews of depression apps. The 61 corresponding apps were categorized by the features they offered (psychoeducation, medical assessment, therapeutic treatment, supportive resources, and entertainment). We then produced word clouds by features and analyzed the reviews using the Linguistic Inquiry Word Count 2015 (Pennebaker Conglomerates, Inc), a lexicon-based natural language analytical tool that analyzes the lexicons used and the valence of a text in 4 dimensions (authenticity, clout, analytic, and tone). We compared the language patterns associated with the different features of the underlying apps. Results: The analysis highlighted significant differences in the sentiments expressed for the different features offered. Psychoeducation apps exhibited more clout but less authenticity (ie, personal disclosure). Medical assessment apps stood out for the strong negative emotions and the relatively negative ratings that they generated. Therapeutic treatment app features generated more positive emotions, even though user feedback tended to be less authentic but more analytical (ie, more factual). Supportive resources (connecting users to physical services and people) and entertainment apps also generated fewer negative emotions and less anxiety. Conclusions: Developers should be careful in selecting the features they offer in their depression apps. Medical assessment features may be riskier as users receive potentially disturbing feedback on their condition and may react with strong negative emotions. In contrast, offering information, contacts, or even games may be safer starting points to engage people with depression at a distance. We highlight the necessity to differentiate how mHealth apps are assessed and vetted based on the features they offer. Methodologically, this study points to novel ways to investigate the impact of mHealth apps and app features on people with mental health issues. mHealth apps exist in a rapidly changing ecosystem that is driven by user satisfaction and adoption decisions. As such, user perceptions are essential and must be monitored to ensure adoption and avoid harm to a fragile population that may not benefit from traditional health care resources. %M 34904955 %R 10.2196/17062 %U https://formative.jmir.org/2021/12/e17062 %U https://doi.org/10.2196/17062 %U http://www.ncbi.nlm.nih.gov/pubmed/34904955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32450 %T The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study %A Ryan,Kelly A %A Smith,Shawna N %A Yocum,Anastasia K %A Carley,Isabel %A Liebrecht,Celeste %A Navis,Bethany %A Vest,Erica %A Bertram,Holli %A McInnis,Melvin G %A Kilbourne,Amy M %+ Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI, 48105, United States, 1 734 936 5524, karyan@umich.edu %K self-management %K app %K bipolar disorder %K symptom management %K mental health %K feasibility %K usability %K acceptability %K intervention %K bipolar %K coping %K survey %K engagement %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. %M 34898452 %R 10.2196/32450 %U https://formative.jmir.org/2021/12/e32450 %U https://doi.org/10.2196/32450 %U http://www.ncbi.nlm.nih.gov/pubmed/34898452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30668 %T Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study %A Davies,Sian M %A Jardine,Jenni %A Gutridge,Kerry %A Bernard,Zara %A Park,Stephen %A Dawson,Tom %A Abel,Kathryn M %A Whelan,Pauline %+ GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 306 7974, sian.davies-5@manchester.ac.uk %K digital mental health %K acceptability %K feasibility %K child and adolescent mental health and well-being %K school-based mental health care %K prevention %K digital assessment and monitoring %K reading screening or ability %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (≥1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. %M 34898446 %R 10.2196/30668 %U https://formative.jmir.org/2021/12/e30668 %U https://doi.org/10.2196/30668 %U http://www.ncbi.nlm.nih.gov/pubmed/34898446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29748 %T Integration of Web Analytics Into Graduate Medical Education: Usability Study %A Massanelli,Jackson %A Sexton,Kevin W %A Lesher,Chris T %A Jensen,Hanna K %A Kimbrough,Mary K %A Privratsky,Anna %A Taylor,John R %A Bhavaraju,Avi %+ Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, United States, 1 501 320 7233, avi99@uams.edu %K graduate medical education %K website analysis %K residency recruitment %K medical education %K website %K analytics %K usage %K usability %K user engagement %K user-centered design %K website design %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department’s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website’s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. %M 34898459 %R 10.2196/29748 %U https://formative.jmir.org/2021/12/e29748 %U https://doi.org/10.2196/29748 %U http://www.ncbi.nlm.nih.gov/pubmed/34898459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e17839 %T The Effect of an Automated Mobile Patient Engagement Application on Emergency Department Revisits: Prospective Observational Study %A Chatterjee,Pothik %A Beck,Adam M %A Brager,Jenna Ashley Levenson %A Durand,Daniel J %A D'Adamo,Christopher R %+ Innovation and Research Department, LifeBridge Health, 2401 W. Belvedere Ave, Baltimore, MD, 21215, United States, 1 410 601 1083, pchatter@lifebridgehealth.org %K patient engagement %K value-based care %K digital health %K mobile app %K automation %K readmission %K revisit %K emergency department %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value-based care or global budget environment. LifeBridge Health, a community health system in Maryland, United States, implemented an automated mobile patient engagement application as part of our enterprise-wide digital health strategy to improve patient engagement and reduce revisits to the ED. Objective: The aim of this paper was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED. Methods: The LifeBridge Health Innovation Department and ED staff from 2 participating health system hospitals collaborated with GetWellNetwork to customize their patient engagement application with automated check-in questions and other on-demand resources (eg, streaming content explaining aspects of self-care during COVID-19). An application link was emailed to adult patients discharged home from the ED. A study of ED visits for patients treated for general medicine and cardiology conditions between August 1, 2018, and July 31, 2019, was conducted using CRISP (Chesapeake Regional Information System for our Patients), Maryland’s state-designated health information exchange. We also used data within GetWell Loop (GetWellNetwork) to track patient activation and engagement. The primary outcome was the number of ED patients who experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary outcomes included the overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Bivariate analysis comparing outcomes among patients who activated the GetWell Loop application to patients who did not was conducted using the Fisher exact test. Multivariate logistic regression modeling with elastic net regularization was also performed to account for potential confounders and potential collinearity of covariates. Results: During this 1-year study, 1062 (27.4%) of 3866 of all emergency patients treated for general medicine or cardiology conditions, who received an invite to use the digital application, activated their account. The patients discharged from the ED, who were treated for general medicine conditions (n=2087) and who activated their GetWell Loop account, experienced a 30-day revisit rate of 17.3% (n=101) compared with 24.6% (n=369) for those who did not activate their account (P<.001). Of the patients treated for cardiology conditions (n=1779), 12.8% (n=61) of those who activated their GetWell account experienced a 30-day revisit compared with 17.7% (n=231) of those who did not activate their account (P=.01). The significance of these findings persisted after adjustment for confounding variables including age, race, sex, and payor in logistic regression modeling (adjusted odds ratio 0.75, 95% CI 0.62-0.92; P=.006). Conclusions: Our results suggest that a significant percentage of patients are willing to utilize a digital application following ED discharge to better engage in their own care, and that usage of such digital applications may significantly reduce 30-day revisit rates. LifeBridge Health’s experience demonstrates that health care systems can leverage automated mobile apps to improve patient engagement and successfully impact clinical outcomes at scale. %M 34898451 %R 10.2196/17839 %U https://formative.jmir.org/2021/12/e17839 %U https://doi.org/10.2196/17839 %U http://www.ncbi.nlm.nih.gov/pubmed/34898451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32165 %T An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study %A Goodday,Sarah M %A Karlin,Emma %A Alfarano,Alexandria %A Brooks,Alexa %A Chapman,Carol %A Desille,Rachelle %A Rangwala,Shazia %A Karlin,Daniel R %A Emami,Hoora %A Woods,Nancy Fugate %A Boch,Adrien %A Foschini,Luca %A Wildman,Mackenzie %A Cormack,Francesca %A Taptiklis,Nick %A Pratap,Abhishek %A Ghassemi,Marzyeh %A Goldenberg,Anna %A Nagaraj,Sujay %A Walsh,Elaine %A , %A Friend,Stephen %+ 4YouandMe, 2901 Third Ave Suite 330, Seattle, WA, 98121, United States, 1 2069288254, sarah@4youandme.org %K stress %K wearable %K digital health %K frontline %K COVID-19 %K health care worker %K alternative %K design %K app %K assessment %K sensor %K engagement %K support %K knowledge %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 %M 34726607 %R 10.2196/32165 %U https://formative.jmir.org/2021/12/e32165 %U https://doi.org/10.2196/32165 %U http://www.ncbi.nlm.nih.gov/pubmed/34726607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30762 %T Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study %A Lee,Austin W %A Kenfield,Stacey A %A Wang,Elizabeth Y %A Enriquez,Anthony %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Breyer,Benjamin N %A Bauer,Scott R %+ Department of Urology, University of California, San Francisco, 550 16th Street, Box 1695, San Francisco, CA, 94158, United States, 1 415 221 4810 ext 24322, Scott.Bauer@ucsf.edu %K LUTS %K tamsulosin %K mobile %K app %K mobile phone %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. Objective: We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. Methods: We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. Results: We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. Conclusions: This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men. %M 34889745 %R 10.2196/30762 %U https://formative.jmir.org/2021/12/e30762 %U https://doi.org/10.2196/30762 %U http://www.ncbi.nlm.nih.gov/pubmed/34889745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29573 %T Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial %A Reilly,Erin Dawna %A Robinson,Stephanie A %A Petrakis,Beth Ann %A Gardner,Melissa M %A Wiener,Renda Soylemez %A Castaneda-Sceppa,Carmen %A Quigley,Karen S %+ Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K cognitive behavioral therapy %K mobile app %K physical activity %K insomnia %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective: This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods: A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results: Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions: These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration: ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354 %M 34889746 %R 10.2196/29573 %U https://formative.jmir.org/2021/12/e29573 %U https://doi.org/10.2196/29573 %U http://www.ncbi.nlm.nih.gov/pubmed/34889746 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e19230 %T Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study %A Thomas,Sarah %A Pulman,Andy %A Dogan,Huseyin %A Jiang,Nan %A Passmore,David %A Pretty,Keith %A Fairbanks,Beth %A Davies Smith,Angela %A Thomas,Peter W %+ Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, United Kingdom, 44 1202 961953, saraht@bournemouth.ac.uk %K multiple sclerosis %K fatigue %K self-management %K cognitive behavioral %K digital health %K mHealth %K eHealth %K development %K participatory design %K usability testing %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective: The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods: Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results: The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions: This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue. %M 34889744 %R 10.2196/19230 %U https://formative.jmir.org/2021/12/e19230 %U https://doi.org/10.2196/19230 %U http://www.ncbi.nlm.nih.gov/pubmed/34889744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29916 %T Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives %A Breland,Jessica Y %A Agha,Khizran %A Mohankumar,Rakshitha %+ Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, United States, 1 650 493 5000, jessica.breland@va.gov %K mHealth %K implementation %K adoption %K engagement %K weight management %K obesity %K weight loss %K mobile health %K veterans %K barriers %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective: This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods: We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results: We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. Conclusions: In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all. %M 34889761 %R 10.2196/29916 %U https://formative.jmir.org/2021/12/e29916 %U https://doi.org/10.2196/29916 %U http://www.ncbi.nlm.nih.gov/pubmed/34889761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28040 %T Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study %A Lin,I-I %A Chen,You-Lin %A Chuang,Li-Ling %+ School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No. 259 Wen-hua 1st Rd, Guishan Dist, Taoyuan, 33302, Taiwan, 886 3 2118800 ext 3177, lchuang@gap.cgu.edu.tw %K mobile health app %K reliability %K home-based fitness assessments %K healthy adults %K mobile phone %K digital health %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. Objective: The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. Methods: A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. Results: The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. Conclusions: Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229 %M 34657835 %R 10.2196/28040 %U https://formative.jmir.org/2021/12/e28040 %U https://doi.org/10.2196/28040 %U http://www.ncbi.nlm.nih.gov/pubmed/34657835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25833 %T Assessing Health Data Security Risks in Global Health Partnerships: Development of a Conceptual Framework %A Espinoza,Juan %A Sikder,Abu Taher %A Dickhoner,James %A Lee,Thomas %+ Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90006, United States, 1 3233612721, jespinoza@chla.usc.edu %K health information technology %K low- and middle-income countries %K low income %K conceptual framework analysis %K framework method %K data security %K decision-making %K database %K information use %K misuse %K global health %K security %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care databases contain a wealth of information that can be used to develop programs and mature health care systems. There is concern that the sensitive nature of health data (eg, ethnicity, reproductive health, sexually transmitted infections, and lifestyle information) can have significant impact on individuals if misused, particularly among vulnerable and marginalized populations. As academic institutions, nongovernmental organizations, and international agencies begin to collaborate with low- and middle-income countries to develop and deploy health information technology (HIT), it is important to understand the technical and practical security implications of these initiatives. Objective: Our aim is to develop a conceptual framework for risk stratification of global health data partnerships and HIT projects. In addition to identifying key conceptual domains, we map each domain to a variety of publicly available indices that could be used to inform a quantitative model. Methods: We conducted an overview of the literature to identify relevant publications, position statements, white papers, and reports. The research team reviewed all sources and used the framework method and conceptual framework analysis to name and categorize key concepts, integrate them into domains, and synthesize them into an overarching conceptual framework. Once key domains were identified, public international data sources were searched for relevant structured indices to generate quantitative counterparts. Results: We identified 5 key domains to inform our conceptual framework: State of HIT, Economics of Health Care, Demographics and Equity, Societal Freedom and Safety, and Partnership and Trust. Each of these domains was mapped to a number of structured indices. Conclusions: There is a complex relationship among the legal, economic, and social domains of health care, which affects the state of HIT in low- and middle-income countries and associated data security risks. The strength of partnership and trust among collaborating organizations is an important moderating factor. Additional work is needed to formalize the assessment of partnership and trust and to develop a quantitative model of the conceptual framework that can help support organizational decision-making. %M 34889752 %R 10.2196/25833 %U https://formative.jmir.org/2021/12/e25833 %U https://doi.org/10.2196/25833 %U http://www.ncbi.nlm.nih.gov/pubmed/34889752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33123 %T A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study %A Hijab,Mohamad Hassan Fadi %A Al-Thani,Dena %A Banire,Bilikis %+ Division of Information and Computer Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, 34110, Qatar, 974 50677321, mhhijab@hbku.edu.qa %K autism %K assistive technology %K mobile app %K social and communication skills %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants’ interactions with the app were collected. Additionally, 6 participants’ parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app’s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=−2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=−0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. %M 34878998 %R 10.2196/33123 %U https://formative.jmir.org/2021/12/e33123 %U https://doi.org/10.2196/33123 %U http://www.ncbi.nlm.nih.gov/pubmed/34878998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25305 %T A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study %A Marques,Marta M %A Matos,Marcela %A Mattila,Elina %A Encantado,Jorge %A Duarte,Cristiana %A Teixeira,Pedro J %A Stubbs,R James %A Sniehotta,Falko F %A Ermes,Miikka %A Harjumaa,Marja %A Leppänen,Juha %A Välkkynen,Pasi %A Silva,Marlene N %A Ferreira,Cláudia %A Carvalho,Sérgio %A Palmeira,Lara %A Horgan,Graham %A Heitmann,Berit Lilienthal %A Evans,Elizabeth H %A Palmeira,António L %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, nº 5 l, Lisbon, 1150-190, Portugal, 351 218803105, mmarques@nms.unl.pt %K mHealth %K behavior change techniques %K weight management %K motivation %K self-regulation %K emotion regulation %K self-monitoring %K user testing %K logic models %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. %M 34870602 %R 10.2196/25305 %U https://www.jmir.org/2021/12/e25305 %U https://doi.org/10.2196/25305 %U http://www.ncbi.nlm.nih.gov/pubmed/34870602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31053 %T Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study %A van Gils,Aniek M %A Visser,Leonie NC %A Hendriksen,Heleen MA %A Georges,Jean %A Muller,Majon %A Bouwman,Femke H %A van der Flier,Wiesje M %A Rhodius-Meester,Hanneke FM %+ Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440685, a.vangils@amsterdamumc.nl %K artificial intelligence %K clinical decision support systems %K dementia %K diagnostic testing %K diagnosis %K prognosis %K communication %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis. Objective: This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners. Methods: Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer’s Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer’s Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54% female) participated in this survey. Results: Most clinicians reported a willingness to use diagnostic (88/109, 80.7%) and prognostic (83/109, 76.1%) computer tools. User-friendliness (71/109, 65.1%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72%) and prognosis (73/96, 76%). In addition, most of them thought favorably regarding the possibility of using the tools themselves. Conclusions: This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity. %M 34870612 %R 10.2196/31053 %U https://formative.jmir.org/2021/12/e31053 %U https://doi.org/10.2196/31053 %U http://www.ncbi.nlm.nih.gov/pubmed/34870612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28782 %T Patient-Reported Outcome Measure for Real-time Symptom Assessment in Women With Endometriosis: Focus Group Study %A van Barneveld,Esther %A Lim,Arianne %A van Hanegem,Nehalennia %A Vork,Lisa %A Herrewegh,Alexandra %A van Poll,Mikal %A Manders,Jessica %A van Osch,Frits %A Spaans,Wilbert %A van Koeveringe,Gommert %A Vrijens,Desiree %A Kruimel,Joanna %A Bongers,Marlies %A Leue,Carsten %+ Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 433876543, esthervb@gmail.com %K endometriosis %K pelvic pain %K positive affect %K negative affect %K patient-reported outcome measure %K focus groups %K experience sampling method %K momentary symptom assessment %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms related to endometriosis have a significant impact on the quality of life, and symptoms often recur. The experience sampling method (ESM), a digital questioning method characterized by randomly repeated momentary assessments, has several advantages over traditionally used measurements, including the ability to assess the temporal relationship between variables such as physical, mental, and social factors. Objective: The aim of this study is to develop an ESM tool for patients with endometriosis to accurately measure symptoms and their course over time, allowing for personalized treatment and adequate monitoring of treatment efficacy in individual patients. Methods: On the basis of international guidelines, items from validated questionnaires were selected through a literature review and during focus groups and multidisciplinary expert meetings. Data analysis was conducted using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). The feasibility and usability of the newly developed momentary assessment tool were tested for 28 consecutive days in 5 patients with endometriosis-related pain symptoms. Results: Momentary assessment items contained questions concerning endometriosis symptoms, general somatic symptoms, psychological symptoms, contextual information, and the use of food and medication. A morning questionnaire on sleep and sexuality was included. In a pilot study, the patients considered the tool easy to use but time consuming. The average compliance rate of momentary assessments was 37.8% (106/280), with the highest completion rate during the first week (39/70, 56%). Therefore, it is advisable to use the ESM for a maximum of 7 days. Conclusions: A new digital tool for endometriosis symptom assessment was developed using the ESM, which may help overcome the limitations of current retrospective questionnaires. After validation and testing, future studies will be planned to evaluate the use of this tool in a clinical setting in order to propose a personalized treatment plan for women with endometriosis. %M 34870608 %R 10.2196/28782 %U https://formative.jmir.org/2021/12/e28782 %U https://doi.org/10.2196/28782 %U http://www.ncbi.nlm.nih.gov/pubmed/34870608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27956 %T Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study %A Dhinagaran,Dhakshenya Ardhithy %A Sathish,Thirunavukkarasu %A Soong,AiJia %A Theng,Yin-Leng %A Best,James %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K chatbot %K conversational agents %K behavior change %K healthy lifestyle behavior change %K pilot study %K feasibility trial %K usability %K acceptability %K preliminary efficacy %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public. Objective: The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore. Methods: We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants’ knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants’ satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress. Results: We recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior. Conclusions: The delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial. %M 34870611 %R 10.2196/27956 %U https://formative.jmir.org/2021/12/e27956 %U https://doi.org/10.2196/27956 %U http://www.ncbi.nlm.nih.gov/pubmed/34870611 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29687 %T Initial Feasibility of the “Families Moving Forward Connect” Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach %A Petrenko,Christie Lynn McGee %A Kautz-Turnbull,Carson Christine %A Roth,Alicia Rose %A Parr,Jennifer Elizabeth %A Tapparello,Cristiano %A Demir,Utku %A Olson,Heather Carmichael %+ Mt. Hope Family Center, University of Rochester, 187 Edinburgh St, Rochester, NY, 14608, United States, 1 585 275 2991, christie.petrenko@rochester.edu %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K intervention %K mobile health %K mHealth %K parenting %K children %K prenatal alcohol %K digital health %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers’ stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. %M 34860661 %R 10.2196/29687 %U https://formative.jmir.org/2021/12/e29687 %U https://doi.org/10.2196/29687 %U http://www.ncbi.nlm.nih.gov/pubmed/34860661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28628 %T Users’ Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study %A Li,Jane %A Silvera-Tawil,David %A Varnfield,Marlien %A Hussain,M Sazzad %A Math,Vanitha %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Cnr Vimiera and Pembroke Roads, Marsfield, 2122, Australia, 61 02 93724163, jane.li@csiro.au %K pregnancy care %K wearable sensors %K mobile health %K acceptance %K mHealth service %K design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women’s monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians’ and pregnant women’s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. %M 34860665 %R 10.2196/28628 %U https://formative.jmir.org/2021/12/e28628 %U https://doi.org/10.2196/28628 %U http://www.ncbi.nlm.nih.gov/pubmed/34860665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27512 %T The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study %A Harrington,Katharine %A Zenk,Shannon N %A Van Horn,Linda %A Giurini,Lauren %A Mahakala,Nithya %A Kershaw,Kiarri N %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 4014, k-kershaw@northwestern.edu %K ecological momentary assessment %K eating behaviors %K crowdsourcing %K food consumption images %K food image processing %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility—usability and acceptability—of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. %M 34860666 %R 10.2196/27512 %U https://formative.jmir.org/2021/12/e27512 %U https://doi.org/10.2196/27512 %U http://www.ncbi.nlm.nih.gov/pubmed/34860666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e26370 %T Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing %A Counson,Isabelle %A Bartholomew,Alexandra %A Crawford,Joanna %A Petrie,Katherine %A Basarkod,Geetanjali %A Moynihan,Victoria %A Pires,Josie %A Cohen,Rachel %A Glozier,Nicholas %A Harvey,Samuel %A Sanatkar,Samineh %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 1 02 9382 4368, s.sanatkar@unsw.edu.au %K digital mental health %K mHealth apps %K help-seeking %K junior physicians %K co-design %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. %M 34860662 %R 10.2196/26370 %U https://formative.jmir.org/2021/12/e26370 %U https://doi.org/10.2196/26370 %U http://www.ncbi.nlm.nih.gov/pubmed/34860662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e24840 %T Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study %A Mastorci,Francesca %A Piaggi,Paolo %A Trivellini,Gabriele %A Doveri,Cristina %A Casu,Anselmo %A Bastiani,Luca %A Marinaro,Irene %A Vassalle,Cristina %A Pingitore,Alessandro %+ Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Via Moruzzi 1, Pisa, 56124, Italy, 39 050312605, pingi@ifc.cnr.it %K adolescent %K well-being management %K schools %K web tool %K health promotion %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. %M 34860668 %R 10.2196/24840 %U https://formative.jmir.org/2021/12/e24840 %U https://doi.org/10.2196/24840 %U http://www.ncbi.nlm.nih.gov/pubmed/34860668 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e22390 %T Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors %A Coumans,Juul M J %A Oenema,Anke %A Bolman,Catherine A W %A Lechner,Lilian %+ Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 45 576 2635, juul.coumans@ou.nl %K diet %K physical activity %K eHealth %K self-determination theory %K motivational interviewing %K process evaluation %K nonusage attrition %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. Objective: This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants’ flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. Methods: This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. Results: Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6%), the PA module (2/12, 17%), and both modules (58/273, 21.2%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). Conclusions: This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study. %M 34860670 %R 10.2196/22390 %U https://formative.jmir.org/2021/12/e22390 %U https://doi.org/10.2196/22390 %U http://www.ncbi.nlm.nih.gov/pubmed/34860670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25071 %T An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study %A Petracca,Francesco %A Tempre,Rosaria %A Cucciniello,Maria %A Ciani,Oriana %A Pompeo,Elena %A Sannino,Luigi %A Lovato,Valeria %A Castaman,Giancarlo %A Ghirardini,Alessandra %A Tarricone,Rosanna %+ Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Via Sarfatti, 10, Milan, 20136, Italy, 39 02 58365257, francesco.petracca@unibocconi.it %K mobile apps %K mHealth %K hemophilia A %K rare diseases %K usability %K user-centered design %K design science %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective: The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods: We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results: The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions: The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration: ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135 %M 34855619 %R 10.2196/25071 %U https://formative.jmir.org/2021/12/e25071 %U https://doi.org/10.2196/25071 %U http://www.ncbi.nlm.nih.gov/pubmed/34855619 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30053 %T A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Riccardi,Giuseppe %+ Speech and Interactive Signal Lab, Department of Engineering and Computer Science, Università degli Studi di Trento, Via Sommarive 5, Povo di Trento, Trento, 38123, Italy, 39 0461282087, morena.danieli@unitn.it %K mental health care %K conversational AI %K mHealth %K personal health care agents %K participatory design %K psychotherapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists’ acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants’ levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. %M 34855607 %R 10.2196/30053 %U https://formative.jmir.org/2021/12/e30053 %U https://doi.org/10.2196/30053 %U http://www.ncbi.nlm.nih.gov/pubmed/34855607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28678 %T Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study %A Mayo-Gamble,Tilicia L %A Quasie-Woode,Delores %A Cunningham-Erves,Jennifer %A Rollins,Margo %A Schlundt,David %A Bonnet,Kemberlee %A Murry,Velma McBride %+ Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, PO Box 8015, Statesboro, GA, 30458, United States, 1 912 478 1249, tmayogamble@georgiasouthern.edu %K sickle cell disease %K digital technology %K rural %K mHealth app %K patient-centered technology %K mobile health %K health outcomes %K hematology %K mobile phone %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. %M 34851295 %R 10.2196/28678 %U https://formative.jmir.org/2021/11/e28678 %U https://doi.org/10.2196/28678 %U http://www.ncbi.nlm.nih.gov/pubmed/34851295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29958 %T Using Patient-Generated Health Data From Twitter to Identify, Engage, and Recruit Cancer Survivors in Clinical Trials in Los Angeles County: Evaluation of a Feasibility Study %A Reuter,Katja %A Angyan,Praveen %A Le,NamQuyen %A Buchanan,Thomas A %+ Department of Public Health and Preventive Medicine, The State University of New York Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, United States, 1 3154641520, reuterk@upstate.edu %K breast cancer %K cancer %K clinical research %K clinical trial %K colon cancer %K infoveillance %K kidney cancer %K lung cancer %K lymphoma %K patient engagement %K prostate cancer %K recruitment %K Twitter %K social media %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Failure to find and attract clinical trial participants remains a persistent barrier to clinical research. Researchers increasingly complement recruitment methods with social media–based methods. We hypothesized that user-generated data from cancer survivors and their family members and friends on the social network Twitter could be used to identify, engage, and recruit cancer survivors for cancer trials. Objective: This pilot study aims to examine the feasibility of using user-reported health data from cancer survivors and family members and friends on Twitter in Los Angeles (LA) County to enhance clinical trial recruitment. We focus on 6 cancer conditions (breast cancer, colon cancer, kidney cancer, lymphoma, lung cancer, and prostate cancer). Methods: The social media intervention involved monitoring cancer-specific posts about the 6 cancer conditions by Twitter users in LA County to identify cancer survivors and their family members and friends and contacting eligible Twitter users with information about open cancer trials at the University of Southern California (USC) Norris Comprehensive Cancer Center. We reviewed both retrospective and prospective data published by Twitter users in LA County between July 28, 2017, and November 29, 2018. The study enrolled 124 open clinical trials at USC Norris. We used descriptive statistics to report the proportion of Twitter users who were identified, engaged, and enrolled. Results: We analyzed 107,424 Twitter posts in English by 25,032 unique Twitter users in LA County for the 6 cancer conditions. We identified and contacted 1.73% (434/25,032) of eligible Twitter users (127/434, 29.3% cancer survivors; 305/434, 70.3% family members and friends; and 2/434, 0.5% Twitter users were excluded). Of them, 51.4% (223/434) were female and approximately one-third were male. About one-fifth were people of color, whereas most of them were White. Approximately one-fifth (85/434, 19.6%) engaged with the outreach messages (cancer survivors: 33/85, 38% and family members and friends: 52/85, 61%). Of those who engaged with the messages, one-fourth were male, the majority were female, and approximately one-fifth were people of color, whereas the majority were White. Approximately 12% (10/85) of the contacted users requested more information and 40% (4/10) set up a prescreening. Two eligible candidates were transferred to USC Norris for further screening, but neither was enrolled. Conclusions: Our findings demonstrate the potential of identifying and engaging cancer survivors and their family members and friends on Twitter. Optimization of downstream recruitment efforts such as screening for digital populations on social media may be required. Future research could test the feasibility of the approach for other diseases, locations, languages, social media platforms, and types of research involvement (eg, survey research). Computer science methods could help to scale up the analysis of larger data sets to support more rigorous testing of the intervention. Trial Registration: ClinicalTrials.gov NCT03408561; https://clinicaltrials.gov/ct2/show/NCT03408561 %M 34842538 %R 10.2196/29958 %U https://formative.jmir.org/2021/11/e29958 %U https://doi.org/10.2196/29958 %U http://www.ncbi.nlm.nih.gov/pubmed/34842538 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31366 %T Contemporary English Pain Descriptors as Detected on Social Media Using Artificial Intelligence and Emotion Analytics Algorithms: Cross-sectional Study %A Tan,Ming Yi %A Goh,Charlene Enhui %A Tan,Hee Hon %+ Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore, 65 67725340, dentmy@nus.edu.sg %K pain descriptors %K social media %K artificial intelligence %K emotion analytics %K McGill Pain Questionnaire %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain description is fundamental to health care. The McGill Pain Questionnaire (MPQ) has been validated as a tool for the multidimensional measurement of pain; however, its use relies heavily on language proficiency. Although the MPQ has remained unchanged since its inception, the English language has evolved significantly since then. The advent of the internet and social media has allowed for the generation of a staggering amount of publicly available data, allowing linguistic analysis at a scale never seen before. Objective: The aim of this study is to use social media data to examine the relevance of pain descriptors from the existing MPQ, identify novel contemporary English descriptors for pain among users of social media, and suggest a modification for a new MPQ for future validation and testing. Methods: All posts from social media platforms from January 1, 2019, to December 31, 2019, were extracted. Artificial intelligence and emotion analytics algorithms (Crystalace and CrystalFeel) were used to measure the emotional properties of the text, including sarcasm, anger, fear, sadness, joy, and valence. Word2Vec was used to identify new pain descriptors associated with the original descriptors from the MPQ. Analysis of count and pain intensity formed the basis for proposing new pain descriptors and determining the order of pain descriptors within each subclass. Results: A total of 118 new associated words were found via Word2Vec. Of these 118 words, 49 (41.5%) words had a count of at least 110, which corresponded to the count of the bottom 10% (8/78) of the original MPQ pain descriptors. The count and intensity of pain descriptors were used to formulate the inclusion criteria for a new pain questionnaire. For the suggested new pain questionnaire, 11 existing pain descriptors were removed, 13 new descriptors were added to existing subclasses, and a new Psychological subclass comprising 9 descriptors was added. Conclusions: This study presents a novel methodology using social media data to identify new pain descriptors and can be repeated at regular intervals to ensure the relevance of pain questionnaires. The original MPQ contains several potentially outdated pain descriptors and is inadequate for reporting the psychological aspects of pain. Further research is needed to examine the reliability and validity of the revised MPQ. %M 34842554 %R 10.2196/31366 %U https://formative.jmir.org/2021/11/e31366 %U https://doi.org/10.2196/31366 %U http://www.ncbi.nlm.nih.gov/pubmed/34842554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30495 %T Patients’ Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study %A Shewchuk,Brittany %A Green,Lee A %A Barber,Tanya %A Miller,Jean %A Teare,Sylvia %A Campbell-Scherer,Denise %A Mrklas,Kelly J %A Li,Linda C %A Marlett,Nancy %A Wasylak,Tracy %A Lopatina,Elena %A McCaughey,Deirdre %A Marshall,Deborah A %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3C58 Health Research Innovation Centre, 3230 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 210 6377, damarsha@ucalgary.ca %K mobile health %K mHealth %K app %K self-management %K osteoarthritis %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. %M 34842526 %R 10.2196/30495 %U https://formative.jmir.org/2021/11/e30495 %U https://doi.org/10.2196/30495 %U http://www.ncbi.nlm.nih.gov/pubmed/34842526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29214 %T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study %A Atukunda,Esther Cathyln %A Matthews,Lynn T %A Musiimenta,Angella %A Mugyenyi,Godfrey Rwambuka %A Mugisha,Samuel %A Ware,Norma C %A Obua,Celestino %A Siedner,Mark J %+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug %K mHealth app %K app development %K messaging %K health education %K health promotion %K mobile phone %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. %M 34842541 %R 10.2196/29214 %U https://formative.jmir.org/2021/11/e29214 %U https://doi.org/10.2196/29214 %U http://www.ncbi.nlm.nih.gov/pubmed/34842541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28620 %T A Phenotyping Algorithm to Identify People With HIV in Electronic Health Record Data (HIV-Phen): Development and Evaluation Study %A May,Sarah B %A Giordano,Thomas P %A Gottlieb,Assaf %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin, Suite 600, Houston, TX, 77030, United States, 1 713 500 3698, Assaf.Gottlieb@uth.tmc.edu %K phenotyping %K algorithms %K electronic health records %K people with HIV %K cohort identification %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Identification of people with HIV from electronic health record (EHR) data is an essential first step in the study of important HIV outcomes, such as risk assessment. This task has been historically performed via manual chart review, but the increased availability of large clinical data sets has led to the emergence of phenotyping algorithms to automate this process. Existing algorithms for identifying people with HIV rely on a combination of International Classification of Disease codes and laboratory tests or closely mimic clinical testing guidelines for HIV diagnosis. However, we found that existing algorithms in the literature missed a significant proportion of people with HIV in our data. Objective: The aim of this study is to develop and evaluate HIV-Phen, an updated criteria-based HIV phenotyping algorithm. Methods: We developed an algorithm using HIV-specific laboratory tests and medications and compared it with previously published algorithms in national and local data sets to identify cohorts of people with HIV. Cohort demographics were compared with those reported in the national and local surveillance data. Chart reviews were performed on a subsample of patients from the local database to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the algorithm. Results: Our new algorithm identified substantially more people with HIV in both national (up to an 85.75% increase) and local (up to an 83.20% increase) EHR databases than the previously published algorithms. The demographic characteristics of people with HIV identified using our algorithm were similar to those reported in national and local HIV surveillance data. Our algorithm demonstrated improved sensitivity over existing algorithms (98% vs 56%-92%) while maintaining a similar overall accuracy (96% vs 80%-96%). Conclusions: We developed and evaluated an updated criteria-based phenotyping algorithm for identifying people with HIV in EHR data that demonstrates improved sensitivity over existing algorithms. %M 34842532 %R 10.2196/28620 %U https://formative.jmir.org/2021/11/e28620 %U https://doi.org/10.2196/28620 %U http://www.ncbi.nlm.nih.gov/pubmed/34842532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29267 %T Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study %A ter Harmsel,Annemieke %A van der Pol,Thimo %A Swinkels,Lise %A Goudriaan,Anna E %A Popma,Arne %A Noordzij,Matthijs L %+ Inforsa, Forensic Mental Health Care, Vlaardingenlaan 5, Amsterdam, 1059 GL, Netherlands, 31 653810776, annemieke.ter.harmsel@inforsa.nl %K biocueing %K biosensing %K biofeedback %K aggression %K forensic psychiatry %K wearable technology %K mobile apps %K usability %K evaluation %K mHealth %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective: The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods: First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results: The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions: This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy. %M 34821567 %R 10.2196/29267 %U https://formative.jmir.org/2021/11/e29267 %U https://doi.org/10.2196/29267 %U http://www.ncbi.nlm.nih.gov/pubmed/34821567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e27323 %T Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study %A Sandbæk,Amanda %A Christensen,Line Due %A Larsen,Lotte Lykke %A Primholdt Christensen,Nina %A Kofod,Frida Greek %A Guassora,Ann Dorrit %A Merrild,Camilla Hoffmann %A Assing Hvidt,Elisabeth %+ Research Unit for General Practice, Bartholins Allé 2, Aarhus, 8000, Denmark, 45 22791482, linedue@ph.au.dk %K general practice %K remote consultation %K implementation science %K resource guide %K communication %K video consultation %K coproduction %K rapid analysis %K workshop %K intervention development %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective: The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods: The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results: A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients’ use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions: The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period. %M 34821560 %R 10.2196/27323 %U https://formative.jmir.org/2021/11/e27323 %U https://doi.org/10.2196/27323 %U http://www.ncbi.nlm.nih.gov/pubmed/34821560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28846 %T Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 713 500 4472, elisabeth.becker@uth.tmc.edu %K human papillomavirus %K vaccination %K qualitative %K focus groups %K sexually transmitted infection %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective: This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods: We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results: The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86%). Approximately half (8/17, 47%) of parents expressed no preference for the focus group format, whereas 47% (8/17) requested a text-only chat format and 6% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions: Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents. %M 34806991 %R 10.2196/28846 %U https://formative.jmir.org/2021/11/e28846 %U https://doi.org/10.2196/28846 %U http://www.ncbi.nlm.nih.gov/pubmed/34806991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30995 %T Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study %A Barrera,Alinne Z %A Hamil,Jaime %A Tandon,Darius %+ Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6504333854, abarrera@paloaltou.edu %K perinatal mental health %K postpartum depression %K public health %K SMS %K technology %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors’ adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants’ usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 %M 34792478 %R 10.2196/30995 %U https://formative.jmir.org/2021/11/e30995 %U https://doi.org/10.2196/30995 %U http://www.ncbi.nlm.nih.gov/pubmed/34792478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29799 %T Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study %A Wilroy,Jereme %A Lai,Byron %A Currie,Madison %A Young,Hui-Ju %A Thirumalai,Mohanraj %A Mehta,Tapan %A Giannone,John %A Rimmer,James %+ University of Alabama at Birmingham, 1717 6th Ave S, Birmingham, AL, 35233, United States, 1 2059344508, jdwilroy@uab.edu %K telehealth %K disability %K COVID-19 %K exercise %K assessments %K feasibility %K mHealth %K teleassessment %K mobility impairment %K home exercise %K participation %K physical disabilities %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants’ home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ≥90% criteria set a priori. Efficiency was measured by a session duration of ≤2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results: Data from 36 participants were included in this feasibility study, and 34 (94%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 %M 34792477 %R 10.2196/29799 %U https://formative.jmir.org/2021/11/e29799 %U https://doi.org/10.2196/29799 %U http://www.ncbi.nlm.nih.gov/pubmed/34792477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29760 %T A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K nondaily %K smoking cessation %K smartphone app %K positive psychology %K mHealth %K happiness %K mobile phone %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. %M 34787577 %R 10.2196/29760 %U https://formative.jmir.org/2021/11/e29760 %U https://doi.org/10.2196/29760 %U http://www.ncbi.nlm.nih.gov/pubmed/34787577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30991 %T A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study %A Jimah,Tamara %A Borg,Holly %A Kehoe,Priscilla %A Pimentel,Pamela %A Turner,Arlene %A Labbaf,Sina %A Asgari Mehrabadi,Milad %A Rahmani,Amir M. %A Dutt,Nikil %A Guo,Yuqing %+ Sue & Bill Gross School of Nursing, University of California, Irvine, 299D Berk Hall, Irvine, CA, 92697, United States, 1 949 824 9057, tjimah@hs.uci.edu %K ecological momentary assessment %K heart rate %K mHealth %K physical activity %K pregnancy %K sleep %K wearable electronic device %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. %M 34787576 %R 10.2196/30991 %U https://formative.jmir.org/2021/11/e30991 %U https://doi.org/10.2196/30991 %U http://www.ncbi.nlm.nih.gov/pubmed/34787576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30572 %T Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial %A Jessen,Stian %A Mirkovic,Jelena %A Halvorsen Brendmo,Elanor %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital HF, Aker Sykehus, Trondheimsveien 23, Oslo, 0586, Norway, 47 9804 9759, stian.jessen@rr-research.no %K mHealth %K personal strengths %K gameful design %K gamification %K user engagement %K explorative %K feasibility %K usefulness %K usability %K design %K self-management %K chronic illness %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre– and post–psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life. %M 34787580 %R 10.2196/30572 %U https://formative.jmir.org/2021/11/e30572 %U https://doi.org/10.2196/30572 %U http://www.ncbi.nlm.nih.gov/pubmed/34787580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29128 %T A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study %A van Oirschot,Pim %A Heerings,Marco %A Wendrich,Karine %A den Teuling,Bram %A Dorssers,Frank %A van Ee,René %A Martens,Marijn Bart %A Jongen,Peter Joseph %+ Orikami Digital Health Products, Ridderstraat 29, Nijmegen, 6511 TM, Netherlands, 31 24 301 0100, pim@mssherpa.nl %K multiple sclerosis %K relapsing remitting %K mobility %K mobile phone %K 2-Minute Walking Test %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked. Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT. Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT. Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5% (SD 18.9 m or 11%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029). The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced. Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit. %M 34787581 %R 10.2196/29128 %U https://formative.jmir.org/2021/11/e29128 %U https://doi.org/10.2196/29128 %U http://www.ncbi.nlm.nih.gov/pubmed/34787581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25824 %T The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences %A Oladele,David %A Iwelunmor,Juliet %A Gbajabiamila,Titilola %A Obiezu-Umeh,Chisom %A Okwuzu,Jane Ogoamaka %A Nwaozuru,Ucheoma %A Musa,Adesola Zaidat %A Idigbe,Ifeoma %A Tahlil,Kadija %A Tang,Weiming %A Conserve,Donaldson F %A Rosenberg,Nora E %A David,Agatha N %A Tucker,Joseph %A Ezechi,Oliver %+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 3149773280, juliet.iwelunmor@slu.edu %K HIV self-testing %K adolescents %K young people %K photo verification %K mobile app %K Nigeria %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users—12 women and 7 men—with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app’s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app’s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user’s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app’s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. %M 34787579 %R 10.2196/25824 %U https://formative.jmir.org/2021/11/e25824 %U https://doi.org/10.2196/25824 %U http://www.ncbi.nlm.nih.gov/pubmed/34787579 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33572 %T Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial %A Nguyen,Tuan Anh %A Tran,Kham %A Esterman,Adrian %A Brijnath,Bianca %A Xiao,Lily Dongxia %A Schofield,Penelope %A Bhar,Sunil %A Wickramasinghe,Nilmini %A Sinclair,Ronald %A Dang,Thu Ha %A Cullum,Sarah %A Turana,Yuda %A Hinton,Ladson %A Seeher,Katrin %A Andrade,Andre Q %A Crotty,Maria %A Kurrle,Susan %A Freel,Stefanie %A Pham,Thang %A Nguyen,Thanh Binh %A Brodaty,Henry %+ Social Gerontology Division, National Ageing Research Institute, 34-54 Poplar Road, Gate 4, Building 9, Melbourne, 3050, Australia, 61 3 8387 2305, t.nguyen@nari.edu.au %K Dementia %K informal carer %K iSupport %K virtual assistant %K digital health %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). Objective: This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Methods: Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. Results: This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). Conclusions: This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz International Registered Report Identifier (IRRID): PRR1-10.2196/33572 %M 34783660 %R 10.2196/33572 %U https://www.researchprotocols.org/2021/11/e33572 %U https://doi.org/10.2196/33572 %U http://www.ncbi.nlm.nih.gov/pubmed/34783660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31843 %T Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing %A Wray,Tyler B %A Chan,Philip A %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K pre-exposure prophylaxis %K HIV %K HIV prevention %K mHealth %K mobile health %K eHealth %K mobile phone %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. %M 34783662 %R 10.2196/31843 %U https://formative.jmir.org/2021/11/e31843 %U https://doi.org/10.2196/31843 %U http://www.ncbi.nlm.nih.gov/pubmed/34783662 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e26212 %T A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp %A Whale,Katie %A Beasant,Lucy %A Wright,Anne J %A Yardley,Lucy %A Wallace,Louise M %A Moody,Louise %A Joinson,Carol %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 4147995, katie.whale@bristol.ac.uk %K incontinence %K urinary incontinence %K digital intervention %K child health %K pediatric %K pediatric incontinence %K smartphone %K intervention development %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. %M 34779780 %R 10.2196/26212 %U https://pediatrics.jmir.org/2021/4/e26212 %U https://doi.org/10.2196/26212 %U http://www.ncbi.nlm.nih.gov/pubmed/34779780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e21462 %T The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study %A Afzali,Tamana %A Lauridsen,Henrik Hein %A Thomsen,Janus Laust %A Hartvigsen,Jan %A Jensen,Martin Bach %A Riis,Allan %+ Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, Aalborg, 9220, Denmark, 45 20823660, ariis@dcm.aau.dk %K data accuracy %K patient satisfaction %K rehabilitation %K low back pain %K internet-based intervention %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Low back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients’ levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers’ loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain. Objective: This study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients’ satisfaction with web-based information for low back pain. Methods: This is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain. Results: The index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data. Conclusions: The index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information. Trial Registration: ClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004 %M 34779785 %R 10.2196/21462 %U https://formative.jmir.org/2021/11/e21462 %U https://doi.org/10.2196/21462 %U http://www.ncbi.nlm.nih.gov/pubmed/34779785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26221 %T Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study %A Lawler,Kate %A Earley,Caroline %A Timulak,Ladislav %A Enrique,Angel %A Richards,Derek %+ E-Mental Health Research Group, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland, 353 851510008, lawlerka@tcd.ie %K depression %K anxiety %K iCBT %K dropout %K internet interventions %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. Objective: The aim of this study is to perform a qualitative analysis of patients’ experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. Methods: A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. Results: The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. Conclusions: Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated. %M 34766909 %R 10.2196/26221 %U https://formative.jmir.org/2021/11/e26221 %U https://doi.org/10.2196/26221 %U http://www.ncbi.nlm.nih.gov/pubmed/34766909 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e23874 %T Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey %A Chukwu,Emeka %A Gilroy,Sonia %A Addaquay,Kojo %A Jones,Nki Nafisa %A Karimu,Victor Gbadia %A Garg,Lalit %A Dickson,Kim Eva %+ Department of Computer Information System, Faculty of Information and Communications Technology (ICT), University of Malta, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K young people %K short message service %K SMS %K chatbot %K text message %K interactive voice response %K IVR %K WhatsApp %K Facebook %K family planning %K contraceptives %K Sierra Leone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. %M 34766908 %R 10.2196/23874 %U https://formative.jmir.org/2021/11/e23874 %U https://doi.org/10.2196/23874 %U http://www.ncbi.nlm.nih.gov/pubmed/34766908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31944 %T Seeking Mental Health Support Among College Students in Video-Based Social Media: Content and Statistical Analysis of YouTube Videos %A Choi,Bogeum %A Kim,Heejun %A Huh-Yoo,Jina %+ Department of Information Science, University of North Texas, 3940 North Elm, Suite E295G, Denton, TX, 76203, United States, 1 940 369 8285, heejun.kim@unt.edu %K mental health %K college student %K social media %K YouTube %K help-seeking %K experiential knowledge %K video types %K content analysis %K time distribution analysis %K depression %K anxiety %K student %K knowledge %K stigma %K strategy %K engagement %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health is a highly stigmatized disease, especially for young people. Due to its free, accessible format, college students increasingly use video-based social media for many aspects of information needs, including how-to tips, career, or health-related needs. The accessibility of video-based social media brings potential in supporting stigmatized contexts, such as college students’ mental health. Understanding which kinds of videos about college students’ mental health have increased viewer engagement will help build a foundation for exploring this potential. Little research has been done to identify video types systematically, how they have changed over time, and their associations on viewer engagement both short term and long term. Objective: This study aims to identify strategies for using video-based social media to combat stigmatized diseases, such as mental health, among college students. We identify who, with what perspective, purpose, and content, makes up the videos available on social media (ie, YouTube) about college students’ mental health and how these factors associate with viewer engagement. We then identify effective strategies for designing video-based social media content for supporting college students’ mental health. Methods: We performed inductive content analysis to identify different types of YouTube videos concerning college students’ mental health (N=452) according to video attributes, including poster, perspective, and purpose. Time analysis showed how video types have changed over time. Fisher’s exact test was used to examine the relationships between video attributes. The Mann-Whitney U test was used to test the association between video types and viewer engagement. Lastly, we investigated the difference in viewer engagement across time between two major types of videos (ie, individuals’ storytelling and organization’s informational videos). Results: Time trend analysis showed a notable increase in the number of (1) videos by individuals, (2) videos that represent students’ perspectives, and (3) videos that share stories and experiential knowledge over the recent years. Fisher’s exact test found all video attributes (ie, poster, perspective, and purpose) are significantly correlated with each other. In addition, the Mann-Whitney U test found that poster (individual vs organization) and purpose (storytelling vs sharing information) type has a significant association with viewer engagement (P<.001). Lastly, individuals’ storytelling videos had a greater engagement in the short term and the long term. Conclusions: The study shows that YouTube videos on college students’ mental health can be well differentiated by the types of posters and the purpose of the videos. Taken together, the videos where individuals share their personal stories, as well as experiential knowledge (ie, tips and advice), engaged more viewers in both the short term and long term. Individuals’ videos on YouTube showed the potential to support college students' mental health in unique ways, such as providing social support, validating experience, and sharing the positive experience of help-seeking. %M 34762060 %R 10.2196/31944 %U https://formative.jmir.org/2021/11/e31944 %U https://doi.org/10.2196/31944 %U http://www.ncbi.nlm.nih.gov/pubmed/34762060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30435 %T Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment %A Dhinagaran,Dhakshenya Ardhithy %A Sathish,Thirunavukkarasu %A Kowatsch,Tobias %A Griva,Konstadina %A Best,James Donovan %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agents %K chatbots %K diabetes %K prediabetes %K healthy lifestyle change %K mobile phone %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public. Objective: We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes. Methods: This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis. Results: The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle. Conclusions: Participants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior. %M 34762053 %R 10.2196/30435 %U https://formative.jmir.org/2021/11/e30435 %U https://doi.org/10.2196/30435 %U http://www.ncbi.nlm.nih.gov/pubmed/34762053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30605 %T A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study %A Drazich,Brittany F %A Nyikadzino,Yeukai %A Gleason,Kelly T %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 3023530657, bdrazich@umaryland.edu %K technology %K disparities %K digital access %K digital literacy %K community %K stakeholders %K digital health %K digital divide %K patient-centered outcomes %D 2021 %7 10.11.2021 %9 Early Report %J JMIR Form Res %G English %X Background: For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations. Objective: We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants’ perceived comfort with digital technology before and after the program. Methods: To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes. Results: We found that the program was feasible to implement and worthwhile for participants (15/16, 94%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions. Conclusions: Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives. %M 34757316 %R 10.2196/30605 %U https://formative.jmir.org/2021/11/e30605 %U https://doi.org/10.2196/30605 %U http://www.ncbi.nlm.nih.gov/pubmed/34757316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30313 %T Development of a Severity Score and Comparison With Validated Measures for Depression and Anxiety: Validation Study %A Lynch,William %A Platt,Michael L %A Pardes,Adam %+ NeuroFlow, Inc, 111 S Independence Mall E, Suite 701, Philadelphia, PA, United States, 1 267 671 7316, adam@neuroflow.com %K PHQ-9 %K GAD-7 %K depression assessment %K anxiety assessment %K measurement-based care %K integrated behavioral health %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Less than 10% of the individuals seeking behavioral health care receive measurement-based care (MBC). Technology has the potential to implement MBC in a secure and efficient manner. To test this idea, a mobile health (mHealth) platform was developed with the goal of making MBC easier to deliver by clinicians and more accessible to patients within integrated behavioral health care. Data from over 3000 users of the mHealth platform were used to develop an output severity score, a robust screening measure for depression and anxiety. Objective: The aim of this study is to compare severity scores with scores from validated assessments for depression and anxiety and scores from clinician review to evaluate the potential added value of this new measure. Methods: The severity score uses patient-reported and passively collected data related to behavioral health on an mHealth platform. An artificial intelligence–derived algorithm was developed that condenses behavioral health data into a single, quantifiable measure for longitudinal tracking of an individual’s depression and anxiety symptoms. Linear regression and Bland-Altman analyses were used to evaluate the relationships and differences between severity scores and Personal Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) scores from over 35,000 mHealth platform users. The severity score was also compared with a review by a panel of expert clinicians for a subset of 250 individuals. Results: Linear regression results showed a strong correlation between the severity score and PHQ-9 (r=0.74; P<.001) and GAD-7 (r=0.80; P<.001) changes. A strong positive correlation was also found between the severity score and expert panel clinical review (r=0.80-0.84; P<.001). However, Bland-Altman analysis and the evaluation of outliers on regression analysis showed that the severity score was significantly different from the PHQ-9. Conclusions: Clinicians can reliably use the mHealth severity score as a proxy measure for screening and monitoring behavioral health symptoms longitudinally. The severity score may identify at-risk individuals who are not identified by the PHQ-9. Further research is warranted to evaluate the sensitivity and specificity of the severity score. %M 34757319 %R 10.2196/30313 %U https://formative.jmir.org/2021/11/e30313 %U https://doi.org/10.2196/30313 %U http://www.ncbi.nlm.nih.gov/pubmed/34757319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28951 %T Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study %A Pal Bhowmick,Ipsita %A Chutia,Dibyajyoti %A Chouhan,Avinash %A Nishant,Nilay %A Raju,P L N %A Narain,Kanwar %A Kaur,Harpreet %A Pebam,Rocky %A Debnath,Jayanta %A Tripura,Rabindra %A Gogoi,Kongkona %A Ch Nag,Suman %A Nath,Aatreyee %A Tripathy,Debabrata %A Debbarma,Jotish %A Das,Nirapada %A Sarkar,Ujjwal %A Debbarma,Rislyn %A Roy,Rajashree %A Debnath,Bishal %A Dasgupta,Dipanjan %A Debbarma,Suraj %A Joy Tripura,Kamal %A Reang,Guneram %A Sharma,Amit %A Rahi,Manju %A Chhibber-Goel,Jyoti %+ International Centre for Genetic Engineering and Biotechnology, Vasant Kunj, New Delhi, 110067, India, 91 011 26741358 ext 170, jyotichhibbergoel@gmail.com %K fever %K health system %K mHealth app %K malaria %K surveillance %K mobile phone %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective: In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods: FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results: The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions: The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems. %M 34757321 %R 10.2196/28951 %U https://formative.jmir.org/2021/11/e28951 %U https://doi.org/10.2196/28951 %U http://www.ncbi.nlm.nih.gov/pubmed/34757321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e27748 %T A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation %A Javier,Sarah J %A Wu,Justina %A Smith,Donna L %A Kanwal,Fasiha %A Martin,Lindsey A %A Clark,Jack %A Midboe,Amanda M %+ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, United States, 1 6504935000, Sarah.Javier@va.gov %K cirrhosis %K informatics %K care coordination %K implementation %K Consolidated Framework for Implementation Research (CFIR) %K quality improvement %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cirrhosis, or scarring of the liver, is a debilitating condition that affects millions of US adults. Early identification, linkage to care, and retention of care are critical for preventing severe complications and death from cirrhosis. Objective: The purpose of this study is to conduct a preimplementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. Methods: Semistructured interviews were conducted between January and May 2016 with frontline providers in liver disease and primary care clinics at 3 Veterans Health Administration medical centers. A total of 10 providers were interviewed, including 8 physicians and midlevel providers from liver-related specialty clinics and 2 primary care providers who managed patients with cirrhosis. The Consolidated Framework for Implementation Research guided the development of the interview guides. Inductive consensus coding and content analysis were used to analyze transcribed interviews and abstracted coded passages, elucidated themes, and insights. Results: The following themes and subthemes emerged from the analyses: outer setting: needs and resources for patients with cirrhosis; inner setting: readiness for implementation (subthemes: lack of resources, lack of leadership support), and implementation climate (subtheme: competing priorities); characteristics of individuals: role within clinic; knowledge and beliefs about P-CIMS (subtheme: perceived and realized benefits; useful features; suggestions for improvement); and perceptions of current practices in managing cirrhosis cases (subthemes: preimplementation process for identifying and linking patients to cirrhosis care; structural and social barriers to follow-up). Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention, but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. Conclusions: P-CIMS shows promise as a powerful tool for identifying, linking, and retaining care in patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in populations with chronic disease. %M 34751653 %R 10.2196/27748 %U https://formative.jmir.org/2021/11/e27748 %U https://doi.org/10.2196/27748 %U http://www.ncbi.nlm.nih.gov/pubmed/34751653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30580 %T A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial %A Suffoletto,Brian %A Goldstein,Tina %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4129016892, suffbp@stanford.edu %K adolescent %K depression %K help seeking %K text message %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. %M 34751665 %R 10.2196/30580 %U https://formative.jmir.org/2021/11/e30580 %U https://doi.org/10.2196/30580 %U http://www.ncbi.nlm.nih.gov/pubmed/34751665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28634 %T Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study %A Herkert,Cyrille %A Graat-Verboom,Lidwien %A Gilsing-Fernhout,Judith %A Schols,Manon %A Kemps,Hareld Marijn Clemens %+ Department of Cardiology, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, Eindhoven, 5631 BM, Netherlands, 31 408888220, cyrille.herkert@mmc.nl %K home-based exercise %K cardiac diseases %K pulmonary diseases %K comorbidities %K elderly %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 %M 34751655 %R 10.2196/28634 %U https://formative.jmir.org/2021/11/e28634 %U https://doi.org/10.2196/28634 %U http://www.ncbi.nlm.nih.gov/pubmed/34751655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e23789 %T A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study %A Steinkamp,Jackson %A Sharma,Abhinav %A Bala,Wasif %A Kantrowitz,Jacob J %+ Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, United States, 1 215 662 4000, jacksonsteinkamp@gmail.com %K electronic medical records %K clinical notes %K information chaos %K information overload %K clinician burnout %K software design %K problem-oriented medical record %K medical records %K electronic records %K documentation %K clinical %K software %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinicians spend large amounts of their workday using electronic medical records (EMRs). Poorly designed documentation systems contribute to the proliferation of out-of-date information, increased time spent on medical records, clinician burnout, and medical errors. Beyond software interfaces, examining the underlying paradigms and organizational structures for clinical information may provide insights into ways to improve documentation systems. In particular, our attachment to the note as the major organizational unit for storing unstructured medical data may be a cause of many of the problems with modern clinical documentation. Notes, as currently understood, systematically incentivize information duplication and information scattering, both within a single clinician’s notes over time and across multiple clinicians’ notes. Therefore, it is worthwhile to explore alternative paradigms for unstructured data organization. Objective: The aim of this study is to demonstrate the feasibility of building an EMR that does not use notes as the core organizational unit for unstructured data and which is designed specifically to disincentivize information duplication and information scattering. Methods: We used specific design principles to minimize the incentive for users to duplicate and scatter information. By default, the majority of a patient’s medical history remains the same over time, so users should not have to redocument that information. Clinicians on different teams or services mostly share the same medical information, so all data should be collaboratively shared across teams and services (while still allowing for disagreement and nuance). In all cases where a clinician must state that information has remained the same, they should be able to attest to the information without redocumenting it. We designed and built a web-based EMR based on these design principles. Results: We built a medical documentation system that does not use notes and instead treats the chart as a single, dynamically updating, and fully collaborative workspace. All information is organized by clinical topic or problem. Version history functionality is used to enable granular tracking of changes over time. Our system is highly customizable to individual workflows and enables each individual user to decide which data should be structured and which should be unstructured, enabling individuals to leverage the advantages of structured templating and clinical decision support as desired without requiring programming knowledge. The system is designed to facilitate real-time, fully collaborative documentation and communication among multiple clinicians. Conclusions: We demonstrated the feasibility of building a non–note-based, fully collaborative EMR system. Our attachment to the note as the only possible atomic unit of unstructured medical data should be reevaluated, and alternative models should be considered. %M 34751651 %R 10.2196/23789 %U https://formative.jmir.org/2021/11/e23789 %U https://doi.org/10.2196/23789 %U http://www.ncbi.nlm.nih.gov/pubmed/34751651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e18969 %T Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study %A Nwaogu,Janet Mayowa %A Chan,Albert P C %A Naslund,John A %A Hon,Carol K H %A Belonwu,Christopher %A Yang,Jackie %+ Department of Building and Real Estate, The Hong Kong Polytechnic University, Kowloon, Hong Kong, 852 52243597, janet.nwaogu@connect.polyu.hk %K mental health %K construction personnel %K digital technology %K digital intervention %K barriers %K motivators %K mobile phone %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. %M 34751652 %R 10.2196/18969 %U https://formative.jmir.org/2021/11/e18969 %U https://doi.org/10.2196/18969 %U http://www.ncbi.nlm.nih.gov/pubmed/34751652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e33335 %T A Virtual Community for Disability Advocacy: Development of a Searchable Artificial Intelligence–Supported Platform %A El Morr,Christo %A Maret,Pierre %A Muhlenbach,Fabrice %A Dharmalingam,Dhayananth %A Tadesse,Rediet %A Creighton,Alexandra %A Kundi,Bushra %A Buettgen,Alexis %A Mgwigwi,Thumeka %A Dinca-Panaitescu,Serban %A Dua,Enakshi %A Gorman,Rachel %+ School of Health Policy and Management, Faculty of Health, York University, Stong College Room 306, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 4167362100, elmorr@yorku.ca %K virtual community %K machine learning %K Semantic Web %K natural language processing %K web intelligence %K health informatics %K Wikibase %K disability rights %K human rights %K CRPD %K equity %K community %K disability %K ethics %K rights %K pilot %K platform %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The lack of availability of disability data has been identified as a major challenge hindering continuous disability equity monitoring. It is important to develop a platform that enables searching for disability data to expose systemic discrimination and social exclusion, which increase vulnerability to inequitable social conditions. Objective: Our project aims to create an accessible and multilingual pilot disability website that structures and integrates data about people with disabilities and provides data for national and international disability advocacy communities. The platform will be endowed with a document upload function with hybrid (automated and manual) paragraph tagging, while the querying function will involve an intelligent natural language search in the supported languages. Methods: We have designed and implemented a virtual community platform using Wikibase, Semantic Web, machine learning, and web programming tools to enable disability communities to upload and search for disability documents. The platform data model is based on an ontology we have designed following the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The virtual community facilitates the uploading and sharing of validated information, and supports disability rights advocacy by enabling dissemination of knowledge. Results: Using health informatics and artificial intelligence techniques (namely Semantic Web, machine learning, and natural language processing techniques), we were able to develop a pilot virtual community that supports disability rights advocacy by facilitating uploading, sharing, and accessing disability data. The system consists of a website on top of a Wikibase (a Semantic Web–based datastore). The virtual community accepts 4 types of users: information producers, information consumers, validators, and administrators. The virtual community enables the uploading of documents, semiautomatic tagging of their paragraphs with meaningful keywords, and validation of the process before uploading the data to the disability Wikibase. Once uploaded, public users (information consumers) can perform a semantic search using an intelligent and multilingual search engine (QAnswer). Further enhancements of the platform are planned. Conclusions: The platform ontology is flexible and can accommodate advocacy reports and disability policy and legislation from specific jurisdictions, which can be accessed in relation to the CRPD articles. The platform ontology can be expanded to fit international contexts. The virtual community supports information upload and search. Semiautomatic tagging and intelligent multilingual semantic search using natural language are enabled using artificial intelligence techniques, namely Semantic Web, machine learning, and natural language processing. %M 34738910 %R 10.2196/33335 %U https://formative.jmir.org/2021/11/e33335 %U https://doi.org/10.2196/33335 %U http://www.ncbi.nlm.nih.gov/pubmed/34738910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25209 %T Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study %A Romeiser,Jamie L %A Cavalcante,James %A Richman,Deborah C %A Singh,Sunitha M %A Liang,Xiaohui %A Pei,Allison %A Sharma,Samanvaya %A Lazarus,Zoe %A Gan,Tong J %A Bennett-Guerrero,Elliott %+ Department of Anesthesiology, Stony Brook University Medical Center, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 631 444 2975, jamie.romeiser@stonybrookmedicine.edu %K concurrent mixed modes %K recovery after surgery %K text messages %K SMS %K email %K perioperative recovery %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As patients are discharged from the hospital more quickly, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increase in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment. Objective: This study aims to investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population and compare response rates for 3 different web-based strategies for delivering recovery surveys over the perioperative period: email, SMS text messaging, and a concurrent mixed approach of using both email and SMS text messaging. Methods: Patients undergoing surgeries managed with an enhanced recovery after surgery pathway were asked to participate in a web-based quality assurance monitoring program at the time of their preoperative surgery appointment. Different follow-up methods were implemented over 3 sequential phases. Patients received Health Insurance Portability and Accountability Act–compliant web-based survey links via email (phase 1), SMS text messaging (phase 2), or concurrently using both email and SMS text messaging (phase 3) using REDCap and Twilio software. Recovery assessments using the established Quality of Recovery-9 instrument were performed 4 days before surgery and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing characteristics of those who participated versus those who did not. Differences in response rates by the web-based collection method were analyzed using adjusted models. Results: A total of 615 patients were asked to participate, with 526 (85.5%) opting for the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes method was the most successful for obtaining responses at each time point compared with text or email alone (pre: 119/160, 74.4% vs 116/173, 67.1% vs 56/130, 43.1%, P<.001; 7 days: 115/172, 66.9% vs 82/164, 50.0% vs 59/126, 46.8%, P=.001; 30 days: 152/234, 65.0% vs 52/105, 49.5% vs 53/123, 43.1%, P=.001, respectively). In the adjusted model, the concurrent mixed modes method significantly predicted response compared with using email alone (odds ratio 3.4; P<.001) and SMS text messaging alone (odds ratio 1.9; P<.001). Additional significant predictors of response were race, partnership, and time. Conclusions: For internet users and smartphone owners, electronic capture of recovery surveys appear to be possible through this mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups. %M 34734827 %R 10.2196/25209 %U https://formative.jmir.org/2021/11/e25209 %U https://doi.org/10.2196/25209 %U http://www.ncbi.nlm.nih.gov/pubmed/34734827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29873 %T Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland %A Thorarinsdottir,Kristjana %A Holmes,Emily A %A Hardarson,Johann %A Hedinsdottir,Unnur %A Kanstrup,Marie %A Singh,Laura %A Hauksdottir,Arna %A Halldorsdottir,Thorhildur %A Gudmundsdottir,Berglind %A Valdimarsdottir,Unnur %A Thordardottir,Edda Bjork %A Gamble,Beau %A Bjornsson,Andri %+ Department of Psychology, University of Iceland, Sæmundargata 12, Reykjavik, 101, Iceland, 354 6942001, kth35@hi.is %K psychological trauma %K intrusive memories %K case report %K visuospatial interference task %K Tetris gameplay %K mental imagery %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention. %M 34734830 %R 10.2196/29873 %U https://formative.jmir.org/2021/11/e29873 %U https://doi.org/10.2196/29873 %U http://www.ncbi.nlm.nih.gov/pubmed/34734830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31649 %T Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study %A Reichold,Michael %A Heß,Miriam %A Kolominsky-Rabas,Peter %A Gräßel,Elmar %A Prokosch,Hans-Ulrich %+ Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, Erlangen, 91058, Germany, 49 91318526720, michael.reichold@fau.de %K dementia %K usability %K evaluation %K mobile device %K registry %K electronic data collection %K offline %K mobile app %K digital health %K usability testing %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project “Digital Dementia Registry Bavaria (digiDEM Bayern),” interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the “Thinking Aloud” method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the “Thinking Aloud” method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents “good” usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry–based research project. %M 34730543 %R 10.2196/31649 %U https://formative.jmir.org/2021/11/e31649 %U https://doi.org/10.2196/31649 %U http://www.ncbi.nlm.nih.gov/pubmed/34730543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28329 %T Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study %A Skovlund,Soren E %A Troelsen,Lise Havbæk %A Noergaard,Lise Mellergaard %A Pietraszek,Anna %A Jakobsen,Poul Erik %A Ejskjaer,Niels %+ Department of Endocrinology, Aalborg University Hospital, Mølleparkvej 4, Aalborg, 9000, Denmark, 45 40228835, soren@sorenskovlund.com %K patient-reported outcomes %K diabetes %K person-centered care %K person-centered communication %K dialog %K mental health %K self-management %K collaborative care %K value-based health care %K mixed-methods %K mobile phone %K mHealth %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Improvements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes. Objective: This study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care. Methods: Overall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses. Results: People with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit. Conclusions: The Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark. %M 34730545 %R 10.2196/28329 %U https://formative.jmir.org/2021/11/e28329 %U https://doi.org/10.2196/28329 %U http://www.ncbi.nlm.nih.gov/pubmed/34730545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28315 %T A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study %A Goh,Lina %A Allen,Natalie E %A Ahmadpour,Naseem %A Ehgoetz Martens,Kaylena A %A Song,Jooeun %A Clemson,Lindy %A Lewis,Simon J G %A MacDougall,Hamish G %A Canning,Colleen G %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 7 Susan Wakil Health Building D18, Camperdown, 2006, Australia, 61 9351 9016, natalie.allen@sydney.edu.au %K Parkinson disease %K freezing of gait %K action observation %K video self-modelling %K virtual reality %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. %M 34730537 %R 10.2196/28315 %U https://formative.jmir.org/2021/11/e28315 %U https://doi.org/10.2196/28315 %U http://www.ncbi.nlm.nih.gov/pubmed/34730537 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25749 %T A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial %A Paquette,Catherine E %A Rubalcava,Dillon T %A Chen,Yun %A Anand,Deepika %A Daughters,Stacey B %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, United States, 1 919 962 9924, daughter@unc.edu %K substance use disorder %K smartphone app %K mHealth %K behavioral activation %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective: This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods: A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results: Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions: This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration: ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887 %M 34730535 %R 10.2196/25749 %U https://formative.jmir.org/2021/11/e25749 %U https://doi.org/10.2196/25749 %U http://www.ncbi.nlm.nih.gov/pubmed/34730535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e27114 %T Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study %A Bhattacharjee,Ananya %A Haque,S M Taiabul %A Hady,Md Abdul %A Alam,S M Raihanul %A Rabbi,Mashfiqui %A Kabir,Muhammad Ashad %A Ahmed,Syed Ishtiaque %+ Department of Computer Science, University of Toronto, 40 St George Street, Toronto, ON, M5S 2E4, Canada, 1 6476196982, ananya@cs.toronto.edu %K Bangladesh %K global south %K social determinant %K students %K undergraduate %K religion %K women %K mobile phone %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied. Objective: This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health. Methods: We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns. Results: Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons). Conclusions: Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world. %M 34726609 %R 10.2196/27114 %U https://formative.jmir.org/2021/11/e27114 %U https://doi.org/10.2196/27114 %U http://www.ncbi.nlm.nih.gov/pubmed/34726609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31064 %T Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis %A Eisenstadt,Amelia %A Liverpool,Shaun %A Metaxa,Athina-Marina %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 20 7794 2313, mia.eisenstadt@annafreud.org %K smartphone %K app %K well-being %K awareness %K mental health %K formative %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users’ understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling. Objective: This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data. Results: A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app’s content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t33=−2.16) and the increase in the well-being measures (t33=2.87) were statistically significant. No adverse events were reported during the follow-up period. Conclusions: The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app. %M 34569466 %R 10.2196/31064 %U https://formative.jmir.org/2021/11/e31064 %U https://doi.org/10.2196/31064 %U http://www.ncbi.nlm.nih.gov/pubmed/34569466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29280 %T Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis %A Doukani,Asmae %A Cerga Pashoja,Arlinda %A Fanaj,Naim %A Qirjako,Gentiana %A Meksi,Andia %A Mustafa,Sevim %A Vis,Christiaan %A Hug,Juliane %+ Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 7787447507, arlinda.cerga-pashoja@lshtm.ac.uk %K e-mental health %K digital mental health %K internet-based cognitive behavioral therapy %K implementation science %K organizational readiness for implementing change %K community mental health center %K qualitative interviews %K content analysis %K Albania and Kosovo %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective: The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods: We used qualitative semistructured focus group discussions that were guided by Bryan Weiner’s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results: Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting “change efficacy” included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For “change commitment,” participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions: In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 %M 34723822 %R 10.2196/29280 %U https://formative.jmir.org/2021/11/e29280 %U https://doi.org/10.2196/29280 %U http://www.ncbi.nlm.nih.gov/pubmed/34723822 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25392 %T A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study %A Carmona,Nicole E %A Usyatynsky,Aleksandra %A Kutana,Samlau %A Corkum,Penny %A Henderson,Joanna %A McShane,Kelly %A Shapiro,Colin %A Sidani,Souraya %A Stinson,Jennifer %A Carney,Colleen E %+ Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 %M 34723820 %R 10.2196/25392 %U https://formative.jmir.org/2021/11/e25392 %U https://doi.org/10.2196/25392 %U http://www.ncbi.nlm.nih.gov/pubmed/34723820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30449 %T Young Adults’ Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement %A Baker,Venetia %A Arnold,Georgia %A Piot,Sara %A Thwala,Lesedi %A Glynn,Judith %A Hargreaves,James %A Birdthistle,Isolde %+ Department of Population Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, venetia.baker1@lshtm.ac.uk %K COVID-19 %K adolescents %K young people %K social media %K edutainment %D 2021 %7 29.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people’s knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer’s perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic’s impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. %M 34596568 %R 10.2196/30449 %U https://formative.jmir.org/2021/10/e30449 %U https://doi.org/10.2196/30449 %U http://www.ncbi.nlm.nih.gov/pubmed/34596568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31086 %T Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study %A Shelby,Tyler %A Caruthers,Tyler %A Kanner,Oren Y %A Schneider,Rebecca %A Lipnickas,Dana %A Grau,Lauretta E %A Manohar,Rajit %A Niccolai,Linda %+ Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, United States, 1 6202284003, tyler.shelby@yale.edu %K mHealth %K digital contact tracing %K Bluetooth %K COVID-19 %K mixed methods %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). Objective: We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. Methods: We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. Results: Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. Conclusions: Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices. %M 34586078 %R 10.2196/31086 %U https://formative.jmir.org/2021/10/e31086 %U https://doi.org/10.2196/31086 %U http://www.ncbi.nlm.nih.gov/pubmed/34586078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30093 %T A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study %A Veludhandi,Anirudh %A Ross,Diana %A Sinha,Cynthia B %A McCracken,Courtney %A Bakshi,Nitya %A Krishnamurti,Lakshmanan %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 5671, lkrishn@emory.edu %K decision support tool %K sickle cell disease %K mobile application %K mHealth %K pediatrics %K transplant %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD. Objective: The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families. Methods: On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients’ management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively. Results: According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology. Conclusions: We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting. %M 34709190 %R 10.2196/30093 %U https://formative.jmir.org/2021/10/e30093 %U https://doi.org/10.2196/30093 %U http://www.ncbi.nlm.nih.gov/pubmed/34709190 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27908 %T Toward an Extended Definition of Major Depressive Disorder Symptomatology: Digital Assessment and Cross-validation Study %A Martin-Key,Nayra A %A Mirea,Dan-Mircea %A Olmert,Tony %A Cooper,Jason %A Han,Sung Yeon Sarah %A Barton-Owen,Giles %A Farrag,Lynn %A Bell,Emily %A Eljasz,Pawel %A Cowell,Daniel %A Tomasik,Jakub %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K major depressive disorder %K subthreshold depression, transdiagnostic symptoms %K digital assessment %K digital mental health %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diagnosing major depressive disorder (MDD) is challenging, with diagnostic manuals failing to capture the wide range of clinical symptoms that are endorsed by individuals with this condition. Objective: This study aims to provide evidence for an extended definition of MDD symptomatology. Methods: Symptom data were collected via a digital assessment developed for a delta study. Random forest classification with nested cross-validation was used to distinguish between individuals with MDD and those with subthreshold symptomatology of the disorder using disorder-specific symptoms and transdiagnostic symptoms. The diagnostic performance of the Patient Health Questionnaire–9 was also examined. Results: A depression-specific model demonstrated good predictive performance when distinguishing between individuals with MDD (n=64) and those with subthreshold depression (n=140) (area under the receiver operating characteristic curve=0.89; sensitivity=82.4%; specificity=81.3%; accuracy=81.6%). The inclusion of transdiagnostic symptoms of psychopathology, including symptoms of depression, generalized anxiety disorder, insomnia, emotional instability, and panic disorder, significantly improved the model performance (area under the receiver operating characteristic curve=0.95; sensitivity=86.5%; specificity=90.8%; accuracy=89.5%). The Patient Health Questionnaire–9 was excellent at identifying MDD but overdiagnosed the condition (sensitivity=92.2%; specificity=54.3%; accuracy=66.2%). Conclusions: Our findings are in line with the notion that current diagnostic practices may present an overly narrow conception of mental health. Furthermore, our study provides proof-of-concept support for the clinical utility of a digital assessment to inform clinical decision-making in the evaluation of MDD. %M 34709182 %R 10.2196/27908 %U https://formative.jmir.org/2021/10/e27908 %U https://doi.org/10.2196/27908 %U http://www.ncbi.nlm.nih.gov/pubmed/34709182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27676 %T Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis %A Hechinger,Mareike %A Fringer,André %+ Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland, 41 58 934 64 79, andre.fringer@zhaw.ch %K nursing care %K health care professionals %K suicidal behavior %K suicidal inclinations %K suicidal ideation %K inpatient %K outpatient %K eHealth %K mHealth %K mental health %K suicide %K stress %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care. Objective: This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development. Methods: A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived. Results: In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life. Conclusions: The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care. %M 34709191 %R 10.2196/27676 %U https://formative.jmir.org/2021/10/e27676 %U https://doi.org/10.2196/27676 %U http://www.ncbi.nlm.nih.gov/pubmed/34709191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20970 %T WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality %A Anderson,Elizabeth %A Koss,Mary %A Castro Luque,Ana Lucía %A Garcia,David %A Lopez,Elise %A Ernst,Kacey %+ Department of Health Promotion Sciences, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, United States, 1 5205050040, andersone@email.arizona.edu %K WhatsApp %K synchronous text-based focus groups %K Zika %K Mexican-origin Latinas %K social media %K mHealth %K focus groups %K smartphones %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. %M 34709185 %R 10.2196/20970 %U https://formative.jmir.org/2021/10/e20970 %U https://doi.org/10.2196/20970 %U http://www.ncbi.nlm.nih.gov/pubmed/34709185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20739 %T Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study %A Chin,Winnie Szu Yun %A Kurowski,Alicia %A Gore,Rebecca %A Chen,Guanling %A Punnett,Laura %A , %+ Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, Room LW711, Boston, MA, 02215, United States, 1 617 632 5602, winnies_chin@dfci.harvard.edu %K mobile apps %K usability testing %K user experience design %K mobile phone %K mhealth %K iterative testing %K participatory research %K user demographics %K worker participation %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers’, developers’, and users’ mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app’s 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data. %M 34709186 %R 10.2196/20739 %U https://formative.jmir.org/2021/10/e20739 %U https://doi.org/10.2196/20739 %U http://www.ncbi.nlm.nih.gov/pubmed/34709186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32382 %T Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study %A Doumas,Diana M %A Midgett,Aida %A Myers,Valerie %A Buller,Mary Klein %+ Institute for the Study of Behavioral Health and Addiction, Boise State Universtiy, 1910 University Drive, Boise, ID, 83702, United States, 1 2084261219, dianadoumas@boisestate.edu %K technology-based bullying intervention %K STAC-T %K usability testing %K middle school %K rural %K low-income %K mobile phone %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. Objective: The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. Methods: A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17%), 4 (66%), and 1 (17%) rated the program as 3, 4, and 5 stars, respectively; 80% (8/10) of students said they would recommend the program; and 60% (6/10) and 40% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. Conclusions: This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. Trial Registration: ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495 %M 34582355 %R 10.2196/32382 %U https://formative.jmir.org/2021/10/e32382 %U https://doi.org/10.2196/32382 %U http://www.ncbi.nlm.nih.gov/pubmed/34582355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31862 %T Evaluating the Clinical Feasibility of an Artificial Intelligence–Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study %A Popescu,Christina %A Golden,Grace %A Benrimoh,David %A Tanguay-Sela,Myriam %A Slowey,Dominique %A Lundrigan,Eryn %A Williams,Jérôme %A Desormeau,Bennet %A Kardani,Divyesh %A Perez,Tamara %A Rollins,Colleen %A Israel,Sonia %A Perlman,Kelly %A Armstrong,Caitrin %A Baxter,Jacob %A Whitmore,Kate %A Fradette,Marie-Jeanne %A Felcarek-Hope,Kaelan %A Soufi,Ghassen %A Fratila,Robert %A Mehltretter,Joseph %A Looper,Karl %A Steiner,Warren %A Rej,Soham %A Karp,Jordan F %A Heller,Katherine %A Parikh,Sagar V %A McGuire-Snieckus,Rebecca %A Ferrari,Manuela %A Margolese,Howard %A Turecki,Gustavo %+ Aifred Health Inc., 1250 Rue Guy Suite #600, Montreal, QC, H3H 2T4, Canada, 1 5144637813, david.benrimoh@mail.mcgill.com %K clinical decision support system %K major depressive disorder %K artificial intelligence %K feasibility %K usability %K mobile phone %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence–powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. Objective: This study aims to examine the feasibility of an artificial intelligence–powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network–based individualized treatment remission prediction. Methods: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. Results: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. Conclusions: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. Trial Registration: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642 %M 34694234 %R 10.2196/31862 %U https://formative.jmir.org/2021/10/e31862 %U https://doi.org/10.2196/31862 %U http://www.ncbi.nlm.nih.gov/pubmed/34694234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28096 %T The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study %A Duong,Hong %A Dao,Sang %A Dang,Huyen %A Nguyen,Linh %A Ngo,Tuan %A Nguyen,Trung %A Tran,Lan Anh %A Nguyen,Doan %A Rivera,Maya %A Nguyen,Nga %+ PATH Vietnam, #1101, 11th floor, Hanoi Towers, 49 Hai Ba Trung Street, Hoan Kiem District, Hanoi, 100000, Vietnam, 84 024 3936 2215 ext 130, ntnguyen@path.org %K immunizations %K immunization registry %K readiness assessment %K electronic immunization records %K Vietnam %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Vietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted. Objective: This study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam—Ha Noi and Son La. Methods: All health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS. Results: Of the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7%) and vaccine stocks (889/990, 90.8%). Most had stable electricity (971/990, 98.1%), at least 1 computer (986/990, 99.6%), and ≥2 trained NIIS end users (825/990, 83.3%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4%) and paper-based logbooks (254/269, 94.4%). However, only 54.5% (206/378) of immunization IDs matched, 57% (13/23) of Bacillus Calmette-Guérin vaccination records were accurate, and 70% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed. Conclusions: The readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data. %M 34694232 %R 10.2196/28096 %U https://formative.jmir.org/2021/10/e28096 %U https://doi.org/10.2196/28096 %U http://www.ncbi.nlm.nih.gov/pubmed/34694232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e33113 %T Medical Students’ Perceptions of a Blockchain-Based Decentralized Work History and Credentials Portfolio: Qualitative Feasibility Study %A Hasselgren,Anton %A Kralevska,Katina %A Gligoroski,Danilo %A Faxvaag,Arild %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Mellomila 71, Trondheim, 7018, Norway, 47 46948498, anton.hasselgren@ntnu.no %K blockchain %K eHealth %K qualitative research %K VerifyMed %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Increased digitization of health care might challenge some of the trust functions that are established in a traditional health care system. We have, with the concept of VerifyMed, developed a decentralized service for work history and competence verification, as a means to increase trust in the virtual interaction between a patient and a caregiver, mitigate administrative burden, and provide patient-reported outcomes seamlessly for health professionals. Objective: This research aimed to validate the use case of a decentralized credentials service for health care professionals in Norway. We also aimed to evaluate the proof-of-concept of VerifyMed, a blockchain-based credential service for health care professionals. Methods: A qualitative approach was applied with data collection through 9 semistructured interviews and 2 focus groups (one with 4 participants and the other with 5 participants). The System Usability Scale (SUS) was used as a part of the interviews. Data were analyzed through the principles of systematic text condensation. The recruitment of participants ended when it was concluded that the data had reached saturation. Results: The following 5 themes were identified from the interviews and focus groups: (1) the need for aggregated storage of work- and study-related verification, (2) trust in a virtual health care environment, (3) the potential use of patient feedback, (4) trust in blockchain technology, and (5) improvements of the VerifyMed concept. The SUS questionnaire gave a score of 69.7. Conclusions: This study has validated the need for a decentralized system where health care professionals can control their credentials and, potentially, their reputation. Future work should update the VerifyMed system according to this input. We concluded that a decentralized system for the storage of work-related verifiable credentials could increase trust in a virtualized health care system. %M 34677137 %R 10.2196/33113 %U https://formative.jmir.org/2021/10/e33113 %U https://doi.org/10.2196/33113 %U http://www.ncbi.nlm.nih.gov/pubmed/34677137 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28622 %T Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial %A Porter,Gwenndolyn %A Michaud,Tzeyu L %A Schwab,Robert J %A Hill,Jennie L %A Estabrooks,Paul A %+ Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025591082, gwenndolyn.porter@unmc.edu %K weight management %K rural %K RE-AIM %K hybrid effectiveness-implementation %K primary care %K obesity %K physicians %K digital health %K health technology %K mobile phone %D 2021 %7 20.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557 %M 34668873 %R 10.2196/28622 %U https://formative.jmir.org/2021/10/e28622 %U https://doi.org/10.2196/28622 %U http://www.ncbi.nlm.nih.gov/pubmed/34668873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e24208 %T Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study %A Smith,Jeremy L %A Allen,Jason W %A Haack,Carla I %A Wehrmeyer,Kathryn L %A Alden,Kayley G %A Lund,Maha B %A Mascaro,Jennifer S %+ Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast, Atlanta, GA, 30322, United States, 1 404 989 0524, jsmi304@emory.edu %K mindfulness %K meditation %K resting state %K fMRI %K connectivity %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app–delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. Objective: This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. Methods: We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list–controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. Results: PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. Conclusions: This pilot study is the first to examine app-based mindfulness for PA students’ mental health and investigate the impact of mindfulness on PA students’ brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees. %M 34665153 %R 10.2196/24208 %U https://formative.jmir.org/2021/10/e24208 %U https://doi.org/10.2196/24208 %U http://www.ncbi.nlm.nih.gov/pubmed/34665153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20458 %T Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial %A Abujarad,Fuad %A Peduzzi,Peter %A Mun,Sophia %A Carlson,Kristina %A Edwards,Chelsea %A Dziura,James %A Brandt,Cynthia %A Alfano,Sandra %A Chupp,Geoffrey %+ Department of Emergency Medicine, School of Medicine, Yale University, 464 Congress Ave, Suite 264-J, New Haven, CT, 06519, United States, 1 (203)928 9259, Fuad.Abujarad@yale.edu %K digital consent %K digital health %K e-consent %K informed consent %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The traditional informed consent (IC) process rarely emphasizes research participants’ comprehension of medical information, leaving them vulnerable to unknown risks and consequences associated with procedures or studies. Objective: This paper explores how we evaluated the feasibility of a digital health tool called Virtual Multimedia Interactive Informed Consent (VIC) for advancing the IC process and compared the results with traditional paper-based methods of IC. Methods: Using digital health and web-based coaching, we developed the VIC tool that uses multimedia and other digital features to improve the current IC process. The tool was developed on the basis of the user-centered design process and Mayer’s cognitive theory of multimedia learning. This study is a randomized controlled trial that compares the feasibility of VIC with standard paper consent to understand the impact of interactive digital consent. Participants were recruited from the Winchester Chest Clinic at Yale New Haven Hospital in New Haven, Connecticut, and healthy individuals were recruited from the community using fliers. In this coordinator-assisted trial, participants were randomized to complete the IC process using VIC on the iPad or with traditional paper consent. The study was conducted at the Winchester Chest Clinic, and the outcomes were self-assessed through coordinator-administered questionnaires. Results: A total of 50 participants were recruited in the study (VIC, n=25; paper, n=25). The participants in both groups had high comprehension. VIC participants reported higher satisfaction, higher perceived ease of use, higher ability to complete the consent independently, and shorter perceived time to complete the consent process. Conclusions: The use of dynamic, interactive audiovisual elements in VIC may improve participants’ satisfaction and facilitate the IC process. We believe that using VIC in an ongoing, real-world study rather than a hypothetical study improved the reliability of our findings, which demonstrates VIC’s potential to improve research participants’ comprehension and the overall process of IC. Trial Registration: ClinicalTrials.gov NCT02537886; https://clinicaltrials.gov/ct2/show/NCT02537886 %M 34665142 %R 10.2196/20458 %U https://formative.jmir.org/2021/10/e20458 %U https://doi.org/10.2196/20458 %U http://www.ncbi.nlm.nih.gov/pubmed/34665142 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29160 %T A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment %A Brogly,Chris %A Shoemaker,J Kevin %A Lizotte,Daniel J %A Kueper,Jacqueline K %A Bauer,Michael %+ Faculty of Information and Media Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 (519) 661 2111, cbrogly@uwo.ca %K smartphones %K undergraduates %K mental health %K lifestyle %K postsecondary institutions %K mHealth %K mobile application %K ecological momentary assessment %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective: The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods: This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results: First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires—such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale–21—was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions: Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19. %M 34665145 %R 10.2196/29160 %U https://formative.jmir.org/2021/10/e29160 %U https://doi.org/10.2196/29160 %U http://www.ncbi.nlm.nih.gov/pubmed/34665145 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e33009 %T Evaluation of a Digital Handheld Hydrogen Breath Monitor to Diagnose Lactose Malabsorption: Interventional Crossover Study %A Mathews,Simon C %A Templeton,Sandy %A Taylor,Stephanie K %A Harris,Sten %A Stewart,Margaret %A Raja,Shruti M %+ Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD, 21287, United States, 1 410 955 5000, smathe14@jhmi.edu %K digital health %K lactose intolerance %K digestive disease %K evaluation %K medical device %K detection %K diagnostic %K digestion %K testing %K performance %K gastrointestinal %K diagnosis %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Lactose malabsorption is a common condition that affects a broad segment of the population. Clinical diagnosis based on symptom recall can be unreliable and conventional testing can be inconvenient, requiring expensive laboratory-based equipment and conduction of the testing in a clinical setting. Objective: The aim of this study is to assess the performance of a digital handheld hydrogen breath monitor (GIMate) in diagnosing lactose malabsorption compared to a US Food and Drug Administration (FDA)–cleared device (H2 Check) for the same indication. Methods: An interventional crossover study was performed in adult participants with a prior confirmed diagnosis of lactose malabsorption or a suspected history of lactose intolerance. Results: A total of 31 participants (mean age 33.9 years) were enrolled in the study. There was 100% positive percent agreement and 100% negative percent agreement between the GIMate monitor and the H2 Check. Correlation between gastrointestinal symptoms and hydrogen values was positive at 0.82 (P<.001). Conclusions: The digital handheld GIMate breath monitor achieved equivalent diagnostic performance to that of an FDA-cleared device in the diagnosis of lactose malabsorption. Trial Registration: ClinicalTrials.gov NCT04754724; https://clinicaltrials.gov/ct2/show/NCT04754724 %M 34544034 %R 10.2196/33009 %U https://formative.jmir.org/2021/10/e33009 %U https://doi.org/10.2196/33009 %U http://www.ncbi.nlm.nih.gov/pubmed/34544034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30916 %T The Accuracy of Tidal Volume Measured With a Smart Shirt During Tasks of Daily Living in Healthy Subjects: Cross-sectional Study %A Mannée,Denise %A de Jongh,Frans %A van Helvoort,Hanneke %+ Department of Pulmonary Disease, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 24 361 1111, denise.mannee@radboudumc.nl %K telemonitoring %K Hexoskin smart shirt %K smart textiles %K textile sensors %K accuracy %K healthy subjects %K calibration %K tidal volume %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Hexoskin is a smart shirt that can take continuous and objective measurements and could be part of a potential telemonitoring system. Objective: The aim of this study was to determine the accuracy of the calibrated Hexoskin in measuring tidal volumes (TVs) in comparison to spirometry during various tasks. Methods: In a cross-sectional study, the TV of 15 healthy subjects was measured while performing seven tasks using spirometry and the Hexoskin. These tasks were performed during two sessions; between sessions, all equipment was removed. A one-time spirometer-based calibration per task was determined in session 1 and applied to the corresponding task in both sessions. Bland-Altman analysis was used to determine the agreement between TV that was measured with the Hexoskin and that measured with spirometry. A priori, we determined that the bias had to be less than ±5%, with limits of agreement (LOA) of less than ±15%. Lung volumes were measured and had to have LOA of less than ±0.150 L. Results: In the first session, all tasks had a median bias within the criteria (±0.6%). In the second session, biases were ±8.9%; only two tasks met the criteria. In both sessions, LOA were within the criteria in six out of seven tasks (±14.7%). LOA of lung volumes were greater than 0.150 L. Conclusions: The Hexoskin was able to correctly measure TV in healthy subjects during various tasks. However, after reapplication of the equipment, calibration factors were not able to be reused to obtain results within the determined boundaries. Trial Registration: Netherlands Trial Register NL6934; https://www.trialregister.nl/trial/6934 %M 34661546 %R 10.2196/30916 %U https://formative.jmir.org/2021/10/e30916 %U https://doi.org/10.2196/30916 %U http://www.ncbi.nlm.nih.gov/pubmed/34661546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32271 %T Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial %A Suffoletto,Brian %A Goldstein,Tina %A Gotkiewicz,Dawn %A Gotkiewicz,Emily %A George,Brandie %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 412 901 6892, suffbp@stanford.edu %K college %K mental health %K self-management %K digital intervention %K mHealth %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 %M 34647893 %R 10.2196/32271 %U https://formative.jmir.org/2021/10/e32271 %U https://doi.org/10.2196/32271 %U http://www.ncbi.nlm.nih.gov/pubmed/34647893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23968 %T Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study %A Halttu,Kirsi %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, P.O. Box 3000, Oulu, FI-90014, Finland, 358 458601190, kirsi.halttu@oulu.fi %K self-monitoring %K wearables %K physical activity tracking %K mHealth %K need for cognition %K persuasive design %K tailoring %K user research %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2%, 63.9%, and 47.3% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. %M 34647894 %R 10.2196/23968 %U https://formative.jmir.org/2021/10/e23968 %U https://doi.org/10.2196/23968 %U http://www.ncbi.nlm.nih.gov/pubmed/34647894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e25772 %T The Use of Task Shifting to Improve Treatment Engagement in an Internet-Based Mindfulness Intervention Among Chinese University Students: Randomized Controlled Trial %A Rodriguez,Marcus %A Eisenlohr-Moul,Tory A %A Weisman,Jared %A Rosenthal,M Zachary %+ Pitzer College, 1050 N Mills Ave, BN 205, Claremont, CA, 91711, United States, 1 9784605088, jweisman@pitzer.edu %K mindfulness %K mental health %K social support %K internet-based intervention %K treatment outcome %K university students %K smartphone %K mobile phone %D 2021 %7 13.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional in-person psychotherapies are incapable of addressing global mental health needs. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received. Objective: Although many meta-analyses have provided evidence supporting the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (eg, high attrition and low adherence). The aim of this study is to investigate the efficacy of an adjunctive treatment component that uses task shifting, wherein mental health care is provided by nonspecialist peer counselors to enhance engagement in an internet-based, self-directed, evidence-based mindfulness intervention among Chinese university students. Methods: From 3 universities across China, 54 students who reported at least mild stress, anxiety, or depression were randomly assigned to a 4-week internet-based mindfulness intervention (MIND) or to the intervention plus peer counselor support (MIND+), respectively. Be Mindful delivers all the elements of mindfulness-based cognitive therapy in an internet-based, 4-week course. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and posttreatment self-reported levels of depression, anxiety, stress, and trait mindfulness. We screened 56 volunteer peer counselor candidates who had no former training in the delivery of mental health services. Of these, 10 were invited to participate in a day-long training, and 4 were selected. Peer counselors were instructed to provide 6 brief (15-20 minute) sessions each week, to help encouraging participants to complete the internet-based intervention. Peer counselors received weekly web-based group supervision. Results: For both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes. The pre-post effect sizes (Cohen d) for mindfulness, depression, anxiety, and stress were 0.55, 0.95, 0.89, and 1.13, respectively. Participants assigned to the MIND+ (vs MIND) condition demonstrated significantly less attrition and more adherence, as indicated by a greater likelihood of completing posttreatment assessments (16/27, 59% vs 7/27, 26%; χ21=6.1; P=.01) and a higher percentage of course completion (72.6/100, 72.6% vs 50.7/100, 50.7%; t52=2.10; P=.04), respectively. No significant between-group differences in daily frequency and duration of mindfulness practice were observed. Multilevel logistic growth models showed that MIND+ participants reported significantly greater pre-post improvements in daily stress ratings (interaction estimate 0.39, SE 0.18; t317=2.29; P=.02) and depression (interaction estimate 0.38, SE 0.16; t330=2.37; P=.02) than those in the MIND condition. Conclusions: This study provides new insights into effective ways of leveraging technology and task shifting to implement large-scale mental health initiatives that are financially feasible, easily transportable, and quickly scalable in low-resource settings. The findings suggest that volunteer peer counselors receiving low-cost, low-intensity training and supervision may significantly improve participants’ indices of treatment engagement and mental health outcomes in an internet-based mindfulness intervention among Chinese university students. %M 34643532 %R 10.2196/25772 %U https://formative.jmir.org/2021/10/e25772 %U https://doi.org/10.2196/25772 %U http://www.ncbi.nlm.nih.gov/pubmed/34643532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28136 %T An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study %A Kruglova,Katya %A O'Connell,Siobhan Bernadette Laura %A Dawadi,Shrinkhala %A Gelgoot,Eden Noah %A Miner,Skye A %A Robins,Stephanie %A Schinazi,Joy %A Zelkowitz,Phyllis %+ Lady Davis Institute for Medical Research, Jewish General Hospital, Ludmer Research & Training Bldg, Montreal, QC, H3A 1A1, Canada, 1 514 340 8222, phyllis.zelkowitz@mcgill.ca %K mHealth app %K mHealth development process %K infertility %K intervention design %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. %M 34636741 %R 10.2196/28136 %U https://formative.jmir.org/2021/10/e28136 %U https://doi.org/10.2196/28136 %U http://www.ncbi.nlm.nih.gov/pubmed/34636741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32365 %T Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design %A Szinay,Dorothy %A Cameron,Rory %A Naughton,Felix %A Whitty,Jennifer A %A Brown,Jamie %A Jones,Andy %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich Research Park Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K discrete choice experiment %K stated preference methods %K mHealth %K digital health %K quantitative methodology %K uptake %K engagement %K methodology %K preference %K Bayesian %K design %K tutorial %K qualitative %K user preference %D 2021 %7 11.10.2021 %9 Tutorial %J J Med Internet Res %G English %X Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals’ preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method—a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique. %M 34633290 %R 10.2196/32365 %U https://www.jmir.org/2021/10/e32365 %U https://doi.org/10.2196/32365 %U http://www.ncbi.nlm.nih.gov/pubmed/34633290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29064 %T Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study %A Watt,Makayla %A Spence,John C %A Tandon,Puneeta %+ University of Alberta, 130-University Campus, Edmonton, AB, T6G2X8, Canada, 1 780 492 9844, ptandon@ualberta.ca %K liver disease %K meditation %K yoga %K breathwork %K behavior theory %K COM-B model %K behaviour change wheel %K behaviour change taxonomy %K internet %K digital %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development. Objective: This study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC. Methods: The steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development. Results: Barriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator. Conclusions: The Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components. Trial Registration: ClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527 %M 34623317 %R 10.2196/29064 %U https://formative.jmir.org/2021/10/e29064 %U https://doi.org/10.2196/29064 %U http://www.ncbi.nlm.nih.gov/pubmed/34623317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26266 %T Conducting Digital Health Care Research: Document Analysis of Challenges Experienced During Intervention Development and Feasibility Study Setup of an Internet-Administered Intervention for Parents of Children Treated for Cancer %A Woodford,Joanne %A Karlsson,Mathilda %A Hagström,Josefin %A Hägg Sylvén,Ylva %A Norbäck,Kajsa %A Grönqvist,Helena %A von Essen,Louise %+ Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, MTC House, Dag Hammarskjölds väg 14B, Uppsala, 752 37, Sweden, 46 704250714, louise-von.essen@kbh.uu.se %K parents %K internet-administered cognitive behavior therapy %K low intensity CBT %K feasibility study %K challenges %K digital healthcare research %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The design and conduct of research to develop, test, and evaluate complex health care interventions is challenging. Although the existing literature describes key challenges associated with the design and conduct of definitive (evaluation) trials, there is a lack of information concerning specific challenges associated with the intervention development phase and setup of feasibility studies. In particular, the literature is scarce concerning the challenges associated with conducting digital health care research, such as research on internet-administered interventions and research using digital features to support the execution of study procedures (eg, recruitment, consent, retention, and data collection and management). This study is conducted in the context of the intervention development and feasibility study setup phases of an internet-administered, guided, low-intensity cognitive behavioral therapy–based intervention for parents of children previously treated for cancer. Objective: The aim of this study is to explore the challenges experienced during the development phase of the internet-administered intervention and digital features to support the execution of the study procedures and a feasibility study setup. Methods: To explore the key challenges experienced, we conducted a document analysis of written records from all study meetings held by the research team (meeting minutes) between June 7, 2018, and January 10, 2020, guided by a thematic analysis approach. Furthermore, discussion groups with members of the research team were held to develop a more detailed understanding of the key challenges experienced. Methods and results are reported in accordance with the relevant items from the Standards for Reporting Qualitative Research checklist. Results: Six main themes were identified: decision-making and communication, expertise, external constraints, flexibility, planning and scheduling, and technical constraints. Conclusions: Significant challenges were experienced during the intervention development and setup phases of the feasibility study. Implications are discussed to inform future design, conduct, and planning of internet-administered intervention development and feasibility studies, especially within the context of digital health care research. %M 34433524 %R 10.2196/26266 %U https://formative.jmir.org/2021/10/e26266 %U https://doi.org/10.2196/26266 %U http://www.ncbi.nlm.nih.gov/pubmed/34433524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23648 %T The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study %A Jo,Youngji %A Barthel,Nathan %A Stierman,Elizabeth %A Clifton,Kathryn %A Pak,Esther Semee %A Ezeiru,Sonachi %A Ekweremadu,Diwe %A Onugu,Nnaemeka %A Ali,Zainab %A Egwu,Elijah %A Akoh,Ochayi %A Uzunyayla,Orkan %A Van Hulle,Suzanne %+ Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, United States, 1 4438001626, youngji1435@gmail.com %K long-lasting insecticide-treated nets %K malaria %K Nigeria %K information communication technology %K geographic information system %K supply chain management %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nigeria has the world’s largest malaria burden, accounting for 27% of the world’s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective: This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods: Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)–based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results: The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions: The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system. %M 34623310 %R 10.2196/23648 %U https://formative.jmir.org/2021/10/e23648 %U https://doi.org/10.2196/23648 %U http://www.ncbi.nlm.nih.gov/pubmed/34623310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32656 %T Detecting Subclinical Social Anxiety Using Physiological Data From a Wrist-Worn Wearable: Small-Scale Feasibility Study %A Shaukat-Jali,Ruksana %A van Zalk,Nejra %A Boyle,David Edward %+ Dyson School of Design Engineering, Imperial College London, 25 Exhibition Road, London, SW7 2AZ, United Kingdom, 44 2083318091, n.van-zalk@imperial.ac.uk %K social anxiety %K wearable sensors %K physiological measurement %K machine learning %K young adults %K mental health %K mHealth %K new methods %K anxiety %K wearable %K sensor %K digital phenotyping %K digital biomarkers %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Subclinical (ie, threshold) social anxiety can greatly affect young people’s lives, but existing solutions appear inadequate considering its rising prevalence. Wearable sensors may provide a novel way to detect social anxiety and result in new opportunities for monitoring and treatment, which would be greatly beneficial for persons with social anxiety, society, and health care services. Nevertheless, indicators such as skin temperature measured by wrist-worn sensors have not been used in prior work on physiological social anxiety detection. Objective: This study aimed to investigate whether subclinical social anxiety in young adults can be detected using physiological data obtained from wearable sensors, including heart rate, skin temperature, and electrodermal activity (EDA). Methods: Young adults (N=12) with self-reported subclinical social anxiety (measured using the widely used self-reported version of the Liebowitz Social Anxiety Scale) participated in an impromptu speech task. Physiological data were collected using an E4 Empatica wearable device. Using the preprocessed data and following a supervised machine learning approach, various classification algorithms such as Support Vector Machine, Decision Tree, Random Forest, and K-Nearest Neighbours (KNN) were used to develop models for 3 different contexts. Models were trained to differentiate (1) between baseline and socially anxious states, (2) among baseline, anticipation anxiety, and reactive anxiety states, and (3) social anxiety among individuals with social anxiety of differing severity. The predictive capability of the singular modalities was also explored in each of the 3 supervised learning experiments. The generalizability of the developed models was evaluated using 10-fold cross-validation as a performance index. Results: With modalities combined, the developed models yielded accuracies between 97.54% and 99.48% when differentiating between baseline and socially anxious states. Models trained to differentiate among baseline, anticipation anxiety, and reactive anxiety states yielded accuracies between 95.18% and 98.10%. Furthermore, the models developed to differentiate between social anxiety experienced by individuals with anxiety of differing severity scores successfully classified with accuracies between 98.86% and 99.52%. Surprisingly, EDA was identified as the most effective singular modality when differentiating between baseline and social anxiety states, whereas ST was the most effective modality when differentiating anxiety among individuals with social anxiety of differing severity. Conclusions: The results indicate that it is possible to accurately detect social anxiety as well as distinguish between levels of severity in young adults by leveraging physiological data collected from wearable sensors. %M 34617905 %R 10.2196/32656 %U https://formative.jmir.org/2021/10/e32656 %U https://doi.org/10.2196/32656 %U http://www.ncbi.nlm.nih.gov/pubmed/34617905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23204 %T Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach %A Mauka,Wilhellmuss %A Mbotwa,Christopher %A Moen,Kåre %A Lichtwarck,Hanne Ochieng %A Haaland,Inga %A Kazaura,Method %A Leyna,Germana H %A Leshabari,Melkizedeck T %A Mmbaga,Elia J %+ Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, United Republic of Tanzania, 255 763225717, wilhemauka@yahoo.com %K mHealth application %K participatory design %K HIV %K pre-exposure prophylaxis %K Africa %K female sex workers %K sex and gender minorities %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 %M 34617904 %R 10.2196/23204 %U https://formative.jmir.org/2021/10/e23204 %U https://doi.org/10.2196/23204 %U http://www.ncbi.nlm.nih.gov/pubmed/34617904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26125 %T Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study %A Tobias,Guy %A Sgan-Cohen,Harold %A Spanier,Assaf B %A Mann,Jonathan %+ Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, 91120, Israel, 972 52 705 2333, guy.tobias@mail.huji.ac.il %K mHealth %K public health %K oral health promotion %K gum health %K willingness to pay %K willingness to use %K willingness %K perception %K attitude %K mouth %K oral health %K dentist %K app %K monitoring %K mixed method %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting. Objective: The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app. Methods: The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires. Results: There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=−2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04). Conclusions: Potential mHealth users will be willing to pay for app use depending on their perception of the app’s ability to help them personally, provided they define themselves as currently unhealthy. %M 34609320 %R 10.2196/26125 %U https://formative.jmir.org/2021/10/e26125 %U https://doi.org/10.2196/26125 %U http://www.ncbi.nlm.nih.gov/pubmed/34609320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32353 %T Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study %A Gordon,Judith S %A Sbarra,David %A Armin,Julie %A Pace,Thaddeus W W %A Gniady,Chris %A Barraza,Yessenya %+ College of Nursing, University of Arizona, 1305 North Martin Avenue, Tucson, AZ, 85721, United States, 1 5206264970, judithg@email.arizona.edu %K COVID-19 %K stress %K anxiety %K isolation %K intervention %K guided imagery %K mobile app %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. %M 34546941 %R 10.2196/32353 %U https://formative.jmir.org/2021/10/e32353 %U https://doi.org/10.2196/32353 %U http://www.ncbi.nlm.nih.gov/pubmed/34546941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e15519 %T Assessing the Acceptability and Feasibility of a Web-Based Screening for Psychoactive Substance Users Among a French Sample of University Students and Workers: Mixed Methods Prospective Study %A Anthoine,Emmanuelle %A Caillon,Julie %A Deparis,Xavier %A Blanche,Michel %A Lebeaupin,Maxime %A Brochard,Marc-Antoine %A Venisse,Jean-Luc %A Moret,Leïla %+ PHU11 Public Health Department, Centre Hospitalier Universitaire (CHU) de Nantes, Hopital Saint-Jacques, 85 Rue Saint-Jacques, Nantes, 44093, France, 33 2 40 84 69 24, lmoret@chu-nantes.fr %K feasibility study %K preventive medicine %K addiction %K screening and brief intervention %K web-based app %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early detection in the prevention of addictive behaviors remains a complex question in practice for most first-line health care workers (HCWs). Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction center for problematic use. Whereas early detection is highly recommended by the World Health Organization, it is not usually performed in practice. Objective: The aim of this study was to assess the acceptability and feasibility of a web-based app, called Pulsio Santé, for health service users and first-line prevention HCW and to carry out an exhaustive process of early detection of psychoactive substance use behaviors. Methods: A mixed methods prospective study was conducted in 2 departments: HCWs from the regional occupational health department and from the university department of preventive medicine dedicated to students were invited to participate. Participants 18 years or older who had been seen in 2017 by a HCW from one of the departments were eligible. The study procedure comprised 5 phases: (1) inclusion of the participants after a face-to-face consultation with an HCW; (2) reception of a text message by participants on their smartphone or by email; (3) self-assessment by participants regarding their substance use with the Pulsio Santé app; (4) if participants agreed, transfer of the results to the HCW; and (5) if participants declined, a message to invite them to get in touch with their general practitioner should the assessment detect a risk. Several feasibility and acceptability criteria were assessed by an analysis of a focus group with the HCW that explored 4 themes (usefulness and advantages, problems and limitations, possible improvements, and finally, integration into routine practice). Results: A total of 1474 people were asked to participate, with 42 HCWs being involved. The percentage of people who agreed to receive a text message or an email, which was considered as the first level of acceptability, was 79.17% (1167/1474). The percentage of participants who clicked on the self-assessment link, considered as the second level of acceptability, was 60.24% (703/1167). The percentage of participants who completed their self-evaluation entirely, which was considered as the first level of feasibility, was 76.24% (536/703). The percentage of participants who shared the results of their evaluation with the HCWs, considered as the second level of feasibility, was 79.48% (426/536). The qualitative study showed that there were obstacles on the side of HCWs in carrying out the recommended interventions for people at risk based on their online screening, such as previous training or adaptations in accordance with specific populations. Conclusions: Quantitative results showed good acceptability and feasibility of the Pulsio Santé app by users and HCWs. There is a need for further studies more directly focused on the limitations highlighted by the qualitative results. %M 34596571 %R 10.2196/15519 %U https://formative.jmir.org/2021/10/e15519 %U https://doi.org/10.2196/15519 %U http://www.ncbi.nlm.nih.gov/pubmed/34596571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28000 %T A Machine Learning Sepsis Prediction Algorithm for Intended Intensive Care Unit Use (NAVOY Sepsis): Proof-of-Concept Study %A Persson,Inger %A Östling,Andreas %A Arlbrandt,Martin %A Söderberg,Joakim %A Becedas,David %+ Department of Statistics, Uppsala University, Box 513, Uppsala, 751 20, Sweden, 46 738275861, inger.persson@statistik.uu.se %K sepsis %K prediction %K early detection %K machine learning %K electronic health record %K EHR %K software as a medical device %K algorithm %K detection %K intensive care unit %K ICU %K proof of concept %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite decades of research, sepsis remains a leading cause of mortality and morbidity in intensive care units worldwide. The key to effective management and patient outcome is early detection, for which no prospectively validated machine learning prediction algorithm is currently available for clinical use in Europe. Objective: We aimed to develop a high-performance machine learning sepsis prediction algorithm based on routinely collected intensive care unit data, designed to be implemented in European intensive care units. Methods: The machine learning algorithm was developed using convolutional neural networks, based on Massachusetts Institute of Technology Lab for Computational Physiology MIMIC-III clinical data from intensive care unit patients aged 18 years or older. The model uses 20 variables to produce hourly predictions of onset of sepsis, defined by international Sepsis-3 criteria. Predictive performance was externally validated using hold-out test data. Results: The algorithm—NAVOY Sepsis—uses 4 hours of input and can identify patients with high risk of developing sepsis, with high performance (area under the receiver operating characteristics curve 0.90; area under the precision-recall curve 0.62) for predictions up to 3 hours before sepsis onset. Conclusions: The prediction performance of NAVOY Sepsis was superior to that of existing sepsis early warning scoring systems and comparable with those of other prediction algorithms designed to predict sepsis onset. The algorithm has excellent predictive properties and uses variables that are routinely collected in intensive care units. %M 34591016 %R 10.2196/28000 %U https://formative.jmir.org/2021/9/e28000 %U https://doi.org/10.2196/28000 %U http://www.ncbi.nlm.nih.gov/pubmed/34591016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27122 %T Radiation Oncologists’ Perceptions of Adopting an Artificial Intelligence–Assisted Contouring Technology: Model Development and Questionnaire Study %A Zhai,Huiwen %A Yang,Xin %A Xue,Jiaolong %A Lavender,Christopher %A Ye,Tiantian %A Li,Ji-Bin %A Xu,Lanyang %A Lin,Li %A Cao,Weiwei %A Sun,Ying %+ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, Guangzhou, 510060, China, 86 02087343066, sunying@sysucc.org.cn %K artificial intelligence %K technology acceptance model %K intension %K resistance %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An artificial intelligence (AI)–assisted contouring system benefits radiation oncologists by saving time and improving treatment accuracy. Yet, there is much hope and fear surrounding such technologies, and this fear can manifest as resistance from health care professionals, which can lead to the failure of AI projects. Objective: The objective of this study was to develop and test a model for investigating the factors that drive radiation oncologists’ acceptance of AI contouring technology in a Chinese context. Methods: A model of AI-assisted contouring technology acceptance was developed based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model by adding the variables of perceived risk and resistance that were proposed in this study. The model included 8 constructs with 29 questionnaire items. A total of 307 respondents completed the questionnaires. Structural equation modeling was conducted to evaluate the model’s path effects, significance, and fitness. Results: The overall fitness indices for the model were evaluated and showed that the model was a good fit to the data. Behavioral intention was significantly affected by performance expectancy (β=.155; P=.01), social influence (β=.365; P<.001), and facilitating conditions (β=.459; P<.001). Effort expectancy (β=.055; P=.45), perceived risk (β=−.048; P=.35), and resistance bias (β=−.020; P=.63) did not significantly affect behavioral intention. Conclusions: The physicians’ overall perceptions of an AI-assisted technology for radiation contouring were high. Technology resistance among Chinese radiation oncologists was low and not related to behavioral intention. Not all of the factors in the Venkatesh UTAUT model applied to AI technology adoption among physicians in a Chinese context. %M 34591029 %R 10.2196/27122 %U https://www.jmir.org/2021/9/e27122 %U https://doi.org/10.2196/27122 %U http://www.ncbi.nlm.nih.gov/pubmed/34591029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e31185 %T A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study %A Snow-Hill,Nyssa L %A Donenberg,Geri %A Feil,Edward G %A Smith,David R %A Floyd,Brenikki R %A Leve,Craig %+ Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 South Wolcott Avenue, MC 579 Box #7, SRH 6th Floor, Chicago, IL, 60612, United States, 1 312 413 2712, nyssa@uic.edu %K health education %K sexual behavior %K juvenile delinquency %K feasibility studies %K evidence-based practice %K adolescent health services %K inservice training %K implementation science %K organizational innovation %K technology %K risk reduction behavior %K mobile phone %K health technology %K health promotion %K sexual health %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. %M 34591028 %R 10.2196/31185 %U https://formative.jmir.org/2021/9/e31185 %U https://doi.org/10.2196/31185 %U http://www.ncbi.nlm.nih.gov/pubmed/34591028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27801 %T Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies %A Joyce,Caroline M %A Saulsgiver,Kathryn %A Mohanty,Salini %A Bachireddy,Chethan %A Molfetta,Carin %A Steffy,Mary %A Yoder,Alice %A Buttenheim,Alison M %+ Department of Epidemiology, Faculty of Medicine, McGill University, 845 Sherbrooke Street W, Montreal, QC, H3A 0G4, Canada, 1 514 398 6258, Caroline.joyce@mail.mcgill.ca %K maternal smoking %K smoking cessation %K financial incentives %K smoking %K pregnant %K postpartum %K incentives %K mHealth %K mobile health %K mobile phone %K smart devices %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. %M 34591023 %R 10.2196/27801 %U https://formative.jmir.org/2021/9/e27801 %U https://doi.org/10.2196/27801 %U http://www.ncbi.nlm.nih.gov/pubmed/34591023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24005 %T Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study %A Spitzer,Kerry A %A Heineman,Brent %A Jewell,Marcella %A Moran,Michael %A Lindenauer,Peter K %+ Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, 3rd Fl, 3601 Main St, Springfield, MA, 01199, United States, 1 413 794 7909, kerry.spitzer@baystatehealth.org %K asthma %K social media %K Instagram %K social support %K digital storytelling %K young adult %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. %M 34591019 %R 10.2196/24005 %U https://formative.jmir.org/2021/9/e24005 %U https://doi.org/10.2196/24005 %U http://www.ncbi.nlm.nih.gov/pubmed/34591019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28538 %T Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study %A Silfee,Valerie %A Williams,Kelly %A Leber,Brett %A Kogan,Jane %A Nikolajski,Cara %A Szigethy,Eva %A Serio,Catherine %+ UPMC Health Plan, U.S. Steel Tower, 600 Grant Street, Pittsburgh, PA, 15219, United States, 1 4124549008, silfeev@upmc.edu %K digital health %K mHealth %K implementation %K cognitive behavioral therapy %K anxiety %K depression %K smartphone %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective: This study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods: Participating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results: A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions: Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow. %M 34529583 %R 10.2196/28538 %U https://formative.jmir.org/2021/9/e28538 %U https://doi.org/10.2196/28538 %U http://www.ncbi.nlm.nih.gov/pubmed/34529583 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26361 %T Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study %A Shade,Marcia %A Rector,Kyle %A Kupzyk,Kevin %+ College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025596641, marcia.shade@unmc.edu %K adherence %K pain medications %K older adults %K reminders %K mHealth %K voice assistants %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. Objective: We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. Methods: A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. Results: In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. Conclusions: Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions. %M 34581677 %R 10.2196/26361 %U https://formative.jmir.org/2021/9/e26361 %U https://doi.org/10.2196/26361 %U http://www.ncbi.nlm.nih.gov/pubmed/34581677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27285 %T Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study %A Wang,Jin %A Pan,Chen %A Ma,Xianghua %+ First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China, 86 17625989728, yixingpanchen@163.com %K quality management system %K human resource management %K artificial intelligence %K online health %K health science %K clinical nutrition %K online platform %K health platform %K nutrition %K patient education %K dietitian %D 2021 %7 27.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions. Objective: This study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control. Methods: The participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information. Results: A total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t93.4=–0.42; P=.02) both show the advancements of the QMSNJ. Conclusions: As the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future. %M 34569942 %R 10.2196/27285 %U https://formative.jmir.org/2021/9/e27285 %U https://doi.org/10.2196/27285 %U http://www.ncbi.nlm.nih.gov/pubmed/34569942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28698 %T Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study %A Myhre,Enid Leren %A Garnweidner-Holme,Lisa %A Dahl,Bente %A Reigstad,Marte Myhre %A Lukasse,Mirjam %+ Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, P O Box 235, Kongsberg, N-3603, Norway, 47 91698469, enid.myhre@usn.no %K early labor %K latent phase %K think aloud %K usability %K website %K labor %K pregnancy %K user-friendliness %K eHealth %K user satisfaction %D 2021 %7 27.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users’ experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website’s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants’ feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants’ experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website’s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. %M 34569940 %R 10.2196/28698 %U https://formative.jmir.org/2021/9/e28698 %U https://doi.org/10.2196/28698 %U http://www.ncbi.nlm.nih.gov/pubmed/34569940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e20131 %T The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study %A McKinstry,Brian %A Alexander,Helen %A Maxwell,Gabriela %A Blaikie,Lesley %A Patel,Sameer %A Guthrie,Bruce %A , %+ Centre for Informatics, Usher Institute, The University of Edinburgh, 17 Burnside Park, Edinburgh, EH165AG, United Kingdom, 44 07803268660, brian.mckinstry@ed.ac.uk %K telemonitoring %K eHealth %K COVID-19 %K primary care %D 2021 %7 27.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective: The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods: A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results: We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions: Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients. %M 34449404 %R 10.2196/20131 %U https://formative.jmir.org/2021/9/e20131 %U https://doi.org/10.2196/20131 %U http://www.ncbi.nlm.nih.gov/pubmed/34449404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29110 %T Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Oduro-Donkor,Dominic %A Lange,Maria %A Menon,Vinod %A Barber,Thomas M %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 2476712201, charlotte@ddm.health %K obesity %K low carb program %K eHealth %K mobile app %K digital health %K health intervention %K mobile health %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. %M 34449405 %R 10.2196/29110 %U https://formative.jmir.org/2021/9/e29110 %U https://doi.org/10.2196/29110 %U http://www.ncbi.nlm.nih.gov/pubmed/34449405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28002 %T “Skip the Small Talk” Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study %A Mote,Jasmine %A Gill,Kathryn %A Fulford,Daniel %+ Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA, 02155, United States, 1 617 627 3781, jasmine.mote@tufts.edu %K COVID-19 %K depression %K digital group %K loneliness %K social connection %K virtual social interaction %K community %K mental health %K connection %K virtual health %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing measures meant to prevent the spread of COVID-19 in the past year have exacerbated loneliness and depression in the United States. While virtual tools exist to improve social connections, there have been limited attempts to assess community-based, virtual methods to promote new social connections. Objective: In this proof-of-concept study, we examined the extent to which Skip the Small Talk (STST)—a business dedicated to hosting events to facilitate structured, vulnerable conversations between strangers—helped reduce loneliness in a virtual format in the early months of the 2020 COVID-19 pandemic. We predicted that participants who attended STST virtual events would show a reduction in loneliness, improvement in positive affect, and reduction in negative affect after attending an event. We were also interested in exploring the role of depression symptoms on these results as well as the types of goals participants accomplished by attending STST events. Methods: Adult participants who registered for an STST virtual event between March 25 and June 30, 2020, completed a survey before attending the event (pre-event survey; N=64) and a separate survey after attending the event (postevent survey; n=25). Participants reported on their depression symptoms, loneliness, and positive and negative affect. Additionally, participants reported the goals they wished to accomplish as well as those they actually accomplished by attending the STST event. Results: The four most cited goals that participants hoped to accomplish before attending the STST event included the following: “to make new friends,” “to have deeper/better conversations with other people,” “to feel less lonely,” and “to practice social skills.” A total of 34% (20/58) of participants who completed the pre-event survey reported depression symptoms that indicated a high risk of a major depressive episode in the preceding 2 weeks. Of the 25 participants who completed the pre- and postevent surveys, participants reported a significant reduction in loneliness (P=.03, Cohen d=0.48) and negative affect (P<.001, Cohen d=1.52) after attending the STST event compared to before the event. Additionally, depressive symptoms were significantly positively correlated with change in negative affect (P=.03), suggesting that the higher the depression score was prior to attending the STST event, the higher the reduction in negative affect was following the event. Finally, 100% of the participants who wished to reduce their loneliness (11/11) or feel less socially anxious (5/5) prior to attending the STST event reported that they accomplished those goals after the event. Conclusions: Our preliminary assessment suggests that the virtual format of STST was helpful for reducing loneliness and negative affect for participants, including those experiencing depression symptoms, during the COVID-19 pandemic. While encouraging, additional research is necessary to demonstrate whether STST has benefits when compared to other social events and interventions and whether such benefits persist beyond the events themselves. %M 34468326 %R 10.2196/28002 %U https://formative.jmir.org/2021/9/e28002 %U https://doi.org/10.2196/28002 %U http://www.ncbi.nlm.nih.gov/pubmed/34468326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29429 %T Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study %A Der-Martirosian,Claudia %A Wyte-Lake,Tamar %A Balut,Michelle %A Chu,Karen %A Heyworth,Leonie %A Leung,Lucinda %A Ziaeian,Boback %A Tubbesing,Sarah %A Mullur,Rashmi %A Dobalian,Aram %+ Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer St MS-152, North Hills, CA, 91343, United States, 1 818 891 7711 ext 36124, claudia.der-martirosian@va.gov %K telehealth %K telemedicine %K veterans %K US Department of Veterans Affairs %K primary care %K cardiology %K home-based primary care %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective: We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results: Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic. %M 34477554 %R 10.2196/29429 %U https://formative.jmir.org/2021/9/e29429 %U https://doi.org/10.2196/29429 %U http://www.ncbi.nlm.nih.gov/pubmed/34477554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30990 %T Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial %A Betz,Marian E %A Polzer,Evan %A Nearing,Kathryn %A Knoepke,Christopher E %A Johnson,Rachel L %A Meador,Lauren %A Matlock,Daniel D %+ Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, B-215, Aurora, CO, 80045, United States, 1 7208486777, marian.betz@ucdenver.edu %K dementia %K cognitive impairment %K firearm %K decision aid %K caregivers %K safety %K feasibility %K pilot trial %K Alzheimer disease %K caregiver support %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access. Objective: We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers. Methods: SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire. Results: Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases. Conclusions: SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy. %M 34550082 %R 10.2196/30990 %U https://formative.jmir.org/2021/9/e30990 %U https://doi.org/10.2196/30990 %U http://www.ncbi.nlm.nih.gov/pubmed/34550082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27447 %T Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach %A Kim,Sunyoung %A Park,Yunoh %A Ackerman,Matthew K %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, United States, 1 848 932 7585, sunyoung.kim@rutgers.edu %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K user-centered design %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. %M 34550080 %R 10.2196/27447 %U https://formative.jmir.org/2021/9/e27447 %U https://doi.org/10.2196/27447 %U http://www.ncbi.nlm.nih.gov/pubmed/34550080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e17913 %T Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers %A Nowaskie,Dustin Z %+ Department of Psychiatry, Indiana University School of Medicine, 355 W 16th Street, #2364, Indianapolis, IN, 46202, United States, 1 317 963 7307, dznowaskie@gmail.com %K cultural competency %K disparities %K e-health %K healthcare %K internet %K LGBTQ+ %K online platform %K providers %K resources %K eHealth %K health care %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health—a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform—was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. %M 34550083 %R 10.2196/17913 %U https://formative.jmir.org/2021/9/e17913 %U https://doi.org/10.2196/17913 %U http://www.ncbi.nlm.nih.gov/pubmed/34550083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27570 %T Evaluation of a Commercial Mobile Health App for Depression and Anxiety (AbleTo Digital+): Retrospective Cohort Study %A Anton,Margaret T %A Greenberger,Heidi Mochari %A Andreopoulos,Evie %A Pande,Reena L %+ AbleTo, Inc, 320 W, 37th Street, 5th floor, New York, NY, 10018, United States, 1 (347) 926 5527, margaret.anton@ableto.com %K digital mental health %K mHealth %K iCBT %K coaching %K depression %K generalized anxiety %K social anxiety %K mobile phone %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although a growing number of randomized trials have established the efficacy of digital interventions for common mental health problems, less is known about the real-world impact of these tools. AbleTo Digital+, a commercially available mental health app for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in a real-world context. Objective: The primary aim of this study is to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs. The secondary aim is to evaluate Digital+ module completion, including the use of 1:1 coaching. Methods: In this retrospective cohort study, we analyzed previously collected and permanently deidentified data from a consecutive cohort of 1896 adults who initiated using one of the three Digital+ eight-module programs (depression, generalized anxiety, or social anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Social Phobia Inventory, respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging, was also evaluated. Results: Significant effects were observed among depression (Cohen d=1.5), generalized anxiety (Cohen d=1.2), and social anxiety (Cohen d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (β=−1.2; P<.001), generalized anxiety (β=−1.1; P<.001), and social anxiety (β=−2.4; P<.001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD 2.7) modules. The average total length of app use was 52.2 (SD 83.5) days. Approximately two-thirds of the users engaged in at least 1 coaching call (66.82%, 1267/1896) or in-app text messaging (66.09%, 1253/1896). Participants who completed at least four modules participated in significantly more coaching calls per module (mean 1.1, SD 0.7) than users who completed fewer than four modules (mean 1.0, SD 1.2; t1407=−2.1; P=.03). Conclusions: This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms throughout the program. %M 34546170 %R 10.2196/27570 %U https://formative.jmir.org/2021/9/e27570 %U https://doi.org/10.2196/27570 %U http://www.ncbi.nlm.nih.gov/pubmed/34546170 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30280 %T Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context %A Budhwani,Suman %A Fujioka,Jamie Keiko %A Chu,Cherry %A Baranek,Hayley %A Pus,Laura %A Wasserman,Lori %A Vigod,Simone %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, suman.budhwani@wchospital.ca %K virtual care %K mental health %K quality of care %K implementation %K COVID-19 %K digital health %K pandemic %K ambulatory care %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. %M 34406967 %R 10.2196/30280 %U https://formative.jmir.org/2021/9/e30280 %U https://doi.org/10.2196/30280 %U http://www.ncbi.nlm.nih.gov/pubmed/34406967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28345 %T Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study %A Schmucker,Michael %A Haag,Martin %+ GECKO Institute, Heilbronn University of Applied Sciences, Max-Planck-Str 39, Heilbronn, 74074, Germany, 49 1757581477, michael.schmucker@hs-heilbronn.de %K resuscitation %K emergency medicine %K mobile applications %K mobile phone %K user-computer interface %K augmented reality %K machine learning %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective: Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods: An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results: According to the statistical results (one-sample t test; P=.42; α=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions: An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing. %M 34542416 %R 10.2196/28345 %U https://formative.jmir.org/2021/9/e28345 %U https://doi.org/10.2196/28345 %U http://www.ncbi.nlm.nih.gov/pubmed/34542416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25883 %T Evaluating Outcomes of a Social Media–Based Peer and Clinician-Supported Smoking Cessation Program in Preventing Smoking Relapse: Mixed Methods Case Study %A Isse,Naohi %A Tachibana,Yuki %A Kinoshita,Makiko %A Fetters,Michael D %+ Department of General Medicine, Ako Municipal Hospital, 1090 Nakahiro, Ako, 6780232, Japan, 81 791 433 222, issenaohi@yahoo.co.jp %K communication %K mixed methods case study research %K online social networking %K smoking cessation %K smoking relapse %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking relapse prevention after completion of a smoking cessation program is highly germane to reducing smoking rates. Objective: The purpose of this study was to evaluate the 1-year outcomes of a social media–based and peer and clinician-supported smoking cessation program on Facebook and examine communication patterns that could support smoking cessation and identify risk of relapse. Methods: We used a mixed methods case study evaluation approach featuring a single-case holistic design. We recruited volunteers who signed up after successful completion of a 12-week clinical smoking cessation program in a general medicine department in Japan. Participants contemporaneously accessed a closed Facebook page, and we analyzed their posts including text and emoticons. We used joint display analysis, which involved iterative structuring and restructuring construct-specific tables with both types of data to find the most effective approach for integrating the quantitative results with the qualitative results of content analysis. Results: One successful participant and 2 relapsed participants were analyzed to explore the specific patterns of postings prior to relapse. Decisive comments about quitting smoking were common among participants, but encouraging messages for peers were more common from the successful participant. Comments seeking social support and reassurance were warning signs of relapse. Conflicted comments also may be a warning sign of relapse risk. Conclusions: These findings based on a mixed methods case study of a social media platform supporting smoking cessation could be used to guide messaging in other online social networking service communities after a smoking cessation program to help reduce smoking relapse. Trial Registration: UMIN Clinical Trials Registry UMIN000031172; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000035595 %M 34542412 %R 10.2196/25883 %U https://formative.jmir.org/2021/9/e25883 %U https://doi.org/10.2196/25883 %U http://www.ncbi.nlm.nih.gov/pubmed/34542412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26602 %T Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study %A Nida,Esmael Kedir %A Bekele,Sisay %A Geurts,Luc %A Vanden Abeele,Vero %+ e-Media Lab, KU Leuven, Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16 30 10 3, isma.kedir@gmail.com %K mHealth acceptance %K UTAUT %K glaucoma screening %K mhealth for eye care %K mhealth %K glaucoma %K visual %K eye %K ophthalmology %K ophthalmic %K mobile phone %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective: This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods: A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results: Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions: This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required. %M 34533462 %R 10.2196/26602 %U https://formative.jmir.org/2021/9/e26602 %U https://doi.org/10.2196/26602 %U http://www.ncbi.nlm.nih.gov/pubmed/34533462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29845 %T Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation %A Burbach,Frank R %A Stiles,Katie M %+ Healios Ltd, Unit 4A Tileyard, Tileyard Rd, London, N7 9AH, United Kingdom, 44 0330 124 4222, katie.stiles@healios.org.uk %K telehealth %K young people %K adolescents %K online psychological therapy %K online neurodevelopmental assessments %K digital services %K realist evaluation %K multiple case study %K CBT %K autism %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case–study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. %M 34369382 %R 10.2196/29845 %U https://formative.jmir.org/2021/9/e29845 %U https://doi.org/10.2196/29845 %U http://www.ncbi.nlm.nih.gov/pubmed/34369382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24542 %T Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study %A Wang,Yi-Chen %A Tsan,Chin-Yuan %A Chen,Meng-Chun %+ Department of Nursing, National Taiwan University Hospital, Yunlin Branch, No 95, Xuefu Rd, Huwei Township, Yunlin County, 632007, Taiwan, 886 5 5354740, yuanf222@gmail.com %K automated dispensing cabinets %K medication administration system %K medication errors %K dispensing %K medication %K nursing %K Taiwan %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective: This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods: We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results: The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). Conclusions: The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. %M 34533467 %R 10.2196/24542 %U https://formative.jmir.org/2021/9/e24542 %U https://doi.org/10.2196/24542 %U http://www.ncbi.nlm.nih.gov/pubmed/34533467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e22312 %T Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development %A Xin,Meiqi %A Coulson,Neil S %A Jiang,Crystal Li %A Sillence,Elizabeth %A Chidgey,Andrew %A Kwan,Norman Nok Man %A Mak,Winnie W S %A Goggins,William %A Lau,Joseph Tak Fai %A Mo,Phoenix Kit Han %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 202D, School of Public Health, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 22528765, phoenix.mo@cuhk.edu.hk %K narrative persuasion %K firsthand experiential stories %K online intervention %K HIV prevention %K sexual behavior %K men who have sex with men %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention. Objective: In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness. Methods: Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery. Results: A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online. Conclusions: We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future. %M 34528889 %R 10.2196/22312 %U https://www.jmir.org/2021/9/e22312 %U https://doi.org/10.2196/22312 %U http://www.ncbi.nlm.nih.gov/pubmed/34528889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23877 %T Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study %A Shikako,Keiko %A Mogo,Ebele R I %A Grand-Maison,Valerie %A Simpson,Robert %A Pritchard-Wiart,Lesley %A Majnemer,Annette %A , %+ School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400, keiko.thomas@mcgill.ca %K implementation research %K mobile health %K children with disabilities %K physical activity promotion %K digital health %K inclusive leisure participation %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users’ identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users’ active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app’s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. %M 34528886 %R 10.2196/23877 %U https://formative.jmir.org/2021/9/e23877 %U https://doi.org/10.2196/23877 %U http://www.ncbi.nlm.nih.gov/pubmed/34528886 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30162 %T Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study %A Kozlov,Elissa %A McDarby,Meghan %A Prescott,Maximo %A Altman,Myra %+ Modern Health, 450 Sansome St, 12th Floor, San Francisco, CA, 94111, United States, 1 603 306 6231, myra@joinmodernhealth.com %K stepped care %K technology %K mental health care %K patient-centered care %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. %M 34343965 %R 10.2196/30162 %U https://formative.jmir.org/2021/9/e30162 %U https://doi.org/10.2196/30162 %U http://www.ncbi.nlm.nih.gov/pubmed/34343965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27745 %T Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study %A Borghouts,Judith %A Eikey,Elizabeth V %A Mark,Gloria %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Zheng,Kai %A Mukamel,Dana B %A Sorkin,Dara H %+ Department of Medicine, University of California, Irvine, 100 Theory, Irvine, CA, 92617, United States, 1 9498240246, jborghou@uci.edu %K mHealth %K mental health %K community college %K students %K structural equation modeling %K mobile apps %K services %K mental health services %K stress %K privacy %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. %M 34519668 %R 10.2196/27745 %U https://www.jmir.org/2021/9/e27745 %U https://doi.org/10.2196/27745 %U http://www.ncbi.nlm.nih.gov/pubmed/34519668 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28028 %T Semisupervised Deep Learning Techniques for Predicting Acute Respiratory Distress Syndrome From Time-Series Clinical Data: Model Development and Validation Study %A Lam,Carson %A Tso,Chak Foon %A Green-Saxena,Abigail %A Pellegrini,Emily %A Iqbal,Zohora %A Evans,Daniel %A Hoffman,Jana %A Calvert,Jacob %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, Suite B, Private Mailbox 65148, 12333 Sowden Rd, Houston, TX, 77080, United States, 1 7149326188, clam@dascena.com %K acute respiratory distress syndrome %K COVID-19 %K semisupervised learning %K deep learning %K machine learning %K algorithm %K prediction %K decision support %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A high number of patients who are hospitalized with COVID-19 develop acute respiratory distress syndrome (ARDS). Objective: In response to the need for clinical decision support tools to help manage the next pandemic during the early stages (ie, when limited labeled data are present), we developed machine learning algorithms that use semisupervised learning (SSL) techniques to predict ARDS development in general and COVID-19 populations based on limited labeled data. Methods: SSL techniques were applied to 29,127 encounters with patients who were admitted to 7 US hospitals from May 1, 2019, to May 1, 2021. A recurrent neural network that used a time series of electronic health record data was applied to data that were collected when a patient’s peripheral oxygen saturation level fell below the normal range (<97%) to predict the subsequent development of ARDS during the remaining duration of patients’ hospital stay. Model performance was assessed with the area under the receiver operating characteristic curve and area under the precision recall curve of an external hold-out test set. Results: For the whole data set, the median time between the first peripheral oxygen saturation measurement of <97% and subsequent respiratory failure was 21 hours. The area under the receiver operating characteristic curve for predicting subsequent ARDS development was 0.73 when the model was trained on a labeled data set of 6930 patients, 0.78 when the model was trained on the labeled data set that had been augmented with the unlabeled data set of 16,173 patients by using SSL techniques, and 0.84 when the model was trained on the entire training set of 23,103 labeled patients. Conclusions: In the context of using time-series inpatient data and a careful model training design, unlabeled data can be used to improve the performance of machine learning models when labeled data for predicting ARDS development are scarce or expensive. %M 34398784 %R 10.2196/28028 %U https://formative.jmir.org/2021/9/e28028 %U https://doi.org/10.2196/28028 %U http://www.ncbi.nlm.nih.gov/pubmed/34398784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25294 %T A Suite of Mobile Conversational Agents for Daily Stress Management (Popbots): Mixed Methods Exploratory Study %A Mauriello,Matthew Louis %A Tantivasadakarn,Nantanick %A Mora-Mendoza,Marco Antonio %A Lincoln,Emmanuel Thierry %A Hon,Grace %A Nowruzi,Parsa %A Simon,Dorien %A Hansen,Luke %A Goenawan,Nathaniel H %A Kim,Joshua %A Gowda,Nikhil %A Jurafsky,Dan %A Paredes,Pablo Enrique %+ Stanford School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, United States, 1 650 723 2300, pparedes@stanford.edu %K conversational agents %K virtual agent %K chatbot %K therapy %K stress relief %K stress management %K mental health %K stress %K exploratory %K support %K mobile phone %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 60%-80% of the primary care visits have a psychological stress component, but only 3% of patients receive stress management advice during these visits. Given recent advances in natural language processing, there is renewed interest in mental health chatbots. Conversational agents that can understand a user’s problems and deliver advice that mitigates the effects of daily stress could be an effective public health tool. However, such systems are complex to build and costly to develop. Objective: To address these challenges, our aim is to develop and evaluate a fully automated mobile suite of shallow chatbots—we call them Popbots—that may serve as a new species of chatbots and further complement human assistance in an ecosystem of stress management support. Methods: After conducting an exploratory Wizard of Oz study (N=14) to evaluate the feasibility of a suite of multiple chatbots, we conducted a web-based study (N=47) to evaluate the implementation of our prototype. Each participant was randomly assigned to a different chatbot designed on the basis of a proven cognitive or behavioral intervention method. To measure the effectiveness of the chatbots, the participants’ stress levels were determined using self-reported psychometric evaluations (eg, web-based daily surveys and Patient Health Questionnaire-4). The participants in these studies were recruited through email and enrolled on the web, and some of them participated in follow-up interviews that were conducted in person or on the web (as necessary). Results: Of the 47 participants, 31 (66%) completed the main study. The findings suggest that the users viewed the conversations with our chatbots as helpful or at least neutral and came away with increasingly positive sentiment toward the use of chatbots for proactive stress management. Moreover, those users who used the system more often (ie, they had more than or equal to the median number of conversations) noted a decrease in depression symptoms compared with those who used the system less often based on a Wilcoxon signed-rank test (W=91.50; Z=−2.54; P=.01; r=0.47). The follow-up interviews with a subset of the participants indicated that half of the common daily stressors could be discussed with chatbots, potentially reducing the burden on human coping resources. Conclusions: Our work suggests that suites of shallow chatbots may offer benefits for both users and designers. As a result, this study’s contributions include the design and evaluation of a novel suite of shallow chatbots for daily stress management, a summary of benefits and challenges associated with random delivery of multiple conversational interventions, and design guidelines and directions for future research into similar systems, including authoring chatbot systems and artificial intelligence–enabled recommendation algorithms. %M 34519655 %R 10.2196/25294 %U https://formative.jmir.org/2021/9/e25294 %U https://doi.org/10.2196/25294 %U http://www.ncbi.nlm.nih.gov/pubmed/34519655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25405 %T Collecting Social Media Information in a Substance Use Intervention Trial With Adolescent Girls With Lifetime Substance Use History: Observational Study %A Ramos,Lili M C %A Delgadillo,Joseline %A Vélez,Sarah %A Dauria,Emily %A Salas,Jamie %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 (628) 206 2212, Marina.Tolou-Shams@ucsf.edu %K adolescent girls %K legal involvement %K substance use %K social media %K health intervention %D 2021 %7 10.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with juvenile legal system contact face numerous barriers to participation in behavioral health intervention research, including housing disruption, legal privacy concerns, and systems mistrust. Technology, such as social media, may be a novel and developmentally appropriate adolescent research study engagement and retention tool. Objective: We examined data on social media information collected for study retention purposes from adolescents participating in a substance use intervention trial. Methods: Data were collected as part of a randomized controlled trial determining efficacy of a group-based substance use intervention for girls and young women (12-24 years) with substance use histories referred from legal and school systems in the United States. Baseline demographic and social media information was analyzed from the subset of 114 adolescent girls (mean age 15.7 years; range 13-18 years), of whom 31.6% (36/114) were legally involved, 87.7% (100/114) belonged to minoritized racial/ethnic groups, and 32.5% (37/114) received public assistance. Results: Most girls (74/114, 64.9%) provided at least one social media account (Instagram, 95% [70/74]; Facebook, 27% [20/74]; and Twitter, 11% [8/74]) during study enrollment. Legally involved girls were significantly less likely to provide social media information than school-referred girls (44% [16/36] versus 74% [58/78]; χ21 [N=114]=9.68, P=.002). Conclusions: Obtaining social media information for study retention purposes from adolescent girls with lifetime substance use appears possible; however, particular subgroups (ie, legally involved girls) may be less likely to provide accounts. Factors shaping legally involved girls’ willingness to provide social media information, including mistrust and privacy concerns, and the impact of researcher’s access to social media information on study retention are critical directions for future research. Trial Registration: ClinicalTrials.gov NCT02293057; https://clinicaltrials.gov/ct2/show/NCT02293057 %M 34505833 %R 10.2196/25405 %U https://formative.jmir.org/2021/9/e25405 %U https://doi.org/10.2196/25405 %U http://www.ncbi.nlm.nih.gov/pubmed/34505833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26434 %T Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach %A Salim,Hani %A Lee,Ping Yein %A Sharif-Ghazali,Sazlina %A Cheong,Ai Theng %A Wong,Jasmine %A Young,Ingrid %A Pinnock,Hilary %A , %+ NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Old Medical School, Doorway 3, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 0131 650 94, hilary.pinnock@ed.ac.uk %K asthma %K self-management %K design sprint %K health literacy %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. %M 34499039 %R 10.2196/26434 %U https://www.jmir.org/2021/9/e26434 %U https://doi.org/10.2196/26434 %U http://www.ncbi.nlm.nih.gov/pubmed/34499039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30237 %T Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis %A Crawford,Natalie D %A Josma,Dorie %A Harrington,Kristin R V %A Morris,Joseph %A Quamina,Alvan %A Birkett,Michelle %A Phillips II,Gregory %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 712 9445, ndcrawford@emory.edu %K think-aloud %K egocentric networks %K sociogram %K social networks %K MSM %K transgender %K network canvas %K black MSM %K infectious disease transmission %K stigma %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Characteristics of an individual’s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as “easy to use,” with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals’ social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. %M 34499040 %R 10.2196/30237 %U https://formative.jmir.org/2021/9/e30237 %U https://doi.org/10.2196/30237 %U http://www.ncbi.nlm.nih.gov/pubmed/34499040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27985 %T Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study %A Cheung,Yin Ting %A Lam,Pok Hong %A Lam,Teddy Tai-Ning %A Lam,Henry Hon Wai %A Li,Chi Kong %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Rm 801, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, New Territories, Hong Kong SAR, Hong Kong, 852 39436833, yinting.cheung@cuhk.edu.hk %K mobile health %K mHealth %K patients %K expectations %K hemophilia %K chronic diseases %K rare diseases %K self-management %D 2021 %7 9.9.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients’ level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75% adult patients and 25% parents of pediatric patients; 87.5% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann–Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95% CI 3.7-4.3) and to manage their health (mean 4.2, 95% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5%), bleeding events (n=48, 85.7%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants’ acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. %M 34499034 %R 10.2196/27985 %U https://formative.jmir.org/2021/9/e27985 %U https://doi.org/10.2196/27985 %U http://www.ncbi.nlm.nih.gov/pubmed/34499034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28356 %T An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach %A Karpathakis,Kassandra %A Libow,Gene %A Potts,Henry W W %A Dixon,Simon %A Greaves,Felix %A Murray,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5303, h.potts@ucl.ac.uk %K digital health %K internet-based interventions %K mHealth %K evaluation studies %K public health %K human-centered design %K service design %K mobile phone %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE’s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. %M 34494965 %R 10.2196/28356 %U https://www.jmir.org/2021/9/e28356 %U https://doi.org/10.2196/28356 %U http://www.ncbi.nlm.nih.gov/pubmed/34494965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e21348 %T Investigation of the Effects of an Online Support Group for Mental Health Problems on Stigma and Help-Seeking Among Japanese Adults: Cross-sectional Study %A Kobori,Osamu %A Yoshinaga,Naoki %+ Department of Psychology, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 1078402, Japan, 81 3 5574 3900, O.Kobori@iuhw.ac.jp %K online support group %K mental health %K depression %K stigma %K help-seeking %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes. Objective: This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. Methods: A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. Results: Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. Conclusions: It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful. %M 34491206 %R 10.2196/21348 %U https://formative.jmir.org/2021/9/e21348 %U https://doi.org/10.2196/21348 %U http://www.ncbi.nlm.nih.gov/pubmed/34491206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27137 %T Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study %A Shalaby,Reham %A Hrabok,Marianne %A Spurvey,Pamela %A Abou El-Magd,Rabab M %A Knox,Michelle %A Rude,Rebecca %A Vuong,Wesley %A Surood,Shireen %A Urichuk,Liana %A Snaterse,Mark %A Greenshaw,Andrew J %A Li,Xin-Min %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K peer support %K recovery %K controlled observational study %K inpatients %K mental health %K supportive text messages %D 2021 %7 3.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. Objective: This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. Methods: This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. Results: A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. Conclusions: Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge. %M 34477565 %R 10.2196/27137 %U https://formative.jmir.org/2021/9/e27137 %U https://doi.org/10.2196/27137 %U http://www.ncbi.nlm.nih.gov/pubmed/34477565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30472 %T Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study %A Yerushalmi,Mor %A Sixsmith,Andrew %A Pollock Star,Ariel %A King,David B %A O'Rourke,Norm %+ Department of Public Health and Multidisciplinary Center for Research on Aging, Ben-Gurion University of the Negev, P O Box 653, Be'er Sheva, 8410501, Israel, 972 549901808, ORourke@bgu.ac.il %K bipolar disorder %K couples %K dyadic analyses %K ecological momentary assessment %K EMA %K bipolar disorder %K partner %K relationships %K mHealth %K mobile apps %K mental health %K depression %K BPD %K mood %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. Objective: We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). Methods: For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified “windows of general availability,” participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner’s specified availability. Results: Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=–.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=–.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. Conclusions: These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important. %M 34473069 %R 10.2196/30472 %U https://formative.jmir.org/2021/9/e30472 %U https://doi.org/10.2196/30472 %U http://www.ncbi.nlm.nih.gov/pubmed/34473069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28784 %T A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study %A Murphy,Jane %A McSharry,Jenny %A Hynes,Lisa %A Molloy,Gerard J %+ School of Psychology, National University of Ireland, Galway, University Rd, Galway, H91 TK33, Ireland, 353 91 524411, j.murphy51@nuigalway.ie %K asthma %K young adult %K medication adherence %K self-management %K mobile applications %K mHealth %K intervention %K usability %K acceptability %K feasibility %K multi-methods %K mobile phone %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with asthma often report low adherence to inhaled corticosteroids (ICS), leading to uncontrolled symptoms and poor disease outcomes. Technology-enabled digital supports such as mobile health (mHealth) asthma smartphone apps have the potential to support adherence to ICS and asthma self-management. There is a need for feasibility studies to determine the usability, acceptability, and feasibility of these interventions. In addition, it is essential to determine the feasibility of recruiting and retaining young adults to plan future efficacy and effectiveness trials and therefore, establish evidence-based asthma apps. Objective: This study aimed to determine (1) the feasibility of recruiting and retaining young adults to a trial and (2) the usability, acceptability, and feasibility of using the AsthmaMD app to support adherence to ICS in a population of young adults living with asthma. Methods: A multi-methods feasibility study was conducted. Young adults aged 18-30 years with asthma and current prescription for ICS were eligible and invited to take part through a university circular email, social media, and general practice sites. Participation involved completing a baseline self-report questionnaire, downloading and using the AsthmaMD app for 2 weeks, and completing the follow-up assessment, including self-report and open-ended questions about participants’ experience of using the app. Primary outcomes included participant recruitment and retention and the usability, acceptability, and feasibility of using AsthmaMD. Quantitative self-report data were analyzed using descriptive statistics, and qualitative open-ended data were analyzed using inductive reflexive thematic analysis. Results: A total of 122 young adults (females, n=101, 82.8%) with a mean age of 24.4 (SD 3.8) years were recruited and they completed baseline measures. Of the 122 young adults, 59 (48.4%) completed the study. The AsthmaMD app received a mean score of 63.1/100 (SD 20.1) on the System Usability Scale (ie, a standardized measure of usability for technology-based apps), and an overall user satisfaction score of 5.8/10 (SD 2.2). Of the 59 participants who completed the study, 49 (83%) participants used the app ≥1 day per week. Two main themes were identified in the qualitative analysis of user experiences: (1) learning how to use the app to suit the individual and (2) benefits and relevance of using the app. Conclusions: The findings from this study indicate that it is feasible to recruit and retain young adults to examine efficacy and effectiveness in a future trial and that young adults living with asthma may find AsthmaMD to be usable, acceptable, and feasible to support adherence to ICS. Our findings also identified opportunities to further optimize the usability of AsthmaMD and similar apps. Based on our findings, we recommend providing more accessible information on how to use the app and replacing medical terminology with simplified language within the app to improve usability. Trial Registration: ISRCTN Registry ISRCTN11295269; https://www.isrctn.com/ISRCTN11295269 %M 34468325 %R 10.2196/28784 %U https://formative.jmir.org/2021/9/e28784 %U https://doi.org/10.2196/28784 %U http://www.ncbi.nlm.nih.gov/pubmed/34468325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26861 %T A Mobile Health App (WYZ) for Engagement in Care and Antiretroviral Therapy Adherence Among Youth and Young Adults Living With HIV: Single-Arm Pilot Intervention Study %A Saberi,Parya %A Lisha,Nadra E %A Erguera,Xavier A %A Hudes,Estie Sid %A Johnson,Mallory O %A Ruel,Theodore %A Neilands,Torsten B %+ Department of Medicine, University of California, San Francisco, 550 16th street, San Francisco, CA, 94143, United States, 1 415 502 1000 ext 17171, Parya.Saberi@ucsf.edu %K youth living with HIV %K mobile health %K mobile app %K engagement in care %K antiretroviral therapy adherence %K pilot %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) interventions have the potential to interact with youth where they are, using a device they already access. Objective: Using predefined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth app, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV. WYZ was designed and developed with input from youth and young adults living with HIV using a human-centered design approach and was based on the information, motivation, and behavioral skills framework to address common barriers to care and ART adherence among youth and young adults living with HIV. Methods: We recruited youth and young adults living with HIV (18-29 years old) from the San Francisco Bay Area to take part in a 6-month pilot trial. Their participation included completing baseline and exit surveys, and participating in seven phone check-ins about their use of WYZ. Results: Youth and young adults living with HIV (N=79) reported high levels of feasibility and acceptability with WYZ use. We met predefined benchmarks for recruitment (79/84, 94%), mean logins per week (5.3), tracking ART adherence (5442/9393, 57.9%), posting chat topics per week (4.8), and app crashes reported per week (0.24). The ease of app download, install, and setup, and comfort with security, privacy, and anonymity were highly rated (all over 91%). Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the predefined benchmark. Conclusions: We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable youth and young adults living with HIV and their providers to make informed decisions when using, recommending, and prescribing the app for improved engagement in HIV care and ART adherence. Trial Registration: ClinicalTrials.gov NCT03587857; https://clinicaltrials.gov/ct2/show/NCT03587857 %M 34463622 %R 10.2196/26861 %U https://formative.jmir.org/2021/8/e26861 %U https://doi.org/10.2196/26861 %U http://www.ncbi.nlm.nih.gov/pubmed/34463622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28075 %T Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings %A Swanston,Emma %A Pulman,Andy %A Dogan,Huseyin %A Murphy,Jane %A Bitters,Fiona %+ Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus,, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 961047, apulman@bournemouth.ac.uk %K nutrition %K food %K behavior change %K mobile health %K police %K lifestyle management %K well-being %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift—an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. %M 34463625 %R 10.2196/28075 %U https://formative.jmir.org/2021/8/e28075 %U https://doi.org/10.2196/28075 %U http://www.ncbi.nlm.nih.gov/pubmed/34463625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28163 %T Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study %A MacPherson,Megan %A Cranston,Kaela %A Johnston,Cara %A Locke,Sean %A Jung,Mary E %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9670, mary.jung@ubc.ca %K text messaging %K prediabetic state %K telemedicine %K telecommunications %K exercise %K diet %K preventive medicine %K mHealth %K intervention development %K behavior change %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. %M 34448713 %R 10.2196/28163 %U https://formative.jmir.org/2021/8/e28163 %U https://doi.org/10.2196/28163 %U http://www.ncbi.nlm.nih.gov/pubmed/34448713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27454 %T Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care %A Coleone,Joane Diomara %A Bellei,Ericles Andrei %A Roman,Mateus Klein %A Kirsten,Vanessa Ramos %A De Marchi,Ana Carolina Bertoletti %+ Institute of Exact Sciences and Geosciences, University of Passo Fundo, B5 Building, São José, Highway BR285, Km 292, Passo Fundo, RS, 99052-900, Brazil, 55 5433168354, 168729@upf.br %K eating %K mobile applications %K primary health care %K aged %K type 2 diabetes mellitus %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective: In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods: First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results: Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions: We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings. %M 34448711 %R 10.2196/27454 %U https://formative.jmir.org/2021/8/e27454 %U https://doi.org/10.2196/27454 %U http://www.ncbi.nlm.nih.gov/pubmed/34448711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e25900 %T Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design %A Ranney,Megan L %A Pittman,Sarah K %A Moseley,Isabelle %A Morgan,Kristen E %A Riese,Alison %A Ybarra,Michele %A Cunningham,Rebecca %A Rosen,Rochelle %+ Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 4014445159, megan_ranney@brown.edu %K adolescent %K mobile health %K digital health %K cyberbullying %K user-centered design %K qualitative %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. %M 34448702 %R 10.2196/25900 %U https://formative.jmir.org/2021/8/e25900 %U https://doi.org/10.2196/25900 %U http://www.ncbi.nlm.nih.gov/pubmed/34448702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26227 %T Satisfaction and Usability of an Information and Communications Technology–Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Lim,Jun Seo %A Piao,Meihua %+ Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220727546, kkh726@snu.ac.kr %K COVID-19 %K mobile app %K telemedicine %K wearable device %K vital sign %K satisfaction %K usability %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)–based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the “self-reporting” item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. %M 34254946 %R 10.2196/26227 %U https://formative.jmir.org/2021/8/e26227 %U https://doi.org/10.2196/26227 %U http://www.ncbi.nlm.nih.gov/pubmed/34254946 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30239 %T Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study %A Motz,Victoria %A Faust,Alison %A Dahmus,Jessica %A Stern,Benjamin %A Soriano,Christopher %A Stine,Jonathan G %+ Penn State Milton S Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, United States, 1 717 531 1017, jstine@pennstatehealth.psu.edu %K physical activity %K fatty liver %K telemedicine %K liver %K nonalcoholic fatty liver disease %K liver disease %K fatty liver disease %K aerobic training %K telehealth %K fitness %K feasibility %K steatohepatitis %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio–visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80% of exercise sessions (mean 84% [SD 3%]) and no adverse events occurred. Body weight (mean –5.1% [SD 3.7%]), body fat (mean –4.4% [SD 2.3%]), and waist circumference (mean –1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1% (SD 8.8%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (–0.5% [SD 0.2%] and –4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 %M 34402795 %R 10.2196/30239 %U https://formative.jmir.org/2021/8/e30239 %U https://doi.org/10.2196/30239 %U http://www.ncbi.nlm.nih.gov/pubmed/34402795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24393 %T Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study %A McCall,Terika %A Ali,Muhammad Osama %A Yu,Fei %A Fontelo,Paul %A Khairat,Saif %+ Center for Medical Informatics, Yale School of Medicine, 300 George Street, Suite 501, New Haven, CT, 06511, United States, 1 203 737 5379, terika.mccall@yale.edu %K African Americans %K women %K mental health %K anxiety %K depression %K telemedicine %K mHealth %K mobile applications %K digital health %K user-centered design %K mobile phone %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants’ visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants’ acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. %M 34133313 %R 10.2196/24393 %U https://formative.jmir.org/2021/8/e24393 %U https://doi.org/10.2196/24393 %U http://www.ncbi.nlm.nih.gov/pubmed/34133313 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e23360 %T Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study %A Ashrafi,Agaah %A Tabatabaee,Maryam %A Sharifi,Vandad %+ Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, Roozbeh Hospital, Tehran, Iran, 98 9123875869, vsharifi@tums.ac.ir %K bipolar disorder %K psychoeducation %K web-based intervention %K feasibility %K acceptability %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. Objective: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. Methods: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. Results: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. Conclusions: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level. %M 34402794 %R 10.2196/23360 %U https://formative.jmir.org/2021/8/e23360 %U https://doi.org/10.2196/23360 %U http://www.ncbi.nlm.nih.gov/pubmed/34402794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e23834 %T Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study %A Schoenmakers,Birgitte %A Wens,Johan %+ Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33/7001, Leuven, 3000, Belgium, 32 495235639, birgitte.schoenmakers@kuleuven.be %K primary care %K education %K graduate %K medical education %K testing %K assessment %K app %K COVID-19 %K efficiency %K accuracy %D 2021 %7 16.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates’ behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure’s impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students’ exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates’ awareness of being monitored via a safe browser plug-in for exams. %M 34398786 %R 10.2196/23834 %U https://formative.jmir.org/2021/8/e23834 %U https://doi.org/10.2196/23834 %U http://www.ncbi.nlm.nih.gov/pubmed/34398786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28383 %T Copyright as a Barrier to Music Therapy Telehealth Interventions: Qualitative Interview Study %A Reid,Amanda %A Kresovich,Alex %+ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, 393 Carroll Hall, Campus Box 3365, Chapel Hill, NC, 27599, United States, 1 9044828702, areid@unc.edu %K telehealth %K music therapy %K diffusion of innovations %K COVID-19 %K copyright law %K fair use %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Music therapy is a multifaceted discipline that harnesses the power of music to treat a wide range of patient populations. A therapist who plays music in a private room for a patient is not subject to copyright restrictions on public performances. However, in the wake of the COVID-19 pandemic, music therapy is no longer strictly confined to the face-to-face setting. This study explores music therapists’ perceptions of copyright law with respect to their ability to provide mediated services to their clients. Objective: The objectives of our study were two-fold. The first was to investigate whether concerns about copyright law are hampering the diffusion of telehealth innovations, and the second was whether these concerns are causing music therapists to avoid therapeutically beneficial telehealth interventions. Methods: Semistructured interviews were conducted with credentialed music therapists (n=18) in the United States between May 2020 and June 2020. With participants’ consent, we used video conference technology to record and transcribe the in-depth interviews. The median interview length was 45 (SD 16.37) minutes. This theoretically informed study employed thematic analysis of the interview data. Results: The COVID-19 pandemic accelerated the adoption of telehealth interventions to facilitate therapy outside of private face-to-face environments: environments where music therapy practices are largely shielded from copyright infringement concerns. Five main themes emerged, including therapists’ uncertainty about permissible uses of music and therapists’ erring on the side of caution causing lost opportunities for care. Our interview data suggest music therapists have altered telehealth interventions in suboptimal ways to avoid copyright liability in a physically distanced environment. Conclusions: Some music therapists “drag their feet” on offering therapeutically appropriate telehealth services to clients because of copyright concerns. Our findings suggest innovative mediated therapies were shied away from or abandoned. These findings offer a novel contribution to the public health literature by highlighting copyright law as an unexpected and unwelcome barrier to the diffusion of music therapy practices in technology-mediated settings. %M 34319241 %R 10.2196/28383 %U https://formative.jmir.org/2021/8/e28383 %U https://doi.org/10.2196/28383 %U http://www.ncbi.nlm.nih.gov/pubmed/34319241 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26565 %T Understanding Physicians’ Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study %A Nies,Sarah %A Patel,Shae %A Shafer,Melissa %A Longman,Laura %A Sharif,Iman %A Pina,Paulo %+ Family Health Centers at New York University Langone, 5800 3rd Avenue, Brooklyn, NY, 11220, United States, 1 2153474369, paulo.pina@nyulangone.org %K telemedicine %K federally qualified health care center %K primary care %K COVID-19 %K telehealth %K physician %K doctor %K preference %K perspective %K dissemination %K appropriate %K cross-sectional %K survey %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. %M 34227993 %R 10.2196/26565 %U https://formative.jmir.org/2021/8/e26565 %U https://doi.org/10.2196/26565 %U http://www.ncbi.nlm.nih.gov/pubmed/34227993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e22608 %T Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study %A Oakley-Girvan,Ingrid %A Davis,Sharon Watkins %A Kurian,Allison %A Rosas,Lisa G %A Daniels,Jena %A Palesh,Oxana Gronskaya %A Mesia,Rachel J %A Kamal,Arif H %A Longmire,Michelle %A Divi,Vasu %+ Medable Inc, 525 University Avenue, Suite A 70, Palo Alto, CA, 94301, United States, 1 408 656 2948, ingrid@medable.com %K cancer %K oncology %K mHealth %K caregiver %K cancer survivor %K mobile app %K smartphone %K feasibility %K caregiver burden %K symptom reporting %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors’ care partners to monitor the survivors’ health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient’s health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner’s health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 %M 34398787 %R 10.2196/22608 %U https://formative.jmir.org/2021/8/e22608 %U https://doi.org/10.2196/22608 %U http://www.ncbi.nlm.nih.gov/pubmed/34398787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e18502 %T Digital Patient-Reported Outcome Measures for Monitoring of Patients on Cancer Treatment: Cross-sectional Questionnaire Study %A Sivanandan,Mayuran Ananth %A Sharma,Catherine %A Bullard,Pippa %A Christian,Judith %+ Department of Oncology and Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, 44 07859877635, ananthsiva@doctors.org.uk %K patient-reported outcome measures %K patient-reported outcomes %K remote monitoring %K toxicity %K outpatients %K digital technology %K digital health %K mobile health %K oncology %K chemotherapy %K immunotherapy %K radiotherapy %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Oncology has been facing increasing outpatient activity associated with higher cancer incidence, better survival rates, and more treatment options. Innovative technological solutions could help deal with this increasing demand. Using digital patient-reported outcome measures (PROMs) to identify patients who need a face-to-face (FTF) appointment is a potential approach. Objective: This study aims to assess the feasibility of digital PROM questionnaires to enable remote symptom monitoring for patients undergoing cancer treatment and their ability to highlight the requirement for an FTF appointment. Methods: This study was performed at a tertiary oncology center between December 2018 and February 2019. The Common Terminology Criteria for Adverse Events were adapted into patient-friendly language to form the basis of treatment-specific digital questionnaires covering specific cancer drugs and radiotherapy treatments. These treatment-specific digital PROM questionnaires were scored by both patients and their clinicians during FTF appointments. Patients and clinicians did not see each other’s scored PROMs. Agreement between patients and clinicians was assessed using descriptive statistics. Patient and staff feedback was also obtained. Results: In total, 90 patients participated in the study across 10 different treatment pathways. By comparing paired patient and clinician responses, the sensitivity of the patient-completed questionnaires in correctly highlighting the need for FTF review was 94% (44/47), and all patients with severe or grade 3+ symptoms were identified (6/6, 100%). Patient-completed PROMs appropriately revealed that 29% (26/90) of the participating patients did not need FTF review based on their symptoms alone. Certain oncological treatment pathways, such as immunotherapy, were found to have a larger proportion of patients with minimal symptoms than others, such as conventional chemotherapy. Patient and staff feedback showed high approval of digital PROMs and their potential for use in remote monitoring. Conclusions: Digital PROM questionnaires can feasibly highlight the need for FTF review in oncology clinics for treatment. Their use with specific treatments could safely reduce the requirement for FTF care, and future work should evaluate their application in the remote monitoring of patients. %M 34398785 %R 10.2196/18502 %U https://formative.jmir.org/2021/8/e18502 %U https://doi.org/10.2196/18502 %U http://www.ncbi.nlm.nih.gov/pubmed/34398785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26369 %T The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis %A Smith-MacDonald,Lorraine %A Jones,Chelsea %A Sevigny,Phillip %A White,Allison %A Laidlaw,Alexa %A Voth,Melissa %A Mikolas,Cynthia %A Heber,Alexandra %A Greenshaw,Andrew J %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804920404, cweiman@ualberta.ca %K trauma %K mental health %K telemedicine %K therapy %K rehabilitation %K digital health %K psychotherapy %K military %K veteran %K first responder %K public safety personnel %K teletherapy %K psychotherapy %K telepsychiatry %K mobile phone %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants’ responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers’ perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. %M 34387549 %R 10.2196/26369 %U https://formative.jmir.org/2021/8/e26369 %U https://doi.org/10.2196/26369 %U http://www.ncbi.nlm.nih.gov/pubmed/34387549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e20678 %T Artificial Intelligence–Based Chatbot for Anxiety and Depression in University Students: Pilot Randomized Controlled Trial %A Klos,Maria Carolina %A Escoredo,Milagros %A Joerin,Angela %A Lemos,Viviana Noemí %A Rauws,Michiel %A Bunge,Eduardo L %+ Interdisciplinary Center for Research in Health and Behavioral Sciences (CIICSAC), Universidad Adventista del Plata (UAP)., National Scientific and Technical Research Council (CONICET)., 25 de Mayo 99, Libertador San Martín, Entre Ríos, 3103, Argentina, 54 3435064263, mcarolinaklos@gmail.com %K artificial intelligence %K chatbots %K conversational agents %K mental health %K anxiety %K depression %K college students %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–based chatbots are emerging as instruments of psychological intervention; however, no relevant studies have been reported in Latin America. Objective: The objective of the present study was to evaluate the viability, acceptability, and potential impact of using Tess, a chatbot, for examining symptoms of depression and anxiety in university students. Methods: This was a pilot randomized controlled trial. The experimental condition used Tess for 8 weeks, and the control condition was assigned to a psychoeducation book on depression. Comparisons were conducted using Mann-Whitney U and Wilcoxon tests for depressive symptoms, and independent and paired sample t tests to analyze anxiety symptoms. Results: The initial sample consisted of 181 Argentinian college students (158, 87.2% female) aged 18 to 33. Data at week 8 were provided by 39 out of the 99 (39%) participants in the experimental condition and 34 out of the 82 (41%) in the control group. On an average, 472 (SD 249.52) messages were exchanged, with 116 (SD 73.87) of the messages sent from the users in response to Tess. A higher number of messages exchanged with Tess was associated with positive feedback (F2,36=4.37; P=.02). No significant differences between the experimental and control groups were found from the baseline to week 8 for depressive and anxiety symptoms. However, significant intragroup differences demonstrated that the experimental group showed a significant decrease in anxiety symptoms; no such differences were observed for the control group. Further, no significant intragroup differences were found for depressive symptoms. Conclusions: The students spent a considerable amount of time exchanging messages with Tess and positive feedback was associated with a higher number of messages exchanged. The initial results show promising evidence for the usability and acceptability of Tess in the Argentinian population. Research on chatbots is still in its initial stages and further research is needed. %M 34092548 %R 10.2196/20678 %U https://formative.jmir.org/2021/8/e20678 %U https://doi.org/10.2196/20678 %U http://www.ncbi.nlm.nih.gov/pubmed/34092548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28855 %T Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study %A Artieta-Pinedo,Isabel %A Paz-Pascual,Carmen %A Bully,Paola %A Espinosa,Maite %A , %+ Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, Osi Barakaldo-Sestao, Lurkizaga S/N, Barakaldo, 48901, Spain, 34 946006667, misabel.artieta@ehu.eus %K prenatal education %K women %K patient decision aid %K decision-making %K clinical decision support systems %K action research and pregnancy %K implementation science %K health service needs and demands %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. %M 34383670 %R 10.2196/28855 %U https://formative.jmir.org/2021/8/e28855 %U https://doi.org/10.2196/28855 %U http://www.ncbi.nlm.nih.gov/pubmed/34383670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24909 %T Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study %A Hoevenaars,Dirk %A Holla,Jasmijn F M %A te Loo,Leonie %A Koedijker,Johan M %A Dankers,Sarah %A Houdijk,Han %A Visser,Bart %A Janssen,Thomas W J %A de Groot,Sonja %A Deutekom,Marije %A , %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Blijdorplaan 15, Haarlem, 2015 CE, Netherlands, 31 621115227, jasmijn.holla@inholland.nl %K mHealth %K mobile app %K lifestyle %K usability %K feasibility %K wheelchair users %K spinal cord injury %K lower limb amputation %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining a healthy lifestyle is important for wheelchair users’ well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. %M 34379056 %R 10.2196/24909 %U https://formative.jmir.org/2021/8/e24909 %U https://doi.org/10.2196/24909 %U http://www.ncbi.nlm.nih.gov/pubmed/34379056 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e29184 %T A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study %A Park,Hyun Sang %A Kim,Kwang Il %A Chung,Ho-Young %A Jeong,Sungmoon %A Soh,Jae Young %A Hyun,Young Ho %A Kim,Hwa Sun %+ Digital Healthcare Department, BIT Computer Co. Ltd., BIT Building 33, Seocho-daero 74-gil, Seocho-gu, Seoul, 06621, Republic of Korea, 82 2 3486 1234 ext 507, hspark@bit.kr %K personal health record app %K workplace health promotion %K Fast Healthcare Interoperability Resources %K national health care data set %K human-centered design %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers’ health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user’s perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user’s perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers’ PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers’ health information scattered across different Korean institutions through an interface method, and workers’ PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers’ health information from different institutions and provides a variety of health care services from linked institutions through workers’ shared PHR. This app is expected to increase workers’ autonomy over their health information and support medical personnel’s decision making regarding workers’ health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user’s perspective, satisfies the prerequisites for its utilization in occupational health. %M 34346894 %R 10.2196/29184 %U https://medinform.jmir.org/2021/8/e29184 %U https://doi.org/10.2196/29184 %U http://www.ncbi.nlm.nih.gov/pubmed/34346894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24112 %T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study %A Derksen,Marloes E %A Jaspers,Monique WM %A van Strijp,Sander %A Fransen,Mirjam P %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl %K think aloud %K heuristic evaluation %K usability %K mHealth %K game elements %K smoking prevention %K user-centered design %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. %M 34346895 %R 10.2196/24112 %U https://formative.jmir.org/2021/8/e24112 %U https://doi.org/10.2196/24112 %U http://www.ncbi.nlm.nih.gov/pubmed/34346895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30862 %T Electronic Paper Displays in Hospital Operations: Proposal for Deployment and Implementation %A Jambaulikar,Guruprasad D %A Marshall,Andrew %A Hasdianda,Mohammad Adrian %A Cao,Chenzhe %A Chen,Paul %A Miyawaki,Steven %A Baugh,Christopher W %A Zhang,Haipeng %A McCabe,Jonathan %A Su,Jennifer %A Landman,Adam B %A Chai,Peter Ray %+ Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 617 732 5640, pchai@bwh.harvard.edu %K electronic ink %K patient satisfaction %K display systems %K whiteboards %K hospital %K deployment %K proposal %K implementation %K communication %K engagement %K efficiency %K usage %D 2021 %7 4.8.2021 %9 Early Report %J JMIR Form Res %G English %X Background: Display signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case. Objective: In this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays. Methods: The public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ≥40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens. Results: We are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction. Conclusions: There are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays. %M 34346904 %R 10.2196/30862 %U https://formative.jmir.org/2021/8/e30862 %U https://doi.org/10.2196/30862 %U http://www.ncbi.nlm.nih.gov/pubmed/34346904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28568 %T Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study %A Hajduczok,Alexander G %A DiJoseph,Kara M %A Bent,Brinnae %A Thorp,Audrey K %A Mullholand,Jon B %A MacKay,Stuart A %A Barik,Sabrina %A Coleman,Jamie J %A Paules,Catharine I %A Tinsley,Andrew %+ Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, United States, 1 7168634928, alexander.hajduczok@jefferson.edu %K COVID-19 %K wearable devices %K remote physiologic monitoring %K heart rate %K heart rate variability %K respiratory rate %K sleep %K REM sleep %K deep sleep %K wearable %K vaccine %K monitoring %K respiratory %K physiological %K cohort %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective: We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods: In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results: In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean –13.44%, SD 13.62%) and second vaccine dose (mean –9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions: This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration: ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703 %M 34236995 %R 10.2196/28568 %U https://formative.jmir.org/2021/8/e28568 %U https://doi.org/10.2196/28568 %U http://www.ncbi.nlm.nih.gov/pubmed/34236995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26852 %T Patients’ Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study %A Riisager,Lisa H G %A Christensen,Anne Bryde %A Scharff,Frederik Bernt %A Arendt,Ida-Marie T P %A Ismail,Israa %A Lau,Marianne Engelbrecht %A Moeller,Stine Bjerrum %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 25300977, lisagr@health.sdu.dk %K app %K PTSD %K mHealth %K qualitative analysis %K patient experience %K posttraumatic stress disorder %K thematic analysis %K smartphone %K intervention %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective: The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods: We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results: A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions: The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk. %M 34346896 %R 10.2196/26852 %U https://formative.jmir.org/2021/8/e26852 %U https://doi.org/10.2196/26852 %U http://www.ncbi.nlm.nih.gov/pubmed/34346896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30241 %T An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Kelly,Megan M %A Reilly,Erin D %A Kim,Daniella %A Baker,Kelsey %A Scout,N F N %A Karekla,Maria %+ Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K LGBT %K embodied agent %K tobacco cessation %K nicotine dependence %K user-centered design %K avatar %K digital health %K minority %K young adult %K teenager %K smoking %K cessation %K intervention %K development %K pilot trial %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. Objective: To address these challenges as well as their preferences for sexual and gender minority–targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy–based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). Methods: Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. Results: For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar’s appearance and movements. Conclusions: Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar’s movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers. %M 34328430 %R 10.2196/30241 %U https://formative.jmir.org/2021/7/e30241 %U https://doi.org/10.2196/30241 %U http://www.ncbi.nlm.nih.gov/pubmed/34328430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30450 %T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach %A Weber,Summer J %A Shearer,Elyse %A Mulvaney,Shelagh A %A Schmidt,Douglas %A Thompson,Chris %A Jones,Jessica %A Ahmad,Haseeb %A Coe,Martina %A Hull,Pamela C %+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu %K WIC %K mobile technology %K maternal-child health %K childhood obesity %K nutrition %K government programs %K mobile app %K user-centered design %K low income %K women %K infant %K child %K formative %K development %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. %M 34328432 %R 10.2196/30450 %U https://formative.jmir.org/2021/7/e30450 %U https://doi.org/10.2196/30450 %U http://www.ncbi.nlm.nih.gov/pubmed/34328432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27436 %T Determining Acceptance of e-Mental Health Interventions in Digital Psychodiabetology Using a Quantitative Web-Based Survey: Cross-sectional Study %A Damerau,Mirjam %A Teufel,Martin %A Musche,Venja %A Dinse,Hannah %A Schweda,Adam %A Beckord,Jil %A Steinbach,Jasmin %A Schmidt,Kira %A Skoda,Eva-Maria %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg Essen, Virchowstr. 174, Essen, 45147, Germany, 49 201 438755 228, mirjam.damerau@uni-due.de %K e-mental health %K acceptance %K UTAUT %K mental health %K diabetes %K e-mental health intervention %K psychodiabetology %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a very common chronic disease that exerts massive physiological and psychological burdens on patients. The digitalization of mental health care has generated effective e-mental health approaches, which offer an indubitable practical value for patient treatment. However, before implementing and optimizing e-mental health tools, their acceptance and underlying barriers and resources should be first determined for developing and establishing effective patient-oriented interventions. Objective: This study aims to assess the acceptance of e-mental health interventions among patients with diabetes and explore its underlying barriers and resources. Methods: A cross-sectional study was conducted in Germany from April 9, 2020, to June 15, 2020, through a web-based survey for which patients were recruited via web-based diabetes channels. The eligibility requirements were adult age (18 years or older), a good command of the German language, internet access, and a diagnosis of diabetes. Acceptance was measured using a modified questionnaire, which was based on the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) and assessed health-related internet use, acceptance of e-mental health interventions, and its barriers and resources. Mental health was measured using validated and established instruments, namely the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-2, and Distress Thermometer. In addition, sociodemographic and medical data regarding diabetes were collected. Results: Of the 340 participants who started the survey, 261 (76.8%) completed it and the final sample comprised 258 participants with complete data sets. The acceptance of e-mental health interventions in patients with diabetes was overall moderate (mean 3.02, SD 1.14). Gender and having a mental disorder had a significant influence on acceptance (P<.001). In an extended UTAUT regression model (UTAUT predictors plus sociodemographics and mental health variables), distress (β=.11; P=.03) as well as the UTAUT predictors performance expectancy (β=.50; P<.001), effort expectancy (β=.15; P=.001), and social influence (β=.28; P<.001) significantly predicted acceptance. The comparison between an extended UTAUT regression model (13 predictors) and the UTAUT-only regression model (performance expectancy, effort expectancy, social influence) revealed no significant difference in explained variance (F10,244=1.567; P=.12). Conclusions: This study supports the viability of the UTAUT model and its predictors in assessing the acceptance of e-mental health interventions among patients with diabetes. Three UTAUT predictors reached a notable amount of explained variance of 75% in the acceptance, indicating that it is a very useful and efficient method for measuring e-mental health intervention acceptance in patients with diabetes. Owing to the close link between acceptance and use, acceptance-facilitating interventions focusing on these three UTAUT predictors should be fostered to bring forward the highly needed establishment of effective e-mental health interventions in psychodiabetology. %M 34328429 %R 10.2196/27436 %U https://formative.jmir.org/2021/7/e27436 %U https://doi.org/10.2196/27436 %U http://www.ncbi.nlm.nih.gov/pubmed/34328429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25947 %T Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives %A Yousef,Hind %A Al-Sheyab,Nihaya %A Al Nsour,Mohannad %A Khader,Yousef %A Al Kattan,Malika %A Bardus,Marco %A Alyahya,Mohammad %A Taha,Hana %A Amiri,Mirwais %+ Global Health Development | Eastern Mediterranean Public Health Network, 4 Abu Al Ataheya St. Apt 5, Sport City, Amman, Jordan, 962 790883656, hyousif@globalhealthdev.org %K family planning %K mobile apps %K social media %K digital technology %K contraceptives %D 2021 %7 28.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women’s empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices. %M 34319250 %R 10.2196/25947 %U https://www.jmir.org/2021/7/e25947 %U https://doi.org/10.2196/25947 %U http://www.ncbi.nlm.nih.gov/pubmed/34319250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27992 %T Clinical Utility and Functionality of an Artificial Intelligence–Based App to Predict Mortality in COVID-19: Mixed Methods Analysis %A Abdulaal,Ahmed %A Patel,Aatish %A Al-Hindawi,Ahmed %A Charani,Esmita %A Alqahtani,Saleh A %A Davies,Gary W %A Mughal,Nabeela %A Moore,Luke Stephen Prockter %+ National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Commonwealth Building 8th Floor, Du Cane Road, London, W12 0NN, United Kingdom, 44 2033158273, l.moore@imperial.ac.uk %K app %K artificial intelligence %K coronavirus %K COVID-19 %K development %K function %K graphical user interface %K machine learning %K model %K mortality %K neural network %K prediction %K usability %K utility %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The artificial neural network (ANN) is an increasingly important tool in the context of solving complex medical classification problems. However, one of the principal challenges in leveraging artificial intelligence technology in the health care setting has been the relative inability to translate models into clinician workflow. Objective: Here we demonstrate the development of a COVID-19 outcome prediction app that utilizes an ANN and assesses its usability in the clinical setting. Methods: Usability assessment was conducted using the app, followed by a semistructured end-user interview. Usability was specified by effectiveness, efficiency, and satisfaction measures. These data were reported with descriptive statistics. The end-user interview data were analyzed using the thematic framework method, which allowed for the development of themes from the interview narratives. In total, 31 National Health Service physicians at a West London teaching hospital, including foundation physicians, senior house officers, registrars, and consultants, were included in this study. Results: All participants were able to complete the assessment, with a mean time to complete separate patient vignettes of 59.35 (SD 10.35) seconds. The mean system usability scale score was 91.94 (SD 8.54), which corresponds to a qualitative rating of “excellent.” The clinicians found the app intuitive and easy to use, with the majority describing its predictions as a useful adjunct to their clinical practice. The main concern was related to the use of the app in isolation rather than in conjunction with other clinical parameters. However, most clinicians speculated that the app could positively reinforce or validate their clinical decision-making. Conclusions: Translating artificial intelligence technologies into the clinical setting remains an important but challenging task. We demonstrate the effectiveness, efficiency, and system usability of a web-based app designed to predict the outcomes of patients with COVID-19 from an ANN. %M 34115603 %R 10.2196/27992 %U https://formative.jmir.org/2021/7/e27992 %U https://doi.org/10.2196/27992 %U http://www.ncbi.nlm.nih.gov/pubmed/34115603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e23229 %T A Biofeedback App for Migraine: Development and Usability Study %A Ingvaldsen,Sigrid Hegna %A Tronvik,Erling %A Brenner,Eiliv %A Winnberg,Ingunn %A Olsen,Alexander %A Gravdahl,Gøril Bruvik %A Stubberud,Anker %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, Trondheim , Norway, 47 73 59 20 20, sigrid.h.ingvaldsen@ntnu.no %K mHealth %K headache %K wearables %K smartphone %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective: The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods: In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results: A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions: The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps. %M 34319243 %R 10.2196/23229 %U https://formative.jmir.org/2021/7/e23229 %U https://doi.org/10.2196/23229 %U http://www.ncbi.nlm.nih.gov/pubmed/34319243 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29463 %T Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study %A Kumwichar,Ponlagrit %A Chongsuvivatwong,Virasakdi %A Prappre,Tagoon %+ Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K app %K mixed-methods analysis %K remote monitoring %K therapy %K tuberculosis %K user experience %K video directly observed therapy %K video-enhanced therapy %K video-observed therapy %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective: This study aimed to describe the VOT system design and identify the potential for system improvements. Methods: This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users’ experience. Results: Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions: Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated. %M 34313602 %R 10.2196/29463 %U https://formative.jmir.org/2021/7/e29463 %U https://doi.org/10.2196/29463 %U http://www.ncbi.nlm.nih.gov/pubmed/34313602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e18198 %T Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications %A Broekhuis,Marijke %A van Velsen,Lex %A Peute,Linda %A Halim,Meilani %A Hermens,Hermie %+ Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7522 AH, Netherlands, 31 0880875728, m.broekhuis@rrd.nl %K usability benchmarking %K eHealth systems %K content analysis %K usability framework %K summative evaluation %K mobile phone %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain. Objective: In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users. Methods: We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement. Results: We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen κ was calculated for 2 data sets on both the category and factor levels, and all Cohen κ values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5% (278/400) of the usability problems can be considered as general usability factors and 30.5% (122/400) as eHealth-specific usability factors. Conclusions: Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain. %M 34313594 %R 10.2196/18198 %U https://formative.jmir.org/2021/7/e18198 %U https://doi.org/10.2196/18198 %U http://www.ncbi.nlm.nih.gov/pubmed/34313594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29159 %T Use of Telemedicine in Depression Care by Physicians: Scoping Review %A Echelard,Jean-François %+ Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada, 1 (514) 343 6111, jfechelard@hotmail.com %K telemedicine %K telepsychiatry %K depression %K mental health %K videoconferencing %D 2021 %7 26.7.2021 %9 Review %J JMIR Form Res %G English %X Background: Depression is a common disorder, and it creates burdens on people’s mental and physical health as well as societal costs. Although traditional in-person consultations are the usual mode of caring for patients with depression, telemedicine may be well suited to psychiatric assessment and management. Telepsychiatry can be defined as the use of information and communication technologies such as videoconferencing and telephone calls for the care of psychopathologies. Objective: This review aims to evaluate the extent and nature of the existing literature on the use of telemedicine for the care of depression by physicians. This review also aims to examine the effects and perceptions regarding this virtual care and determine how it compares to traditional in-person care. Methods: The Arksey and O’Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed. Relevant articles were identified through a search of three databases (MEDLINE, Cochrane Database of Systematic Reviews, and PsycArticles) on October 11, 2020. The search terms were “(virtual OR telemedicine OR teleconsultation* OR telehealth OR phone* OR webcam* OR telepsychiatry) AND (depress*)”. Eligibility criteria were applied to select studies about the use of telemedicine for the care of patients with depression specifically by physicians. An Excel file (Microsoft Corporation) was used to chart data from all included articles. Results: The search resulted in the identification of 28 articles, and all 13 nonreview studies were analyzed in detail. Most nonreview studies were conducted in the United States during the last decade. Most telemedicine programs were led by psychiatrists, and the average study population size was 135. In all applicable studies, telepsychiatry tended to perform at least as well as in-person care regarding improvement in depression severity, patient satisfaction, quality of life, functioning, cost-effectiveness, and most other perceptions and variables. Cultural sensitivity and collaborative care were part of the design of some telemedicine programs. Conclusions: Additional randomized, high-quality studies are recommended to evaluate various outcomes of the use of telemedicine for depression care, including depression variables, perceptions, health care outcomes and other outcomes. Studies should be conducted in various clinical contexts, including primary care. Telepsychiatry is a promising modality of care for patients suffering from depression. %M 34309571 %R 10.2196/29159 %U https://formative.jmir.org/2021/7/e29159 %U https://doi.org/10.2196/29159 %U http://www.ncbi.nlm.nih.gov/pubmed/34309571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e24634 %T Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study %A van der Kamp,Mattienne %A Reimering Hartgerink,Pamela %A Driessen,Jean %A Thio,Bernard %A Hermens,Hermie %A Tabak,Monique %+ Department of Pediatrics, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512KZ, Netherlands, 31 534872310, mattienne@gmail.com %K telemedicine %K feasibility studies %K child %K self-management %K asthma %K patient acceptance of health care %K ambulatory care %K remote sensing technology %K cost-benefit analysis %K health care costs %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. Objective: The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. Methods: We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. Results: Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from €71,784 to €14,018, US $1=€0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. Conclusions: eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care. %M 34309568 %R 10.2196/24634 %U https://formative.jmir.org/2021/7/e24634 %U https://doi.org/10.2196/24634 %U http://www.ncbi.nlm.nih.gov/pubmed/34309568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27865 %T Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study %A Scholl,Julia %A Kohls,Elisabeth %A Görges,Frauke %A Steinbrecher,Marc %A Baldofski,Sabrina %A Moessner,Markus %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K online %K group chats %K COVID-19 pandemic %K psychiatric outpatient setting %K online interventions %K e-mental health %K COVID-19 %K pandemic %K mental health %K psychoeducation %K online chat %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r %M 34161252 %R 10.2196/27865 %U https://formative.jmir.org/2021/7/e27865 %U https://doi.org/10.2196/27865 %U http://www.ncbi.nlm.nih.gov/pubmed/34161252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of 9%). Across HbA1c cohorts, the mean baseline BMI was 35.83 (SD 7.79), and the moderate-risk cohort (7% ≤ HbA1c ≤ 9%) reported the highest mean value (36.6, SD 7.79). At 12 weeks, patients reported a significant decrease in HbAlc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate-risk cohort showing the greatest reduction (−0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest-risk cohort showed the greatest improvements in diabetes distress (−0.76; P=.005). Conclusions: Acknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline HbA1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high HbA1c experienced the greatest HbA1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching. %M 34010804 %R 10.2196/24981 %U https://diabetes.jmir.org/2021/2/e24981 %U https://doi.org/10.2196/24981 %U http://www.ncbi.nlm.nih.gov/pubmed/34010804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26452 %T Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study %A Safaeinili,Nadia %A Vilendrer,Stacie %A Williamson,Emma %A Zhao,Zicheng %A Brown-Johnson,Cati %A Asch,Steven M %A Shieh,Lisa %+ Department of Medicine, School of Medicine, Stanford University, 1265 Welch Rd x216, Stanford, CA, 94305, United States, 1 8053001922, nadiasaf@stanford.edu %K telemedicine %K inpatient %K COVID-19 %K qualitative %K RE-AIM %K infection control %K personal protective equipment %K implementation science %K quality improvement %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective: To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods: Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results: All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient–clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions: Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team. %M 34033576 %R 10.2196/26452 %U https://formative.jmir.org/2021/6/e26452 %U https://doi.org/10.2196/26452 %U http://www.ncbi.nlm.nih.gov/pubmed/34033576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25151 %T Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study %A Maharaj,Alita %A Lim,David %A Murphy,Rinki %A Serlachius,Anna %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 3073, a.serlachius@auckland.ac.nz %K type 2 diabetes %K mobile apps %K diabetes %K self-management %K user engagement %K app %K mHealth %K randomized controlled trial %K intervention %K efficacy %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. Objective: We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. Methods: Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. Results: In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. Conclusions: Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671 %M 34132640 %R 10.2196/25151 %U https://formative.jmir.org/2021/6/e25151 %U https://doi.org/10.2196/25151 %U http://www.ncbi.nlm.nih.gov/pubmed/34132640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26195 %T An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study %A Larsen,Britta %A Greenstadt,Emily D %A Olesen,Brittany L %A Marcus,Bess H %A Godino,Job %A Zive,Michelle M %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr., San Diego, CA, United States, 1 8585348429, blarsen@ucsd.edu %K mobile health %K human-centered design %K qualitative research %K adolescent health %K health disparities %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Only 3% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population. Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework. Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases. Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. %M 34128823 %R 10.2196/26195 %U https://formative.jmir.org/2021/6/e26195 %U https://doi.org/10.2196/26195 %U http://www.ncbi.nlm.nih.gov/pubmed/34128823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24896 %T A Caregiver Digital Intervention to Support Shared Decision Making in Child and Adolescent Mental Health Services: Development Process and Stakeholder Involvement Analysis %A Liverpool,Shaun %A Edbrooke-Childs,Julian %+ Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Rd, Ormskirk, United Kingdom, 44 169 557 5171, shaun.liverpool.14@ucl.ac.uk %K digital health intervention %K caregivers %K parents %K child mental health %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents and caregivers are generally recognized by literature and the law as key to child and adolescent mental health decisions. Digital interventions are increasingly being used to support care and treatment in child and adolescent mental health services (CAMHS). However, evidence of the design and development process is generally not made available. Objective: In light of calls for more transparency, this paper aims to describe the development of an evidence-based, theoretically informed digital decision support intervention for parents and caregivers of young people accessing CAMHS. Methods: The intervention was developed in line with the UK Medical Research Council framework for developing complex interventions. The process incorporated the steps for developing patient decision aids, as follows: assessing need, assessing feasibility; defining objectives; identifying the framework of decision support; and selecting the methods, designs, and dissemination approach. We synthesized theory, research, international guidelines, and input from relevant stakeholders using an iterative design approach. Results: The development steps resulted in Power Up for Parents, a decision support intervention, with five key features (ie, decisions, goals, journey, support, and resources). The intervention aims to encourage discussion, allow parents to ask questions during sessions or seek further information between sessions, and allow service providers to tailor the shared decision-making process to accommodate the needs of the parent and child. Conclusions: We confirmed that it is possible to use input from end users—integrated with theory and evidence—to create digital interventions to be used in CAMHS. Key lessons with implications for practice, policy, and implementation science, along with preliminary findings, are presented. International Registered Report Identifier (IRRID): RR2-10.2196/14571 %M 34128821 %R 10.2196/24896 %U https://formative.jmir.org/2021/6/e24896 %U https://doi.org/10.2196/24896 %U http://www.ncbi.nlm.nih.gov/pubmed/34128821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26417 %T A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series %A Beresford,Thomas %A Ronan,Patrick J %A Hipp,Daniel %+ Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, (116), 1700 North Wheeling Street, Aurora, CO, 80045, United States, 1 7207237374, thomas.beresford@ucdenver.edu %K cognition %K COVID-19 %K safety %K remote use %K delirium %K brain injury, brain %K diagnosis %K assessment %K test %K telehealth %K telemedicine %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. %M 34010137 %R 10.2196/26417 %U https://formative.jmir.org/2021/6/e26417 %U https://doi.org/10.2196/26417 %U http://www.ncbi.nlm.nih.gov/pubmed/34010137 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e17418 %T Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study %A Twimukye,Adelline %A Bwanika Naggirinya,Agnes %A Parkes-Ratanshi,Rosalind %A Kasirye,Ronnie %A Kiragga,Agnes %A Castelnuovo,Barbara %A Wasswa,Jacob %A Nabaggala,Maria Sarah %A Katabira,Elly %A Lamorde,Mohammed %A King,Rachel Lisa %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, University Hall Lane, Kampala, 10218, Uganda, 256 256 312 307000, anaggirinya@idi.co.ug %K HIV %K mHealth %K young adults %K adherence %K qualitative %K Uganda %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 %M 34121665 %R 10.2196/17418 %U https://mhealth.jmir.org/2021/6/e17418 %U https://doi.org/10.2196/17418 %U http://www.ncbi.nlm.nih.gov/pubmed/34121665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23884 %T Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study %A Donevant,Sara %A Heiney,Sue P %A Wineglass,Cassandra %A Schooley,Benjamin %A Singh,Akanksha %A Sheng,Jingxi %+ College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, United States, 1 803 777 7672, Donevant@mailbox.sc.edu %K mHealth %K breast cancer survivors %K medication adherence %K cultural considerations %K mobile health applications %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. %M 34114955 %R 10.2196/23884 %U https://formative.jmir.org/2021/6/e23884 %U https://doi.org/10.2196/23884 %U http://www.ncbi.nlm.nih.gov/pubmed/34114955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27280 %T Development of the 12-Item Social Media Disinformation Scale and its Association With Social Media Addiction and Mental Health Related to COVID-19 in Tunisia: Survey-Based Pilot Case Study %A Guelmami,Noomen %A Ben Khalifa,Maher %A Chalghaf,Nasr %A Kong,Jude Dzevela %A Amayra,Tannoubi %A Wu,Jianhong %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 2818392210, robertobragazzi@gmail.com %K COVID-19 pandemic %K media disinformation %K social media addiction %K mental health %K scale validation %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media. Objective: Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users. Methods: A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis. Results: The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument’s dimensions with internet addiction and mental health factors showed positive associations. Conclusions: The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts. %M 34021742 %R 10.2196/27280 %U https://formative.jmir.org/2021/6/e27280 %U https://doi.org/10.2196/27280 %U http://www.ncbi.nlm.nih.gov/pubmed/34021742 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e24276 %T Feasibility of an Internet-Based Intervention to Promote Exercise for People With Spinal Cord Injury: Observational Pilot Study %A Ochoa,Christa %A Cole,Maria %A Froehlich-Grobe,Katherine %+ Craig Hospital, 3425 S Clarkson Street, Englewood, CO, 80113, United States, 1 2145317260, KFroehlich-Grobe@Craighospital.org %K spinal cord injury %K lifestyle intervention %K physical activity %K health promotion %K eHealth %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. Objective: This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. Methods: We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. Results: Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%. Conclusions: The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial. %M 34106086 %R 10.2196/24276 %U https://rehab.jmir.org/2021/2/e24276 %U https://doi.org/10.2196/24276 %U http://www.ncbi.nlm.nih.gov/pubmed/34106086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28055 %T Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders %A Heyen,Janna Marie %A Weigl,Noé %A Müller,Mario %A Müller,Stefan %A Eberle,Urs %A Manoliu,Andrei %A Vetter,Stefan %A Brown,Adam D %A Berger,Thomas %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Lenggstrasse 31, PO Box 1931, Zürich, CH-8032, Switzerland, 41 (0)44 384 21 11, birgit.kleim@pukzh.ch %K anxiety %K COVID-19 %K electronic mental health %K feasibility %K first responder %K mental health %K mindfulness %K resilience %K self-efficacy %K sleep quality %K stress %K training %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. Objective: This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. Methods: We developed COVID-19–specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19–related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. Results: In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. %M 33999835 %R 10.2196/28055 %U https://formative.jmir.org/2021/6/e28055 %U https://doi.org/10.2196/28055 %U http://www.ncbi.nlm.nih.gov/pubmed/33999835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25687 %T Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers %A Nam,Soohyun %A Jeon,Sangchoon %A Ash,Garrett %A Whittemore,Robin %A Vlahov,David %+ School of Nursing, Yale University, 400 West Campus Dr, West Haven, CT, 06516, United States, 1 203 737 2822, soohyun.nam@yale.edu %K racial discrimination %K physical activity %K ecological momentary assessment %K African American %K pilot study %K mobile phone %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective: The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associations between daily real-time racial discrimination and PA outcomes (total energy expenditure, sedentary time, and moderate-to-vigorous PA patterns) measured by ecological momentary assessment (EMA) and accelerometers in healthy African Americans. Methods: This pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community. After participants completed baseline surveys, they were asked to wear an accelerometer for 7 days to measure their PA levels. EMA was sent to participants 5 times per day for 7 days to assess daily real-time racial discrimination. Multilevel models were used to examine the within- and between-person associations of daily racial discrimination on PA. Results: More EMA-reported daily racial discrimination was associated with younger age (r=0.75; P=.02). Daily EMA-reported microaggression was associated with depressive symptoms (r=0.66; P=.05), past race-related events (r=0.82; P=.004), and lifetime discrimination (r=0.78; P=.01). In the within-person analyses, the day-level association of racial discrimination and sedentary time was significant (β=.30, SE 0.14; P=.03), indicating that on occasions when participants reported more racial discrimination than usual, more sedentary time was observed. Between-person associations of racial discrimination (β=−.30, SE 0.28; P=.29) or microaggression (β=−.34, SE 0.36; P=.34) with total energy expenditure were suggestive but inconclusive. Conclusions: Concurrent use of EMA and accelerometers is a feasible method to examine the relationship between racial discrimination and PA in real time. Examining daily processes at the within-person level has the potential to elucidate the mechanisms of which racial discrimination may have on health and health behaviors and to guide the development of personalized interventions for increasing PA in racial ethnic minorities. Future studies with a precision health approach, incorporating within- and between-person associations, are warranted to further elucidate the effects of racial discrimination and PA. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22068 %M 34096870 %R 10.2196/25687 %U https://formative.jmir.org/2021/6/e25687 %U https://doi.org/10.2196/25687 %U http://www.ncbi.nlm.nih.gov/pubmed/34096870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23118 %T Expanding the Reach of Research: Quantitative Evaluation of a Web-Based Approach for Remote Recruitment of People Who Hear Voices %A Buck,Benjamin %A Chander,Ayesha %A Brian,Rachel M %A Wang,Weichen %A Campbell,Andrew T %A Ben-Zeev,Dror %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 221 8518, buckbe@uw.edu %K digital health %K research procedures %K recruitment %K mobile phone %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Similar to other populations with highly stigmatized medical or psychiatric conditions, people who hear voices (ie, experience auditory verbal hallucinations [AVH]) are often difficult to identify and reach for research. Technology-assisted remote research strategies reduce barriers to research recruitment; however, few studies have reported on the efficiency and effectiveness of these approaches. Objective: This study introduces and evaluates the efficacy of technology-assisted remote research designed for people who experience AVH. Methods: Our group developed an integrated, automated and human complementary web-based recruitment and enrollment apparatus that incorporated Google Ads, web-based screening, identification verification, hybrid automation, and interaction with live staff. We examined the efficacy of that apparatus by examining the number of web-based advertisement impressions (ie, number of times the web-based advertisement was viewed); clicks on that advertisement; engagement with web-based research materials; and the extent to which it succeeded in representing a broad sample of individuals with AVH, assessed through the self-reported AVH symptom severity and demographic representativeness (relative to the US population) of the sample recruited. Results: Over an 18-month period, our Google Ads advertisement was viewed 872,496 times and clicked on 11,183 times. A total amount of US $4429.25 was spent on Google Ads, resulting in 772 individuals who experience AVH providing consent to participate in an entirely remote research study (US $0.40 per click on the advertisement and US $5.73 per consented participant) after verifying their phone number, passing a competency screening questionnaire, and providing consent. These participants reported high levels of AVH frequency (666/756, 88.1% daily or more), distress (689/755, 91.3%), and functional interference (697/755, 92.4%). They also represented a broad sample of diversity that mirrored the US population demographics. Approximately one-third (264/756, 34.9%) of the participants had never received treatment for their AVH and, therefore, were unlikely to be identified via traditional clinic-based research recruitment strategies. Conclusions: Web-based procedures allow for time saving, cost-efficient, and representative recruitment of individuals with AVH and can serve as a model for future studies focusing on hard-to-reach populations. %M 34081011 %R 10.2196/23118 %U https://formative.jmir.org/2021/6/e23118 %U https://doi.org/10.2196/23118 %U http://www.ncbi.nlm.nih.gov/pubmed/34081011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24509 %T Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre–Post Study %A Ho,Kendall %A Novak Lauscher,Helen %A Cordeiro,Jennifer %A Hawkins,Nathaniel %A Scheuermeyer,Frank %A Mitton,Craig %A Wong,Hubert %A McGavin,Colleen %A Ross,Dianne %A Apantaku,Glory %A Karim,Mohammad Ehsan %A Bhullar,Amrit %A Abu-Laban,Riyad %A Nixon,Suzanne %A Smith,Tyler %+ Digital Emergency Medicine, University of British Columbia, 818 West 10th Avenue, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 822 0327, kendall.ho@ubc.ca %K telemonitoring %K heart failure %K home health monitoring %K technology %K telehealth %K emergency care %K community care %K emergency department %K quality of life %K self-efficacy %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 %M 34081015 %R 10.2196/24509 %U https://formative.jmir.org/2021/6/e24509 %U https://doi.org/10.2196/24509 %U http://www.ncbi.nlm.nih.gov/pubmed/34081015 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e19941 %T Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach %A Sun,Ruo-Ting %A Han,Wencui %A Chang,Hsin-Lu %A Shaw,Michael J %+ Department of Management Information Systems, National Chengchi University, 64, Sec 2, Chinan Rd,, Taipei, 116, Taiwan, 886 2 29393091 ext 81214, hlchang@nccu.edu.tw %K adherence %K mobile health %K motivation %K personality %K MBTI %K action design research %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. %M 34076580 %R 10.2196/19941 %U https://mhealth.jmir.org/2021/6/e19941 %U https://doi.org/10.2196/19941 %U http://www.ncbi.nlm.nih.gov/pubmed/34076580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24937 %T Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups %A Norris,Anne E %A Thalasinos,Roxana Delcampo %A Hecht,Michael L %+ REAL Prevention, LLC, 817 Kingsbridge Dr, Oviedo, FL, 32765, United States, 1 4074161727, anne@real-prevention.com %K implementation science %K mobile apps %K peer influence %K early intervention %K adolescent health %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency. %M 34076578 %R 10.2196/24937 %U https://formative.jmir.org/2021/6/e24937 %U https://doi.org/10.2196/24937 %U http://www.ncbi.nlm.nih.gov/pubmed/34076578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22970 %T Using a Mobile App–Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data %A Ormel,Ilja %A Onu,Charles C %A Magalhaes,Mona %A Tang,Terence %A Hughes,John B %A Law,Susan %+ Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montréal, QC, H2T 1W1, Canada, 1 (514) 345 3511 ext 5060, ilja.ormel@mail.mcgill.ca %K qualitative research %K illness narratives %K experiential information %K breast cancer %K surgery %K tailored information %K recommender system %K patient information and communication %K mobile app %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women’s capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others’ experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs—offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women’s experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women’s personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people’s experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. %M 34076582 %R 10.2196/22970 %U https://formative.jmir.org/2021/6/e22970 %U https://doi.org/10.2196/22970 %U http://www.ncbi.nlm.nih.gov/pubmed/34076582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e17858 %T Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study %A Fakih El Khoury,Cosette %A Crutzen,Rik %A Schols,Jos MGA %A Halfens,Ruud JG %A Karavetian,Mirey %+ Department of Health Sciences, Zayed University, Academic city PO Box 19282, Dubai, United Arab Emirates, 971 562446865, kmirey@gmail.com %K renal diet %K mhealth %K dietary app %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information. Objective: The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy. Methods: This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials. Results: Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4% (SD 13.9) to 68.1% (SD 13.3) after intervention with a large effect size (d=1.22, 95% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus. Conclusions: The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention. %M 34061034 %R 10.2196/17858 %U https://formative.jmir.org/2021/6/e17858 %U https://doi.org/10.2196/17858 %U http://www.ncbi.nlm.nih.gov/pubmed/34061034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26989 %T Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study %A Detweiler Guarino,Isadora %A Cowan,Devin R %A Fellows,Abigail M %A Buckey,Jay C %+ Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 6012, Jay.C.Buckey.Jr@dartmouth.edu %K computerized cognitive behavioral therapy %K interactive media %K COVID-19 %K computer-based therapy %K usability %K acceptability %K cognitive behavioral therapy %K therapy %K effectiveness %K digital health %K depression %K stress %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. Objective: The primary aim is to determine users’ levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. Methods: Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. Results: A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. Conclusions: Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. Trial Registration: ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061 %M 33973856 %R 10.2196/26989 %U https://formative.jmir.org/2021/5/e26989 %U https://doi.org/10.2196/26989 %U http://www.ncbi.nlm.nih.gov/pubmed/33973856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24108 %T Using Social Media for Qualitative Health Research in Danish Women of Reproductive Age: Online Focus Group Study on Facebook %A Temmesen,Camilla Gry %A Nielsen,Henriette Svarre %A Andersen,Heidi Lene Myglegård %A Birch Petersen,Kathrine %A Clemensen,Jane %+ Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3, Odense, 5000, Denmark, 45 26215135, ctemmesen@health.sdu.dk %K internet %K social media %K Facebook %K online focus groups %K women %K reproduction %K reproductive age %K motherhood %K participatory design %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms provide new possibilities within health research. With Facebook being the largest social network in the world, it constitutes a potential platform for recruitment and data collection from women of reproductive age. Women in Denmark and in other Western countries postpone motherhood and risk infertility due to their advanced age when they try to conceive. To date, no study has explored Danish women’s reflections on the timing of motherhood within a social media setting. Objective: The aim of this study was to explore the challenges and opportunities of using Facebook as a platform for qualitative health research in Danish women of reproductive age. Methods: This study was a qualitative study based on 3 online focus groups on Facebook with 26 Danish women of reproductive age discussing the timing of motherhood in January 2020. Results: Conducting online focus groups on Facebook was successful in this study as the web-based approach was found suitable for developing qualitative data with women of reproductive age and made recruitment easy and free of charge. All participants found participating in an online focus group to be a positive experience. More than half of the women participating in the online focus groups found it advantageous to meet on Facebook instead of meeting face-to-face. Conclusions: Conducting online focus groups on Facebook is a suitable method to access qualitative data from women of reproductive age. Participants were positive toward being a part of an online focus group. Online focus groups on social media have the potential to give women of reproductive age a voice in the debate of motherhood. %M 34057418 %R 10.2196/24108 %U https://formative.jmir.org/2021/5/e24108 %U https://doi.org/10.2196/24108 %U http://www.ncbi.nlm.nih.gov/pubmed/34057418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e20179 %T Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis %A Moreno,Megan A %A Gaus,Quintin %A Wilt,Megan %A Arseniev-Koehler,Alina %A Ton,Adrienne %A Adrian,Molly %A VanderStoep,Ann %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 (608) 262 4440, mamoreno@pediatrics.wisc.edu %K adolescents %K content analysis %K depression %K Facebook %K social media %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual’s experiences of depression. However, most studies have examined depression displays on social media at a single time point. Objective: This study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender. Methods: Participants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons. Results: A total of 78 participants’ Facebook profiles were examined, of which 40 (51%) were male. At time 1, 62% (48/78) of the adolescents had a Facebook profile, and 54% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19%) females and 12 (15%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63). Conclusions: This content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach. %M 34057422 %R 10.2196/20179 %U https://formative.jmir.org/2021/5/e20179 %U https://doi.org/10.2196/20179 %U http://www.ncbi.nlm.nih.gov/pubmed/34057422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18261 %T A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study %A Juarascio,Adrienne %A Srivastava,Paakhi %A Presseller,Emily %A Clark,Kelsey %A Manasse,Stephanie %A Forman,Evan %+ Center for Weight, Eating and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Suite 232, Philadelphia, PA, 19104, United States, 1 2678156511, ps887@drexel.edu %K eating disorders %K telemedicine %K mobile phone %K smartphone %K technology %K cognitive behavioral therapy %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. Objective: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. Methods: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. Results: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. Conclusions: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed. %M 34057416 %R 10.2196/18261 %U https://formative.jmir.org/2021/5/e18261 %U https://doi.org/10.2196/18261 %U http://www.ncbi.nlm.nih.gov/pubmed/34057416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25705 %T A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study %A Wang,Gubing %A Albayrak,Armagan %A Kortuem,Gerd %A van der Cammen,Tischa JM %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 655548210, g.wang-2@tudelft.nl %K human-centered design %K data visualizations %K person-centered care %K people with dementia %K assistive technology %K health care design %K care management %K internet of things %K data-driven design %K data-enabled design %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective: This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods: The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results: The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into “client level,” “ward level,” and “team level.” The corresponding actions taken by the care team were classified into “investigation” and “implementation.” User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions: By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context. %M 34047703 %R 10.2196/25705 %U https://formative.jmir.org/2021/5/e25705 %U https://doi.org/10.2196/25705 %U http://www.ncbi.nlm.nih.gov/pubmed/34047703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24417 %T Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention %A Slade,Mike %A Rennick-Egglestone,Stefan %A Llewellyn-Beardsley,Joy %A Yeo,Caroline %A Roe,James %A Bailey,Sylvia %A Smith,Roger Andrew %A Booth,Susie %A Harrison,Julian %A Bhogal,Adaresh %A Penas Morán,Patricia %A Hui,Ada %A Quadri,Dania %A Robinson,Clare %A Smuk,Melanie %A Farkas,Marianne %A Davidson,Larry %A van der Krieke,Lian %A Slade,Emily %A Bond,Carmel %A Nicholson,Joe %A Grundy,Andrew %A Charles,Ashleigh %A Hare-Duke,Laurie %A Pollock,Kristian %A Ng,Fiona %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 409326, stefan.egglestone@nottingham.ac.uk %K narratives %K storytelling %K intervention development %K mental health %K online intervention %K patient involvement %K narrative medicine %K internet %K recovery %K mobile phone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). Objective: This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. Methods: Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made. Results: KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses. Conclusions: RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health. %M 34042595 %R 10.2196/24417 %U https://formative.jmir.org/2021/5/e24417 %U https://doi.org/10.2196/24417 %U http://www.ncbi.nlm.nih.gov/pubmed/34042595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22513 %T Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study %A Fonner,Virginia A %A Kennedy,Samuel %A Desai,Rohan %A Eichberg,Christie %A Martin,Lisa %A Meissner,Eric G %+ Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur, Suite 104, Charleston, SC, 29407, United States, 1 8438761463, fonner@musc.edu %K HIV %K mHealth %K text messaging %K video calling %K implementation science %K mobile phone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients. %M 34042596 %R 10.2196/22513 %U https://formative.jmir.org/2021/5/e22513 %U https://doi.org/10.2196/22513 %U http://www.ncbi.nlm.nih.gov/pubmed/34042596 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 2 %P e25679 %T A Digital Mobile Community App for Caregivers in Singapore: Predevelopment and Usability Study %A Lwin,May O %A Sheldenkar,Anita %A Panchapakesan,Chitra %+ Nanyang Technological University, 31 Nanyang Link, Singapore, Singapore, 65 67905966, chitrapk@ntu.edu.sg %K caregiving %K technological solution %K mobile application %K easy communication %K caregiver %K mobile app %K communication %K elderly %K aging population %K internet technology %K community network %K network %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: With increasing life expectancy and aging populations, the global prevalence of chronic diseases and the long-term care required for people with comorbidities is rising. This has led to an ever-growing need for caregiving. Previous literature has shown that caregivers face problems of isolation and loneliness. However, many health organizations mainly focus their efforts on in-person community groups that require participants to meet physically. This is not always convenient or accessible for caregivers who are often juggling caring for their care recipient with family and work responsibilities. Objective: With medical advancements such as the proliferation of mobile phones and internet technology, caregivers may have opportunities for easier access to resources and support. Technological innovations could help empower the caregiving community to seek assistance for improving their quality of life at their convenience. A community network app called Caregivers’ Circle was conceptualized in response to the needs of the caregivers on a day-to-day caregiving journey. This paper traces the predevelopment inquiry and technical details of this app to provide a clear understanding of its implementation along with a usability study to gauge user opinion of the app within Singapore. Methods: A predevelopment survey was conducted to identify specific needs of caregivers and gaps in the currently available web-based community networks. The survey consisted of questions on demographical data, health-related issues of the care recipient, mental and physical health–related issues of the caregiver, digital media use, information seeking, and support. This pre–app development survey was completed by 103 caregivers. Qualitative enquiries were also conducted with caregivers within Singapore to identify issues related to caregiving, support provided, and what caregivers would want from a caregiving mobile app. Results: From the feedback garnered from the caregivers, the developers were able to identify several caregivers’ needs and gaps within the current support networks. This feedback was integrated into the mobile app called Caregivers’ Circle upon development. The features of this app include a public forum for community discussions, a marketplace to buy and sell items, care groups to hold private discussions with friends or other users of the app, and a friends feature to search and add new caregiving friends. Conclusions: In general, the caregivers liked the Caregivers’ Circle app and were confident that this app could help them have a better quality of life. The Caregivers’ Circle app is unique in its integrated approach. The integration of many features that caregivers need on a daily basis into an easy app can save their time as well as help them navigate their life smoothly. %M 34345796 %R 10.2196/25679 %U https://nursing.jmir.org/2021/2/e25679 %U https://doi.org/10.2196/25679 %U http://www.ncbi.nlm.nih.gov/pubmed/34345796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e28007 %T The Effect of Training on Participant Adherence With a Reporting Time Frame for Momentary Subjective Experiences in Ecological Momentary Assessment: Cognitive Interview Study %A Wen,Cheng K Fred %A Junghaenel,Doerte U %A Newman,David B %A Schneider,Stefan %A Mendez,Marilyn %A Goldstein,Sarah E %A Velasco,Sarah %A Smyth,Joshua M %A Stone,Arthur A %+ Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Verna and Peter Dauterive Hall 405H, Los Angeles, CA, 90089, United States, 1 2138212894, chengkuw@usc.edu %K ecological momentary assessment %K EMA %K cognitive interview %K participant training %K reporting period %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants’ adherence to the reporting instructions. Objective: This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants’ adherence to the EMA reporting timeframe instructions. Methods: Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73). Results: The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ21=16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed. Conclusions: The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies. %M 34037524 %R 10.2196/28007 %U https://formative.jmir.org/2021/5/e28007 %U https://doi.org/10.2196/28007 %U http://www.ncbi.nlm.nih.gov/pubmed/34037524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27473 %T Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses %A Singh,Laura %A Kanstrup,Marie %A Depa,Katherine %A Falk,Ann-Charlotte %A Lindström,Veronica %A Dahl,Oili %A Göransson,Katarina E %A Rudman,Ann %A Holmes,Emily A %+ Department of Psychology, Uppsala University, Box 1225, Uppsala, 75142, Sweden, 46 018 471 2118, laura.singh@psyk.uu.se %K intrusive memories %K psychological trauma %K prevention %K pilot trial %K COVID-19 %K digital intervention %K remote delivery %K cognitive science %K person-based approach %K mixed methods %K co-design %K health care staff %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. %M 33886490 %R 10.2196/27473 %U https://formative.jmir.org/2021/5/e27473 %U https://doi.org/10.2196/27473 %U http://www.ncbi.nlm.nih.gov/pubmed/33886490 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24044 %T Bispectral Index Alterations and Associations With Autonomic Changes During Hypnosis in Trauma Center Researchers: Formative Evaluation Study %A Dunham,C Michael %A Burger,Amanda J %A Hileman,Barbara M %A Chance,Elisha A %A Hutchinson,Amy E %+ St Elizabeth Youngstown Hospital, 1044 Belmont Avenue, Youngstown, OH, 44501, United States, 1 330 480 3907, dunham.michael@sbcglobal.net %K bispectral index %K hypnosis %K heart rate variability %K electromyography %K skin conductance %K skin temperature %K respiratory rate %K expired carbon dioxide %K neurofeedback %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous work performed by our group demonstrated that intermittent reductions in bispectral index (BIS) values were found during neurofeedback following mindfulness instructions. Hypnosis was induced to enhance reductions in BIS values. Objective: This study aims to assess physiologic relaxation and explore its associations with BIS values using autonomic monitoring. Methods: Each session consisted of reading a 4-minute baseline neutral script and playing an 18-minute hypnosis tape to 3 researchers involved in the BIS neurofeedback study. In addition to BIS monitoring, autonomic monitoring was performed, and this included measures of electromyography (EMG), skin temperature, skin conductance, respiratory rate, expired carbon dioxide, and heart rate variability. The resulting data were analyzed using two-tailed t tests, correlation analyses, and multivariate linear regression analyses. Results: We found that hypnosis was associated with reductions in BIS (P<.001), EMG (P<.001), respiratory rate (P<.001), skin conductance (P=.006), and very low frequency power (P=.04); it was also associated with increases in expired carbon dioxide (P<.001), skin temperature (P=.04), high frequency power (P<.001), and successive heart interbeat interval difference (P=.04) values. Decreased BIS values were associated with reduced EMG measures (R=0.76; P<.001), respiratory rate (R=0.35; P=.004), skin conductance (R=0.57; P<.001), and low frequency power (R=0.32; P=.01) and with increased high frequency power (R=−0.53; P<.001), successive heart interbeat interval difference (R=−0.32; P=.009), and heart interbeat interval SD (R=−0.26; P=.04) values. Conclusions: Hypnosis appeared to induce mental and physical relaxation, enhance parasympathetic neural activation, and attenuate sympathetic nervous system activity, changes that were associated with BIS values. Findings from this preliminary formative evaluation suggest that the current hypnosis model may be useful for assessing autonomic physiological associations with changes in BIS values, thus motivating us to proceed with a larger investigation in trauma center nurses and physicians. %M 34037529 %R 10.2196/24044 %U https://formative.jmir.org/2021/5/e24044 %U https://doi.org/10.2196/24044 %U http://www.ncbi.nlm.nih.gov/pubmed/34037529 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22461 %T Neural Machine Translation–Based Automated Current Procedural Terminology Classification System Using Procedure Text: Development and Validation Study %A Joo,Hyeon %A Burns,Michael %A Kalidaikurichi Lakshmanan,Sai Saradha %A Hu,Yaokun %A Vydiswaran,V G Vinod %+ Department of Learning Health Sciences, University of Michigan, North Campus Research Center, Ann Arbor, MI, 48109, United States, 1 7347649826, thejoo@umich.edu %K CPT classification %K natural language processing %K machine learning %K neural machine translation %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Administrative costs for billing and insurance-related activities in the United States are substantial. One critical cause of the high overhead of administrative costs is medical billing errors. With advanced deep learning techniques, developing advanced models to predict hospital and professional billing codes has become feasible. These models can be used for administrative cost reduction and billing process improvements. Objective: In this study, we aim to develop an automated anesthesiology current procedural terminology (CPT) prediction system that translates manually entered surgical procedure text into standard forms using neural machine translation (NMT) techniques. The standard forms are calculated using similarity scores to predict the most appropriate CPT codes. Although this system aims to enhance medical billing coding accuracy to reduce administrative costs, we compare its performance with that of previously developed machine learning algorithms. Methods: We collected and analyzed all operative procedures performed at Michigan Medicine between January 2017 and June 2019 (2.5 years). The first 2 years of data were used to train and validate the existing models and compare the results from the NMT-based model. Data from 2019 (6-month follow-up period) were then used to measure the accuracy of the CPT code prediction. Three experimental settings were designed with different data types to evaluate the models. Experiment 1 used the surgical procedure text entered manually in the electronic health record. Experiment 2 used preprocessing of the procedure text. Experiment 3 used preprocessing of the combined procedure text and preoperative diagnoses. The NMT-based model was compared with the support vector machine (SVM) and long short-term memory (LSTM) models. Results: The NMT model yielded the highest top-1 accuracy in experiments 1 and 2 at 81.64% and 81.71% compared with the SVM model (81.19% and 81.27%, respectively) and the LSTM model (80.96% and 81.07%, respectively). The SVM model yielded the highest top-1 accuracy of 84.30% in experiment 3, followed by the LSTM model (83.70%) and the NMT model (82.80%). In experiment 3, the addition of preoperative diagnoses showed 3.7%, 3.2%, and 1.3% increases in the SVM, LSTM, and NMT models in top-1 accuracy over those in experiment 2, respectively. For top-3 accuracy, the SVM, LSTM, and NMT models achieved 95.64%, 95.72%, and 95.60% for experiment 1, 95.75%, 95.67%, and 95.69% for experiment 2, and 95.88%, 95.93%, and 95.06% for experiment 3, respectively. Conclusions: This study demonstrates the feasibility of creating an automated anesthesiology CPT classification system based on NMT techniques using surgical procedure text and preoperative diagnosis. Our results show that the performance of the NMT-based CPT prediction system is equivalent to that of the SVM and LSTM prediction models. Importantly, we found that including preoperative diagnoses improved the accuracy of using the procedure text alone. %M 34037526 %R 10.2196/22461 %U https://formative.jmir.org/2021/5/e22461 %U https://doi.org/10.2196/22461 %U http://www.ncbi.nlm.nih.gov/pubmed/34037526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18771 %T Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study %A Donelle,Lorie %A Facca,Danica %A Burke,Shauna %A Hiebert,Bradley %A Bender,Emma %A Ling,Stephen %+ Arthur Labatt Family School of Nursing, The University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 5198688675, dfacca2@uwo.ca %K child %K children %K internet %K social media %K digital literacy %K digital inclusion %K quality of life %K mobile phone %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. %M 34037525 %R 10.2196/18771 %U https://formative.jmir.org/2021/5/e18771 %U https://doi.org/10.2196/18771 %U http://www.ncbi.nlm.nih.gov/pubmed/34037525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e14851 %T Utilizing Lean Software Methods To Improve Acceptance of Global eHealth Initiatives: Results From the Implementation of the Basic Emergency Care App %A Rose,Christian %A Nichols,Taylor %A Hackner,Daniel %A Chang,Julia %A Straube,Steven %A Jooste,Willem %A Sawe,Hendry %A Tenner,Andrea %+ Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4159159585, ccrose@stanford.edu %K lean %K eHealth %K emergency %K global health %K app development %K decision support %K primary survey %K mHealth %K Africa %K Tanzania %K low- and middle income countries %K LMIC %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health systems in low- and middle-income countries face considerable challenges in providing high-quality accessible care. eHealth has had mounting interest as a possible solution given the unprecedented growth in mobile phone and internet technologies in these locations; however, few apps or software programs have, as of yet, gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to engage and meet local stakeholder needs and the high costs of software development. Objective: World Health Organization Basic Emergency Care course participants requested a mobile point-of-care adjunct to the primary course material. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees’ reported needs and avoid some of the abovementioned failings. We aimed to use the well-described Lean software development strategy—given our familiarity with its elements and its ubiquitous use in medicine, global health, and software development—to complete this task efficiently and with maximal stakeholder involvement. Methods: From September 2016 through January 2017, the Basic Emergency Care app was designed and developed at the University of California San Francisco. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania—World Health Organization Basic Emergency Care partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of Basic Emergency Care course material. Results: Our user-centered mobile app was developed with an iterative participatory approach with its first version available within 6 months and with high acceptance—95% of Basic Emergency Care Course participants felt that it was useful. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance and allows for efficient feedback and expansion. Conclusions: We believe that utilizing Lean software development strategies may help global health advocates and researchers build eHealth solutions with a process that is familiar and with buy-in across stakeholders that is responsive, rapid to deploy, and sustainable. %M 33882013 %R 10.2196/14851 %U https://formative.jmir.org/2021/5/e14851 %U https://doi.org/10.2196/14851 %U http://www.ncbi.nlm.nih.gov/pubmed/33882013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25078 %T Changes in Perceived Stress Following a 10-Week Digital Mindfulness-Based Stress Reduction Program: Retrospective Study %A Venkatesan,Aarathi %A Krymis,Holly %A Scharff,Jenny %A Waber,Art %+ Vida Health, 100 Montgomery St #750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, aarathi.venkatesan@vida.com %K perceived stress %K health coaching %K digital mental health intervention %K digital therapeutics %K mobile phone %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the need for effective scalable interventions for mental health conditions such as depression, anxiety, and stress has grown, the digital delivery of mindfulness-based stress reduction (MBSR) has gained interest as a promising intervention in this domain. Objective: This study aims to evaluate the changes in perceived stress following a 10-week digital MBSR program that combined an app-based digital program with weekly one-on-one remote sessions with a health coach. Methods: This study used a retrospective, observational design. A total of 229 participants with moderate-to-high perceived stress scores as assessed by the Perceived Stress Scale (PSS)-10 enrolled in the 10-week Vida Health MBSR program. The program included weekly remote sessions with a certified health coach and digital content based on concepts fundamental to mindfulness practice. The PSS-10 was used to evaluate perceived stress. Of the 229 participants, 131 (57.2%) were considered program completers and provided at least one follow-up PSS-10. A secondary analysis examined the changes in stress scores at 6 months. This analysis was restricted to participants who had been enrolled in the program for at least 6 months (n=121). To account for random and fixed effects, linear mixed effects modeling was used to assess changes in stress scores over time. An intention-to-treat approach was used to evaluate the changes in perceived stress across the entire study cohort, including those who were lost to follow-up. In addition, a reliable change index was computed to evaluate the changes in scores from the baseline. Results: The findings revealed a significant positive association between program time and stress reduction (B=−0.365; P<.001) at 12 weeks. We observed an average reduction in stress scores of 3.17 points (95% CI −3.93 to −2.44) by program week 6 and 4.86 points (95% CI −5.86 to −3.85) by program week 12. Overall, 83.2% (109/131) of participants showed a reduction in stress scores by week 12, with 40.5% (53/131) of participants showing reliable improvement at 12 weeks and 47.8% (56/131) of participants showing a shift to a lower stress level category (ie, moderate-to-low stress). The intention-to-treat analysis revealed a significant, although attenuated, reduction in stress scores at 12 weeks (B=−0.23; P<.001). Participants who completed more lessons had an increased likelihood of moving down at least one stress level category (odds ratio 1.512, 95% CI 1.056 to 2.166; P=.02). In assessing medium-term outcomes, among participants who had completed at least 6 months in the program, 48.8% (59/121) of members provided a 6-month assessment. We observed a significant reduction in stress scores at 6 months (t58=10.24; P<.001), with 61% (36/59) of participants showing reliable improvement. Conclusions: The findings of this retrospective, observational study suggest that a blended, digital mindfulness-based intervention may support program uptake and meaningful, sustained reduction in stress outcomes. %M 34032571 %R 10.2196/25078 %U https://formative.jmir.org/2021/5/e25078 %U https://doi.org/10.2196/25078 %U http://www.ncbi.nlm.nih.gov/pubmed/34032571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24766 %T Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation %A Ali,Zarqa %A Joergensen,Kristina Melbardis %A Andersen,Anders Daniel %A Chiriac,Andrei %A Bjerre-Christensen,Theis %A Manole,Ionela %A Dutei,Ana-Maria %A Deaconescu,Irina %A Suru,Alina %A Serban,Adina %A Isberg,Ari Pall %A Dahiya,Priyanka %A Thomsen,Simon Francis %A Zibert,John Robert %+ Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark, 45 60122596, zarqa_ali@hotmail.com %K atopic dermatitis %K eczema %K remote assessment %K photo %K photographs %K EASI %K SCORAD %K severity %K assessment %K agreement %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground. Objective: We aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation. Methods: During scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability. Results: A total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively. Conclusions: In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low. %M 34032580 %R 10.2196/24766 %U https://formative.jmir.org/2021/5/e24766 %U https://doi.org/10.2196/24766 %U http://www.ncbi.nlm.nih.gov/pubmed/34032580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22915 %T A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study %A McMaughan,Darcy Jones %A Lin,Sherry %A Ozmetin,Jennifer %A Beverly,Judith Gayle %A Brog,Joshua %A Naiser,Emily %+ Oklahoma State University, 423 Willard, Stillwater, OK, United States, 1 979 204 3983, darcy.mcmaughan@okstate.edu %K youth with special health care needs %K health care transitions %K eHealth %K usability %K concurrent think aloud method %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. %M 34032579 %R 10.2196/22915 %U https://formative.jmir.org/2021/5/e22915 %U https://doi.org/10.2196/22915 %U http://www.ncbi.nlm.nih.gov/pubmed/34032579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26402 %T Optimization of Patient Flow in Urgent Care Centers Using a Digital Tool for Recording Patient Symptoms and History: Simulation Study %A Montazeri,Maryam %A Multmeier,Jan %A Novorol,Claire %A Upadhyay,Shubhanan %A Wicks,Paul %A Gilbert,Stephen %+ Ada Health GmbH, Karl-Liebknecht-Str 1, Berlin, 10178, Germany, 49 3040367390, science@ada.com %K symptom assessment app %K discrete event simulation %K health care system %K patient flow modeling %K patient flow %K simulation %K urgent care %K waiting times %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Crowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app. Objective: We simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff. Methods: A discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario. Results: Discrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17%, whereas a time saving of 5 minutes led to a 54.88% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times. Conclusions: Small time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale. %M 34018963 %R 10.2196/26402 %U https://formative.jmir.org/2021/5/e26402 %U https://doi.org/10.2196/26402 %U http://www.ncbi.nlm.nih.gov/pubmed/34018963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25969 %T mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives %A Magee,Michael Reece %A McNeilage,Amy Gray %A Avery,Nicholas %A Glare,Paul %A Ashton-James,Claire Elizabeth %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Lvl 2 Douglas Building, Royal North Shore Hospital, St Leonards, 2065, Australia, 61 294631528, claire.ashton-james@sydney.edu.au %K prescription opioids %K chronic noncancer pain %K tapering %K digital health %K support %K mobile health technology %K SMS %K mobile phone %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging– or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support. Objective: This study aims to examine patients’ use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Methods: A total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients’ experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants’ typical mobile phone use and level of interest in mobile technology–based support for opioid tapering. Semistructured interviews further explored patients’ use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data. Results: All participants reported owning and using a mobile phone, and most (17/21, 81%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging–based (17/21, 81%) and app-based (15/21, 71%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement. Conclusions: The results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging–based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients’ preferences for functionality, content, and design are addressed. %M 34003133 %R 10.2196/25969 %U https://formative.jmir.org/2021/5/e25969 %U https://doi.org/10.2196/25969 %U http://www.ncbi.nlm.nih.gov/pubmed/34003133 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24566 %T The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study %A Bowling,April B %A Slavet,James %A Hendrick,Chelsea %A Beyl,Robbie %A Nauta,Phillip %A Augustyn,Marilyn %A Mbamalu,Mediatrix %A Curtin,Carol %A Bandini,Linda %A Must,Aviva %A Staiano,Amanda E %+ Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845, United States, 1 978 837 5187, bowlinga@merrimack.edu %K exercise %K diet %K sleep %K mental health %K children %K adolescent %K health promotion %K telehealth %K exergaming %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. Objective: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. Methods: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. Results: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. Conclusions: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. Trial Registration: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415. %M 33988508 %R 10.2196/24566 %U https://formative.jmir.org/2021/5/e24566 %U https://doi.org/10.2196/24566 %U http://www.ncbi.nlm.nih.gov/pubmed/33988508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26163 %T A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach %A Potzel,Anne Lotte %A Gar,Christina %A Seissler,Jochen %A Lechner,Andreas %+ Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich, 80336, Germany, 49 894 400 521 85, andreas.lechner@med.uni-muenchen.de %K mHealth %K diabetes prevention %K health behavior %K cardiometabolic disease %K gestational diabetes mellitus %K smartphone app %K intervention mapping %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective: The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women’s expected standards of commercial health apps. Methods: The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (“TRIANGLE”) was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results: The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features—a challenge system, human coaching, and a library—address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions: The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration: German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736 %M 33973864 %R 10.2196/26163 %U https://mhealth.jmir.org/2021/5/e26163 %U https://doi.org/10.2196/26163 %U http://www.ncbi.nlm.nih.gov/pubmed/33973864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25503 %T Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study %A Sezgin,Emre %A Noritz,Garey %A Lin,Simon %A Huang,Yungui %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, esezgin1@gmail.com %K children with special health care needs %K care management %K care coordination %K voice-enabled mobile app %K health information technology %K voice assistant %K voice interaction %K mobile phone %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. %M 33865233 %R 10.2196/25503 %U https://formative.jmir.org/2021/5/e25503 %U https://doi.org/10.2196/25503 %U http://www.ncbi.nlm.nih.gov/pubmed/33865233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27868 %T Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study %A Darcy,Alison %A Daniels,Jade %A Salinger,David %A Wicks,Paul %A Robinson,Athena %+ Woebot Health, 650 Fifth Street, San Francisco, CA, , United States, 1 851694777, alison@woebothealth.com %K conversational agents %K mobile mental health %K chatbots %K depression %K anxiety %K digital health %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are far more patients in mental distress than there is time available for mental health professionals to support them. Although digital tools may help mitigate this issue, critics have suggested that technological solutions that lack human empathy will prevent a bond or therapeutic alliance from being formed, thereby narrowing these solutions’ efficacy. Objective: We aimed to investigate whether users of a cognitive behavioral therapy (CBT)–based conversational agent would report therapeutic bond levels that are similar to those in literature about other CBT modalities, including face-to-face therapy, group CBT, and other digital interventions that do not use a conversational agent. Methods: A cross-sectional, retrospective study design was used to analyze aggregate, deidentified data from adult users who self-referred to a CBT-based, fully automated conversational agent (Woebot) between November 2019 and August 2020. Working alliance was measured with the Working Alliance Inventory-Short Revised (WAI-SR), and depression symptom status was assessed by using the 2-item Patient Health Questionnaire (PHQ-2). All measures were administered by the conversational agent in the mobile app. WAI-SR scores were compared to those in scientific literature abstracted from recent reviews. Results: Data from 36,070 Woebot users were included in the analysis. Participants ranged in age from 18 to 78 years, and 57.48% (20,734/36,070) of participants reported that they were female. The mean PHQ-2 score was 3.03 (SD 1.79), and 54.67% (19,719/36,070) of users scored over the cutoff score of 3 for depression screening. Within 5 days of initial app use, the mean WAI-SR score was 3.36 (SD 0.8) and the mean bond subscale score was 3.8 (SD 1.0), which was comparable to those in recent studies from the literature on traditional, outpatient, individual CBT and group CBT (mean bond subscale scores of 4 and 3.8, respectively). PHQ-2 scores at baseline weakly correlated with bond scores (r=−0.04; P<.001); however, users with depression and those without depression had high bond scores of 3.45. Conclusions: Although bonds are often presumed to be the exclusive domain of human therapeutic relationships, our findings challenge the notion that digital therapeutics are incapable of establishing a therapeutic bond with users. Future research might investigate the role of bonds as mediators of clinical outcomes, since boosting the engagement and efficacy of digital therapeutics could have major public health benefits. %M 33973854 %R 10.2196/27868 %U https://formative.jmir.org/2021/5/e27868 %U https://doi.org/10.2196/27868 %U http://www.ncbi.nlm.nih.gov/pubmed/33973854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26186 %T Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study %A Lai,Jocelyn %A Rahmani,Amir %A Yunusova,Asal %A Rivera,Alexander P %A Labbaf,Sina %A Hu,Sirui %A Dutt,Nikil %A Jain,Ramesh %A Borelli,Jessica L %+ UCI THRIVE Lab, Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 4086565508, jocelyn.lai@uci.edu %K COVID-19 %K emerging adulthood %K multimodal personal chronicles %K case study %K wearable internet of things %K individualized mHealth %K college students %K mental health %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The year 2020 has been challenging for many, particularly for young adults who have been adversely affected by the COVID-19 pandemic. Emerging adulthood is a developmental phase with significant changes in the patterns of daily living; it is a risky phase for the onset of major mental illness. College students during the pandemic face significant risk, potentially losing several protective factors (eg, housing, routine, social support, job, and financial security) that are stabilizing for mental health and physical well-being. Individualized multiple assessments of mental health, referred to as multimodal personal chronicles, present an opportunity to examine indicators of health in an ongoing and personalized way using mobile sensing devices and wearable internet of things. Objective: To assess the feasibility and provide an in-depth examination of the impact of the COVID-19 pandemic on college students through multimodal personal chronicles, we present a case study of an individual monitored using a longitudinal subjective and objective assessment approach over a 9-month period throughout 2020, spanning the prepandemic period of January through September. Methods: The individual, referred to as Lee, completed psychological assessments measuring depression, anxiety, and loneliness across 4 time points in January, April, June, and September. We used the data emerging from the multimodal personal chronicles (ie, heart rate, sleep, physical activity, affect, behaviors) in relation to psychological assessments to understand patterns that help to explicate changes in the individual’s psychological well-being across the pandemic. Results: Over the course of the pandemic, Lee’s depression severity was highest in April, shortly after shelter-in-place orders were mandated. His depression severity remained mildly severe throughout the rest of the months. Associations in positive and negative affect, physiology, sleep, and physical activity patterns varied across time periods. Lee’s positive affect and negative affect were positively correlated in April (r=0.53, P=.04) whereas they were negatively correlated in September (r=–0.57, P=.03). Only in the month of January was sleep negatively associated with negative affect (r=–0.58, P=.03) and diurnal beats per minute (r=–0.54, P=.04), and then positively associated with heart rate variability (resting root mean square of successive differences between normal heartbeats) (r=0.54, P=.04). When looking at his available contextual data, Lee noted certain situations as supportive coping factors and other situations as potential stressors. Conclusions: We observed more pandemic concerns in April and noticed other contextual events relating to this individual’s well-being, reflecting how college students continue to experience life events during the pandemic. The rich monitoring data alongside contextual data may be beneficial for clinicians to understand client experiences and offer personalized treatment plans. We discuss benefits as well as future directions of this system, and the conclusions we can draw regarding the links between the COVID-19 pandemic and college student mental health. %M 33882022 %R 10.2196/26186 %U https://formative.jmir.org/2021/5/e26186 %U https://doi.org/10.2196/26186 %U http://www.ncbi.nlm.nih.gov/pubmed/33882022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e20779 %T Video Consultation as an Adequate Alternative to Face-to-Face Consultation in Continuous Positive Airway Pressure Use for Newly Diagnosed Patients With Obstructive Sleep Apnea: Randomized Controlled Trial %A Kooij,Laura %A Vos,Petra JE %A Dijkstra,Antoon %A Roovers,Elisabeth A %A van Harten,Wim H %+ Rijnstate, Wagnerlaan 55, Arnhem, Netherlands, 31 088 0058888, WvanHarten@Rijnstate.nl %K video consultation %K eHealth %K obstructive sleep apnea %K continuous positive airway pressure %K randomized controlled trial %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of continuous positive airway pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (eg, self-efficacy) and support during treatment have been found to be important in CPAP use. Video consultation may be useful to support patients during treatment. So far, video consultation has rarely been evaluated in thorough controlled research, with only a limited number of outcomes assessed. Objective: The aim of the study was to evaluate the superiority of video consultation over face-to-face consultation for patients with obstructive sleep apnea (OSA) on CPAP use (minutes per night), adherence, self-efficacy, risk outcomes, outcome expectancies, expectations and experiences with video consultation, and satisfaction of patients and nurses. Methods: A randomized controlled trial was conducted with an intervention (video consultation) and a usual care group (face-to-face consultation). Patients with confirmed OSA (apnea-hypopnea index >15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet or smartphone, and proficient in the Dutch language were recruited from a large teaching hospital. CPAP use was monitored remotely, with short-term (weeks 1 to 4) and long-term (week 4, week 12, and week 24) assessments. Questionnaires were completed at baseline and after 4 weeks on self-efficacy, risk perception, outcome expectancies (Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultation (covering constructs of the unified theory of acceptance and use of technology), and satisfaction. Nurse satisfaction was evaluated using questionnaires. Results: A total of 140 patients were randomized (1:1 allocation). The use of video consultation for OSA patients does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. A significant difference in change over time was found between groups for short-term (P-interaction=.008) but not long-term (P-interaction=.68) CPAP use. CPAP use decreased in the long term (P=.008), but no significant difference was found between groups (P=.09). Change over time for adherence was not significantly different in the short term (P-interaction=.17) or long term (P-interaction=.51). A relation was found between CPAP use and self-efficacy (P=.001), regardless of the intervention arm (P=.25). No significant difference between groups was found for outcome expectancies (P=.64), self-efficacy (P=.41), and risk perception (P=.30). The experiences were positive, and 95% (60/63) intended to keep using video consultation. Patients in both groups rated the consultations on average with an 8.4. Overall, nurses (n=3) were satisfied with the video consultation system. Conclusions: Support of OSA patients with video consultation does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. The findings of this research suggest that self-efficacy is an important factor in improving CPAP use and that video consultation may be a feasible way to support patients starting CPAP. Future research should focus on blended care approaches in which self-efficacy receives greater emphasis. Trial Registration: Clinicaltrials.gov NCT04563169; https://clinicaltrials.gov/show/NCT04563169 %M 33973866 %R 10.2196/20779 %U https://formative.jmir.org/2021/5/e20779 %U https://doi.org/10.2196/20779 %U http://www.ncbi.nlm.nih.gov/pubmed/33973866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e28668 %T A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study %A Petrocchi,Serena %A Filipponi,Chiara %A Montagna,Giacomo %A Bonollo,Marta %A Pagani,Olivia %A Meani,Francesco %+ Department of Obstetrics and Gynecology, Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Capelli 1, Viganello, 6962, Switzerland, 41 091 811 63 08, francesco.meani@eoc.ch %K breast cancer %K decision-making process %K breast cancer patient %K smartphone app %K empowerment %K breast cancer journey %K mobile app %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35%), organizing the cure path and being aware of the steps in cancer management (5/20, 25%), facilitating doctor-patient communication (4/20, 20%), and having detailed information about the resources offered by the hospital (2/20, 10%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital’s electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. %M 33970120 %R 10.2196/28668 %U https://formative.jmir.org/2021/5/e28668 %U https://doi.org/10.2196/28668 %U http://www.ncbi.nlm.nih.gov/pubmed/33970120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23809 %T Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis %A Graham,Andrea K %A Munson,Sean A %A Reddy,Madhu %A Neubert,Sarah W %A Green,Emilie A %A Chang,Angela %A Spring,Bonnie %A Mohr,David C %A Wildes,Jennifer E %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 5266, andrea.graham@northwestern.edu %K obesity %K binge eating %K user-centered design %K mobile intervention %K engagement %K experimental therapeutics %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. %M 33970114 %R 10.2196/23809 %U https://formative.jmir.org/2021/5/e23809 %U https://doi.org/10.2196/23809 %U http://www.ncbi.nlm.nih.gov/pubmed/33970114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18096 %T Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study %A de Looff,Pieter Christiaan %A Nijman,Henk %A Didden,Robert %A Noordzij,Matthijs L %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, Netherlands, 31 030 2256405, peterdelooff@gmail.com %K forensic psychiatry %K wearable biosensors %K intellectual disabilities %K usability %K acceptance %K continuous use %K emotion regulation %K behavior regulation %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods: A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use. %M 33970115 %R 10.2196/18096 %U https://formative.jmir.org/2021/5/e18096 %U https://doi.org/10.2196/18096 %U http://www.ncbi.nlm.nih.gov/pubmed/33970115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e16156 %T A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability %A Peltola,Maria Kristiina %A Poikonen-Saksela,Paula %A Mattson,Johanna %A Parkkari,Timo %+ Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Paciuksenkatu 3, Helsinki, 00029, Finland, 358 504900591, maria.k.peltola@hus.fi %K electronic patient-reported outcome %K adverse events %K patients with cancer %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona’s suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93%) patients and 15/17 (88%) professionals reported that the program was easy or quite easy to use; 38/44 (86%) patients and 11/17 (65%) professionals found Noona reliable, and 38/44 (86%) patients and 10/17 (59%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient’s symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. %M 33955841 %R 10.2196/16156 %U https://formative.jmir.org/2021/5/e16156 %U https://doi.org/10.2196/16156 %U http://www.ncbi.nlm.nih.gov/pubmed/33955841 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e23671 %T Cancer Clinicians’ Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study %A Richards,Rebecca %A Kinnersley,Paul %A Brain,Kate %A Wood,Fiona %+ Division of Population Medicine, Cardiff University, 503, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, United Kingdom, 44 029206 87185, wood@cf.ac.uk %K education, medical %K medical information exchange %K smartphone %K mobile apps %K mobile phone %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients’ needs and can provide further insight into the type of app and features that might be most beneficial. Objective: This study aims to explore cancer clinicians’ views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored. Methods: A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis. Results: Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians’ workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients’ age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. Conclusions: This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process. %M 33955836 %R 10.2196/23671 %U https://cancer.jmir.org/2021/2/e23671 %U https://doi.org/10.2196/23671 %U http://www.ncbi.nlm.nih.gov/pubmed/33955836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26590 %T A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation %A Golden,Eddye A %A Zweig,Micol %A Danieletto,Matteo %A Landell,Kyle %A Nadkarni,Girish %A Bottinger,Erwin %A Katz,Lindsay %A Somarriba,Ricardo %A Sharma,Vansh %A Katz,Craig L %A Marin,Deborah B %A DePierro,Jonathan %A Charney,Dennis S %+ Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Fl, New York, NY, 10065, United States, 1 4014398798, eddye.golden@mssm.edu %K mHealth %K resilience %K mental health %K COVID-19 %K HCWs %K digital health %K health app %K mental health platform %K mobile phone %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. %M 33872189 %R 10.2196/26590 %U https://formative.jmir.org/2021/5/e26590 %U https://doi.org/10.2196/26590 %U http://www.ncbi.nlm.nih.gov/pubmed/33872189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24118 %T Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study %A Haque,Saira Naim %A DeStefano,Sydney %A Banger,Alison %A Rutledge,Regina %A Romaire,Melissa %+ RTI International, 3040 E Cornwallis Street, Research Triangle Park, NC, 27709, United States, 1 919 541 6894, mromaire@rti.org %K telehealth %K rural health %K health IT %K telemedicine %K virtual care %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods: This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. %M 33949958 %R 10.2196/24118 %U https://formative.jmir.org/2021/5/e24118 %U https://doi.org/10.2196/24118 %U http://www.ncbi.nlm.nih.gov/pubmed/33949958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23974 %T Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis %A Fahey,Margaret C %A Klesges,Robert C %A Kocak,Mehmet %A Gladney,Leslie A %A Talcott,Gerald W %A Krukowski,Rebecca A %+ Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38105, United States, 1 901 448 2426, rkrukows@uthsc.edu %K technology-based intervention %K counselor communication %K counselor feedback %K counselor %K weight loss %K lifestyle %K wellness %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Feedback for participants’ self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. Objective: The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. Methods: The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. Results: There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). Conclusions: Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 %M 33949954 %R 10.2196/23974 %U https://formative.jmir.org/2021/5/e23974 %U https://doi.org/10.2196/23974 %U http://www.ncbi.nlm.nih.gov/pubmed/33949954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23599 %T Impact of an Online Gastrointestinal Symptom History Taker on Physician Documentation and Charting Time: Pragmatic Controlled Trial %A Hall,Natalie J %A Berry,Sameer K %A Aguilar,Jack %A Brier,Elizabeth %A Shah,Parth %A Cheng,Derek %A Herman,Jeremy %A Stein,Theodore %A Spiegel,Brennan M R %A Almario,Christopher V %+ Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite 800, Los Angeles, CA, 90048, United States, 1 310 423 4462, Christopher.Almario@csmc.edu %K patient-provider portal %K computer-generated patient history %K patient-reported outcome %K gastrointestinal %K EHR %D 2021 %7 4.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A potential benefit of electronic health records (EHRs) is that they could potentially save clinician time and improve documentation by auto-generating the history of present illness (HPI) in partnership with patients prior to the clinic visit. We developed an online patient portal called AEGIS (Automated Evaluation of Gastrointestinal [GI] Symptoms) that systematically collects patient GI symptom information and then transforms the data into a narrative HPI that is available for physicians to review in the EHR prior to seeing the patient. Objective: This study aimed to compare whether use of an online GI symptom history taker called AEGIS improves physician-centric outcomes vs usual care. Methods: We conducted a pragmatic controlled trial among adults aged ≥18 years scheduled for a new patient visit at 4 GI clinics at an academic medical center. Patients who completed AEGIS were matched with controls in the intervention period who did not complete AEGIS as well as controls who underwent usual care in the pre-intervention period. Of note, the pre-intervention control group was formed as it was not subject to contamination bias, unlike for post-intervention controls. We then compared the following outcomes among groups: (1) documentation of alarm symptoms, (2) documentation of family history of GI malignancy, (3) number of follow-up visits in a 6-month period, (4) number of tests ordered in a 6-month period, and (5) charting time (difference between appointment time and time the encounter was closed). Multivariable regression models were used to adjust for potential confounding. Results: Of the 774 patients who were invited to complete AEGIS, 116 (15.0%) finished it prior to their visit. The 116 AEGIS patients were then matched with 343 and 102 controls in the pre- and post-intervention periods, respectively. There were no statistically significant differences among the groups for documentation of alarm symptoms and GI cancer family history, number of follow-up visits and ordered tests, or charting time (all P>.05). Conclusions: Use of a validated online HPI-generation portal did not improve physician documentation or reduce workload. Given universal adoption of EHRs, further research examining how to optimally leverage patient portals for improving outcomes are needed. %M 33944789 %R 10.2196/23599 %U https://formative.jmir.org/2021/5/e23599 %U https://doi.org/10.2196/23599 %U http://www.ncbi.nlm.nih.gov/pubmed/33944789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26294 %T Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study %A AlHadi,Ahmad N %A Alammari,Khawla A %A Alsiwat,Lojain J %A Alhaidri,Nojood E %A Alabdulkarim,Nouf H %A Altwaijri,Nouf A %A AlSohaili,Shamma A %+ Department of Psychiatry, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia, 966 118066346, alhadi@ksu.edu.sa %K CBT %K iCBT %K cCBT %K knowledge %K attitude %K mental health care professionals %K computer usage %K psychotherapy %K therapy %K cognitive behavioral therapy %K health care worker %K perception %K Saudi Arabia %K preference %K mental health %D 2021 %7 3.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population. %M 33938810 %R 10.2196/26294 %U https://formative.jmir.org/2021/5/e26294 %U https://doi.org/10.2196/26294 %U http://www.ncbi.nlm.nih.gov/pubmed/33938810 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e27164 %T Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 %A Albright,Glenn %A Khalid,Nikita %A Shockley,Kristen %A Robinson,Kelsey %A Hughes,Kevin %A Pace-Danley,Bethany %+ Peer Assistance Services, Inc, 2170 South Parker Road, Suite 229, Denver, CO, 80231, United States, 1 303 369 0039 ext 245, bpace-danley@peerassist.org %K simulations %K behavior change %K motivational interviewing %K virtual humans %K role play %K substance use %K prevention %K alcohol %K public awareness %K innovation %K interview %K COVID-19 %K pilot study %K simulation %K communication %K problem solving %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives. Objective: This pilot study examines the impact of the One Degree: Shift the Influence role play simulation, designed to teach family, friends, and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use. Methods: Participants recruited for this mixed methods study completed a presurvey, the simulation, and a postsurvey, and were sent a 6-week follow-up survey. The simulation involves practicing a role play conversation with a virtual human coded with emotions, a memory, and a personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing. Results: A matched sample analysis of variance revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.01), including starting a conversation with someone regarding substance use, avoiding upsetting someone while bringing up concerns, focusing on observable facts, and problem solving. Qualitative data provided further evidence of the simulation’s positive impact on the ability to have meaningful conversations about substance use. Conclusions: This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence that use role play practice can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention. %M 33848972 %R 10.2196/27164 %U https://formative.jmir.org/2021/4/e27164 %U https://doi.org/10.2196/27164 %U http://www.ncbi.nlm.nih.gov/pubmed/33848972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25299 %T Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach %A Hernandez-Ramos,Rosa %A Aguilera,Adrian %A Garcia,Faviola %A Miramontes-Gomez,Jose %A Pathak,Laura Elizabeth %A Figueroa,Caroline Astrid %A Lyles,Courtney Rees %+ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94110, United States, 1 628 206 6483, courtney.Lyles@ucsf.edu %K digital literacy %K digital divide %K underserved %K patient-centered %K digital health %K mhealth %K intervention %K telehealth %K COVID-19 %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre–COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre–COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient’s digital literacy skills. Comparing recruitment during pre–COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre–COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 %M 33872184 %R 10.2196/25299 %U https://formative.jmir.org/2021/4/e25299 %U https://doi.org/10.2196/25299 %U http://www.ncbi.nlm.nih.gov/pubmed/33872184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25462 %T Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial %A Yeo,Pei Shi %A Nguyen,Tu Ngoc %A Ng,Mary Pei Ern %A Choo,Robin Wai Munn %A Yap,Philip Lin Kiat %A Ng,Tze Pin %A Wee,Shiou Liang %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Tower E, Level 4, Singapore, 768024, Singapore, 65 6592 4606, weeshiouliang@gmail.com %K group-based computerized cognitive training %K cognition %K gait %K community program implementation %K healthy older adults %K cognitive %K community program %K cognitive training %K elderly %K aging %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive training can improve cognition in healthy older adults. Objective: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=–0.57, P=.01, 95% CI [–1.00 to –0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=–13.5, P=.01, 95% CI [–23.95 to –3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [–0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=–0.36, P=.08, 95% CI [–0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [–0.05 to 0.96]) that were not statistically significant. Conclusions: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. Trial Registration: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591 %M 33904819 %R 10.2196/25462 %U https://formative.jmir.org/2021/4/e25462 %U https://doi.org/10.2196/25462 %U http://www.ncbi.nlm.nih.gov/pubmed/33904819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26213 %T A Brief Training Program to Support the Use of a Digital Pill System for Medication Adherence: Pilot Descriptive Study %A Chai,Peter R %A Bustamante,Maria J %A Goodman,Georgia %A Mohamed,Yassir %A Najarro,Jesse %A Sullivan,Matthew C %A Castillo-Mancilla,Jose %A Coyle,Ryan P %A Mayer,Kenneth H %A Rosen,Rochelle K %A Baumgartner,Susan L %A Alpert,Pamela E %A Boyer,Edward W %A O'Cleirigh,Conall %+ Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02411, United States, 1 617 732 5640, pchai@bwh.harvard.edu %K digital pill system %K technology training %K HIV prevention %K PrEP %K ingestible sensors %K mobile phone %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital pill systems (DPSs), which comprise ingestible radiofrequency sensors integrated into a gelatin capsule that overencapsulates a medication, can directly measure ingestion events. Objective: Teaching users to operate a DPS is vital to ensure the collection of actionable ingestion and adherence data. In this study, we aim to develop and pilot a training program, grounded in the Technology Acceptance Model, to instruct individuals on DPS operation. Methods: A two-part training program, comprising in-person and text message–based components, was used with HIV-negative men who have sex with men with nonalcohol substance use, who had enrolled in a 90-day pilot demonstration study using the DPS to measure adherence to pre-exposure prophylaxis. We assessed the number of responses to text check-ins, the number and types of episodes where technical support was requested, the resolutions of such issues, and engagement with the program over the study period. Participant feedback on the program was evaluated through qualitative user experience interviews. Results: A total of 15 participants were enrolled in and completed the program. Seven technical challenges related to DPS operations were reported across 5 participants. Most commonly, participants requested support connecting the wearable Reader device with their smartphone, charging the Reader, and operating the mobile app. A total of 6 issues were resolved asynchronously or in real time via phone; 1 required in-person evaluation and resolution. Preliminary qualitative findings indicate that both the in-person and remote follow-up components of the training program were perceived as acceptable. Suggested improvements included repeated DPS refresher sessions at in-person follow-up visits and enhanced written materials for the independent resolution of technological issues. Conclusions: A brief two-part DPS training program, drawing from individuals’ experiences and from the Technology Acceptance Model, can provide valuable insights for users. The program also identifies and addresses several areas of actual or potential challenges related to operating a DPS and allows for the resolution of such issues within the first week of DPS use. %M 33890863 %R 10.2196/26213 %U https://formative.jmir.org/2021/4/e26213 %U https://doi.org/10.2196/26213 %U http://www.ncbi.nlm.nih.gov/pubmed/33890863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23432 %T A Mental Health–Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study %A McKeon,Grace %A Steel,Zachary %A Wells,Ruth %A Newby,Jill %A Hadzi-Pavlovic,Dusan %A Vancampfort,Davy %A Rosenbaum,Simon %+ School of Psychiatry, University of New South Wales, Level 1, AGSM, Botany Street, Sydney, 2031, Australia, 61 9065 9097, g.mckeon@unsw.edu.au %K physical activity %K PTSD %K social media %K first responders %K mental health %K families %K online %K exercise %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. Objective: This study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. Methods: We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. Results: In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant. Conclusions: The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246. %M 33885376 %R 10.2196/23432 %U https://formative.jmir.org/2021/4/e23432 %U https://doi.org/10.2196/23432 %U http://www.ncbi.nlm.nih.gov/pubmed/33885376 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21678 %T Chatbot-Based Assessment of Employees’ Mental Health: Design Process and Pilot Implementation %A Hungerbuehler,Ines %A Daley,Kate %A Cavanagh,Kate %A Garcia Claro,Heloísa %A Kapps,Michael %+ Vitalk, TNH Health, R. Pais Leme, 215 - Sala 2504, Pinheiros, São Paulo, 05424-150, Brazil, 55 11963883018, drkatedaley@gmail.com %K chatbot %K conversational agent %K online %K digital health %K mobile phone %K mental health %K workplace %K work stress %K survey %K response rate %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. Objective: The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. Methods: A fully automated chatbot (“Viki”) was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium–sized enterprise (120 employees). Results: The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. Conclusions: A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews. %M 33881403 %R 10.2196/21678 %U https://formative.jmir.org/2021/4/e21678 %U https://doi.org/10.2196/21678 %U http://www.ncbi.nlm.nih.gov/pubmed/33881403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19564 %T Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study %A Palotai,Miklos %A Wallack,Max %A Kujbus,Gergo %A Dalnoki,Adam %A Guttmann,Charles %+ Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215, United States, 1 617 278 0613, palotai@bwh.harvard.edu %K multiple sclerosis %K fatigue %K depression %K mobile application %K mobile phone %K real-time assessment %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. %M 33861208 %R 10.2196/19564 %U https://mhealth.jmir.org/2021/4/e19564 %U https://doi.org/10.2196/19564 %U http://www.ncbi.nlm.nih.gov/pubmed/33861208 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e20468 %T Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial %A Park,Linda G %A Elnaggar,Abdelaziz %A Lee,Sei J %A Merek,Stephanie %A Hoffmann,Thomas J %A Von Oppenfeld,Julia %A Ignacio,Nerissa %A Whooley,Mary A %+ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Room 531A, San Francisco, CA, United States, 1 415 221 4810 ext 22573, abdelaziz.elnaggar@ucsf.edu %K physical activity %K cardiac rehabilitation %K digital health %K mobile app %K wearable device %K mHealth %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 %M 33861204 %R 10.2196/20468 %U https://formative.jmir.org/2021/4/e20468 %U https://doi.org/10.2196/20468 %U http://www.ncbi.nlm.nih.gov/pubmed/33861204 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24647 %T A Gamified, Social Media–Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial %A Boyle,Sarah C %A LaBrie,Joseph W %+ HeadsUp Labs, Department of Psychology, Loyola Marymount University, 1 LMU Drive, Suite 3787, Los Angeles, CA, 90045, United States, 1 8182909940, sarah.boyle@lmu.edu %K sexual minority women %K alcohol %K intervention %K social norms %K gamification %K protocol %K mobile phone %D 2021 %7 16.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge. Objective: This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ). Methods: The core components of a PNF intervention were delivered within LezParlay, a fun, social media–inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded. Results: Analyses will evaluate whether PNF on alcohol use reduces participants’ drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits. Conclusions: This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): DERR1-10.2196/24647 %M 33861212 %R 10.2196/24647 %U https://www.researchprotocols.org/2021/4/e24647 %U https://doi.org/10.2196/24647 %U http://www.ncbi.nlm.nih.gov/pubmed/33861212 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e21586 %T Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process %A Noack,Eva Maria %A Schulze,Jennifer %A Müller,Frank %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 55139 68193, evamaria.noack@med.uni-goettingen.de %K paramedic %K interpreter %K medical translation %K application software %K app %K digital communication tool %K foreign-language patients %K language barrier %K participatory design %K prehospital emergency care %K emergency medical service %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented. Objective: We aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients. Methods: We actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field. Results: With input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history–taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive. Conclusions: The nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics’ work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use. Trial Registration: German Clinical Trials Register DRKS00016719; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016719 International Registered Report Identifier (IRRID): RR2-10.1186/s12913-020-05098-5 %M 33851933 %R 10.2196/21586 %U https://mhealth.jmir.org/2021/4/e21586 %U https://doi.org/10.2196/21586 %U http://www.ncbi.nlm.nih.gov/pubmed/33851933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24976 %T Feasibility and Acceptability of a Smoking Cessation Smartphone App (My QuitBuddy) in Older Persons: Pilot Randomized Controlled Trial %A Peek,Jenny %A Hay,Karen %A Hughes,Pauline %A Kostellar,Adrienne %A Kumar,Subodh %A Bhikoo,Zaheerodin %A Serginson,John %A Marshall,Henry M %+ The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Level 2, Admin Building, Rode Rd, Chermside, 4032, Australia, 61 (07) 3139 6802, jenny.peek@health.qld.gov.au %K mHealth %K mobile apps %K motivation %K smartphone %K smoking cessation %K tobacco smoking %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike. Objective: We conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers. Methods: Adult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the “My QuitBuddy” smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence. Results: We randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14. Conclusions: Internet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user–app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true %M 33851923 %R 10.2196/24976 %U https://formative.jmir.org/2021/4/e24976 %U https://doi.org/10.2196/24976 %U http://www.ncbi.nlm.nih.gov/pubmed/33851923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23304 %T A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study %A Lim,Ji Young %A Kim,Jong Kwang %A Kim,Yoon %A Ahn,So-Yeon %A Yu,Jonghan %A Hwang,Ji Hye %+ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea, 82 2 3410 2816, jhlee.hwang@samsung.com %K breast cancer %K mobile health %K rehabilitation %K cancer continuum %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. %M 33847589 %R 10.2196/23304 %U https://formative.jmir.org/2021/4/e23304 %U https://doi.org/10.2196/23304 %U http://www.ncbi.nlm.nih.gov/pubmed/33847589 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e20461 %T A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation %A Cerbas,Shannon %A Kelemen,Arpad %A Liang,Yulan %A Sik-Lanyi,Cecilia %A Van de Castle,Barbara %+ University of Maryland, Baltimore, 655 W Lombard St, Baltimore, MD, 21201, United States, 1 410 706 4812, liang@umaryland.edu %K cancer %K mobile app %K gamification %K bone marrow transplant %K alpha testing %K physical activity %D 2021 %7 13.4.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. Objective: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. Methods: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Results: Internal consistency and the instrument’s reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach α=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). Conclusions: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game’s assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery. %M 37725560 %R 10.2196/20461 %U https://xmed.jmir.org/2021/2/e20461 %U https://doi.org/10.2196/20461 %U http://www.ncbi.nlm.nih.gov/pubmed/37725560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25513 %T A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App %A Thornton,Louise %A Gardner,Lauren Anne %A Osman,Bridie %A Green,Olivia %A Champion,Katrina Elizabeth %A Bryant,Zachary %A Teesson,Maree %A Kay-Lambkin,Frances %A Chapman,Cath %A , %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), 160 City Road, Sydney, 2006, Australia, 61 286279012, lauren.gardner@sydney.edu.au %K mHealth %K mobile phone %K chronic disease %K adolescents %K health promotion %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. %M 33843590 %R 10.2196/25513 %U https://formative.jmir.org/2021/4/e25513 %U https://doi.org/10.2196/25513 %U http://www.ncbi.nlm.nih.gov/pubmed/33843590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21127 %T Brief Interventions via Electronic Health Record Messaging for Population-Based Suicide Prevention: Mixed Methods Pilot Study %A Whiteside,Ursula %A Richards,Julie %A Simon,Gregory E %+ NowMattersNow.org, 1645 140th Ave NE, Suite A41053, Bellevue, WA, 98005, United States, 1 206 679 6349, ursulawhiteside@gmail.com %K suicide %K suicide prevention %K dialectical behavior therapy %K caring message %K web-based %K NowMattersNow.org %K prevention %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: New opportunities to create and evaluate population-based selective prevention programs for suicidal behavior are emerging in health care settings. Standard depression severity measures recorded in electronic medical records (EMRs) can be used to identify patients at risk for suicide and suicide attempt, and promising interventions for reducing the risk of suicide attempt in at-risk populations can be adapted for web-based delivery in health care. Objective: This study aims to evaluate a pilot of a psychoeducational program, focused on developing emotion regulation techniques via a web-based dialectical behavior therapy (DBT) skills site, including four DBT skills, and supported by secure message coaching, including elements of caring messages. Methods: Patients were eligible based on the EMR-documented responses to the Patient Health Questionnaire indicating suicidal thoughts. We measured feasibility via the proportion of invitees who opened program invitations, visited the web-based consent form page, and consented; acceptability via qualitative feedback from participants about the DBT program; and engagement via the proportion of invitees who began DBT skills as well as the number of website visits for DBT skills and the degree of site engagement. Results: A total of 60 patients were invited to participate. Overall, 93% (56/60) of the patients opened the invitation and 43% (26/60) consented to participate. DBT skills website users visited the home page on an average of 5.3 times (SD 6.0). Procedures resulted in no complaints and some participant feedback emphasizing the usefulness of DBT skills. Conclusions: This study supports the potential of using responses to patient health questionnaires in EMRs to identify a high-risk population and offer key elements of caring messages and DBT adapted for a low-intensity intervention. A randomized trial evaluating the effectiveness of this program is now underway (ClinicalTrials.gov: NCT02326883). %M 33843599 %R 10.2196/21127 %U https://formative.jmir.org/2021/4/e21127 %U https://doi.org/10.2196/21127 %U http://www.ncbi.nlm.nih.gov/pubmed/33843599 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e22399 %T A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers %A Seljelid,Berit %A Varsi,Cecilie %A Solberg Nes,Lise %A Øystese,Kristin Astrid %A Børøsund,Elin %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Box 4950 Nydalen, Oslo, N-0424, Norway, 47 22894357, elin.borosund@rr-research.no %K eHealth %K digital communication %K secure messages %K digital symptom assessment %K implementation %K tailoring %K Consolidated Framework for Implementation Research %K CFIR %K facilitators %K barriers %K stakeholders %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective: The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods: A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results: Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions: This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning. %M 33830063 %R 10.2196/22399 %U https://www.jmir.org/2021/4/e22399 %U https://doi.org/10.2196/22399 %U http://www.ncbi.nlm.nih.gov/pubmed/33830063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21444 %T Reasons for Discontinuing Active Participation on the Internet Forum Tinnitus Talk: Mixed Methods Citizen Science Study %A Budimir,Sanja %A Kuska,Martin %A Spiliopoulou,Myra %A Schlee,Winfried %A Pryss,Rüdiger %A Andersson,Gerhard %A Goedhart,Hazel %A Harrison,Stephen %A Vesala,Markku %A Hegde,Gourish %A Langguth,Berthold %A Pieh,Christoph %A Probst,Thomas %+ Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems an der Donau, 3500, Austria, 43 27328932531, sanja.budimir@donau-uni.ac.at %K tinnitus %K Tinnitus Talk %K Internet forum %K dropout %K reasons for discontinuation %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus Talk is a nonprofit online self-help forum. Asking inactive users about their reasons for discontinued usage of health-related online platforms such as Tinnitus Talk is important for quality assurance. Objective: The aim of this study was to explore reasons for discontinued use of Tinnitus Talk, and their associations to the perceptions of Tinnitus Talk and the age of users who ceased logging on to the platform. Methods: Initially, 13,745 users that did not use Tinnitus Talk within the previous 2 months were contacted and the response rate was 20.47% (n=2814). After dataset filtering, a total of 2172 past members of Tinnitus Talk were included in the analyses. Nine predefined reasons for discontinued usage of Tinnitus Talk were included in the survey as well as one open question. Moreover, there were 14 predefined questions focusing on perception of Tinnitus Talk (usefulness, content, community, and quality of members’ posts). Mixed methods analyses were performed. Frequencies and correlation coefficients were calculated for quantitative data, and grounded theory methodology was utilized for exploration of the qualitative data. Results: Quantitative analysis revealed reasons for discontinued use of Tinnitus Talk as well as associations of these reasons with perceptions of Tinnitus Talk and age. Among the eight predefined reasons for discontinued use of Tinnitus Talk, the most frequently reported was not finding the information they were looking for (451/2695, 16.7%). Overall, the highest rated perception of Tinnitus Talk was content-related ease of understanding (mean 3.9, SD 0.64). A high number (nearly 40%) of participants provided additional free text explaining why they discontinued use. Qualitative analyses identified a total of 1654 specific reasons, more than 93% of which (n=1544) could be inductively coded. The coding system consisted of 33 thematically labeled codes clustered into 10 categories. The most frequent additional reason for discontinuing use was thinking that there is no cure or help for tinnitus symptoms (375/1544, 24.3%). Significant correlations (P<.001) were observed between reasons for discontinued usage and perception of Tinnitus Talk. Several reasons for discontinued usage were associated with the examined dimensions of perception of Tinnitus Talk (usefulness, content, community, as well as quality of members’ posts). Moreover, significant correlations (P<.001) between age and reasons for discontinued use were found. Older age was associated with no longer using Tinnitus Talk because of not finding what they were looking for. In addition, older participants had a generally less positive perception of Tinnitus Talk than younger participants (P<.001). Conclusions: This study contributes to understanding the reasons for discontinued usage of online self-help platforms, which are typically only reported according to the dropout rates. Furthermore, specific groups of users who did not benefit from Tinnitus Talk were identified, and several practical implications for improvement of the structure, content, and goals of Tinnitus Talk were suggested. %M 33830060 %R 10.2196/21444 %U https://formative.jmir.org/2021/4/e21444 %U https://doi.org/10.2196/21444 %U http://www.ncbi.nlm.nih.gov/pubmed/33830060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e18764 %T User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study %A Jung,Se Young %A Hwang,Hee %A Lee,Keehyuck %A Lee,Donghyun %A Yoo,Sooyoung %A Lim,Kahyun %A Lee,Ho-Young %A Kim,Eric %+ Department of Digital Healthcare, Seoul National University Bundang Hospital, Dolma-ro 172, Seongnam, Republic of Korea, 82 317870114, chrisruga@naver.com %K electronic health records %K mental health care %K qualitative study %K mobile phone %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the rapid adoption of electronic health records (EHRs) resulting from the reimbursement program of the US government, EHR adoption in behavioral hospitals is still slow, and there remains a lack of evidence regarding barriers and facilitators to the implementation of mental health care EHRs. Objective: The aim of this study is to analyze the experience of mental health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of a mental health care EHR. Methods: In this phenomenological qualitative study, we interviewed physicians, nurses, pharmacists, mental health clinicians, and administrative professionals separately at 4 behavioral hospitals in the United States. We conducted semistructured interviews (N=43) from behavioral hospitals involved in the adoption of the mental health care EHR. Purposeful sampling was used to maximize the diversity. Transcripts were coded and analyzed for emergent domains. An exploratory data analysis was conducted. Results: Content analyses revealed 7 barriers and 4 facilitators. The most important barriers to implementing the mental health care EHR were the low levels of computer proficiency among nurses, complexity of the system, alert fatigue, and resistance because of legacy systems. This led to poor usability, low acceptability, and distrust toward the system. The major facilitators to implementing the mental health care EHR were well-executed training programs, improved productivity, better quality of care, and the good usability of the mental health care EHR. Conclusions: Health care professionals expected to enhance their work productivity and interprofessional collaboration by introducing the mental health care EHR. Routine education for end users is an essential starting point for the successful implementation of mental health care EHR electronic decision support. When adopting the mental health care EHR, managers need to focus on common practices in behavioral hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of mental health care into the system. %M 33830061 %R 10.2196/18764 %U https://formative.jmir.org/2021/4/e18764 %U https://doi.org/10.2196/18764 %U http://www.ncbi.nlm.nih.gov/pubmed/33830061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24461 %T A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study %A Beerten,Simon Gabriël %A Proesmans,Tine %A Vaes,Bert %+ Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 blok h - bus 7001, Leuven, 3000, Belgium, 32 16194050, simon.beerten@kuleuven.be %K atrial fibrillation %K smartphone app %K FibriCheck %K primary care %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective: We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods: Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results: There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions: FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration: ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493 %M 33825692 %R 10.2196/24461 %U https://formative.jmir.org/2021/4/e24461 %U https://doi.org/10.2196/24461 %U http://www.ncbi.nlm.nih.gov/pubmed/33825692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e19022 %T Facebook Ads Manager as a Recruitment Tool for a Health and Safety Survey of Farm Mothers: Pilot Study %A Burke,Richard R %A Weichelt,Bryan P %A Namkoong,Kang %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Avenue, Marshfield, WI, 54449, United States, 1 715 389 3789, burke.richard@marshfieldresearch.org %K Facebook %K recruitment %K advertisement %K agriculture %K health %K safety %K survey %K online %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms have experienced unprecedented levels of growth and usage over the past decade, with Facebook hosting 2.7 billion active users worldwide, including over 200 million users in the United States. Facebook users have been underutilized and understudied by the academic community as a resource for participant recruitment. Objective: We performed a pilot study to explore the efficacy and cost-effectiveness of Facebook advertisements for the recruitment of an online agricultural health and safety survey. Methods: We undertook a 1-week advertising campaign utilizing the integrated, targeted advertising platform of Facebook Ads Manager with a target-spending limit of US $294. We created and posted three advertisements depicting varying levels of agricultural safety adoption leading to a brief survey on farm demographics and safety attitudes. We targeted our advertisements toward farm mothers aged 21-50 years in the United States and determined cost-effectiveness and potential biases. No participant incentive was offered. Results: We reached 40,024 users and gathered 318 advertisement clicks. Twenty-nine participants consented to the survey with 24 completions. Including personnel costs, the cost per completed survey was US $17.42. Compared to the distribution of female producers in the United States, our advertisements were unexpectedly overrepresented in the eastern United States and were underrepresented in the western United States. Conclusions: Facebook Ads Manager represents a potentially cost-effective and timely method to recruit participants for online health and safety research when targeting a specific population. However, social media recruitment mirrors traditional recruitment methods in its limitations, exhibiting geographic, response, and self-selection biases that need to be addressed. %M 33825686 %R 10.2196/19022 %U https://formative.jmir.org/2021/4/e19022 %U https://doi.org/10.2196/19022 %U http://www.ncbi.nlm.nih.gov/pubmed/33825686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21638 %T Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study %A Acorda,Darlene %A Businelle,Michael %A Santa Maria,Diane %+ Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX, 77030, United States, 1 832 824 1179, darlene.e.acorda@uth.tmc.edu %K youth experiencing homelessness %K ecological momentary assessment %K mobile apps %K behavior change %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. %M 33821805 %R 10.2196/21638 %U https://formative.jmir.org/2021/4/e21638 %U https://doi.org/10.2196/21638 %U http://www.ncbi.nlm.nih.gov/pubmed/33821805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26562 %T Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives %A Tatar,Ovidiu %A Abdel-Baki,Amal %A Tra,Christophe %A Mongeau-Pérusse,Violaine %A Arruda,Nelson %A Kaur,Navdeep %A Landry,Vivianne %A Coronado-Montoya,Stephanie %A Jutras-Aswad,Didier %+ Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St-Denis Street Viger Tower, 5th floor, room R05.740, Montreal, QC, H2X 1P1, Canada, 1 514 890 8000 ext 35703, didier.jutras-aswad@umontreal.ca %K psychology %K intervention %K cannabis misuse %K cannabis use disorder %K young adult %K clinician %K psychosis %K schizophrenia %K dual diagnosis %K qualitative %K acceptability %K technology-based %K telemedicine %K mHealth %K digital health %K eHealth %K application %K smartphone %K mobile phone %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective: The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods: A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results: Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions: This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. %M 33818397 %R 10.2196/26562 %U https://formative.jmir.org/2021/4/e26562 %U https://doi.org/10.2196/26562 %U http://www.ncbi.nlm.nih.gov/pubmed/33818397 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e23447 %T Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience %A Wong,Howard W %A Lo,Brian %A Shi,Jenny %A Hollenberg,Elisa %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Chaim,Gloria %A Cleverley,Kristin %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Voineskos,Aristotle %A Wiljer,David %+ UHN Digital, University Health Network, R. Fraser Elliott Building RFE 3-411, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K transition-aged youth %K qualitative study %K user experience %K help-seeking %K mental health %K postsecondary %K mobile apps %K adolescent %D 2021 %7 2.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students’ attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants’ overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 %M 33797395 %R 10.2196/23447 %U https://mental.jmir.org/2021/4/e23447 %U https://doi.org/10.2196/23447 %U http://www.ncbi.nlm.nih.gov/pubmed/33797395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24727 %T Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study %A Zeghari,Radia %A König,Alexandra %A Guerchouche,Rachid %A Sharma,Garima %A Joshi,Jyoti %A Fabre,Roxane %A Robert,Philippe %A Manera,Valeria %+ Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d’Azur, 10 Rue Molière, Nice, France, 33 4 92 03 47 66, radia.zeghari@univ-cotedazur.fr %K apathy %K action units %K assessment %K ICT %K facial video analysis %K neurocognitive disorders %K neurocognitive %K facial analysis %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective: We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods: A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results: Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task’s valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions: Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument. %M 33787499 %R 10.2196/24727 %U https://formative.jmir.org/2021/3/e24727 %U https://doi.org/10.2196/24727 %U http://www.ncbi.nlm.nih.gov/pubmed/33787499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22603 %T Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study %A van Noort,Esther M J %A Claessens,Danny %A Moor,Catharina C %A Berg,Carlijn A L Van Den %A Kasteleyn,Marise J %A in 't Veen,Johannes C C M %A Van Schayck,Onno C P %A Chavannes,Niels H %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 162520571, e.m.j.van_noort@lumc.nl %K COVID-19 %K patient-reported outcomes %K ABCoV tool %K monitoring %K patient outcome %K long-term impact %K tool %K assessment %K online patient platform %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. Although many patients recover from the acute phase of the disease, experience with other virus outbreaks has raised concerns regarding possible late sequelae of the infection. Objective: This study aims to develop an online tool to assess the long-term burden of COVID-19 in patients. Methods: In this paper, we describe the process of development, assessment, programming, implementation, and use of this new tool: the assessment of burden of COVID-19 (ABCoV) tool. This new tool is based on the well-validated assessment of burden of chronic obstructive pulmonary disease tool. Results: As of January 2021, the new ABCoV tool has been used in an online patient platform by more than 2100 self-registered patients and another 400 patients in a hospital setting, resulting in over 2500 patients. These patients have submitted the ABCoV questionnaire 3926 times. Among the self-registered patients who agreed to have their data analyzed (n=1898), the number of females was high (n=1153, 60.7%), many were medically diagnosed with COVID-19 (n=892, 47.0%), and many were relatively young with only 7.4% (n=141) being older than 60 years. Of all patients that actually used the tool (n=1517), almost one-quarter (n=356, 23.5%) used the tool twice, and only a small group (n=76, 5.0%) used the tool 6 times. Conclusions: This new ABCoV tool has been broadly and repeatedly used, and may provide insight into the perceived burden of disease, provide direction for personalized aftercare for people post COVID-19, and help us to be prepared for possible future recurrences. %M 33729982 %R 10.2196/22603 %U https://formative.jmir.org/2021/3/e22603 %U https://doi.org/10.2196/22603 %U http://www.ncbi.nlm.nih.gov/pubmed/33729982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22695 %T Global Collaborative Social Network (Share4Rare) to Promote Citizen Science in Rare Disease Research: Platform Development Study %A Radu,Roxana %A Hernández-Ortega,Sara %A Borrega,Oriol %A Palmeri,Avril %A Athanasiou,Dimitrios %A Brooke,Nicholas %A Chapí,Inma %A Le Corvec,Anaïs %A Guglieri,Michela %A Perera-Lluna,Alexandre %A Garrido-Aguirre,Jon %A Ryll,Bettina %A Nafria Escalera,Begonya %+ Sant Joan de Déu Research Institute, Santa Rosa 39-57, Esplugues de Llobregat, 08950, Spain, 34 669167771, bnafria@sjdhospitalbarcelona.org %K Share4Rare %K rare disease %K citizen science %K participatory medicine %K natural history %K genotype %K phenotype %D 2021 %7 29.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Rare disease communities are spread around the globe and segmented by their condition. Little research has been performed on the majority of rare diseases. Most patients who are affected by a rare disease have no research on their condition because of a lack of knowledge due to absence of common groups in the research community. Objective: We aimed to develop a safe and secure community of rare disease patients, without geographic or language barriers, to promote research. Methods: Cocreation design methodology was applied to build Share4Rare, with consultation and input through workshops from a variety of stakeholders (patients, caregivers, clinicians, and researchers). Results: The workshops allowed us to develop a layered version of the platform based on educating patients and caregivers with publicly accessible information, a secure community for the patients and caregivers, and a research section with the purpose of collecting patient information for analysis, which was the core and final value of the platform. Conclusions: Rare disease research requires global collaboration in which patients and caregivers have key roles. Collective intelligence methods implemented in digital platforms reduce geographic and language boundaries and involve patients in a unique and universal project. Their contributions are essential to increase the amount of scientific knowledge that experts have on rare diseases. Share4Rare has been designed as a global platform to facilitate the donation of clinical information to foster research that matters to patients with rare conditions. The codesign methods with patients have been essential to create a patient-centric design. %M 33779572 %R 10.2196/22695 %U https://formative.jmir.org/2021/3/e22695 %U https://doi.org/10.2196/22695 %U http://www.ncbi.nlm.nih.gov/pubmed/33779572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27882 %T The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study %A Bente,Britt Elise %A van 't Klooster,Jan Willem Jaap Roderick %A Schreijer,Maud Annemarie %A Berkemeier,Lea %A van Gend,Joris Elmar %A Slijkhuis,Peter Jan Hendrik %A Kelders,Saskia Marion %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K usability testing %K user evaluation %K user experience %K contact tracing apps %K CoronaMelder %K COVID-19 %K pandemic %K mobile apps %K mHealth %K public health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. %M 33724198 %R 10.2196/27882 %U https://formative.jmir.org/2021/3/e27882 %U https://doi.org/10.2196/27882 %U http://www.ncbi.nlm.nih.gov/pubmed/33724198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18460 %T System Architecture for "Support Through Mobile Messaging and Digital Health Technology for Diabetes" (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies %A Chi,Yuan %A Velardo,Carmelo %A Allen,Julie %A Robinson,Stephanie %A Riga,Evgenia %A Judge,David %A Tarassenko,Lionel %A Farmer,Andrew J %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, United Kingdom, 44 01865 617675, yuan.chi@eng.ox.ac.uk %K type 2 diabetes %K short message service %K health-related behavior %K mobile health %K mHealth %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. Objective: This paper describes the overall architecture of a tailored intervention delivery system used in the pilot and randomized controlled feasibility studies of SuMMiT-D and reports its performance. Methods: The SuMMiT-D system includes several platforms and resources to recruit participants and deliver messages as tailored interventions. Its core component is called the clinical system and is responsible for interacting with the participants by receiving and sending SMS text messages from and to them. The personalization and tailoring of brief messages for each participant is based on a list of built-in commands that they can use. Results: For the pilot study, a total of 48 participants were recruited; they had a median age of 64 years (first quartile, third quartile [Q1, Q3: 54.5, 69]). For the feasibility study, a total of 209 participants were recruited and randomly assigned to either the control or intervention group; they had a median age of 65 years (Q1, Q3: 56, 71), with 41.1% (86/209) being female. The participants used the SuMMiT-D system for up to 6 months (26 weeks) and had a wide range of different interactions with the SuMMiT-D system while tailored interventions were being delivered. For both studies, we had low withdrawal rates: only 4.2% and 5.3% for the pilot and feasibility studies, respectively. Conclusions: A system was developed to successfully deliver brief messages as tailored health interventions to more than 250 people with type 2 diabetes via SMS text messages. On the basis of the low withdrawal rates and positive feedback received, it can be inferred that the SuMMiT-D system is robust, user-friendly, useful, and positive for most participants. From the two studies, we found that online recruitment was more efficient than recruitment via postal mail; a regular SMS text reminder (eg, every 4 weeks) can potentially increase the participants’ interactions with the system. Trial Registration: ISRCTN Registry ISRCTN13404264; http://www.isrctn.com/ISRCTN13404264 %M 33769299 %R 10.2196/18460 %U https://formative.jmir.org/2021/3/e18460 %U https://doi.org/10.2196/18460 %U http://www.ncbi.nlm.nih.gov/pubmed/33769299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25810 %T Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder %A Dopke,Cynthia A %A McBride,Alyssa %A Babington,Pamela %A Jonathan,Geneva K %A Michaels,Tania %A Ryan,Chloe %A Duffecy,Jennifer %A Mohr,David C %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave., Suite 7-102, Chicago, IL, 60611, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K human support %K adherence %K self-management %K behavior change %K mHealth %K bipolar disorder %D 2021 %7 24.3.2021 %9 Viewpoint %J JMIR Form Res %G English %X Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention. %M 33759798 %R 10.2196/25810 %U https://formative.jmir.org/2021/3/e25810 %U https://doi.org/10.2196/25810 %U http://www.ncbi.nlm.nih.gov/pubmed/33759798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e26355 %T Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A Smith,Harriet %A Williamson,Heidi %A , %+ The Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 83882, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K qualitative %K participatory design %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. %M 33759791 %R 10.2196/26355 %U https://formative.jmir.org/2021/3/e26355 %U https://doi.org/10.2196/26355 %U http://www.ncbi.nlm.nih.gov/pubmed/33759791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22498 %T Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App–Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study %A Li,Sophie H %A Graham,Bronwyn M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 4530, s.h.li@blackdog.org.au %K insomnia %K gender differences %K adolescents %K sleep disturbance %K sleep quality %K sleep %K gender %K digital interventions %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents. Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents. Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined. Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07). Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents. %M 33755029 %R 10.2196/22498 %U https://formative.jmir.org/2021/3/e22498 %U https://doi.org/10.2196/22498 %U http://www.ncbi.nlm.nih.gov/pubmed/33755029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24667 %T A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study %A Teckie,Sewit %A Solomon,Jeffrey %A Kadapa,Karthik %A Sanchez,Keisy %A Orner,David %A Kraus,Dennis %A Kamdar,Dev P %A Pereira,Lucio %A Frank,Douglas %A Diefenbach,Michael %+ Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th Street, New York, NY, 10010, United States, 1 212 434 2919, steckie@northwell.edu %K mHealth %K ePROs %K head and neck cancer %K mobile phone %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. %M 33739291 %R 10.2196/24667 %U https://formative.jmir.org/2021/3/e24667 %U https://doi.org/10.2196/24667 %U http://www.ncbi.nlm.nih.gov/pubmed/33739291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e19408 %T e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study %A Smit,Marloes A %A van Pelt,Gabi W %A Dequeker,Elisabeth MC %A Al Dieri,Raed %A Tollenaar,Rob AEM %A van Krieken,J Han JM %A Mesker,Wilma E %A , %+ Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715264005, w.e.mesker@lumc.nl %K colon cancer %K tumor-stroma ratio %K validation %K e-Learning %K reproducibility study %K cancer %K tumor %K colon %K reproducibility %K carcinoma %K prognosis %K diagnostic %K implementation %K online learning %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. Objective: The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction. Methods: The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin–stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ≤50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen κ score after each set to evaluate the reproducibility. Results: Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median κ score improved from 0.72 to 0.77 (P=.002). Conclusions: e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. Trial Registration: The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072 International Registered Report Identifier (IRRID): RR2-10.2196/13464 %M 33739293 %R 10.2196/19408 %U https://formative.jmir.org/2021/3/e19408 %U https://doi.org/10.2196/19408 %U http://www.ncbi.nlm.nih.gov/pubmed/33739293 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24726 %T eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study %A van Buul,Amanda R %A Derksen,Caroline %A Hoedemaker,Ouke %A van Dijk,Oscar %A Chavannes,Niels H %A Kasteleyn,Marise J %+ Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands, 31 715297550, a.r.van_buul@lumc.nl %K COPD %K eHealth %K exacerbations %K hospitalizations %K mHealth %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. Objective: This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. Methods: This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. Results: The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results. Conclusions: The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD. %M 33734091 %R 10.2196/24726 %U https://formative.jmir.org/2021/3/e24726 %U https://doi.org/10.2196/24726 %U http://www.ncbi.nlm.nih.gov/pubmed/33734091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22659 %T Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial %A Van de Winckel,Ann %A Nawshin,Tanjila %A Byron,Casey %+ Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St SE (MMC 388), Minneapolis, MN, 55455, United States, 1 612 625 1191, avandewi@umn.edu %K chronic disease %K spinal cord injury %K stroke %K telehealth %K telemedicine %K traumatic brain injury %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective: To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods: We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results: Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions: The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration: ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280 %M 33640865 %R 10.2196/22659 %U https://formative.jmir.org/2021/3/e22659 %U https://doi.org/10.2196/22659 %U http://www.ncbi.nlm.nih.gov/pubmed/33640865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24738 %T Using a Personal Health Library–Enabled mHealth Recommender System for Self-Management of Diabetes Among Underserved Populations: Use Case for Knowledge Graphs and Linked Data %A Ammar,Nariman %A Bailey,James E %A Davis,Robert L %A Shaban-Nejad,Arash %+ Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center, 50 N Dunlap Street, Memphis, TN, 38103, United States, 1 901 287 5863, ashabann@uthsc.edu %K personal health library %K mobile health %K personal health knowledge graph %K patient-centered design %K personalized health %K recommender system %K observations of daily living %K Semantic Web %K privacy %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditionally, digital health data management has been based on electronic health record (EHR) systems and has been handled primarily by centralized health providers. New mechanisms are needed to give patients more control over their digital health data. Personal health libraries (PHLs) provide a single point of secure access to patients' digital health data and enable the integration of knowledge stored in their digital health profiles with other sources of global knowledge. PHLs can help empower caregivers and health care providers to make informed decisions about patients’ health by understanding medical events in the context of their lives. Objective: This paper reports the implementation of a mobile health digital intervention that incorporates both digital health data stored in patients’ PHLs and other sources of contextual knowledge to deliver tailored recommendations for improving self-care behaviors in diabetic adults. Methods: We conducted a thematic assessment of patient functional and nonfunctional requirements that are missing from current EHRs based on evidence from the literature. We used the results to identify the technologies needed to address those requirements. We describe the technological infrastructures used to construct, manage, and integrate the types of knowledge stored in the PHL. We leverage the Social Linked Data (Solid) platform to design a fully decentralized and privacy-aware platform that supports interoperability and care integration. We provided an initial prototype design of a PHL and drafted a use case scenario that involves four actors to demonstrate how the proposed prototype can be used to address user requirements, including the construction and management of the PHL and its utilization for developing a mobile app that queries the knowledge stored and integrated into the PHL in a private and fully decentralized manner to provide better recommendations. Results: To showcase the main features of the mobile health app and the PHL, we mapped those features onto a framework comprising the user requirements identified in a use case scenario that features a preventive intervention from the diabetes self-management domain. Ongoing development of the app requires a formative evaluation study and a clinical trial to assess the impact of the digital intervention on patient-users. We provide synopses of both study protocols. Conclusions: The proposed PHL helps patients and their caregivers take a central role in making decisions regarding their health and equips their health care providers with informatics tools that support the collection and interpretation of the collected knowledge. By exposing the PHL functionality as an open service, we foster the development of third-party applications or services and provide motivational technological support in several projects crossing different domains of interest. %M 33724197 %R 10.2196/24738 %U https://formative.jmir.org/2021/3/e24738 %U https://doi.org/10.2196/24738 %U http://www.ncbi.nlm.nih.gov/pubmed/33724197 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23568 %T Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation %A Lindsay,Sally %A Kolne,Kendall %A Barker,Donna J %A Colantonio,Angela %A Stinson,Jennifer %A Moll,Sandra %A Thomson,Nicole %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3654, slindsay@hollandbloorview.ca %K continuing education %K gender-identity %K gender-sensitive care %K rehabilitation %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities. %M 33720023 %R 10.2196/23568 %U https://formative.jmir.org/2021/3/e23568 %U https://doi.org/10.2196/23568 %U http://www.ncbi.nlm.nih.gov/pubmed/33720023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23979 %T Attitudes of Australian Patients Undergoing Treatment for Upper Gastrointestinal Cancers to Different Models of Nutrition Care Delivery: Qualitative Investigation %A Furness,Kate %A Huggins,Catherine Elizabeth %A Truby,Helen %A Croagh,Daniel %A Haines,Terry Peter %+ Monash Health, Nutrition and Dietetics, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, 3168, Australia, 61 95944180, kate.furness@monashhealth.org %K qualitative %K upper gastrointestinal %K cancer %K nutrition %K mobile phone %D 2021 %7 12.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults diagnosed with cancers of the stomach, esophagus, and pancreas are at high risk of malnutrition. In many hospital-based health care settings, there is a lack of systems in place to provide the early and intensive nutritional support that is required by these high-risk cancer patients. Our research team conducted a 3-arm parallel randomized controlled trial to test the provision of an early and intensive nutrition intervention to patients with upper gastrointestinal cancers using a synchronous telephone-based delivery approach versus an asynchronous mobile app–based approach delivered using an iPad compared with a control group to address this issue. Objective: This study aims to explore the overall acceptability of an early and intensive eHealth nutrition intervention delivered either via a synchronous telephone-based approach or an asynchronous mobile app–based approach. Methods: Patients who were newly diagnosed with upper gastrointestinal cancer and who consented to participate in a nutrition intervention were recruited. In-depth, semistructured qualitative interviews were conducted by telephone and transcribed verbatim. Data were analyzed using deductive thematic analysis using the Theoretical Framework of Acceptability in NVivo Pro 12 Plus. Results: A total of 20 participants were interviewed, 10 from each intervention group (synchronous or asynchronous delivery). Four major themes emerged from the qualitative synthesis: participants’ self-efficacy, low levels of burden, and intervention comprehension were required for intervention effectiveness and positive affect; participants sought a sense of support and security through relationship building and rapport with their dietitian; knowledge acquisition and learning-enabled empowerment through self-management; and convenience, flexibility, and bridging the gap to hard-to-reach individuals. Conclusions: Features of eHealth models of nutrition care delivered via telephone and mobile app can be acceptable to those undergoing treatment for upper gastrointestinal cancer. Convenience, knowledge acquisition, improved self-management, and support were key benefits for the participants. Future interventions should focus on home-based interventions delivered with simple, easy-to-use technology. Providing participants with a choice of intervention delivery mode (synchronous or asynchronous) and allowing them to make individual choices that align to their individual values and capabilities may support improved outcomes. Trial Registration: Australian and New Zealand Clinical Trial Registry (ACTRN) 12617000152325; https://tinyurl.com/p3kxd37b. %M 33709939 %R 10.2196/23979 %U https://formative.jmir.org/2021/3/e23979 %U https://doi.org/10.2196/23979 %U http://www.ncbi.nlm.nih.gov/pubmed/33709939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18325 %T Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach %A Wolbers,Roos %A Bode,Christina %A Siemerink,Ester %A Siesling,Sabine %A Pieterse,Marcel %+ Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, Enschede, 7500 AE, Netherlands, 31 534896044, c.bode@utwente.nl %K breast cancer %K cognitive bias modification %K eHealth %K fatigue %K oncology %K psychology %K vitality %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 50% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. %M 33688833 %R 10.2196/18325 %U https://formative.jmir.org/2021/3/e18325 %U https://doi.org/10.2196/18325 %U http://www.ncbi.nlm.nih.gov/pubmed/33688833 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e13182 %T A Clinical Decision Support System (KNOWBED) to Integrate Scientific Knowledge at the Bedside: Development and Evaluation Study %A Martinez-Garcia,Alicia %A Naranjo-Saucedo,Ana Belén %A Rivas,Jose Antonio %A Romero Tabares,Antonio %A Marín Cassinello,Ana %A Andrés-Martín,Anselmo %A Sánchez Laguna,Francisco José %A Villegas,Roman %A Pérez León,Francisco De Paula %A Moreno Conde,Jesús %A Parra Calderón,Carlos Luis %+ Group of Research and Innovation in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Av Manuel Siurot, Seville, 41013, Spain, 34 955 01 36 16, alicia.martinez.garcia@juntadeandalucia.es %K evidence-based medicine %K clinical decision support system %K scientific knowledge integration %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The evidence-based medicine (EBM) paradigm requires the development of health care professionals’ skills in the efficient search of evidence in the literature, and in the application of formal rules to evaluate this evidence. Incorporating this methodology into the decision-making routine of clinical practice will improve the patients’ health care, increase patient safety, and optimize resources use. Objective: The aim of this study is to develop and evaluate a new tool (KNOWBED system) as a clinical decision support system to support scientific knowledge, enabling health care professionals to quickly carry out decision-making processes based on EBM during their routine clinical practice. Methods: Two components integrate the KNOWBED system: a web-based knowledge station and a mobile app. A use case (bronchiolitis pathology) was selected to validate the KNOWBED system in the context of the Paediatrics Unit of the Virgen Macarena University Hospital (Seville, Spain). The validation was covered in a 3-month pilot using 2 indicators: usability and efficacy. Results: The KNOWBED system has been designed, developed, and validated to support clinical decision making in mobility based on standards that have been incorporated into the routine clinical practice of health care professionals. Using this tool, health care professionals can consult existing scientific knowledge at the bedside, and access recommendations of clinical protocols established based on EBM. During the pilot project, 15 health care professionals participated and accessed the system for a total of 59 times. Conclusions: The KNOWBED system is a useful and innovative tool for health care professionals. The usability surveys filled in by the system users highlight that it is easy to access the knowledge base. This paper also sets out some improvements to be made in the future. %M 33709932 %R 10.2196/13182 %U https://medinform.jmir.org/2021/3/e13182 %U https://doi.org/10.2196/13182 %U http://www.ncbi.nlm.nih.gov/pubmed/33709932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22473 %T Remote Measurement in Rheumatoid Arthritis: Qualitative Analysis of Patient Perspectives %A White,Katie M %A Ivan,Alina %A Williams,Ruth %A Galloway,James B %A Norton,Sam %A Matcham,Faith %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 7850684847, katie.white@kcl.ac.uk %K rheumatoid arthritis %K remote measurement technologies %K symptom assessment %K disease management %K smartphone %K qualitative research %K mobile phone %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Rheumatoid arthritis (RA) is characterized by recurrent fluctuations in symptoms such as joint pain, swelling, and stiffness. Remote measurement technologies (RMTs) offer the opportunity to track symptoms continuously and in real time; therefore, they may provide a more accurate picture of RA disease activity as a complement to prescheduled general practitioner appointments. Previous research has shown patient interest in remote symptom tracking in RA and has provided evidence for its clinical validity. However, there is a lack of co-design in the current development of systems, and the features of RMTs that best promote optimal engagement remain unclear. Objective: This study represents the first in a series of work that aims to develop a multiparametric RMT system for symptom tracking in RA. The objective of this study is to determine the important outcomes for disease management in patients with RA and how these can be best captured via remote measurement. Methods: A total of 9 patients (aged 23-77 years; mean 55.78, SD 17.54) with RA were recruited from King’s College Hospital to participate in two semistructured focus groups. Both focus group discussions were conducted by a facilitator and a lived-experience researcher. The sessions were recorded, transcribed, independently coded, and analyzed for themes. Results: Thematic analysis identified a total of four overarching themes: important symptoms and outcomes in RA, management of RA symptoms, views on the current health care system, and views on the use of RMTs in RA. Mobility and pain were key symptoms to consider for symptom tracking as well as symptom triggers. There is a general consensus that the ability to track fluctuations and transmit such data to clinicians would aid in individual symptom management and the effectiveness of clinical care. Suggestions for visually capturing symptom fluctuations in an app were proposed. Conclusions: The findings support previous work on the acceptability of RMT with RA disease management and address key outcomes for integration into a remote monitoring system for RA self-management and clinical care. Clear recommendations for RMT design are proposed. Future work will aim to take these recommendations into a user testing phase. %M 33687333 %R 10.2196/22473 %U https://formative.jmir.org/2021/3/e22473 %U https://doi.org/10.2196/22473 %U http://www.ncbi.nlm.nih.gov/pubmed/33687333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25123 %T Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study %A Naqvi,Imama Ali %A Montiel,Tahani Casameni %A Bittar,Yazan %A Hunter,Norma %A Okpala,Munachi %A Johnson,Constance %A Weiner,Mark G %A Savitz,Sean %A Sharrief,Anjail %A Beauchamp,Jennifer Elizabeth Sanner %+ Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Irving Medical Center, 710 W 168th St, 6th Fl, Ste 650, New York, NY, 10032, United States, 1 212 305 8253, ian2108@cumc.columbia.edu %K internet access %K stroke %K caregivers %K surveys %K questionnaires %K mobile phone %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. %M 33683206 %R 10.2196/25123 %U https://formative.jmir.org/2021/3/e25123 %U https://doi.org/10.2196/25123 %U http://www.ncbi.nlm.nih.gov/pubmed/33683206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23843 %T A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study %A Okpara,Kelechi S %A Hecht,Jennifer %A Wohlfeiler,Dan %A Prior,Matthew %A Klausner,Jeffrey D %+ David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 (310) 825 6373, kokpara@mednet.ucla.edu %K patient-led digital contact notification %K COVID-19 %K digital contact tracing %K contact notification website %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email. When alerts are made through the latter, it is called digital contact notification. Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the number of website users and message senders, the types of messages sent, and the geographic distribution of senders. Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19 to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August 17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders, types of messages sent, and geographic distribution of the senders. Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages, which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority of US senders residing in California (49%). Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use to notify their close contacts about a recent COVID-19 diagnosis. %M 33621189 %R 10.2196/23843 %U https://formative.jmir.org/2021/3/e23843 %U https://doi.org/10.2196/23843 %U http://www.ncbi.nlm.nih.gov/pubmed/33621189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25220 %T Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team %A Silsand,Line %A Severinsen,Gro-Hilde %A Berntsen,Gro %+ Norwegian Centre for E-health Research, Sykehusveien 23, Tromsø, 9019, Norway, 47 91335053, line.silsand@ehealthresearch.no %K person-centered care %K rapid digitalization %K health care %K videoconferencing %K persons with complex, long-term needs %K COVID-19 %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient’s response to “What matters to you?” drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. Objective: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. Methods: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. Results: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. Conclusions: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios. %M 33646965 %R 10.2196/25220 %U https://formative.jmir.org/2021/3/e25220 %U https://doi.org/10.2196/25220 %U http://www.ncbi.nlm.nih.gov/pubmed/33646965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e20175 %T Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study %A Roux de Bézieux,Hector %A Bullard,James %A Kolterman,Orville %A Souza,Michael %A Perraudeau,Fanny %+ Pendulum Therapeutics, Inc, 933 20th Street, San Francisco, CA, 94107, United States, 1 650 276 6517, fanny.perraudeau@pendulum.co %K clinical trials %K continuous glucose monitoring %K lifestyle modification %K mobile app %K telemedicine %K diabetes %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. Objective: We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. Methods: Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. Results: All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. Conclusions: We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. Trial Registration: ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888. %M 33661120 %R 10.2196/20175 %U https://formative.jmir.org/2021/3/e20175 %U https://doi.org/10.2196/20175 %U http://www.ncbi.nlm.nih.gov/pubmed/33661120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23892 %T Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign “Better Off With You”: Qualitative Study %A Carrotte,Elise Rose %A Webb,Marianne %A Flego,Anna %A Vincent,Bonnie %A Heath,Jack %A Blanchard,Michelle %+ Anne Deveson Research Centre, SANE Australia, PO Box 226, South Melbourne, 3205, Australia, 61 3 9682 5933, elise.carrotte@sane.org %K suicide %K interpersonal theory of suicide %K social media %K co-design %K lived experience %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia. Objective: The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You. Methods: This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis. Results: In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information. Conclusions: This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective. %M 33656441 %R 10.2196/23892 %U https://formative.jmir.org/2021/3/e23892 %U https://doi.org/10.2196/23892 %U http://www.ncbi.nlm.nih.gov/pubmed/33656441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19309 %T Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study %A Sesel,Amy-Lee %A Sharpe,Louise %A Beadnall,Heidi N %A Barnett,Michael H %A Szabo,Marianna %A Naismith,Sharon L %+ School of Psychology, University of Sydney, Camperdown NSW, Sydney, 2006, Australia, 61 2 9351 4558, amy-lee.sesel@sydney.edu.au %K multiple sclerosis %K mindfulness %K depression %K program development %K internet intervention %K qualitative research %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective: This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods: We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results: We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions: The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program. %M 33650980 %R 10.2196/19309 %U https://www.jmir.org/2021/3/e19309 %U https://doi.org/10.2196/19309 %U http://www.ncbi.nlm.nih.gov/pubmed/33650980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25583 %T A Digital Health Tool to Understand and Prevent Cannabis-Impaired Driving Among Youth: A Cross-sectional Study of Responses to a Brief Intervention for Cannabis Use %A Moreno,Georgina %A van Mierlo,Trevor %+ Department of Economics, California State University, Long Beach, 1250 Bellflower Blvd MS-4607, Long Beach, CA, 90840-4607, United States, 1 310 600 1767, gigi.moreno@csulb.edu %K cannabis use %K driving after cannabis use %K internet %K intervention %K online intervention %K digital health %K cannabis %K drug %K online tool %K youth %K adolescent %K Canada %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cannabis legalization has raised concern about an increased risk of cannabis-impaired driving, particularly among youth. Youth advocates and policy makers require cost-effective tools to target educational resources to promote responsible cannabis use. Objective: The objective of this paper is threefold. First, it describes how a youth advocacy organization disseminated a low-cost digital brief intervention to educate and inform young people about responsible cannabis use. Second, it illustrates how digital tools can help promote understanding about attitudes and behaviors toward cannabis while simultaneously offering tailored education. Finally, this paper contributes to examining behavioral factors associated with youth cannabis-impaired driving by quantifying relationships between cannabis users' willingness to drive impaired and self-reported demographic and behavioral factors. Methods: This paper analyzed data from 1110 completed Check Your Cannabis (CYC) brief interventions between March 2019 and October 2020. The CYC asks respondents a brief set of questions about their cannabis use and their personal beliefs and behaviors. Respondents receive comprehensive feedback about their cannabis use and how it compares with others. They also receive a summary of reported behaviors with brief advice. An ordered probit model was used to test relationships between cannabis use, demographics, and driving behaviors to gain further insights. Results: The vast majority (817/1110, 73.6%) of respondents reported using cannabis. However, a much smaller share of respondents reported problems associated with their cannabis use (257/1110, 23.2%) or driving after cannabis use (342/1110, 30.8%). We found statistically significant relationships between driving after cannabis use and age; Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk score; and polysubstance use. However, we did not find gender to be a significant determinant of driving after cannabis use. We estimated that every 10-point increase in the ASSIST score increased the probability of sometimes driving after cannabis use by 7.3% (P<.001). Relative to respondents who reported never drinking alcohol or using other substances with cannabis, those who sometimes drink or use other substances with cannabis were 13% (P<.001) more likely to sometimes or always drive after using cannabis. Conclusions: The digital health tool cost the youth advocacy organization approximately Can $0.90 (US $0.71) per use. Due to the tool's unlimited use structure, the per-use cost would further decrease with increased use by the organization’s target population. Based on our results, public health campaigns and other interventions may consider tailoring resources to frequent cannabis users, youth with high ASSIST scores, and those with polysubstance abuse. The cost-effectiveness of delivering digital brief interventions with unlimited use is attractive, as increased use decreases the per-user cost. Further research examining the efficacy of digital health interventions targeting problematic cannabis use is required. %M 33650982 %R 10.2196/25583 %U https://formative.jmir.org/2021/3/e25583 %U https://doi.org/10.2196/25583 %U http://www.ncbi.nlm.nih.gov/pubmed/33650982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25235 %T Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children’s and Young People’s Mental Health: Mixed Methods Pilot Randomized Controlled Trial %A Liverpool,Shaun %A Edbrooke-Childs,Julian %+ Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, 4-8 Rodney Street, The Kantor Centre of Excellence, London, N1 9JH, United Kingdom, 44 7539468630, shaun.liverpool.14@ucl.ac.uk %K mental health %K pilot projects %K child %K adolescent %K parents %K shared decision making %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Interventions to involve parents in decisions regarding children’s and young people’s mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. Objective: This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children’s and young people’s mental health. Methods: A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children’s and young people’s mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents’ anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial. Results: Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50% (6/12) of the sites successfully recruited participants, and only 38% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention. Conclusions: Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984. International Registered Report Identifier (IRRID): RR2-10.2196/14571 %M 33650973 %R 10.2196/25235 %U https://formative.jmir.org/2021/3/e25235 %U https://doi.org/10.2196/25235 %U http://www.ncbi.nlm.nih.gov/pubmed/33650973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22950 %T Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges %A Mbao,Mbita %A Collins-Pisano,Caroline %A Fortuna,Karen %+ Dartmouth College, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States, 1 603 722 5727, karen.L.Fortuna@dartmouth.edu %K older adults %K peer support %K self-management %K mobile technology %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. %M 33650979 %R 10.2196/22950 %U https://formative.jmir.org/2021/3/e22950 %U https://doi.org/10.2196/22950 %U http://www.ncbi.nlm.nih.gov/pubmed/33650979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e17993 %T A Rest Quality Metric Using a Cluster-Based Analysis of Accelerometer Data and Correlation With Digital Medicine Ingestion Data: Algorithm Development %A Heidary,Zahra %A Cochran,Jeffrey M %A Peters-Strickland,Timothy %A Knights,Jonathan %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 609 524 6788, jeffrey.cochran@otsuka-us.com %K serious mental illness %K rest quality %K actimetry %K behavioral health %K digital medicine %K accelerometer %K medication adherence %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adherence to medication regimens and patient rest are two important factors in the well-being of patients with serious mental illness. Both of these behaviors are traditionally difficult to record objectively in unsupervised populations. Objective: A digital medicine system that provides objective time-stamped medication ingestion records was used by patients with serious mental illness. Accelerometer data from the digital medicine system was used to assess rest quality and thus allow for investigation into correlations between rest and medication ingestion. Methods: Longest daily rest periods were identified and then evaluated using a k-means clustering algorithm and distance metric to quantify the relative quality of patient rest during these periods. This accelerometer-derived quality-of-rest metric, along with other accepted metrics of rest quality, such as duration and start time of the longest rest periods, was compared to the objective medication ingestion records. Overall medication adherence classification based on rest features was not performed due to a lack of patients with poor adherence in the sample population. Results: Explorations of the relationship between these rest metrics and ingestion did seem to indicate that patients with poor adherence experienced relatively low quality of rest; however, patients with better adherence did not necessarily exhibit consistent rest quality. This sample did not contain sufficient patients with poor adherence to draw more robust correlations between rest quality and ingestion behavior. The correlation of temporal outliers in these rest metrics with daily outliers in ingestion time was also explored. Conclusions: This result demonstrates the ability of digital medicine systems to quantify patient rest quality, providing a framework for further work to expand the participant population, compare these rest metrics to gold-standard sleep measurements, and correlate these digital medicine biomarkers with objective medication ingestion data. %M 33650981 %R 10.2196/17993 %U https://formative.jmir.org/2021/3/e17993 %U https://doi.org/10.2196/17993 %U http://www.ncbi.nlm.nih.gov/pubmed/33650981 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e13591 %T Web-Based Dietary Intake Estimation to Assess the Reproducibility and Relative Validity of the EatWellQ8 Food Frequency Questionnaire: Validation Study %A Alawadhi,Balqees %A Fallaize,Rosalind %A Franco,Rodrigo Zenun %A Hwang,Faustina %A Lovegrove,Julie %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, United Kingdom, 44 0118 378 6418, j.a.lovegrove@reading.ac.uk %K web-based %K Kuwait %K weighed food record %K app %K food frequency questionnaire %K validation %K dietary assessment %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake. Objective: This study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR). Methods: Reproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups. Results: A total of 99 Kuwaiti participants (64/99, 65% female and 35/99, 35% male) completed the study—53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88% for nutrient intakes and 86% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95% CI −0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84% for nutrient intake and 74% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85% for nutrient intake and 83% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes. Conclusions: The results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes. %M 33650974 %R 10.2196/13591 %U https://formative.jmir.org/2021/3/e13591 %U https://doi.org/10.2196/13591 %U http://www.ncbi.nlm.nih.gov/pubmed/33650974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22571 %T A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study %A Hollander,Justin B %A Folta,Sara C %A Graves,Erin Michelle %A Allen,Jennifer D %A Situ,Minyu %+ Department of Urban and Environmental Policy and Planning, School of Arts and Sciences, Tufts University, 97 Talbot Avenue, Medford, MA, 02155, United States, 1 6176273394, justin.hollander@tufts.edu %K physical activity %K smartphone %K mobile app %K sense of belongingness %K community cohesion %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity. Objective: We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity. Methods: We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences. Results: This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=−.79; 95% CI −4.0 to 2.4; P=.63) or miles (b=−.07; 95% CI −0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members. Conclusions: Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion. %M 33646132 %R 10.2196/22571 %U https://formative.jmir.org/2021/3/e22571 %U https://doi.org/10.2196/22571 %U http://www.ncbi.nlm.nih.gov/pubmed/33646132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18240 %T Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study %A Militello,Lisa %A Sezgin,Emre %A Huang,Yungui %A Lin,Simon %+ Martha S Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, 1585 Neil Ave, 145 Newton Hall, Columbus, OH, 43210, United States, 1 3128135007, militello.14@osu.edu %K perinatal care %K infant mortality %K health education %K mobile health %K feasibility studies %K family %K mobile phone %K webcasts as topic %K user-computer interface %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children’s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention–Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants’ perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. %M 33646136 %R 10.2196/18240 %U https://formative.jmir.org/2021/3/e18240 %U https://doi.org/10.2196/18240 %U http://www.ncbi.nlm.nih.gov/pubmed/33646136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18853 %T Rural Residents’ Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews %A Schoenberg,Nancy %A Dunfee,Madeline %A Yeager,Hannah %A Rutledge,Matthew %A Pfammatter,Angela %A Spring,Bonnie %+ Department of Behavior Science, University of Kentucky, 760 Press Avenue, 372 Healthy Kentucky Research Building, Lexington, KY, 40536, United States, 1 859 323 8175, nesch@uky.edu %K rural populations %K technology %K exercise %K diet %K community-based participatory research %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. Objective: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program—Make Better Choices 2—consists of personalized health coaching, accelerometer use, and financial incentives. Methods: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. Results: We identified 3 main themes regarding Appalachian residents’ perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. Conclusions: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents. %M 33635278 %R 10.2196/18853 %U https://formative.jmir.org/2021/2/e18853 %U https://doi.org/10.2196/18853 %U http://www.ncbi.nlm.nih.gov/pubmed/33635278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19074 %T Assessment of Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey %A Freise,Lisa %A Neves,Ana Luisa %A Flott,Kelsey %A Harrison,Paul %A Kelly,John %A Darzi,Ara %A Mayer,Erik K %+ Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, St Mary’s Campus Queen, Elizabeth Queen Mother Wing, London, W2 1NY, United Kingdom, 44 (0)20 7589 5111, ana.luisa.neves14@ic.ac.uk %K patient portals %K electronic health records %K patient participation %K medical errors %K patient safety %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective: The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods: A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results: A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions: While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care. %M 33635277 %R 10.2196/19074 %U https://formative.jmir.org/2021/2/e19074 %U https://doi.org/10.2196/19074 %U http://www.ncbi.nlm.nih.gov/pubmed/33635277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18224 %T Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study %A Barber-Gumbs,Tai %A Trolle Lagerros,Ylva %A Sena,Laura M %A Gittelsohn,Joel %A Chang,Larry W %A Zachary,Wayne W %A Surkan,Pamela J %+ Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Room E5523, Baltimore, MD, 21205-2179, United States, 1 410 502 7396, psurkan@jhu.edu %K diabetes %K mHealth %K type 2 diabetes mellitus %K diabetes self-management %K mobile app %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs. %M 33635279 %R 10.2196/18224 %U https://formative.jmir.org/2021/2/e18224 %U https://doi.org/10.2196/18224 %U http://www.ncbi.nlm.nih.gov/pubmed/33635279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18172 %T Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study %A Alqahtani,Felwah %A Winn,Andrea %A Orji,Rita %+ Faculty of Computer Science, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 9027892230, Felwah.alqahtani@dal.ca %K mental health %K mobile app %K focus groups %K design recommendation %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist people in achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by various mental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a need for research to explore and understand end users’ perceptions, needs, and concerns with respect to such technologies. Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who have experienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental health app that would be substantially more engaging and effective than the currently available apps to improve mental health and well-being. Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis (average age 26.7 years, SD 23.63; 16/32, 50% male; 16/32, 50% female). We asked participants about their experiences with mental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help Anxiety Management app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mental health and well-being mobile app. Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something to distract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interacting with others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeating motivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mental health apps, participants identified that general design characteristics; personalization of the app, including tracking and feedback, live support, and social community; and providing motivational content and relaxation exercises are the most important features that users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance to provide suggestions, goal setting, and privacy preservation were surprisingly the least requested features. Conclusions: Understanding end users’ needs and concerns about mental health apps will inform the future design of mental health apps that are useful to and used by many people. %M 33635281 %R 10.2196/18172 %U https://formative.jmir.org/2021/2/e18172 %U https://doi.org/10.2196/18172 %U http://www.ncbi.nlm.nih.gov/pubmed/33635281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22854 %T Comparison of Facebook, Google Ads, and Reddit for the Recruitment of People Who Considered but Did Not Obtain Abortion Care in the United States: Cross-sectional Survey %A Moseson,Heidi %A Wollum,Alexandra %A Seymour,Jane W %A Zuniga,Carmela %A Thompson,Terri-Ann %A Gerdts,Caitlin %+ Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, United States, 1 5108222696, hmoseson@gmail.com %K abortion, induced %K abortion seekers %K abortion surveys %K bias, selection %K pregnancy, unplanned %K research subject recruitment %K reproductive health %K social media %K social stigma %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, abortion access is restricted by numerous logistical, financial, social, and policy barriers. Most studies on abortion-seeking experiences in the United States have recruited participants from abortion clinics. However, clinic-based recruitment strategies fail to capture the experiences of people who consider an abortion but do not make it to an abortion clinic. Research indicates that many people search for abortion information on the web; however, web-based recruitment remains underutilized in abortion research. Objective: This study aims to establish the feasibility of using Facebook, Google Ads, and Reddit as recruitment platforms for a study on abortion-seeking experiences in the United States. Methods: From August to September 2018, we posted recruitment advertisements for a survey about abortion-seeking experiences through Facebook, Google Ads, and Reddit. Eligible participants were US residents aged 15-49 years who had been pregnant in the past 5 years and had considered abortion for a pregnancy in this period but did not abort. For each platform, we recorded staff time to develop advertisements and manage recruitment, as well as costs related to advertisement buys and social marketing firm support. We summarized the number of views and clicks for each advertisement where possible, and we calculated metrics related to cost per recruited participant and recruitment rate by week for each platform. We assessed differences across platforms using the chi-square and Kruskal-Wallis tests. Results: Overall, study advertisements received 77,464 views in the 1-month period (from Facebook and Google; information not available for Reddit) and 2808 study page views. After clicking on the advertisements, there were 1254 initiations of the eligibility screening survey, which resulted in 98 eligible survey participants (75 recruited from Facebook, 14 from Google Ads, and 9 from Reddit). The cost for each eligible participant in each platform was US $49.48 for Facebook, US $265.93 for Google Ads, and US $182.78 for Reddit. A total of 84% (66/79) of those who screened eligible from Facebook completed the short survey compared with 73% (8/11) of those who screened eligible from Reddit and 13% (7/53) of those who screened eligible from Google Ads. Conclusions: These results suggest that Facebook advertisements may be the most time- and cost-effective strategy to recruit people who considered but did not obtain an abortion in the United States. Adapting and implementing Facebook-based recruitment strategies for research on abortion access could facilitate a more complete understanding of the barriers to abortion care in the United States. %M 33625368 %R 10.2196/22854 %U https://formative.jmir.org/2021/2/e22854 %U https://doi.org/10.2196/22854 %U http://www.ncbi.nlm.nih.gov/pubmed/33625368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14179 %T Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study %A Maatoug,Redwan %A Peiffer-Smadja,Nathan %A Delval,Guillaume %A Brochu,Térence %A Pitrat,Benjamin %A Millet,Bruno %+ Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, 47-83 Boulevard de l'hôpital, Paris, 75013, France, 33 682476484, redwanmaatoug@gmail.com %K ecological momentary assessment %K depression %K smartphone %K feasibility study %K user experience %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective: The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods: Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results: Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions: This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations. %M 33625367 %R 10.2196/14179 %U https://formative.jmir.org/2021/2/e14179 %U https://doi.org/10.2196/14179 %U http://www.ncbi.nlm.nih.gov/pubmed/33625367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24561 %T A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study %A Waselewski,Marika Elise %A Flickinger,Tabor Elisabeth %A Canan,Chelsea %A Harrington,William %A Franklin,Taylor %A Otero,Kori Nicole %A Huynh,Jacqueline %A Waldman,Ava Lena Davila %A Hilgart,Michelle %A Ingersoll,Karen %A Ait-Daoud Tiouririne,Nassima %A Dillingham,Rebecca Anne %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 734 647 3305, marikag@med.umich.edu %K opioid use disorder %K mHealth %K retention in care %K self-management %K opioids %K public health %K mobile phone %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. Objective: The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. Methods: Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers’ perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants’ input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. Results: Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. Conclusions: The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program’s effect on clinical outcomes, patient linkage, and engagement in care. %M 33620324 %R 10.2196/24561 %U https://formative.jmir.org/2021/2/e24561 %U https://doi.org/10.2196/24561 %U http://www.ncbi.nlm.nih.gov/pubmed/33620324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e17672 %T Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan %A Tian,Peter George Jaminal %A Harris,Jeffrey Richard %A Seikaly,Hadi %A Chambers,Thane %A Alvarado,Sara %A Eurich,Dean %+ Department of Family Medicine, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada, 1 780 492 6306, petergeo@ualberta.ca %K telephone consultations %K teleconsultations %K remote consultations %K telemedicine %K eHealth %K environmental scan %D 2021 %7 23.2.2021 %9 Review %J JMIR Form Res %G English %X Background: Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective: As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods: We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results: The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions: Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.  %M 33620325 %R 10.2196/17672 %U https://formative.jmir.org/2021/2/e17672 %U https://doi.org/10.2196/17672 %U http://www.ncbi.nlm.nih.gov/pubmed/33620325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e23870 %T Evaluating Closures of Fresh Fruit and Vegetable Vendors During the COVID-19 Pandemic: Methodology and Preliminary Results Using Omnidirectional Street View Imagery %A Ali,Shahmir H %A Imbruce,Valerie M %A Russo,Rienna G %A Kaplan,Samuel %A Stevenson,Kaye %A Mezzacca,Tamar Adjoian %A Foster,Victoria %A Radee,Ashley %A Chong,Stella %A Tsui,Felice %A Kranick,Julie %A Yi,Stella S %+ Department of Population Health, NYU Grossman School of Medicine, 8th Floor, Room 8-13, 180 Madison Avenue, New York, NY, United States, 1 646 501 3477, Stella.Yi@nyulangone.org %K built environment %K Google Street View %K food retail environment %K COVID-19 %K geographic surveillance %K food %K longitudinal %K supply chain %K economy %K demand %K service %K vendor %K surveillance %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has significantly disrupted the food retail environment. However, its impact on fresh fruit and vegetable vendors remains unclear; these are often smaller, more community centered, and may lack the financial infrastructure to withstand supply and demand changes induced by such crises. Objective: This study documents the methodology used to assess fresh fruit and vegetable vendor closures in New York City (NYC) following the start of the COVID-19 pandemic by using Google Street View, the new Apple Look Around database, and in-person checks. Methods: In total, 6 NYC neighborhoods (in Manhattan and Brooklyn) were selected for analysis; these included two socioeconomically advantaged neighborhoods (Upper East Side, Park Slope), two socioeconomically disadvantaged neighborhoods (East Harlem, Brownsville), and two Chinese ethnic neighborhoods (Chinatown, Sunset Park). For each neighborhood, Google Street View was used to virtually walk down each street and identify vendors (stores, storefronts, street vendors, or wholesalers) that were open and active in 2019 (ie, both produce and vendor personnel were present at a location). Past vendor surveillance (when available) was used to guide these virtual walks. Each identified vendor was geotagged as a Google Maps pinpoint that research assistants then physically visited. Using the “notes” feature of Google Maps as a data collection tool, notes were made on which of three categories best described each vendor: (1) open, (2) open with a more limited setup (eg, certain sections of the vendor unit that were open and active in 2019 were missing or closed during in-person checks), or (3) closed/absent. Results: Of the 135 open vendors identified in 2019 imagery data, 35% (n=47) were absent/closed and 10% (n=13) were open with more limited setups following the beginning of the COVID-19 pandemic. When comparing boroughs, 35% (28/80) of vendors in Manhattan were absent/closed, as were 35% (19/55) of vendors in Brooklyn. Although Google Street View was able to provide 2019 street view imagery data for most neighborhoods, Apple Look Around was required for 2019 imagery data for some areas of Park Slope. Past surveillance data helped to identify 3 additional established vendors in Chinatown that had been missed in street view imagery. The Google Maps “notes” feature was used by multiple research assistants simultaneously to rapidly collect observational data on mobile devices. Conclusions: The methodology employed enabled the identification of closures in the fresh fruit and vegetable retail environment and can be used to assess closures in other contexts. The use of past baseline surveillance data to aid vendor identification was valuable for identifying vendors that may have been absent or visually obstructed in the street view imagery data. Data collection using Google Maps likewise has the potential to enhance the efficiency of fieldwork in future studies. %M 33539310 %R 10.2196/23870 %U http://formative.jmir.org/2021/2/e23870/ %U https://doi.org/10.2196/23870 %U http://www.ncbi.nlm.nih.gov/pubmed/33539310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18385 %T Improving Efficiency of Clinical Studies Using a Total Digital Approach: Prospective Observational Study %A Schenck-Gustafsson,Karin %A Carnlöf,Carina %A Jensen-Urstad,Mats %A Insulander,Per %+ Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Norrbacka S1:02, Stockholm, S 17176, Sweden, 46 707686487, karin.schenck-gustafsson@ki.se %K ECG recordings %K women %K palpitations %K full digitalization %K eAuthentication %K BankID %K clinical trial %K mHealth %K electrocardiogram %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In general, most clinical studies have long recruitment periods. Signing the informed consent is particularly time-consuming when the participant must meet physically with the researchers. Therefore, introducing fully web-based techniques with the use of eAuthentication (BankID) and new digital electrocardiogram (ECG) monitoring could speed up inclusion time, increase adherence, and also reach out to more remote regions. Objective: The objectives of this study were to explore whether inclusion of a large number of participants could be realized quickly by using a total digital approach both for information and signing of informed consent, along with ECG monitoring and instant feedback on a mobile device. We also explored whether this approach can increase adherence in registration of ECG recordings and answering questionnaires, and if it would result in a more geographically uniform distribution of participants covering a wide age span. Methods: Women with palpitations were intensively studied over 2 months by means of a handheld ECG monitoring device (Coala Heart Monitor). The device connects to a smartphone or tablet, which allows the participants to obtain the results immediately. Recruitment, study information, and signing the informed consent form with the help of BankID were performed in a completely digital manner. Results: Between March and May 2018, 2424 women indicated their interest in participating in the study. On June 19, 2018, presumptive participants were invited to log in and register. After 25 days, 1082 women were included in the study; among these, 1020 women fulfilled the inclusion criteria, 913 of whom completed all phases of the study: recording ECG using the handheld device, completion of the prestudy questionnaires, and completion of the poststudy questionnaires 2 months after the ECG recordings. The dropout rate was 9%. In total, 101,804 ECG recordings were made. The mean age was 56 (SD 11) years (range 21-88 years) and 35 participants were 75 years or older. The participants were evenly distributed between living in the countryside and in cities. Conclusions: Total digital inclusion recruitment of 1082 participants was achieved in only 25 days, and resulted in a good geographical distribution, excellent adherence, and ability to reach a vast age span, including elderly women. Studies using a total digital design would be particularly appealing during a pandemic since physical contact should be avoided as much as possible. Trial Registration: ISRCTN Registry ISRCTN22495299; http://www.isrctn.com/ISRCTN22495299 %M 33599617 %R 10.2196/18385 %U http://formative.jmir.org/2021/2/e18385/ %U https://doi.org/10.2196/18385 %U http://www.ncbi.nlm.nih.gov/pubmed/33599617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21432 %T Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Sturlugata 1, Reykjavik, 101, Iceland, 354 6184805, erlendu@hi.is %K mHealth %K intervention %K adolescent %K attrition %K self-efficacy %K mental health %K physical activity %K young adult %K behavior %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. %M 33481750 %R 10.2196/21432 %U http://formative.jmir.org/2021/2/e21432/ %U https://doi.org/10.2196/21432 %U http://www.ncbi.nlm.nih.gov/pubmed/33481750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14760 %T A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study %A Jung,Hyunggu %A Demiris,George %A Tarczy-Hornoch,Peter %A Zachry,Mark %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K mobile health %K older adults %K diabetes %K dietary assessment %K smartphone app %K usability test %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants’ opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. %M 33493129 %R 10.2196/14760 %U http://formative.jmir.org/2021/2/e14760/ %U https://doi.org/10.2196/14760 %U http://www.ncbi.nlm.nih.gov/pubmed/33493129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e23200 %T Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study %A Krijnen-de Bruin,Esther %A Geerlings,Jasmijn A %A Muntingh,Anna DT %A Scholten,Willemijn D %A Maarsingh,Otto R %A van Straten,Annemieke %A Batelaan,Neeltje M %A van Meijel,Berno %+ Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, Netherlands, 31 884662683, esther.krijnendebruin@inholland.nl %K relapse prevention %K anxiety disorder %K depressive disorder %K eHealth %K general practice %K qualitative research %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective: This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods: Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results: Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions: The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2034-6 %M 33591277 %R 10.2196/23200 %U http://formative.jmir.org/2021/2/e23200/ %U https://doi.org/10.2196/23200 %U http://www.ncbi.nlm.nih.gov/pubmed/33591277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22220 %T A Web-Based Self-Management Support Prototype for Adults With Chronic Kidney Disease (My Kidneys My Health): Co-Design and Usability Testing %A Donald,Maoliosa %A Beanlands,Heather %A Straus,Sharon E %A Smekal,Michelle %A Gil,Sarah %A Elliott,Meghan J %A Herrington,Gwen %A Harwood,Lori %A Waldvogel,Blair %A Delgado,Maria %A Sparkes,Dwight %A Tong,Allison %A Grill,Allan %A Novak,Marta %A James,Matthew Thomas %A Brimble,K Scott %A Samuel,Susan %A Tu,Karen %A Farragher,Janine %A Hemmelgarn,Brenda R %+ Faculty of Medicine and Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Edmonton, AB, T6G 2B7, Canada, 1 780 492 9728, Brenda.Hemmelgarn@albertahealthservices.ca %K chronic kidney disease %K knowledge-to-action framework %K integrated knowledge translation %K patient engagement %K patient-oriented research %K self-management %K web-based intervention %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient’s unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. Objective: The aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. Methods: A multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. Results: In step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. Conclusions: The My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted. %M 33560245 %R 10.2196/22220 %U https://formative.jmir.org/2021/2/e22220 %U https://doi.org/10.2196/22220 %U http://www.ncbi.nlm.nih.gov/pubmed/33560245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21737 %T Development and Feasibility of a Digital Acceptance and Commitment Therapy–Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study %A Hemmings,Nicola R %A Kawadler,Jamie M %A Whatmough,Rachel %A Ponzo,Sonia %A Rossi,Alessio %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Department of Organizational Psychology, Birkbeck University of London, Malet St, London, WC1E 7HX, United Kingdom, 44 7716362200, nhemmi01@mail.bbk.ac.uk %K anxiety %K depression %K acceptance and commitment therapy %K person-based approach %K mHealth %K mental health %K digital %K remote %K smartphone %K mobile phone %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. %M 33560232 %R 10.2196/21737 %U https://formative.jmir.org/2021/2/e21737 %U https://doi.org/10.2196/21737 %U http://www.ncbi.nlm.nih.gov/pubmed/33560232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19234 %T Recruitment of Participants for a 3D Virtual Supermarket: Cross-sectional Observational Study %A Hoenink,Jody C %A Mackenbach,Joreintje D %A van der Laan,Laura Nynke %A Lakerveld,Jeroen %A Waterlander,Wilma %A Beulens,Joline W J %+ Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, Netherlands, 31 204449681, j.c.hoenink@amsterdamumc.nl %K online study %K nudges %K pricing %K recruitment strategies %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual supermarkets offer a practical and affordable setting to test the efficacy of different pricing and nudging strategies before they are implemented in the real world. Despite the advantages of using virtual supermarkets for this purpose, conducting studies in online settings is challenging with regard to recruitment and retention of sufficient and suitable participants. Objective: To describe cost, time, and retention with regard to participants recruited using various strategies and potential sociodemographic differences between participants recruited via different strategies. Methods: This cross-sectional study used data from a randomized controlled trial in which 455 Dutch adults with low and high educational levels were invited to shop 5 times in a 3D virtual supermarket. Participants were recruited via social media and flyers. A log that tracked the costs of and time spent on the different recruitment strategies was kept by the study team. Outcome measures included the cost of recruitment strategies, the time investment by researchers, and recruitment and attrition rates of participants in the study. Results: The median age of study completers was 31.0 (IQR 25.0) and 157 out of 346 study completers (45.4%) were highly educated. Out of the 455 included participants, 235 (51.6%) were recruited via social media campaigns, 131 (28.8%) via home-delivered flyers, 38 (8.4%) via flyers directly distributed by the study team, and 46 (10.1%) via word-of-mouth. Of all paid recruitment strategies, social media campaigns were the cheapest and least time-consuming, whereas the distribution of flyers by the study team was the most expensive and time-consuming recruitment strategy. Age, sex, overweight status, employment situation, and number of adults within the household varied by recruitment strategy. Conclusions: Using different recruitment strategies resulted in the efficient recruitment of a representative study sample and retention of participants was relatively high. While “word-of-mouth” was the most cost- and time-effective recruitment strategy, using only one type of recruitment strategy could result in a demographically skewed study population. %M 33560230 %R 10.2196/19234 %U http://formative.jmir.org/2021/2/e19234/ %U https://doi.org/10.2196/19234 %U http://www.ncbi.nlm.nih.gov/pubmed/33560230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients’ pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19–related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24061 %T Designing a Personalized Health Dashboard: Interdisciplinary and Participatory Approach %A Weijers,Miriam %A Bastiaenen,Caroline %A Feron,Frans %A Schröder,Kay %+ Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 +31646442957, miriam.weijers@ggdzl.nl %K visualization design model %K dashboard %K evaluation %K personalized health care %K International Classification of Functioning, Disability and Health (ICF) %K patient access to records %K human–computer interaction %K health information visualization %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children’s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective: This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods: Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type Abstraction, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype. Results: A comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children’s health and “entry points” for preventive, individualized health plans. Conclusions: Describing this developmental process offers guidance on how to utilize the nested design model within a health care context. %M 33560229 %R 10.2196/24061 %U https://formative.jmir.org/2021/2/e24061 %U https://doi.org/10.2196/24061 %U http://www.ncbi.nlm.nih.gov/pubmed/33560229 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e12218 %T Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma: Prospective Multicenter Randomized Clinical Trial %A Almonacid,Carlos %A Melero,Carlos %A López Viña,Antolín %A Cisneros,Carolina %A Pérez de Llano,Luis %A Plaza,Vicente %A García-Rivero,Juan Luis %A Romero Falcón,Auxiliadora %A Ramos,Jacinto %A Bazús González,Teresa %A Andrés Prado,María %A Muriel,Alfonso %+ Department of Respiratory Medicine, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala de Henares, Ctra. De Colmenar Viejo, km. 9,100, Madrid, , Spain, 34 655 534 475, caralmsan@gmail.com %K asthma %K adherence %K SMS %K control %K cell phone %K inhaler %K Smartinhaler %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. Objective: The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. Methods: A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. Results: There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P=.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Conclusions: Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care. %M 33560235 %R 10.2196/12218 %U http://formative.jmir.org/2021/2/e12218/ %U https://doi.org/10.2196/12218 %U http://www.ncbi.nlm.nih.gov/pubmed/33560235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19243 %T Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study %A Clouse,Kate %A Phillips,Tamsin K %A Mogoba,Phepo %A Ndlovu,Linda %A Bassett,Jean %A Myer,Landon %+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 (615) 343 5351, kate.clouse@vanderbilt.edu %K HIV/AIDS %K South Africa %K smartphone %K mobile health %K pregnancy %K GPS tracking %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Peripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time. Objective: The aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users’ attitudes toward the proposed app. Methods: We conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations. Results: In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual’s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. Conclusions: Women living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. %M 33555261 %R 10.2196/19243 %U https://formative.jmir.org/2021/2/e19243 %U https://doi.org/10.2196/19243 %U http://www.ncbi.nlm.nih.gov/pubmed/33555261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e25184 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using a Chatbot Augmented Intelligence Genetic Counselor: Development and Feasibility Study %A Sato,Ann %A Haneda,Eri %A Suganuma,Nobuyasu %A Narimatsu,Hiroto %+ Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, 81 045 520 2222, hiroto-narimatsu@umin.org %K artificial intelligence %K augmented intelligence %K hereditary cancer %K familial cancer %K IBM Watson %K preliminary screening %K cancer %K genetics %K chatbot %K screening %K feasibility %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common form of cancer in Japan; genetic background and hereditary breast and ovarian cancer (HBOC) are implicated. The key to HBOC diagnosis involves screening to identify high-risk individuals. However, genetic medicine is still developing; thus, many patients who may potentially benefit from genetic medicine have not yet been identified. Objective: This study’s objective is to develop a chatbot system that uses augmented intelligence for HBOC screening to determine whether patients meet the National Comprehensive Cancer Network (NCCN) BRCA1/2 testing criteria. Methods: The system was evaluated by a doctor specializing in genetic medicine and certified genetic counselors. We prepared 3 scenarios and created a conversation with the chatbot to reflect each one. Then we evaluated chatbot feasibility, the required time, the medical accuracy of conversations and family history, and the final result. Results: The times required for the conversation were 7 minutes for scenario 1, 15 minutes for scenario 2, and 16 minutes for scenario 3. Scenarios 1 and 2 met the BRCA1/2 testing criteria, but scenario 3 did not, and this result was consistent with the findings of 3 experts who retrospectively reviewed conversations with the chatbot according to the 3 scenarios. A family history comparison ascertained by the chatbot with the actual scenarios revealed that each result was consistent with each scenario. From a genetic medicine perspective, no errors were noted by the 3 experts. Conclusions: This study demonstrated that chatbot systems could be applied to preliminary genetic medicine screening for HBOC. %M 33544084 %R 10.2196/25184 %U https://formative.jmir.org/2021/2/e25184 %U https://doi.org/10.2196/25184 %U http://www.ncbi.nlm.nih.gov/pubmed/33544084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e20464 %T Quantification of Smoking Characteristics Using Smartwatch Technology: Pilot Feasibility Study of New Technology %A Cole,Casey Anne %A Powers,Shannon %A Tomko,Rachel L %A Froeliger,Brett %A Valafar,Homayoun %+ Department of Computer Science and Engineering, University of South Carolina, 1400 Assembly Street, Columbia, SC, 29208, United States, 1 9372067968, coleca@email.sc.edu %K smartwatch %K CReSS %K smoking topography %K ASPIRE %K automated %K wearable technology %K wearable computing %K smoking %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: While there have been many technological advances in studying the neurobiological and clinical basis of tobacco use disorder and nicotine addiction, there have been relatively minor advances in technologies for monitoring, characterizing, and intervening to prevent smoking in real time. Better understanding of real-time smoking behavior can be helpful in numerous applications without the burden and recall bias associated with self-report. Objective: The goal of this study was to test the validity of using a smartwatch to advance the study of temporal patterns and characteristics of smoking in a controlled laboratory setting prior to its implementation in situ. Specifically, the aim was to compare smoking characteristics recorded by Automated Smoking PerceptIon and REcording (ASPIRE) on a smartwatch with the pocket Clinical Research Support System (CReSS) topography device, using video observation as the gold standard. Methods: Adult smokers (N=27) engaged in a video-recorded laboratory smoking task using the pocket CReSS while also wearing a Polar M600 smartwatch. In-house software, ASPIRE, was used to record accelerometer data to identify the duration of puffs and interpuff intervals (IPIs). The recorded sessions from CReSS and ASPIRE were manually annotated to assess smoking topography. Agreement between CReSS-recorded and ASPIRE-recorded smoking behavior was compared. Results: ASPIRE produced more consistent number of puffs and IPI durations relative to CReSS, when comparing both methods to visual puff count. In addition, CReSS recordings reported many implausible measurements in the order of milliseconds. After filtering implausible data recorded from CReSS, ASPIRE and CReSS produced consistent results for puff duration (R2=.79) and IPIs (R2=.73). Conclusions: Agreement between ASPIRE and other indicators of smoking characteristics was high, suggesting that the use of ASPIRE is a viable method of passively characterizing smoking behavior. Moreover, ASPIRE was more accurate than CReSS for measuring puffs and IPIs. Results from this study provide the foundation for future utilization of ASPIRE to passively and accurately monitor and quantify smoking behavior in situ. %M 33544083 %R 10.2196/20464 %U https://formative.jmir.org/2021/2/e20464 %U https://doi.org/10.2196/20464 %U http://www.ncbi.nlm.nih.gov/pubmed/33544083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22406 %T Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study %A Appel,Lora %A Kisonas,Erika %A Appel,Eva %A Klein,Jennifer %A Bartlett,Deanna %A Rosenberg,Jarred %A Smith,Christopher NC %+ Faculty of Health, School of Health Policy and Management, York University, 426 Health, Nursing and Environmental Studies Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 6475046537, lora.appel@uhn.ca %K virtual reality %K wearable electronic devices %K sensory art therapies %K hospitalization %K hospitals, community %K hospitals, general %K aged %K humans %K dementia %K behavioral symptoms %K nature %K mobile phone %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals. Objective: This study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia. Methods: A prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator–facilitated sessions of viewing immersive 360° VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience. Results: All recruited participants (N=10) completed the study. Of the 10 participants, 7 (70%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported. Conclusions: It is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals. %M 33533720 %R 10.2196/22406 %U https://formative.jmir.org/2021/2/e22406 %U https://doi.org/10.2196/22406 %U http://www.ncbi.nlm.nih.gov/pubmed/33533720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24382 %T Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation %A Kosowan,Leanne %A Katz,Alan %A Halas,Gayle %A LaBine,Lisa %A Singer,Alexander %+ Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada, 1 204 789 3442, Alan.katz@umanitoba.ca %K risk factors %K information technology %K primary health care %K primary prevention %D 2021 %7 2.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. Objective: This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. Methods: This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. Results: Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. Conclusions: Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care. %M 33528376 %R 10.2196/24382 %U https://formative.jmir.org/2021/2/e24382 %U https://doi.org/10.2196/24382 %U http://www.ncbi.nlm.nih.gov/pubmed/33528376 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22723 %T Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study %A Di Matteo,Daniel %A Wang,Wendy %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Yu,Julia %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, DL Pratt Building, 6 King's College Road, Toronto, ON, M5S 3H5, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K mobile sensing %K passive sensing %K psychiatric assessment %K mood and anxiety disorders %K mobile apps %K linguistics %K speech recognition %K speech content %K lexical choice %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. Objective: The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. Results: The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (r=0.41, P<.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (r=–0.22, P=.04) and generalized anxiety (r=–0.29, P=.007), and vision-related words with social anxiety (r=0.31, P=.003). Conclusions: In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health. %M 33512325 %R 10.2196/22723 %U http://formative.jmir.org/2021/1/e22723/ %U https://doi.org/10.2196/22723 %U http://www.ncbi.nlm.nih.gov/pubmed/33512325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e17501 %T Development and Feasibility of a Family-Based Health Behavior Intervention Using Intelligent Personal Assistants: Randomized Controlled Trial %A Carlin,Angela %A Logue,Caomhan %A Flynn,Jonathan %A Murphy,Marie H %A Gallagher,Alison M %+ Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 2871675037, a.carlin1@ulster.ac.uk %K children %K parent %K physical activity %K healthy eating %K technology %K mobile phone %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intelligent personal assistants such as Amazon Echo and Google Home have become increasingly integrated into the home setting and, therefore, may facilitate behavior change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context. Objective: This feasibility study aims to develop the Intelligent Personal Assistant Project (IPAP) and assess the acceptability and feasibility of this technology for promoting and maintaining physical activity and other health-related behaviors in both parents and children. Methods: This pilot feasibility study was conducted in 2 phases. For phase 1, families who were attending a community-based weight management project were invited to participate, whereas phase 2 recruited families not currently receiving any additional intervention. Families were randomly allocated to either the intervention group (received a smart speaker for use in the family home) or the control group. The IPAP intervention aimed to promote positive health behaviors in the family setting through utilization of the functions of a smart speaker and its linked intelligent personal assistant. Data were collected on recruitment, retention, outcome measures, intervention acceptability, device interactions, and usage. Results: In total, 26 families with at least one child aged 5 to 12 years were recruited, with 23 families retained at follow-up. Across phase 1 of the intervention, families interacted with the intelligent personal assistant a total of 65 times. Although device interactions across phase 2 of the intervention were much higher (312 times), only 10.9% (34/312) of interactions were coded as relevant (related to diet, physical activity or well-being). Focus groups highlighted that the families found the devices acceptable and easy to use and felt that the prompts or reminders were useful in prompting healthier behaviors. Some further intervention refinements in relation to the timing of prompts and integrating feedback alongside the devices were suggested by families. Conclusions: Using intelligent personal assistants to deliver health-related messages and information within the home is feasible, with high levels of engagement reported by participating families. This novel feasibility study highlights important methodological considerations that should inform future trials testing the effectiveness of intelligent personal assistants in promoting positive health-related behaviors. Trial Registration: ISRCTN Registry ISRCTN16792534; http://www.isrctn.com/ISRCTN16792534 %M 33507155 %R 10.2196/17501 %U http://formative.jmir.org/2021/1/e17501/ %U https://doi.org/10.2196/17501 %U http://www.ncbi.nlm.nih.gov/pubmed/33507155 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e15369 %T A Smartphone App to Support Sedentary Behavior Change by Visualizing Personal Mobility Patterns and Action Planning (SedVis): Development and Pilot Study %A Wang,Yunlong %A König,Laura M. %A Reiterer,Harald %+ Department of Computer and Information Science, University of Konstanz, Universitätsstraße 10, Konstanz, 78457, Germany, 49 7531 88 3704, yunlong.wang@uni-konstanz.de %K sedentary behavior %K data visualization %K mobile app %K action planning %K human mobility patterns %K mobile phone %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Prolonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, simple yet practical solutions for behavior change are needed to avoid detrimental health effects. Objective: The mobile app SedVis was developed based on the health action process approach. The app provides personal mobility pattern visualization (for both physical activity and sedentary behavior) and action planning for sedentary behavior change. The primary aim of the study is to investigate the effect of mobility pattern visualization on users’ action planning for changing their sedentary behavior. The secondary aim is to evaluate user engagement with the visualization and user experience of the app. Methods: A 3-week user study was conducted with 16 participants who had the motivation to reduce their sedentary behavior. Participants were allocated to either an active control group (n=8) or an intervention group (n=8). In the 1-week baseline period, none of the participants had access to the functions in the app. In the following 2-week intervention period, only the intervention group was given access to the visualizations, whereas both groups were asked to make action plans every day and reduce their sedentary behavior. Participants’ sedentary behavior was estimated based on the sensor data of their smartphones, and their action plans and interaction with the app were also recorded by the app. Participants’ intention to change their sedentary behavior and user experience of the app were assessed using questionnaires. Results: The data were analyzed using both traditional null hypothesis significance testing (NHST) and Bayesian statistics. The results suggested that the visualizations in SedVis had no effect on the participants’ action planning according to both the NHST and Bayesian statistics. The intervention involving visualizations and action planning in SedVis had a positive effect on reducing participants’ sedentary hours, with weak evidence according to Bayesian statistics (Bayes factor, BF+0=1.92; median 0.52; 95% CI 0.04-1.25), whereas no change in sedentary time was more likely in the active control condition (BF+0=0.28; median 0.18; 95% CI 0.01-0.64). Furthermore, Bayesian analysis weakly suggested that the more frequently the users checked the app, the more likely they were to reduce their sedentary behavior (BF−0=1.49; r=−0.50). Conclusions: Using a smartphone app to collect data on users’ mobility patterns and provide real-time feedback using visualizations may be a promising method to induce changes in sedentary behavior and may be more effective than action planning alone. Replications with larger samples are needed to confirm these findings. %M 33502322 %R 10.2196/15369 %U http://formative.jmir.org/2021/1/e15369/ %U https://doi.org/10.2196/15369 %U http://www.ncbi.nlm.nih.gov/pubmed/33502322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e24662 %T Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study %A Kunkle,Sarah %A Yip,Manny %A Hunt,Justin %A Ξ,Watson %A Udall,Dana %A Arean,Patricia %A Nierenberg,Andrew %A Naslund,John A %+ Ginger, 116 New Montgomery Street, San Francisco, CA, United States, 1 7175197355, sarah@ginger.io %K mental health %K digital health %K anxiety %K telehealth %K virtual care %K utilization %K outcome %K retrospective %K observational %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. Objective: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. Methods: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. Results: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app-only”). Higher GAD-7 intake scores were also associated with decreased odds of improvement. Conclusions: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. %M 33496679 %R 10.2196/24662 %U http://formative.jmir.org/2021/1/e24662/ %U https://doi.org/10.2196/24662 %U http://www.ncbi.nlm.nih.gov/pubmed/33496679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e19413 %T A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings %A Rutland,Sarah B %A Bergquist,Rikard Palmer %A Hager,Andreas %A Geurs,Robin %A Mims,Cathy %A Gutierrez,Hector H %A Oates,Gabriela R %+ Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Lowder 620, 1600 7th Ave S, Birmingham, AL, 35233, United States, 1 2056389583, goates@uab.edu %K cystic fibrosis %K mHealth %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. Objective: The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. Methods: Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. Results: A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. Conclusions: This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users’ needs and evidence-based practice recommendations. %M 33496667 %R 10.2196/19413 %U http://formative.jmir.org/2021/1/e19413/ %U https://doi.org/10.2196/19413 %U http://www.ncbi.nlm.nih.gov/pubmed/33496667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20841 %T A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype %A Benedict,Catherine %A Dauber-Decker,Katherine L %A King,D'Arcy %A Hahn,Alexandria %A Ford,Jennifer S %A Diefenbach,Michael %+ Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305-5718, United States, 1 2012077117, cbenedict@stanford.edu %K patient-centered care %K user-centered design %K decision support techniques %K decision aid %K cancer %K fertility %K internet-based intervention %K web-based intervention %K mobile phone %K psychosocial intervention %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients’ needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users’ needs, values, abilities, and limitations. Objective: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. Methods: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. Results: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. Conclusions: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement. %M 33480848 %R 10.2196/20841 %U http://formative.jmir.org/2021/1/e20841/ %U https://doi.org/10.2196/20841 %U http://www.ncbi.nlm.nih.gov/pubmed/33480848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13908 %T Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study %A Meherali,Salima %A Hartling,Lisa %A Scott,Shannon D %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 7804921037, shannon.scott@ualberta.ca %K acute otitis media %K knowledge translation %K pediatric %K parent’s experiences %K information needs %K global health %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users. Objective: This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools. Methods: Parents’ perceptions of the translated knowledge translation tools’ usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data. Results: Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents. Conclusions: Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes. %M 33470942 %R 10.2196/13908 %U http://formative.jmir.org/2021/1/e13908/ %U https://doi.org/10.2196/13908 %U http://www.ncbi.nlm.nih.gov/pubmed/33470942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e18214 %T The Acceptability and Efficacy of Electronic Data Collection in a Hospital Neurodevelopmental Clinic: Pilot Questionnaire Study %A Patel,Shrujna %A Boulton,Kelsie Ann %A Redoblado-Hodge,Marie Antoinette %A Papanicolaou,Angela %A Barnett,Diana %A Bennett,Beverley %A Drevensek,Suzi %A Cramsie,Jane %A Ganesalingam,Kalaichelvi %A Ong,Natalie %A Rozsa,Magdalen %A Sutherland,Rebecca %A Williamsz,Marcia %A Pokorski,Izabella %A Song,Yun Ju Christine %A Silove,Natalie %A Guastella,Adam John %+ Autism Clinic for Translational Research, Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia, 61 2 9351 0539, adam.guastella@sydney.edu.au %K electronic data collection %K family-centered care %K hospital-based data collection %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing need for cost-efficient and patient-centered approaches to support families in hospital- and community-based neurodevelopmental services. For such purposes, electronic data collection (EDC) may hold advantages over paper-based data collection. Such EDC approaches enable automated data collection for scoring and interpretation, saving time for clinicians and services and promoting more efficient service delivery. Objective: This pilot study evaluated the efficacy of EDC for the Child Development Unit, a hospital-based diagnostic assessment clinic in the Sydney Children’s Hospital Network. Caregiver response rates and preference for EDC or paper-based methods were evaluated as well as the moderating role of demographic characteristics such as age, level of education, and ethnic background. Methods: Families were sent either a paper-based questionnaire via post or an electronic mail link for completion before attending their first on-site clinic appointment for assessment. A total of 62 families were provided a paper version of the questionnaire, while 184 families were provided the online version of the same questionnaire. Results: Completion rates of the questionnaire before the first appointment were significantly higher for EDC (164/184, 89.1%) in comparison to paper-based methods (24/62, 39%; P<.001). Within the EDC group, a vast majority of respondents indicated a preference for completing the questionnaire online (151/173, 87.3%), compared to paper completion (22/173, 12.7%; P<.001). Of the caregiver demographic characteristics, only the respondent’s level of education was associated with modality preference, such that those with a higher level of education reported a greater preference for EDC (P=.04). Conclusions: These results show that EDC is feasible in hospital-based clinics and has the potential to offer substantial benefits in terms of centralized data collation, time and cost savings, efficiency of service, and resource allocation. The results of this study therefore support the continued use of electronic methods to improve family-centered care in clinical practices. %M 33464217 %R 10.2196/18214 %U http://formative.jmir.org/2021/1/e18214/ %U https://doi.org/10.2196/18214 %U http://www.ncbi.nlm.nih.gov/pubmed/33464217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20491 %T Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping %A Hallsworth,Kate %A McPherson,Stuart %A Anstee,Quentin M %A Flynn,Darren %A Haigh,Laura %A Avery,Leah %+ Centre for Rehabilitation, School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, United Kingdom, 44 1642384130 ext 4130, leah.avery@tees.ac.uk %K nonalcoholic fatty liver disease %K internet-based intervention %K lifestyle %K diet %K physical activity %K weight loss %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonalcoholic fatty liver disease (NAFLD) is linked to excessive calorie consumption, physical inactivity, and being overweight. Patients with NAFLD can halt or decelerate progression and potentially reverse their condition by changing their lifestyle behavior. International guidelines recommend the use of lifestyle interventions; however, there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific interventions to support weight loss and improve liver function. Objective: This study aims to use intervention mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes in their dietary and physical activity behavior to promote weight loss. Methods: Intervention mapping consisted of 6 steps: step 1 involved a needs assessment with primary and secondary health care professionals (HCPs) and patients with NAFLD; step 2 involved identification of the social cognitive determinants of change and behavioral outcomes of the intervention; step 3 involved linking social cognitive determinants of behavioral outcomes with behavior change techniques to effectively target dietary and physical activity behavior; step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content was identified as important for improving knowledge and skills from steps 1 and 2; step 5 involved the development of an implementation plan with a digital provider of lifestyle behavior change programs to patients with NAFLD using their delivery platform and lifestyle coaches; and step 6 involved piloting the digital intervention with patients to obtain data on access, usability, and content. Results: A digital intervention was developed, consisting of 8 modules; self-regulatory tools; and provision of telephone support by trained lifestyle coaches to help facilitate behavioral intention, enactment, and maintenance. A commercial provider of digital lifestyle behavior change programs enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. A total of 11 of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average 4 times over the piloting period). The most frequently accessed modules were welcome to the program, understanding NAFLD, and food and NAFLD. Goal setting and self-monitoring tools were accessed on 22 occasions (4 times per tool on average). A total of 3 out of 11 participants requested access to a lifestyle coach. Conclusions: Intervention mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process for patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimization of information content, and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness. %M 33448929 %R 10.2196/20491 %U http://www.jmir.org/2021/1/e20491/ %U https://doi.org/10.2196/20491 %U http://www.ncbi.nlm.nih.gov/pubmed/33448929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23190 %T Mobile App–Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis %A Shah,Sachin Shailendra %A Gvozdanovic,Andrew %A Knight,Matthew %A Gagnon,Julien %+ Huma Therapeutics, 13th Floor Millbank Tower, 21-24 Millbank, London, SW1P 4QP, United Kingdom, 44 7875210783, sachsshah@gmail.com %K mHealth %K remote patient monitoring %K digital health %K COVID-19 %K service improvement %K cost-effectiveness %K monitoring %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician’s workload in the context of a COVID-19–specific virtual ward. Objective: This prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital. Methods: A prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2). Results: In all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data. Conclusions: Smartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought. %M 33400675 %R 10.2196/23190 %U http://formative.jmir.org/2021/1/e23190/ %U https://doi.org/10.2196/23190 %U http://www.ncbi.nlm.nih.gov/pubmed/33400675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22450 %T Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study %A Jackowich,Robyn A %A Mooney,Kayla M %A Hecht,Evelyn %A Pukall,Caroline F %+ Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada, 1 613 533 3200, caroline.pukall@queensu.ca %K persistent genital arousal disorder %K genitopelvic dysesthesia %K online program %K pelvic floor %K pilot %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. %M 33427673 %R 10.2196/22450 %U http://formative.jmir.org/2021/1/e22450/ %U https://doi.org/10.2196/22450 %U http://www.ncbi.nlm.nih.gov/pubmed/33427673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20692 %T Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Arnelo,Urban %A Frennert,Susanne %+ Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, Stockholm, 141 57 Huddinge, Sweden, 46 8 790 80 71, hedvigam@kth.se %K telemedicine %K telementoring %K teleconsulting %K technology acceptance model %K professional users %K specialties, surgical/education %K attitude %K clinical staff %K surgery %K framework %K surgeon %K user-centered %K interview %K survey %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective: Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation. Results: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05). Conclusions: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes. %M 33427670 %R 10.2196/20692 %U https://formative.jmir.org/2021/1/e20692 %U https://doi.org/10.2196/20692 %U http://www.ncbi.nlm.nih.gov/pubmed/33427670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23000 %T Attitudes and Perceptions Toward COVID-19 Digital Surveillance: Survey of Young Adults in the United States %A Maytin,Lauren %A Maytin,Jason %A Agarwal,Priya %A Krenitsky,Anna %A Krenitsky,JoAnn %A Epstein,Robert S %+ Epstein Health LLC, 50 Tice Blvd, Suite 340, Woodcliff Lake, NJ, 07677, United States, 1 201 285 5800, repstein@epsteinhealth.com %K attitude %K perception %K young adult %K COVID-19 %K digital surveillance %K population health technologies %K surveillance %K population %K survey %K adolescent %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 is an international health crisis of particular concern in the United States, which saw surges of infections with the lifting of lockdowns and relaxed social distancing. Young adults have proven to be a critical factor for COVID-19 transmission and are an important target of the efforts to contain the pandemic. Scalable digital public health technologies could be deployed to reduce COVID-19 transmission, but their use depends on the willingness of young adults to participate in surveillance. Objective: The aim of this study is to determine the attitudes of young adults regarding COVID-19 digital surveillance, including which aspects they would accept and which they would not, as well as to determine factors that may be associated with their willingness to participate in digital surveillance. Methods: We conducted an anonymous online survey of young adults aged 18-24 years throughout the United States in June 2020. The questionnaire contained predominantly closed-ended response options with one open-ended question. Descriptive statistics were applied to the data. Results: Of 513 young adult respondents, 383 (74.7%) agreed that COVID-19 represents a public health crisis. However, only 231 (45.1%) agreed to actively share their COVID-19 status or symptoms for monitoring and only 171 (33.4%) reported a willingness to allow access to their cell phone for passive location tracking or contact tracing. Conclusions: Despite largely agreeing that COVID-19 represents a serious public health risk, the majority of young adults sampled were reluctant to participate in digital monitoring to manage the pandemic. This was true for both commonly used methods of public health surveillance (such as contact tracing) and novel methods designed to facilitate a return to normal (such as frequent symptom checking through digital apps). This is a potential obstacle to ongoing containment measures (many of which rely on widespread surveillance) and may reflect a need for greater education on the benefits of public health digital surveillance for young adults. %M 33347420 %R 10.2196/23000 %U http://formative.jmir.org/2021/1/e23000/ %U https://doi.org/10.2196/23000 %U http://www.ncbi.nlm.nih.gov/pubmed/33347420 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13770 %T Mobile App–Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review %A Chan,Eric C %A Sun,Yuting %A Aitchison,Katherine J %A Sivapalan,Sudhakar %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7802332709, echantai@ualberta.ca %K mobile apps %K mental health %K bipolar disorder %K smartphone %K cell phone %D 2021 %7 8.1.2021 %9 Review %J JMIR Form Res %G English %X Background: Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective: This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. Methods: We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results: A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions: These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated. %M 33416510 %R 10.2196/13770 %U https://formative.jmir.org/2021/1/e13770 %U https://doi.org/10.2196/13770 %U http://www.ncbi.nlm.nih.gov/pubmed/33416510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22319 %T Improving Primary Care Medication Processes by Using Shared Electronic Medication Plans in Switzerland: Lessons Learned From a Participatory Action Research Study %A Bugnon,Benjamin %A Geissbuhler,Antoine %A Bischoff,Thomas %A Bonnabry,Pascal %A von Plessen,Christian %+ Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Rue Michel-Servet 1, CMU Bâtiment B, Geneva, 1211, Switzerland, 41 796250180, benjamin.bugnon@gmail.com %K shared electronic medication plan %K medication list %K medication reconciliation %K electronic health records %K primary care %K national eHealth strategy %K Switzerland %K participatory action research %K complex adaptive system %K eHealth %K medication %K health information technology %K implementation %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several countries have launched health information technology (HIT) systems for shared electronic medication plans. These systems enable patients and health care professionals to use and manage a common list of current medications across sectors and settings. Shared electronic medication plans have great potential to improve medication management and patient safety, but their integration into complex medication-related processes has proven difficult, and there is little scientific evidence to guide their implementation. Objective: The objective of this paper is to summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the systemwide implementation of shared electronic medication plans. We collected experiences, assessed the influences of the local context, and analyzed underlying mechanisms influencing the implementation. Methods: In this formative action research study, we followed 5 clusters of health care professionals during 6 months. The clusters represented rural and urban primary care settings. A total of 18 health care professionals (primary care physicians, pharmacists, and nurses) used the pilot version of a shared electronic medication plan on a secure web platform, the precursor of Switzerland’s electronic patient record infrastructure. We undertook 3 group interviews with each of the 5 clusters, analyzed the content longitudinally and across clusters, and summarized it into lessons learned. Results: Participants considered medication plan management, digitalized or not, a core element of good clinical practice. Requirements for the successful implementation of a shared electronic medication plan were the integration into and simplification of clinical routines. Participants underlined the importance of an enabling setting with designated reference professionals and regular high-quality interactions with patients. Such a setting should foster trusting relationships and nurture a culture of safety and data privacy. For participants, the HIT was a necessary but insufficient building block toward better interprofessional communication, especially in transitions. Despite oral and written information, the availability of shared electronic medication plans did not generate spontaneous demand from patients or foster more engagement in their medication management. The variable settings illustrated the diversity of medication management and the need for local adaptations. Conclusions: The results of our study present a unique and comprehensive description of the sociotechnical challenges of implementing shared electronic medication plans in primary care. The shared ownership among multiple stakeholders is a core challenge for implementers. No single stakeholder can build and maintain a safe, usable HIT system with up-to-date medication information. Buy-in from all involved health care professionals is necessary for consistent medication reconciliation along the entire care pathway. Implementers must balance the need to change clinical processes to achieve improvements with the need to integrate the shared electronic medication plan into existing routines to facilitate adoption. The lack of patient involvement warrants further study. %M 33410753 %R 10.2196/22319 %U http://formative.jmir.org/2021/1/e22319/ %U https://doi.org/10.2196/22319 %U http://www.ncbi.nlm.nih.gov/pubmed/33410753 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20636 %T Cancer Patients’ Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study %A Kongshaug,Nina %A Skolbekken,John-Arne %A Faxvaag,Arild %A Hofsli,Eva %+ Cancer Clinic, St. Olav's University Hospital, Postbox 8905, Trondheim, 7491, Norway, 47 99703704, nina.kongshaug@stolav.no %K mhealth %K mobile app %K smartphone app %K oral chemotherapy %K patient safety %K home-based cancer treatment %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Oral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues. Objective: The aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner. Methods: Fourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed. Results: The smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work. Conclusions: Patients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic’s limited resources for follow up of patients on oral anticancer medications. %M 33404505 %R 10.2196/20636 %U https://formative.jmir.org/2021/1/e20636 %U https://doi.org/10.2196/20636 %U http://www.ncbi.nlm.nih.gov/pubmed/33404505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20410 %T The Use of Small Electronic Devices and Health: Feasibility of Interventions for a Forthcoming Crossover Design %A Larsen,Lisbeth Hoekjaer %A Lauritzen,Maja Hedegaard %A Gangstad,Sirin Wilhelmsen %A Kjaer,Troels Wesenberg %+ Department of Neurology, Zealand University Hospital, Sygehusvej 10, Roskilde, , Denmark, 45 41 55 85 92, lisbla@regionsjaelland.dk %K accelerometer %K activity trackers %K aerobic capacity %K insufficient sleep %K media use %K screen time %K sleep problems %K smartphones %K wearable tracking devices %D 2021 %7 4.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Modern lifestyle is heavily affected by technology such as smartphones, tablets, and other small computers; yet it remains unclear how our health and well-being are affected by the heavy use of these devices. Objective: This feasibility study aims to test two different interventions of an experimental protocol for a forthcoming large-scale community-based study and get estimates of parameters for sample size calculation. The aim of the large-scale study is to investigate the effect of (1) a wearable tracking device on aerobic capacity (VO2max/kg) and the effect of (2) restricting media use on total sleep time. Methods: Twenty healthy participants were included and equipped with a wrist-worn device tracking physical activity and sleep. Participants were allocated to either a physical activity group, which was instructed to use the wrist-worn device to support exercise, or a sleep silent group, which was instructed to remove or switch off all electronic devices in the bedroom (except the wrist-worn tracking device). The intervention lasted approximately 4 weeks. Data collected included blood pressure, submaximal cycle ergometer test, self-reported technology use, and compliance of using the wearable tracking device. Results: All participants wore the wearable tracking device 95.8% (SD 4.4%) of the time. Participants in the physical activity group increased aerobic capacity from 30.38 (SD 8.98) to 32.1 (SD 8.71) mL/kg/min (t=–2.31, P=.046) and decreased their systolic blood pressure from 126.5 (SD 15.8) mm Hg to 121.8 (SD 11.7) mm Hg (t=2.72, P=.02). The sleep silent group prolonged their time offline before bedtime from 18.1 (SD 19.4) minutes to 27.2 (SD 17.3) minutes (t=–2.94, P=.02). Conclusions: The two interventions are feasible to conduct. Participants were willing to wear the tracking device on their wrist and restrict all media use in their bedroom and thereby reduce bedtime technology use. Our results also suggest that tracking physical activity using a wearable device is accompanied by noteworthy health benefits. We outline necessary adjustments for a forthcoming large-scale study. %M 33393907 %R 10.2196/20410 %U https://formative.jmir.org/2021/1/e20410 %U https://doi.org/10.2196/20410 %U http://www.ncbi.nlm.nih.gov/pubmed/33393907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e19677 %T Development and Feasibility of an App to Decrease Risk Factors for Type 2 Diabetes in Hispanic Women With Recent Gestational Diabetes (Hola Bebé, Adiós Diabetes): Pilot Pre-Post Study %A Seely,Ellen W %A Weitzman,Patricia Flynn %A Cortes,Dharma %A Romero Vicente,Sara %A Levkoff,Sue E %+ Endocrinology, Diabetes and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, United States, 1 6177325012, eseely@bwh.harvard.edu %K gestational diabetes mellitus %K diabetes prevention %K Hispanic %K Latina %K intervention %K mobile apps %K mHealth %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking. Objective: This study aimed to (1) develop a mobile app (¡Hola Bebé, Adiós Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight. Methods: Social cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study. Results: In total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.” To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement. Conclusions: These data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054 %M 33382039 %R 10.2196/19677 %U http://formative.jmir.org/2020/12/e19677/ %U https://doi.org/10.2196/19677 %U http://www.ncbi.nlm.nih.gov/pubmed/33382039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17265 %T Stochastic Channel-Based Federated Learning With Neural Network Pruning for Medical Data Privacy Preservation: Model Development and Experimental Validation %A Shao,Rulin %A He,Hongyu %A Chen,Ziwei %A Liu,Hui %A Liu,Dianbo %+ Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 6177101859, dianbo@mit.edu %K federated learning %K differential privacy preserving %K neural network pruning %K health care %K privacy %K medical data %K machine learning %K neural network %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial neural networks have achieved unprecedented success in the medical domain. This success depends on the availability of massive and representative datasets. However, data collection is often prevented by privacy concerns, and people want to take control over their sensitive information during both the training and using processes. Objective: To address security and privacy issues, we propose a privacy-preserving method for the analysis of distributed medical data. The proposed method, termed stochastic channel-based federated learning (SCBFL), enables participants to train a high-performance model cooperatively and in a distributed manner without sharing their inputs. Methods: We designed, implemented, and evaluated a channel-based update algorithm for a central server in a distributed system. The update algorithm will select the channels with regard to the most active features in a training loop, and then upload them as learned information from local datasets. A pruning process, which serves as a model accelerator, was further applied to the algorithm based on the validation set. Results: We constructed a distributed system consisting of 5 clients and 1 server. Our trials showed that the SCBFL method can achieve an area under the receiver operating characteristic curve (AUC-ROC) of 0.9776 and an area under the precision-recall curve (AUC-PR) of 0.9695 with only 10% of channels shared with the server. Compared with the federated averaging algorithm, the proposed SCBFL method achieved a 0.05388 higher AUC-ROC and 0.09695 higher AUC-PR. In addition, our experiment showed that 57% of the time is saved by the pruning process with only a reduction of 0.0047 in AUC-ROC performance and a reduction of 0.0068 in AUC-PR performance. Conclusions: In this experiment, our model demonstrated better performance and a higher saturating speed than the federated averaging method, which reveals all of the parameters of local models to the server. The saturation rate of performance could be promoted by introducing a pruning process and further improvement could be achieved by tuning the pruning rate. %M 33350391 %R 10.2196/17265 %U http://formative.jmir.org/2020/12/e17265/ %U https://doi.org/10.2196/17265 %U http://www.ncbi.nlm.nih.gov/pubmed/33350391 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17542 %T A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach %A Bashi,Nazli %A Varnfield,Marlien %A Karunanithi,Mohanraj %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 5 - UQ Health Sciences, Building 901/16, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia, 61 732533611, ghafouryan@hotmail.com %K mobile health %K mHealth %K mobile health apps %K smartphone %K mobile phone %K self-management %K patient education %K cardiovascular disease %K acute coronary syndrome %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology–Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists’ survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients’ data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. %M 33337339 %R 10.2196/17542 %U http://formative.jmir.org/2020/12/e17542/ %U https://doi.org/10.2196/17542 %U http://www.ncbi.nlm.nih.gov/pubmed/33337339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17317 %T Mentoring Young African American Men and Transgender Women Who Have Sex With Men on Sexual Health: Formative Research for an HIV Mobile Health Intervention for Mentors %A Kaufman,Michelle R %A Casella,Albert %A Wiginton,John Mark %A Xu,Wenjian %A DuBois,David L %A Arrington-Sanders,Renata %A Simon,Jeannette %A Levine,Deb %+ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 257, Baltimore, MD, 21205, United States, 1 4109552313, michellekaufman@jhu.edu %K mentoring %K HIV %K mobile app %K mHealth %K men who have sex with men %K transgender %K African Americans %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promoting health behaviors. This is especially true for youth at risk for HIV, such as African American youth with sexual and gender minority (SGM) identities. In the past decade, natural mentoring and mentoring programs have proliferated as a key prevention and intervention strategy to improve outcomes for young people at risk for poor academic, social, and health issues. Mentors appear to be able to facilitate health promotion among young SGM by modeling healthy behaviors; however, mentors’ knowledge and resource needs regarding sexual health topics including HIV are understudied, as is the potential role of mobile technology in enhancing mentoring relationships and the ability of mentors to learn about sensitive issues faced by youth. Objective: The aim of this study is to explore how mentoring plays a role in the sexual health of African American SGM youth and understand how mentoring relationships can be strengthened through mobile technology to promote youth HIV prevention behaviors. Methods: In-depth interviews were conducted with African American SGM youth mentees (n=17) and mentors (n=20) to such youths in 3 Mid-Atlantic cities. Mentee interviews focused on discussions regarding sexual health and HIV and how a mentor could broach such topics. Mentor interviews explored whether sexual health and HIV are currently mentoring topics, mentors’ knowledge and confidence in mentoring on these issues, and barriers to discussions. All participants were asked if a mobile app could help facilitate mentoring on sensitive health issues, particularly HIV and sexual health. Data were transcribed, coded, and analyzed for relevant themes. Results: Sexual health was a common topic in mentoring relationships, occurring more in natural mentorships than in mentoring program pairs. Mentors and mentees felt positive about such discussions. Mentors expressed having limited knowledge beyond condom use and HIV testing, and expressed a need for more complete resources. Both mentors and mentees had mixed comfort levels when discussing sexual health. Sufficient trust and shared lived experiences made discussions easier. Mentees have multifaceted needs; however, mentors stated that an app resource that provided self-training, resources, support from other mentors, and tips for better mentoring could prove beneficial. Conclusions: For the African American SGM community, access to natural mentors is crucial for young people to learn healthy behaviors. A mobile resource to assist mentors in confidently having discussions with mentees may be a promising way to promote healthy practices. %M 33331822 %R 10.2196/17317 %U https://formative.jmir.org/2020/12/e17317 %U https://doi.org/10.2196/17317 %U http://www.ncbi.nlm.nih.gov/pubmed/33331822 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e22755 %T Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review %A Balcombe,Luke %A De Leo,Diego %+ School of Health and Sport Science, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, Australia, 61 0447505709, lukebalcombe@gmail.com %K athletes %K screening %K tracking %K engagement %K well-being %K stress %K adjustment %K COVID-19 %K hybrid model of care %K digital mental health %K machine learning %K artificial intelligence %D 2020 %7 14.12.2020 %9 Viewpoint %J JMIR Form Res %G English %X Background: There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Major disruptions to life, such as the COVID-19 pandemic, present an opportunity for a better understanding of the experience of stressors and vulnerability. Faster and better ways of psychological screening and tracking are more generally required in response to the increased demand upon mental health care services. The argument that mental and physical health should be considered together as part of a biopsychosocial approach is garnering acceptance in elite athlete literature. However, the sporting population are unique in that there is an existing stigma of mental health, an underrecognition of mental ill-health, and engagement difficulties that have hindered research, prevention, and intervention efforts. Objective: The aims of this paper are to summarize and evaluate the literature on athletes’ increased vulnerability to mental ill-health and digital mental health solutions as a complement to prevention and intervention, and to show relationships between athlete mental health problems and resilience as well as digital mental health screening and tracking, and faster and better treatment algorithms. Methods: This mini review shapes literature in the fields of athlete mental health and digital mental health by summarizing and evaluating journal and review articles drawn from PubMed Central and the Directory of Open Access Journals. Results: Consensus statements and systematic reviews indicated that elite athletes have comparable rates of mental ill-health prevalence to the general population. However, peculiar subgroups require disentangling. Innovative expansion of data collection and analytics is required to respond to engagement issues and advance research and treatment programs in the process. Digital platforms, machine learning, deep learning, and artificial intelligence are useful for mental health screening and tracking in various subpopulations. It is necessary to determine appropriate conditions for algorithms for use in recommendations. Partnered with real-time automation and machine learning models, valid and reliable behavior sensing, digital mental health screening, and tracking tools have the potential to drive a consolidated, measurable, and balanced risk assessment and management strategy for the prevention and intervention of the sequelae of mental ill-health. Conclusions: Athletes are an at-risk subpopulation for mental health problems. However, a subgroup of high-level athletes displayed a resilience that helped them to positively adjust after a period of overwhelming stress. Further consideration of stress and adjustments in brief screening tools is recommended to validate this finding. There is an unrealized potential for broadening the scope of mental health, especially symptom and disorder interpretation. Digital platforms for psychological screening and tracking have been widely used among general populations, but there is yet to be an eminent athlete version. Sports in combination with mental health education should address the barriers to help-seeking by increasing awareness, from mental ill-health to positive functioning. A hybrid model of care is recommended, combining traditional face-to-face approaches along with innovative and evaluated digital technologies, that may be used in prevention and early intervention strategies. %M 33271497 %R 10.2196/22755 %U http://formative.jmir.org/2020/12/e22755/ %U https://doi.org/10.2196/22755 %U http://www.ncbi.nlm.nih.gov/pubmed/33271497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e15602 %T Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study %A Van Asbroeck,Stephanie %A Matthys,Christophe %+ Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49, DIEET, Leuven, Belgium, 32 016 34 26 55, christophe.matthys@uzleuven.be %K image recognition %K dietary assessment %K automated food recognition %K accuracy %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the domain of dietary assessment, there has been an increasing amount of criticism of memory-based techniques such as food frequency questionnaires or 24 hour recalls. One alternative is logging pictures of consumed food followed by an automatic image recognition analysis that provides information on type and amount of food in the picture. However, it is currently unknown how well commercial image recognition platforms perform and whether they could indeed be used for dietary assessment. Objective: This is a comparative performance study of commercial image recognition platforms. Methods: A variety of foods and beverages were photographed in a range of standardized settings. All pictures (n=185) were uploaded to selected recognition platforms (n=7), and estimates were saved. Accuracy was determined along with totality of the estimate in the case of multiple component dishes. Results: Top 1 accuracies ranged from 63% for the application programming interface (API) of the Calorie Mama app to 9% for the Google Vision API. None of the platforms were capable of estimating the amount of food. These results demonstrate that certain platforms perform poorly while others perform decently. Conclusions: Important obstacles to the accurate estimation of food quantity need to be overcome before these commercial platforms can be used as a real alternative for traditional dietary assessment methods. %M 33284118 %R 10.2196/15602 %U https://formative.jmir.org/2020/12/e15602 %U https://doi.org/10.2196/15602 %U http://www.ncbi.nlm.nih.gov/pubmed/33284118 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e14344 %T Internet-Delivered Tobacco Treatment for People Using Cannabis: A Randomized Trial in Two Australian Cannabis Clinics %A Hindson,Josephine %A Hanstock,Tanya %A Dunlop,Adrian %A Kay-Lambkin,Frances %+ University of Newcastle, University Dr, Callaghan, Australia, 61 416204031, frances.kaylambkin@newcastle.edu.au %K tobacco %K cannabis %K help-seeking behavior %K internet-based intervention %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use is disproportionately higher in people who smoke cannabis than in the general population, increasing the severity of dependence for cannabis use, decreasing the likelihood of successful quit attempts for both cannabis and tobacco, and increasing the risk of relapse for both substances. Opportunities to address tobacco use in people using cannabis are being missed. Objective: This study aims to investigate the feasibility of engaging tobacco smokers who were accessing treatment for cannabis, with a tobacco-focused internet-based Healthy Lifestyle Program (iHeLP; 4 modules). It was hypothesized that iHeLP completion would be associated with decreases in tobacco use and improved quality of life (QoL) and psychological health. It was also hypothesized that iHeLP completion would be higher in those who additionally received telephone support. Given that iHeLP aimed to improve healthy lifestyle behaviors, it was also hypothesized that there would be reductions in cannabis use. Methods: A total of 13 smokers seeking treatment for cannabis use were randomly allocated to iHeLP alone or iHeLP plus telephone support. Participants were engaged in iHeLP over 8 weeks and completed a 12-week follow-up assessment. Results: Results from 10 participants who completed the follow-up indicated that the acceptability of iHeLP was high-very high in terms of general satisfaction, appropriateness of services, effectiveness, and met need. Additional telephone support increased modal module completion rates for iHeLP from 0 to 2 but did not provide any other significant advantages over iHeLP alone in terms of cannabis use, tobacco use, QoL, or psychological health. Participants in the iHeLP-alone condition (n=4) reported a mean reduction of 5.5 (SD 9.00) tobacco cigarettes per day between baseline and follow-up, with a concomitant mean reduction in expired carbon monoxide (CO) of 5.5 parts per million (ppm, SD 6.91). The iHeLP plus telephone support group (n=6) reported a mean reduction of 1.13 (SD 4.88) tobacco cigarettes per day and a mean reduction of 9.337 ppm of expired CO (SD 5.65). A urinalysis indicated that abstinence from cannabis was achieved by 2 participants in the iHeLP-alone group and three participants in the iHeLP plus telephone support group. Between baseline and follow-up assessments, iHeLP-alone participants reported a mean reduction in days of use of cannabis in the prior month of 6.17 days (SD 13.30). The average reduction in the number of days of cannabis use for the iHeLP plus telephone support group was also 6.17 days (SD 13.59). Conclusions: Despite the small sample size, this study provides preliminary support for the use of internet-delivered, tobacco-focused interventions in tobacco smokers seeking treatment for cannabis use. %M 33284121 %R 10.2196/14344 %U https://formative.jmir.org/2020/12/e14344 %U https://doi.org/10.2196/14344 %U http://www.ncbi.nlm.nih.gov/pubmed/33284121 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e19863 %T Effects of Goal Type and Reinforcement Type on Self-Reported Domain-Specific Walking Among Inactive Adults: 2×2 Factorial Randomized Controlled Trial %A McEntee,Mindy L %A Cantley,Alison %A Foreman,Emily %A Berardi,Vincent %A Phillips,Christine B. %A Hurley,Jane C. %A Hovell,Melbourne F. %A Hooker,Steven %A Adams,Marc A %+ College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ, United States, 1 (602) 496 0860, mindy.mcentee@asu.edu %K exercise %K population health %K goals %K reward %K walking %K mHealth %K health promotion %K health behavior %K adaptive intervention %K behavioral intervention %D 2020 %7 4.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: WalkIT Arizona was a 2×2 factorial trial examining the effects of goal type (adaptive versus static) and reinforcement type (immediate versus delayed) to increase moderate to vigorous physical activity (MVPA) among insufficiently active adults. The 12-month intervention combined mobile health (mHealth) technology with behavioral strategies to test scalable population-health approaches to increasing MVPA. Self-reported physical activity provided domain-specific information to help contextualize the intervention effects. Objective: The aim of this study was to report on the secondary outcomes of self-reported walking for transportation and leisure over the course of the 12-month WalkIT intervention. Methods: A total of 512 participants aged 19 to 60 years (n=330 [64.5%] women; n=425 [83%] Caucasian/white, n=96 [18.8%] Hispanic/Latinx) were randomized into interventions based on type of goals and reinforcements. The International Physical Activity Questionnaire-long form assessed walking for transportation and leisure at baseline, and at 6 months and 12 months of the intervention. Negative binomial hurdle models were used to examine the effects of goal and reinforcement type on (1) odds of reporting any (versus no) walking/week and (2) total reported minutes of walking/week, adjusted for neighborhood walkability and socioeconomic status. Separate analyses were conducted for transportation and leisure walking, using complete cases and multiple imputation. Results: All intervention groups reported increased walking at 12 months relative to baseline. Effects of the intervention differed by domain: a significant three-way goal by reinforcement by time interaction was observed for total minutes of leisure walking/week, whereas time was the only significant factor that contributed to transportation walking. A sensitivity analysis indicated minimal differences between complete case analysis and multiple imputation. Conclusions: This study is the first to report differential effects of adaptive versus static goals for self-reported walking by domain. Results support the premise that individual-level PA interventions are domain- and context-specific and may be helpful in guiding further intervention refinement. Trial Registration: Preregistered at clinicaltrials.gov: (NCT02717663) https://clinicaltrials.gov/ct2/show/NCT02717663 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.05.001 %M 33275107 %R 10.2196/19863 %U https://formative.jmir.org/2020/12/e19863 %U https://doi.org/10.2196/19863 %U http://www.ncbi.nlm.nih.gov/pubmed/33275107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e21671 %T User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study %A Tweheyo,Raymond %A Selig,Hannah %A Gibson,Dustin G %A Pariyo,George William %A Rutebemberwa,Elizeus %+ Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, P O Box, 7072, Kampala, 256, Uganda, 256 772466695, rtweheyo@musph.ac.ug %K interactive voice response %K noncommunicable diseases %K qualitative %K Uganda %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective: This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods: A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant’s perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results: Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller’s identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions: Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual. %M 33270037 %R 10.2196/21671 %U https://formative.jmir.org/2020/12/e21671 %U https://doi.org/10.2196/21671 %U http://www.ncbi.nlm.nih.gov/pubmed/33270037 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e20325 %T Care Me Too, a Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care: Qualitative Usability Study %A Liu,Mandong %A Jiang,Tongge %A Yu,Kexin %A Wu,Shinyi %A Jordan-Marsh,Maryalice %A Chi,Iris %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA, 90089, United States, 86 176 6259 0259, mandongl@usc.edu %K mHealth %K co-design %K usability %K acceptability %K immigrant %K caregiver %K mobile phone %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiving and self-care are challenging for Chinese immigrants in the United States due to limited accessible support and resources. Few interventions exist to assist Chinese immigrant caregivers in better performing self-care. To address this gap in the literature, our team developed the Care Me Too app to engage Chinese immigrant caregivers in self-care and conducted a user experience test to assess its usability and acceptability. Objective: This paper aims to report the results of the app’s usability and acceptability testing with Chinese immigrant caregivers and to solicit participants’ feedback of the app design and functions. Methods: A total of 22 Mandarin-speaking Chinese caregivers participated in the study, which consisted of 2 parts: the in-lab testing and the 1-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to assess user experience of the app’s usability and acceptability and to solicit feedback for app design and functions. Directed content analysis was used to analyze the qualitative data. Results: Among the 22 participants, the average age was 60.5 (SD 8.1) years, ranging from 46 to 80 years; 17 (77%) participants were women and 14 (64%) had an associate degree or higher. Participants reported uniformly positive ratings of the usability and acceptability of the app and provided detailed suggestions for app improvement. We generated guidelines for mobile health (mHealth) app designs targeting immigrant caregivers, including weighing flexibility versus majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying the log-in process, improving access to and the content on the help document, designing functions to cater to the population’s context, and ensuring offline access. Conclusions: The main contribution of this study is the improved understanding of Chinese caregivers’ user experiences with a language-appropriate mHealth app for a population that lacks accessible caregiving and self-care resources and support. It is recommended that future researchers and app designers consider the proposed guidelines when developing mHealth apps for their population to enhance user experience and harness mHealth’s value. %M 33263552 %R 10.2196/20325 %U https://formative.jmir.org/2020/12/e20325 %U https://doi.org/10.2196/20325 %U http://www.ncbi.nlm.nih.gov/pubmed/33263552 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20360 %T Mobile App (UPrEPU) to Monitor Adherence to Pre-exposure Prophylaxis in Men Who Have Sex With Men: Protocol for a User-Centered Approach to Mobile App Design and Development %A Strong,Carol %A Wu,Huei-Jiuan %A Tseng,Yuan-Chi %A Yuan,Chien-Wen %A Yu,Yi-Fang %A Liao,Jay Chiehen %A Chen,Yi-Wen %A Hung,Yi-Chen %A Li,Chia-Wen %A Huang,Po-Hsien %A Ko,Nai-Ying %A Ku,Stephane Wen-Wei %+ Department of Public Health, College of Medicine, National Cheng Kung University Hospital, 8F-8068, No 138, ShengLi Rd, North District, Tainan City, 704, Taiwan, 886 6 2353535 ext 5963, carol.chiajung@gmail.com %K mobile apps %K pre-exposure prophylaxis %K event-driven %K sexual behavior %K men who have sex with men %K user-centered design approach %D 2020 %7 1.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Daily and on-demand pre-exposure prophylaxis (PrEP) has been well demonstrated to effectively prevent HIV acquisition for men who have sex with men (MSM). More than half of the MSM PrEP users in Taiwan prefer on-demand PrEP; however, on-demand PrEP involves a complicated dosing regimen because it requires precoital and postcoital dosing and sex events are hard to anticipate. Although there are a growing number of mobile apps designed to improve access to HIV prevention services and HIV medication adherence, few mobile apps focus on adherence to PrEP or are designed to accommodate a complicated, on-demand PrEP dosing schedule. Objective: The aim of this project is to evaluate the usability of a newly developed mobile app (UPrEPU) to assist MSM PrEP users to self-monitor their adherence to either daily or on-demand PrEP using a user-centered scheme. Methods: This research will be conducted in 2 phases: app development and usability study. In the app development phase, we will first conduct formative research with end users and stakeholders through in-depth interviews; the results will provide PrEP users’ and PrEP navigators’ personas as material used in the app conceptualization stage. PrEP navigators are individuals in the health care system that help HIV-negative individuals who need assistance in accessing PrEP care. A low-fidelity prototype of the app feature will be formatted by applying a participatory design approach to engage PrEP users, designers, and app developers in the design process of the app. Then, a high-fidelity prototype of the app will be developed for the usability study and refined iteratively by the multidisciplinary team and new internal testers. Internal testers include the research team consisting of experts in public health, infectious disease, and industrial design and a close network of the research team that is taking PrEP. In the usability study phase, we will enroll 70 MSM PrEP users and follow them up for 4 months. Usability, feasibility, and effectiveness of adherence monitoring will be evaluated. Results: Refinement of the UPrEPU app is currently ongoing. The usability study commenced in May 2020. Conclusions: The UPrEPU app is one of the first apps designed to help MSM PrEP users to self-manage their PrEP schedule better regardless of dosing modes. With a design-thinking approach and adapting to the cultural context in Taiwan’s MSM population, this novel app will have substantial potential to be acceptable and feasible and contribute to the reduction of new HIV infections. Trial Registration: ClinicalTrials.gov NCT04248790; https://clinicaltrials.gov/ct2/show/NCT04248790 International Registered Report Identifier (IRRID): PRR1-10.2196/20360 %M 33258793 %R 10.2196/20360 %U https://www.researchprotocols.org/2020/12/e20360 %U https://doi.org/10.2196/20360 %U http://www.ncbi.nlm.nih.gov/pubmed/33258793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e22507 %T Development of a Web-Based Acceptance and Commitment Therapy Intervention to Support Lifestyle Behavior Change and Well-Being in Health Care Staff: Participatory Design Study %A Brown,Menna %A Hooper,Nic %A Eslambolchilar,Parisa %A John,Ann %+ Swansea University Medical School, Swansea University, Singleton Park Campus, Data Science Building, Floor 3, Swansea, SA2 8PP, United Kingdom, 44 1792 606312, menna.brown@swansea.ac.uk %K participatory design %K eMental health %K engagement %K acceptance and commitment therapy %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease. Objective: This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective. Methods: A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype. Results: Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included. Conclusions: The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage. %M 33252350 %R 10.2196/22507 %U https://formative.jmir.org/2020/11/e22507 %U https://doi.org/10.2196/22507 %U http://www.ncbi.nlm.nih.gov/pubmed/33252350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14787 %T Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany %A Dittrich,Florian %A Back,David Alexander %A Harren,Anna Katharina %A Landgraeber,Stefan %A Reinecke,Felix %A Serong,Sebastian %A Beck,Sascha %+ Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstraße 100, Building 37, Homburg, 66421, Germany, 49 68411624520, Florian.Dittrich@uks.eu %K mHealth %K smartphone %K communication %K medicine %K surveys and questionnaires %K technology %K orthopedics %K trauma surgery %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. %M 33252340 %R 10.2196/14787 %U http://formative.jmir.org/2020/11/e14787/ %U https://doi.org/10.2196/14787 %U http://www.ncbi.nlm.nih.gov/pubmed/33252340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e22756 %T Informing the Development of a Digital Health Platform Through Universal Points of Care: Qualitative Survey Study %A Craven,Michael P %A Andrews,Jacob A %A Lang,Alexandra R %A Simblett,Sara K %A Bruce,Stuart %A Thorpe,Sarah %A Wykes,Til %A Morriss,Richard %A Hollis,Chris %A , %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Mindtech, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 7484 218, jacob.andrews@nottingham.ac.uk %K epilepsy %K multiple sclerosis %K depression %K wearable electronic devices %K remote sensing technology %K health personnel %K mobile phones %K mHealth %K eHealth %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Epilepsy, multiple sclerosis (MS), and depression are chronic conditions where technology holds potential in clinical monitoring and self-management. Over 5 years, the Remote Assessment of Disease and Relapse - Central Nervous System (RADAR-CNS) consortium has explored the application of remote measurement technology (RMT) to the management and self-management of patients in these clinical areas. The consortium is large and includes clinical and nonclinical researchers as well as a patient advisory board. Objective: This formative development study aimed to understand how consortium members viewed the potential of RMT in epilepsy, MS, and depression. Methods: In this qualitative survey study, we developed a methodological tool, universal points of care (UPOC), to gather views on the potential use, acceptance, and value of a novel RMT platform across 3 chronic conditions (MS, epilepsy, and depression). UPOC builds upon use case scenario methodology, using expert elicitation and analysis of care pathways to develop scenarios applicable across multiple conditions. After developing scenarios, we elicited views on the potential of RMT in these different scenarios through a survey administered to 28 subject matter experts, consisting of 16 health care practitioners; 5 health care services researchers; and 7 people with lived experience of MS, epilepsy, or depression. Survey results were analyzed thematically and using an existing framework of factors describing links between design and context. Results: The survey elicited potential beneficial applications of the RADAR-CNS RMT system as well as patient, clinical, and nonclinical requirements of RMT across the 3 conditions of interest. Potential applications included recognition of early warning signs of relapse from subclinical signals for MS, seizure precipitant signals for epilepsy, and behavior change in depression. RMT was also thought to have the potential to overcome the problem of underreporting, which is especially problematic in epilepsy, and to allow the capture of secondary symptoms that are not generally collected in MS, such as mood. Conclusions: Respondents suggested novel and unanticipated uses of RMT, including the use of RMT to detect emerging side effects of treatment, enable behavior change for sleep regulation and activity, and offer a way to include family and other carers in a care network, which could assist with goal setting. These suggestions, together with others from this and related work, will inform the development of the system for its eventual application in research and clinical practice. The UPOC methodology was effective in directing respondents to consider the value of health care technologies in condition-specific experiences of everyday life and working practice. %M 33242009 %R 10.2196/22756 %U http://formative.jmir.org/2020/11/e22756/ %U https://doi.org/10.2196/22756 %U http://www.ncbi.nlm.nih.gov/pubmed/33242009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18567 %T Surveillance of Cardiovascular Risk Factors in the Fifth Military Sector Health Center, Ngaoundéré, Cameroon: Observational Study %A Bell Ngan,Williams %A Essama Eno Belinga,Lawrence %A Essam Nlo'o,Alain Serges Patrick %A Roche,Frederic %A Goethals,Luc %A Mandengue,Samuel Honoré %A Bongue,Bienvenu %+ Autonomic Nervous System Research Laboratory, University of Jean Monnet, 10 rue tréfilerie, Saint-Etienne, France, 33 0681021199, bienvenu.bongue@cetaf.fr %K prevention %K noncommunicable disease %K cardiovascular diseases %K cardiovascular risk %K soldiers %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They were responsible for 40 million of the 57 million deaths recorded worldwide in 2016. In Cameroon, epidemiological studies have been devoted to NCDs and their risk factors. However, none provides specific information on their extent or the distribution of their risk factors within the Cameroonian defense forces. Objective: The objective of our study was to assess the cardiovascular risk of a Cameroonian military population compared with that of its neighboring civilian population. Methods: We conducted a cross-sectional study that involved subjects aged 18 to 58 years, recruited from October 2017 to November 2018 at the Fifth Military Sector Health Center in Ngaoundéré, Cameroon. Data collection and assessment were done according to the World Health Organization (WHO)’s STEPS manual for surveillance of risk factors for chronic NCDs and the Alcohol Use Disorders Identification Test. Five cardiovascular risk factors were assessed: smoking, harmful alcohol consumption, obesity/overweight, hypertension, and diabetes. The risk was considered high in subjects with 3 or more of the factors. Univariate analysis and multivariate logistic regression were carried out according to their indications. Results: Our study sample of 566 participants included 295 soldiers and 271 civilians of the same age group (median age 32 years versus 33 years, respectively; P=.57). The military sample consisted of 31 officers and 264 noncommissioned officers (NCOs). Soldiers were more exposed to behavioral risk factors than civilians, with a prevalence of smoking of 13.9% versus 4.4% (P<.001) and excessive alcohol consumption of 61.7% versus 14.8% (P<.001). They also presented with a higher cardiovascular risk than civilians (odds ratio 2.7, 95% CI 1.50-4.81; P<.001), and among the military participants, the cardiovascular risk was higher for officers than for NCOs (51.6% versus 14.0%, respectively; P<.001). Conclusions: Cameroonian soldiers are particularly exposed to cardiovascular behavioral risk factors and consequently are at higher risk of NCDs. Trial Registration: ClinicalTrials.gov NCT04315441; https://clinicaltrials.gov/ct2/show/NCT04315441 %M 33242013 %R 10.2196/18567 %U http://formative.jmir.org/2020/11/e18567/ %U https://doi.org/10.2196/18567 %U http://www.ncbi.nlm.nih.gov/pubmed/33242013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18565 %T Integrating a Web-Based Self-Management Tool (Managing Joint Pain on the Web and Through Resources) for People With Osteoarthritis-Related Joint Pain With a Web-Based Social Network Support Tool (Generating Engagement in Network Involvement): Design, Development, and Early Evaluation %A Clarkson,Paul %A Vassilev,Ivaylo %A Rogers,Anne %A Brooks,Charlotte %A Wilson,Nicky %A Lawson,Jem %A Adams,Jo %+ NIHR ARC Wessex, Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, School of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Southampton, SO17 1BJ, United Kingdom, 44 02380 597909, p.d.clarkson@soton.ac.uk %K joint pain %K osteoarthritis %K internet %K self-management %K social networks %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Joint pain caused by osteoarthritis (OA) is highly prevalent and can be extremely debilitating. Programs to support self-management of joint pain can be effective; however, most programs are designed to build self-efficacy and rarely engage social networks. Digital interventions are considered acceptable by people with joint pain. However, many existing resources are not accessible for or developed alongside people with lower health literacy, which disproportionately affects people with OA. Objective: This study aims to design and develop an accessible digital self-management tool for people with joint pain and integrate this with an existing social network activation tool (Generating Engagement in Network Involvement [GENIE]) and to explore the feasibility of these linked tools for supporting the management of joint pain. Methods: The study was conducted in 2 phases: a design and development stage and a small-scale evaluation. The first phase followed the person-based approach to establish guiding principles for the development of a new site (Managing joint Pain On the Web and through Resources [EMPOWER]) and its integration with GENIE. People with joint pain were recruited from libraries, a community café, and an exercise scheme to take part in 3 focus groups. EMPOWER was tested and refined using think-aloud interviews (n=6). In the second phase, participants were recruited through the web via libraries to participate in a small-scale evaluation using the LifeGuide platform to record use over a 1-month period. Participants (n=6) were asked to complete evaluation questionnaires on their experiences. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework was used to explore the feasibility of the sites. Results: The focus groups established guiding principles for the development of the tool. These included ensuring accessibility and relevance for people with OA-related joint pain and recognizing that joint pain is the reason for seeking support, trust, social facilitation, and goal setting. Think-aloud interviews identified issues with user experience and site navigation and the need for professional input for referral and goal setting, confusion, and tensions over the role of GENIE and site connectivity. Participants expected the sites to be specific to their pain-related needs. EMPOWER was accessed 18 times; 6 users registered with the site during the evaluation study. Participants mostly explored information pages on being active and being a healthy weight. Only one participant undertook goal setting and 4 participants visited the GENIE website. Conclusions: Using the NASSS framework, we identified the complexity associated with integrating EMPOWER and GENIE. The value proposition domain highlighted the technical and conceptual complexity associated with integrating approaches. Although identified as theoretically achievable, the integration of differing propositions may have caused cognitive and practical burdens for users. Nevertheless, we believe that both approaches have a distinct role in the self-management of joint pain. %M 33242011 %R 10.2196/18565 %U http://formative.jmir.org/2020/11/e18565/ %U https://doi.org/10.2196/18565 %U http://www.ncbi.nlm.nih.gov/pubmed/33242011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21577 %T Early-Stage Feasibility of a Mobile Health Intervention (Copilot) to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Multimethods Approach %A Korpershoek,Yvonne JG %A Holtrop,Tjitske %A Vervoort,Sigrid CJM %A Schoonhoven,Lisette %A Schuurmans,Marieke J %A Trappenburg,Jaap CA %+ Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 638763949, yvonne.korpershoek@hu.nl %K mobile health %K mHealth %K mobile app %K COPD %K exacerbation %K self-management %K self-care %D 2020 %7 19.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective: The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods: A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results: In total, 14 HCPs participated in this study—8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions: This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing. %M 33211013 %R 10.2196/21577 %U http://formative.jmir.org/2020/11/e21577/ %U https://doi.org/10.2196/21577 %U http://www.ncbi.nlm.nih.gov/pubmed/33211013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18759 %T Technology-Enabled Solutions for Australian Mental Health Services Reform: Impact Evaluation %A LaMonica,Haley M %A Milton,Alyssa %A Braunstein,Katharine %A Rowe,Shelley C %A Ottavio,Antonia %A Jackson,Tanya %A Easton,Michael A %A Hambleton,Ashlea %A Hickie,Ian B %A Davenport,Tracey A %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 293510785, haley.lamonica@sydney.edu.au %K evaluation methodology %K mental health %K health care reform %K technology %K mobile phone %K community-based participatory research %D 2020 %7 19.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Health information technologies (HITs) are becoming increasingly recognized for their potential to provide innovative solutions to improve the delivery of mental health services and drive system reforms for better outcomes. Objective: This paper describes the baseline results of a study designed to systematically monitor and evaluate the impact of implementing an HIT, namely the InnoWell Platform, into Australian mental health services to facilitate the iterative refinement of the HIT and the service model in which it is embedded to meet the needs of consumers and their supportive others as well as health professionals and service providers. Methods: Data were collected via web-based surveys, semistructured interviews, and a workshop with staff from the mental health services implementing the InnoWell Platform to systematically monitor and evaluate its impact. Descriptive statistics, Fisher exact tests, and a reliability analysis were used to characterize the findings from the web-based surveys, including variability in the results between the services. Semistructured interviews were coded using a thematic analysis, and workshop data were coded using a basic content analysis. Results: Baseline data were collected from the staff of 3 primary youth mental health services (n=18), a counseling service for veterans and their families (n=23), and a helpline for consumers affected by eating disorders and negative body image issues (n=6). As reported via web-based surveys, staff members across the services consistently agreed or strongly agreed that there was benefit associated with using technology as part of their work (38/47, 81%) and that the InnoWell Platform had the potential to improve outcomes for consumers (27/45, 60%); however, there was less certainty as to whether their consumers’ capability to use technology aligned with how the InnoWell Platform would be used as part of their mental health care (11/45, 24% of the participants strongly disagreed or disagreed; 15/45, 33% were neutral; and 19/45, 42% strongly agreed or agreed). During the semistructured interviews (n=3) and workshop, participants consistently indicated that the InnoWell Platform was appropriate for their respective services; however, they questioned whether the services’ respective consumers had the digital literacy required to use the technology. Additional potential barriers to implementation included health professionals’ digital literacy and service readiness for change. Conclusions: Despite agreement among participants that HITs have the potential to result in improved outcomes for consumers and services, service readiness for change (eg, existing technology infrastructure and the digital literacy of staff and consumers) was noted to potentially impact the success of implementation, with less than half (20/45, 44%) of the participants indicating that their service was ready to implement new technologies to enhance mental health care. Furthermore, participants reported mixed opinions as to whether it was their responsibility to recommend technology as part of standard care. %M 33211024 %R 10.2196/18759 %U https://formative.jmir.org/2020/11/e18759 %U https://doi.org/10.2196/18759 %U http://www.ncbi.nlm.nih.gov/pubmed/33211024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21450 %T A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App %A Brewer,LaPrincess C %A Kumbamu,Ashok %A Smith,Christina %A Jenkins,Sarah %A Jones,Clarence %A Hayes,Sharonne N %A Burke,Lora %A Cooper,Lisa A %A Patten,Christi A %+ Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 0325, brewer.laprincess@mayo.edu %K mobile health %K eHealth %K community-based participatory research %K health promotion %K African Americans %K mobile phone %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population. Objective: This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study. Methods: We included 2 semistructured focus groups (n=4 and n=5) to explore participants’ views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes. Results: In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals’ cardiovascular risk. Conclusions: This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted. Trial Registration: ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822. %M 33200999 %R 10.2196/21450 %U http://formative.jmir.org/2020/11/e21450/ %U https://doi.org/10.2196/21450 %U http://www.ncbi.nlm.nih.gov/pubmed/33200999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e19508 %T Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study %A Huberty,Jennifer %A Puzia,Megan E %A Larkey,Linda %A Irwin,Michael R %A Vranceanu,Ana-Maria %+ College of Health Solutions, Arizona State University, 550 North 3rd St., Phoenix, AZ, 85004, United States, 1 602 827 2456, jennifer.huberty@asu.edu %K insomnia %K mental health %K mindfulness %K meditation %K mobile apps %K consumer behavior %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep. Objective: We conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep. Methods: Participants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as “good sleepers,” “poor sleepers,” or “those with insomnia diagnosis.” Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance. Results: There was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ22=1548.8, P<.001), reduce depression or anxiety (χ22=15.5, P<.001), or improve overall health (χ22=57.6, P<.001). Respondents with insomnia used Calm most often (mean 5.417 days/week, SD 1.936), followed by poor sleepers (mean 5.043 days/week, SD 2.027; F2=21.544, P<.001). The most common time to use Calm was while lying down to sleep (7607/9686, 78.54%), and bedtime use was more common among poor sleepers and those with insomnia (χ22=382.7, P<.001). Compared to good and poor sleepers, those with insomnia were more likely to use Calm after waking up at night (χ22=410.3, P<.001). Most participants tried to use Calm on a regular basis (5031/8597, 58.52%), but regular nighttime use was most common among those with insomnia (646/977, 66.1%), followed by poor sleepers (4040/6930, 58.30%; χ22=109.3, P<.001). Conclusions: Of the paying subscribers to Calm who have used one of the sleep components, approximately 90% have sleep difficulties, and 77% started using Calm primarily for sleep. These descriptive data point to areas of focus for continued refinement of app features and content, followed by prospective trials testing efficacy of consumer-based meditation mobile apps for improving sleep. %M 33185552 %R 10.2196/19508 %U http://formative.jmir.org/2020/11/e19508/ %U https://doi.org/10.2196/19508 %U http://www.ncbi.nlm.nih.gov/pubmed/33185552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e17065 %T Artificial Intelligence Chatbot for Depression: Descriptive Study of Usage %A Dosovitsky,Gilly %A Pineda,Blanca S %A Jacobson,Nicholas C %A Chang,Cyrus %A Escoredo,Milagros %A Bunge,Eduardo L %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 417 2015, ebunge@paloaltou.edu %K chatbot %K artificial intelligence %K depression %K mobile health %K telehealth %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots. Objective: This study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations. Methods: Interactions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules. Results: Users sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules. Conclusions: Overall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper. %M 33185563 %R 10.2196/17065 %U http://formative.jmir.org/2020/11/e17065/ %U https://doi.org/10.2196/17065 %U http://www.ncbi.nlm.nih.gov/pubmed/33185563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14988 %T Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis %A Bowie-DaBreo,Dionne %A Sünram-Lea,Sandra I %A Sas,Corina %A Iles-Smith,Heather %+ Research and Innovation Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom, 44 113 206 0469, dionne.bowie@nhs.net %K mobile mental health %K mHealth %K mobile apps %K depression %K clinical guidance %K NICE guidelines %K NHS %K safety %K ethics %K content analysis %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety. Objective: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression. Methods: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults. Results: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression. Conclusions: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design. %M 33185566 %R 10.2196/14988 %U http://formative.jmir.org/2020/11/e14988/ %U https://doi.org/10.2196/14988 %U http://www.ncbi.nlm.nih.gov/pubmed/33185566 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e20167 %T Assessing the Efficacy and Acceptability of a Web-Based Intervention for Resilience Among College Students: Pilot Randomized Controlled Trial %A Enrique Roig,Angel %A Mooney,Olwyn %A Salamanca-Sanabria,Alicia %A Lee,Chi Tak %A Farrell,Simon %A Richards,Derek %+ E-mental Health Research Group, School of Psychology, Trinity College Dublin, The University of Dublin, College Green, Dublin, , Ireland, 353 1 896 1000, enriquea@tcd.ie %K web-based intervention %K resilience %K well-being %K positive psychology %K human support %K automated support %K college students %K randomized controlled trial %D 2020 %7 11.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: College students are at elevated risk for developing mental health problems and face specific barriers around accessing evidence-based treatment. Web-based interventions that focus on mental health promotion and strengthening resilience represent one possible solution. Providing support to users has shown to reduce dropout in these interventions. Further research is needed to assess the efficacy and acceptability of these interventions and explore the viability of automating support. Objective: This study investigated the feasibility of a new web-based resilience program based on positive psychology, provided with human or automated support, in a sample of college students. Methods: A 3-armed closed pilot randomized controlled trial design was used. Participants were randomized to the intervention with human support (n=29), intervention with automated support (n=26), or waiting list (n=28) group. Primary outcomes were resilience and well-being, respectively measured by the Connor–Davidson Resilience Scale and Pemberton Happiness Index. Secondary outcomes included measures of depression and anxiety, self-esteem, and stress. Outcomes were self-assessed through online questionnaires. Intention-to-treat and per-protocol analyses were conducted. Results: All participants demonstrated significant improvements in resilience and related outcomes, including an unexpected improvement in the waiting list group. Within- and between-group effect sizes ranged from small to moderate and within-group effects were typically larger for the human than automated support group. A total of 36 participants began the program and completed 46.46% of it on average. Participants were generally satisfied with the program and found it easy to use. Conclusions: Findings support the feasibility of the intervention. Preliminary evidence for the equal benefit of human and automated support needs to be supported by further research with a larger sample. Results of this study will inform the development of a full-scale trial, from which stronger conclusions may be drawn. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 11866034; http://www.isrctn.com/ISRCTN11866034 International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2019.100254 %M 33174530 %R 10.2196/20167 %U http://formative.jmir.org/2020/11/e20167/ %U https://doi.org/10.2196/20167 %U http://www.ncbi.nlm.nih.gov/pubmed/33174530 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e21964 %T Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study %A Choi,Yong K %A Thompson,Hilaire J %A Demiris,George %+ Department of Public Health Sciences, School of Medicine, University of California Davis, 4610 X Street, Suite 2301, Sacramento, CA, 95817, United States, 1 916 734 6083, ygchoi@ucdavis.edu %K Internet of Things %K smart home %K independent living %K aging %K healthy aging %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Aging %G English %X Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents’ safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined. Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart home devices in the actual residences of older adults to facilitate healthy aging. Methods: We conducted a 2-month feasibility study on community-dwelling older adults. Participants chose among different IoT devices to be installed and deployed within their homes. The IoT devices tested varied depending on the participant’s preference: a door and window sensor, a multipurpose sensor (motion, temperature, luminosity, and humidity), a voice-operated smart speaker, and an internet protocol (IP) video camera. Results: We recruited a total of 37 older adults for this study, with 35 (95%) successfully completing all procedures in the 2-month study. The average age of the sample was 78 (SD 9) years and primarily comprised women (29/37, 78%), those who were educated (31/37, 86%; bachelor’s degree or higher), and those affected by chronic conditions (33/37, 89%). The most widely chosen devices among the participants were multipurpose sensors and smart speakers. An IP camera was a significantly unpopular choice among participants in both phases. The participant feedback suggests that perceived privacy concerns, perceived usefulness, and curiosity to technology were strong factors when considering which device to have installed in their home. Conclusions: Overall, our deployment results revealed that the use of IoT smart home devices is feasible in actual residences of older adults. These findings may inform the follow-up assessment of IoT technologies and their impact on health-related outcomes and advance our understanding of the role of IoT home-based monitoring technologies to promote successful aging-in-place for older adults. Future trials should consider older adults’ preferences for the different types of smart home devices to be installed in real-world residential settings. %M 33170128 %R 10.2196/21964 %U http://aging.jmir.org/2020/2/e21964/ %U https://doi.org/10.2196/21964 %U http://www.ncbi.nlm.nih.gov/pubmed/33170128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e24587 %T Diagnosing Chronic Obstructive Airway Disease on a Smartphone Using Patient-Reported Symptoms and Cough Analysis: Diagnostic Accuracy Study %A Porter,Paul %A Claxton,Scott %A Brisbane,Joanna %A Bear,Natasha %A Wood,Javan %A Peltonen,Vesa %A Della,Phillip %A Purdie,Fiona %A Smith,Claire %A Abeyratne,Udantha %+ Joondalup Health Campus, Suite 204, Joondalup Health Campus, , Perth, 6027, Australia, 61 0412484747, phporter@iinet.net.au %K respiratory %K medicine %K diagnostic algorithm %K telehealth %K acute care %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Rapid and accurate diagnosis of chronic obstructive pulmonary disease (COPD) is problematic in acute care settings, particularly in the presence of infective comorbidities. Objective: The aim of this study was to develop a rapid smartphone-based algorithm for the detection of COPD in the presence or absence of acute respiratory infection and evaluate diagnostic accuracy on an independent validation set. Methods: Participants aged 40 to 75 years with or without symptoms of respiratory disease who had no chronic respiratory condition apart from COPD, chronic bronchitis, or emphysema were recruited into the study. The algorithm analyzed 5 cough sounds and 4 patient-reported clinical symptoms, providing a diagnosis in less than 1 minute. Clinical diagnoses were determined by a specialist physician using all available case notes, including spirometry where available. Results: The algorithm demonstrated high positive percent agreement (PPA) and negative percent agreement (NPA) with clinical diagnosis for COPD in the total cohort (N=252; PPA=93.8%, NPA=77.0%, area under the curve [AUC]=0.95), in participants with pneumonia or infective exacerbations of COPD (n=117; PPA=86.7%, NPA=80.5%, AUC=0.93), and in participants without an infective comorbidity (n=135; PPA=100.0%, NPA=74.0%, AUC=0.97). In those who had their COPD confirmed by spirometry (n=229), PPA was 100.0% and NPA was 77.0%, with an AUC of 0.97. Conclusions: The algorithm demonstrated high agreement with clinical diagnosis and rapidly detected COPD in participants presenting with or without other infective lung illnesses. The algorithm can be installed on a smartphone to provide bedside diagnosis of COPD in acute care settings, inform treatment regimens, and identify those at increased risk of mortality due to seasonal or other respiratory ailments. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001521213; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375939 %M 33170129 %R 10.2196/24587 %U http://formative.jmir.org/2020/11/e24587/ %U https://doi.org/10.2196/24587 %U http://www.ncbi.nlm.nih.gov/pubmed/33170129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18067 %T Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study %A Kawadler,Jamie M %A Hemmings,Nicola Rose %A Ponzo,Sonia %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, , London, , United Kingdom, 44 7527016574, jamie@biobeats.com %K health and well-being %K health promotion %K organizational and leadership support %K workplace %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective: The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods: A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend. Conclusions: The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress. %M 32969341 %R 10.2196/18067 %U https://formative.jmir.org/2020/11/e18067 %U https://doi.org/10.2196/18067 %U http://www.ncbi.nlm.nih.gov/pubmed/32969341 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e23337 %T Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences %A Stratton,Elizabeth %A Choi,Isabella %A Peters,Dorian %A Calvo,Rafael A %A Harvey,Samuel B %A Glozier,Nicholas %+ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 61 295151439, Elizabeth.stratton@sydney.edu.au %K employee disclosure %K decision aid tool %K mental health %K web-based %D 2020 %7 6.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. Objective: This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. Methods: A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. Results: A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. Conclusions: The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld. %M 33155982 %R 10.2196/23337 %U https://formative.jmir.org/2020/11/e23337 %U https://doi.org/10.2196/23337 %U http://www.ncbi.nlm.nih.gov/pubmed/33155982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e17359 %T A Behavioral Change Smartphone App and Program (ToDo-CR) to Decrease Sedentary Behavior in Cardiac Rehabilitation Participants: Prospective Feasibility Cohort Study %A Freene,Nicole %A van Berlo,Sander %A McManus,Margaret %A Mair,Tarryn %A Davey,Rachel %+ Physiotherapy, University of Canberra, University Dr, Bruce, 2617, Australia, 61 262015550, nicole.freene@canberra.edu.au %K mHealth %K eHealth %K sedentary behavior %K cardiac rehabilitation %K mobile phone %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. Objective: This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. Methods: Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do’s). Do’s were delivered via the app, with participants receiving 14 to 19 Do’s during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. Results: Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks. Conclusions: The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app. %M 33141091 %R 10.2196/17359 %U https://formative.jmir.org/2020/11/e17359 %U https://doi.org/10.2196/17359 %U http://www.ncbi.nlm.nih.gov/pubmed/33141091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21309 %T Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study %A Loescher,Lois %A Heslin,Kelly %A Silva,Graciela %A Muramoto,Myra %+ College of Nursing, University of Arizona, 1305 N Martin Ave, P.O. Box 210203, Tucson, AZ, 85721, United States, 1 5206266169, loescher@arizona.edu %K cancer prevention %K skin cancer %K e-training %K electronic intervention %K massage therapists %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non–health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients’ skin on a regular basis, which can allow MTs to initiate “helping conversations” (ie, brief behavioral interventions aimed at reducing the risk of skin cancer). Objective: The purpose of this study was to evaluate (1) the feasibility of recruiting, enrolling, and retaining Arizona MTs in an online electronic training (e-training) and (2) the preliminary efficacy of e-training on knowledge, attitudes/beliefs, and practice of risk reduction for skin cancer. We explored MTs’ ability to assess suspicious skin lesions. Methods: We adapted the existing educational content on skin cancer for applicability to MTs and strategies from previous research on helping conversations. We assessed the feasibility of providing such e-training, using Research Electronic Data Capture (REDCap) tools for data capture. We assessed the preliminary efficacy using established self-report surveys at baseline, immediately post training, and at 3 and 6 months post training. Results: A total of 95 participants enrolled in the study, of which 77% (73/95) completed the assessments at 6 months (overall attrition=23%). Project satisfaction and e-training acceptability were high. Knowledge, personal behaviors (skin self-examination, clinical skin examination, sun protection frequency), and practice attitudes (appropriateness and comfort with client-focused communication) of risk reduction for skin cancer improved significantly and were sustained throughout the study. Conclusions: The e-training was feasible and could be delivered online successfully to MTs. Participants were highly satisfied with and accepting of the e-training. As such, e-training has potential as an intervention in larger trials with MTs for reducing the risk of skin cancer. International Registered Report Identifier (IRRID): RR2-10.2196/13480 %M 33136054 %R 10.2196/21309 %U https://formative.jmir.org/2020/11/e21309 %U https://doi.org/10.2196/21309 %U http://www.ncbi.nlm.nih.gov/pubmed/33136054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19887 %T Adaptation of a Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Services for First-Episode Psychosis: Results From the Horyzons-Canada Phase 1 Study %A Lal,Shalini %A Gleeson,John %A Rivard,Lysanne %A D'Alfonso,Simon %A Joober,Ridha %A Malla,Ashok %A Alvarez-Jimenez,Mario %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 514 890 8000 ext 31581, shalini.lal@umontreal.ca %K psychotic disorders %K mental health %K telemedicine %K young adult %K mental health services %K cultural adaptation %K mobile phone %K e-mental health %K virtual care %K schizophrenia %K e-health %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health care contexts. As such, there is an increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings. Objective: We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for first-episode psychosis (FEP). The aim of this study is to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada. Methods: This research took place in 2 specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26-56 years) and 11 patients (age range 19-37 years). Following the digital health adaptation framework developed by our team, we used a mixed methods approach, combining descriptive quantitative and qualitative methods across 3 stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations. Results: Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (eg, for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation. These included terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, the need help now feature, and the list of trigger words to flag posts indicative of potential risk. Conclusions: In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage the internet and mobile technologies for delivering youth mental health services. As countries look to one another for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more important than ever. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8810 %M 33118945 %R 10.2196/19887 %U http://formative.jmir.org/2020/10/e19887/ %U https://doi.org/10.2196/19887 %U http://www.ncbi.nlm.nih.gov/pubmed/33118945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17898 %T Follow-Up of Cancer Patients Receiving Anti-PD-(L)1 Therapy Using an Electronic Patient-Reported Outcomes Tool (KISS): Prospective Feasibility Cohort Study %A Iivanainen,Sanna %A Alanko,Tuomo %A Vihinen,Pia %A Konkola,Teemu %A Ekstrom,Jussi %A Virtanen,Henri %A Koivunen,Jussi %+ Department of Oncology and Radiotherapy, Oulu University Hospital, PB 22, 90029 OYS, Oulu, Finland, 358 83153789, jussi.koivunen@ppshp.fi %K ePRO %K immune checkpoint inhibitors %K symptoms %K side-effects %K anti-PD-(L)1 therapy %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Immune checkpoint inhibitors (ICIs) have become a standard of care for various tumor types. Their unique spectrum of side effects demands continuous and long-lasting assessment of symptoms. Electronic patient-reported outcome (ePRO) follow-up has been shown to improve survival and quality of life of cancer patients treated with chemotherapy. Objective: This study aimed to investigate whether ePRO follow-up of cancer patients treated with ICIs is feasible. The study analyzed (1) the variety of patient reported symptoms, (2) etiology of alerts, (3) symptom correlations, and (4) patient compliance. Methods: In this prospective, one-arm, multi-institutional study, we recruited adult cancer patients whose advanced cancer was treated with anti-programmed cell death protein 1 (PD)- ligand (L)1 agents in outpatient settings. The ePRO tool consisted of a weekly questionnaire evaluating the presence of typical side effects, with an algorithm assessing the severity of the symptom according to National Cancer Institute Common Terminology Criteria for Adverse Events and an urgency algorithm sending alerts to the care team. A patient experience survey was conducted monthly. The patients were followed up to 6 months or until disease progression. Results: A total of 889 symptom questionnaires was completed by 37 patients (lung cancer, n=15; melanoma, n=9; genitourinary cancer, n=9; head and neck cancer, n=4). Patients showed good adherence to ePRO follow-up. The most common grade 1 symptoms were fatigue (28%) and itching (13%), grade 2 symptoms were loss of appetite (12%) and nausea (12%), and grade 3-4 symptoms were cough (6%) and loss of appetite (4%). The most common reasons for alerts were loss of appetite and shortness of breath. In the treatment benefit analysis, positive correlations were seen between clinical benefit and itching as well as progressive disease and chest pain. Conclusions: According to the results, ePRO follow-up of cancer patients receiving ICIs is feasible. ePROs capture a wide range of symptoms. Some symptoms correlate to treatment benefit, suggesting that individual prediction models could be generated. Trial Registration: Clinical Trials Register, NCT3928938; https://clinicaltrials.gov/ct2/show/NCT03928938 %M 33112242 %R 10.2196/17898 %U http://formative.jmir.org/2020/10/e17898/ %U https://doi.org/10.2196/17898 %U http://www.ncbi.nlm.nih.gov/pubmed/33112242 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e23893 %T Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study %A Bostrøm,Katrine %A Børøsund,Elin %A Varsi,Cecilie %A Eide,Hilde %A Flakk Nordang,Elise %A Schreurs,Karlein MG %A Waxenberg,Lori B %A Weiss,Karen E %A Morrison,Eleshia J %A Cvancarova Småstuen,Milada %A Stubhaug,Audun %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, Oslo, Oslo, N-0424, Norway, 47 91332341, lise.solberg.nes@rr-research.no %K chronic pain %K feasibility %K acceptability %K self-management %K eHealth %K digital %K cognitive-behavioral pain %K usability %K user centered %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients’ daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. Objective: This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. Methods: The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior–based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. Results: Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, “totally agree” or “agree”; 39/45, 87%) and easy to use (42/45, 93%), and as having easily understandable exercises (44/45, 98%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). Conclusions:  Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 %M 33094734 %R 10.2196/23893 %U http://formative.jmir.org/2020/10/e23893/ %U https://doi.org/10.2196/23893 %U http://www.ncbi.nlm.nih.gov/pubmed/33094734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e16094 %T Coding Systems for Clinical Decision Support: Theoretical and Real-World Comparative Analysis %A Delvaux,Nicolas %A Vaes,Bert %A Aertgeerts,Bert %A Van de Velde,Stijn %A Vander Stichele,Robert %A Nyberg,Peter %A Vermandere,Mieke %+ Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J - box 7001, Leuven, B-3000, Belgium, 32 16379885, nicolas.delvaux@kuleuven.be %K clinical decision support systems %K clinical coding %K medical informatics %K electronic health records %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective clinical decision support systems require accurate translation of practice recommendations into machine-readable artifacts; developing code sets that represent clinical concepts are an important step in this process. Many clinical coding systems are currently used in electronic health records, and it is unclear whether all of these systems are capable of efficiently representing the clinical concepts required in executing clinical decision support systems. Objective: The aim of this study was to evaluate which clinical coding systems are capable of efficiently representing clinical concepts that are necessary for translating artifacts into executable code for clinical decision support systems. Methods: Two methods were used to evaluate a set of clinical coding systems. In a theoretical approach, we extracted all the clinical concepts from 3 preventive care recommendations and constructed a series of code sets containing codes from a single clinical coding system. In a practical approach using data from a real-world setting, we studied the content of 1890 code sets used in an internationally available clinical decision support system and compared the usage of various clinical coding systems. Results: SNOMED CT and ICD-10 (International Classification of Diseases, Tenth Revision) proved to be the most accurate clinical coding systems for most concepts in our theoretical evaluation. In our practical evaluation, we found that International Classification of Diseases (Tenth Revision) was most often used to construct code sets. Some coding systems were very accurate in representing specific types of clinical concepts, for example, LOINC (Logical Observation Identifiers Names and Codes) for investigation results and ATC (Anatomical Therapeutic Chemical Classification) for drugs. Conclusions: No single coding system seems to fulfill all the needs for representing clinical concepts for clinical decision support systems. Comprehensiveness of the coding systems seems to be offset by complexity and forms a barrier to usability for code set construction. Clinical vocabularies mapped to multiple clinical coding systems could facilitate clinical code set construction. %M 33084593 %R 10.2196/16094 %U http://formative.jmir.org/2020/10/e16094/ %U https://doi.org/10.2196/16094 %U http://www.ncbi.nlm.nih.gov/pubmed/33084593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17512 %T XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study %A Torres Silva,Ever Augusto %A Uribe,Sebastian %A Smith,Jack %A Luna Gomez,Ivan Felipe %A Florez-Arango,Jose Fernando %+ Bioengineering Research Group, Universidad Pontificia Bolivariana, Calle 78B #72A - 109, Medellin, 050034, Colombia, 57 44488388 ext 19337, ever.torres@upb.edu.co %K clinical decision support systems %K computer-interpretable guidelines %K knowledge representation %K state machine %K system design %K XML %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability. Objective: This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician’s perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow. Methods: We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings. Results: In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable. Conclusions: Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine. %M 33064087 %R 10.2196/17512 %U http://formative.jmir.org/2020/10/e17512/ %U https://doi.org/10.2196/17512 %U http://www.ncbi.nlm.nih.gov/pubmed/33064087 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e15037 %T Understanding Problems With Sleep, Sexual Functioning, Energy, and Appetite Among Patients Who Access Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression: Qualitative Exploratory Study %A Edmonds,Michael R %A Hadjistavropoulos,Heather D %A Gullickson,Kirsten M %A Asmundson,Aleiia JN %A Dear,Blake F %A Titov,Nickolai %+ Online Therapy Unit, Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, Canada, 1 306 585 5133, hadjista@uregina.ca %K cognitive behavioral therapy %K anxiety %K depression %K internet-based intervention %K sleep %K sexual health %K motivation %K appetite %D 2020 %7 13.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Transdiagnostic internet-delivered cognitive behavioral therapy (T-ICBT) is an effective treatment for anxiety and depression, and nowadays, there is interest in exploring ways to optimize T-ICBT in routine care. T-ICBT programs are designed to address the primary cognitive-affective and behavioral symptoms of anxiety and depression (eg, low mood, worry, anhedonia, and avoidance). Treatment also has the potential to resolve other symptom concerns (eg, sleep disruption, sexual dysfunction, lack of energy, and appetite or weight changes). Having additional information regarding the extent of these concerns and how concerns change over time could prove beneficial for further development of T-ICBT in routine care. Objective: This exploratory formative study aims to better understand sleep, sexual functioning, energy, and appetite concerns among T-ICBT clients seeking treatment for depression and anxiety. A qualitative analytic approach was used to identify themes in the symptom concerns reported by patients in the areas of sleep, sexual functioning, energy, and appetite at the time of enrollment. Patient responses to related items from screening measures for anxiety and depression were also examined pre- and posttreatment. Methods: Patients in routine care who applied for a T-ICBT program for depression and anxiety over a 1-year period were included in this study. As part of the application and screening process, participants completed depression and anxiety symptom measures (ie, 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale). These same measures were administered posttreatment. Subsequently, they were asked if they were experiencing any problems with sleep, sexual activity, energy, or appetite (yes or no). If their response was yes, they were presented with an open-ended comment box that asked them to describe the problems they had experienced in those areas. Results: A total of 462 patients were admitted to T-ICBT during the study period, of which 438 endorsed having some problems with sleep, sexual activity, energy, or appetite. The analysis of open-ended responses indicated that 73.4% (339/462) of patients reported sleep problems (eg, difficulty initiating or maintaining sleep), 69.3% (320/462) of patients reported problems with energy or motivation (eg, tiredness and low motivation), 57.4% (265/462) of patients reported appetite or body weight concerns (eg, changes in appetite and weight loss or gain), and 30.1% (139/462) of patients described concerns with sexual functioning (eg, loss of interest in sex and difficulty with arousal). Item analysis of symptom measures demonstrated that T-ICBT produced improvements in sleep, energy, and appetite in 8 weeks. Sexual dysfunction and weight changes were not represented in the screening measures, so it remains unclear what effect T-ICBT has on these symptoms. Conclusions: Sleep disruption, lack of energy, appetite or weight changes, and sexual dysfunction are common concerns reported by clients enrolled in T-ICBT in routine practice and may deserve greater attention in T-ICBT program development and administration. %M 33048054 %R 10.2196/15037 %U http://formative.jmir.org/2020/10/e15037/ %U https://doi.org/10.2196/15037 %U http://www.ncbi.nlm.nih.gov/pubmed/33048054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e21344 %T Integration of Online Treatment Into the “New Normal” in Mental Health Care in Post–COVID-19 Times: Exploratory Qualitative Study %A Bierbooms,Joyce J P A %A van Haaren,Monique %A IJsselsteijn,Wijnand A %A de Kort,Yvonne A W %A Feijt,Milou %A Bongers,Inge M B %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 630642496, J.J.P.A.Bierbooms@tilburguniversity.edu %K online treatment %K sustainability %K mental health care %K COVID-19 %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the “new normal” in mental health care will be like in post–COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? Objective: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. Methods: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. Results: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. Conclusions: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care. %M 33001835 %R 10.2196/21344 %U http://formative.jmir.org/2020/10/e21344/ %U https://doi.org/10.2196/21344 %U http://www.ncbi.nlm.nih.gov/pubmed/33001835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19533 %T A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage %A Zhang,Haipeng %A Dimitrov,Dimitar %A Simpson,Lynn %A Plaks,Nina %A Singh,Balaji %A Penney,Stephen %A Charles,Jo %A Sheehan,Rosemary %A Flammini,Steven %A Murphy,Shawn %A Landman,Adam %+ Digital Innovation Hub, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 6174591650, hzhang37@partners.org %K public health %K clinical informatics %K digital health %K coronavirus %K COVID-19 %K SARS-CoV-2 %K 2019-nCov %K app %K eHealth %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: As of July 17, 2020, the COVID-19 pandemic has affected over 14 million people worldwide, with over 3.68 million cases in the United States. As the number of COVID-19 cases increased in Massachusetts, the Massachusetts Department of Public Health mandated that all health care workers be screened for symptoms daily prior to entering any hospital or health care facility. We rapidly created a digital COVID-19 symptom screening tool to enable this screening for a large, academic, integrated health care delivery system, Partners HealthCare, in Boston, Massachusetts. Objective: The aim of this study is to describe the design and development of the COVID Pass COVID-19 symptom screening application and report aggregate usage data from the first three months of its use across the organization. Methods: Using agile principles, we designed, tested, and implemented a solution over the span of one week using progressively customized development approaches as the requirements and use case become more solidified. We developed the minimum viable product (MVP) of a mobile-responsive, web-based, self-service application using research electronic data capture (REDCap). For employees without access to a computer or mobile device to use the self-service application, we established a manual process where in-person, socially distanced screeners asked employees entering the site if they have symptoms and then manually recorded the responses in an Office 365 Form. A custom .NET Framework application solution was developed as COVID Pass was scaled. We collected log data from the .NET application, REDCap, and Microsoft Office 365 from the first three months of enterprise deployment (March 30 to June 30, 2020). Aggregate descriptive statistics, including overall employee attestations by day and site, employee attestations by application method (COVID Pass automatic screening vs manual screening), employee attestations by time of day, and percentage of employees reporting COVID-19 symptoms, were obtained. Results: We rapidly created the MVP and gradually deployed it across the hospitals in our organization. By the end of the first week, the screening application was being used by over 25,000 employees each weekday. After three months, 2,169,406 attestations were recorded with COVID Pass. Over this period, 1865/160,159 employees (1.2%) reported positive symptoms. 1,976,379 of the 2,169,406 attestations (91.1%) were generated from the self-service screening application. The remainder were generated either from manual attestation processes (174,865/2,169,406, 8.1%) or COVID Pass kiosks (25,133/2,169,406, 1.2%). Hospital staff continued to work 24 hours per day, with staff attestations peaking around shift changes between 7 and 8 AM, 2 and 3 PM, 4 and 6 PM, and 11 PM and midnight. Conclusions: Using rapid, agile development, we quickly created and deployed a dedicated employee attestation application that gained widespread adoption and use within our health system. Further, we identified 1865 symptomatic employees who otherwise may have come to work, potentially putting others at risk. We share the story of our implementation, lessons learned, and source code (via GitHub) for other institutions who may want to implement similar solutions. %M 32877348 %R 10.2196/19533 %U https://formative.jmir.org/2020/10/e19533 %U https://doi.org/10.2196/19533 %U http://www.ncbi.nlm.nih.gov/pubmed/32877348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e22485 %T Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study %A Davis,Teaniese %A DiClemente,Ralph Joseph %A Prietula,Michael %+ Goizueta Business School & Hubert Department of Global Health, Emory University, Goizueta Business School, 1300 Clifton Road, Atlanta, GA, 30322, United States, 1 7709009034, mj.prietula@emory.edu %K short message service %K HIV %K African Americans %K adolescent %K female %K texting %K mHealth %K ADAPT-ITT framework %K intervention study %K health status disparities %K young adult %K risk reduction behavior %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. Objective: This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator–led phone calling to text-based communication. Methods: The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board’s request, this phase included an optional, additional week of text-based PMI messages. Results: The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. Conclusions: The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives. %M 32831178 %R 10.2196/22485 %U https://formative.jmir.org/2020/10/e22485 %U https://doi.org/10.2196/22485 %U http://www.ncbi.nlm.nih.gov/pubmed/32831178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e20501 %T Ethnicity Differences in Sleep Changes Among Prehypertensive Adults Using a Smartphone Meditation App: Dose-Response Trial %A Sieverdes,John C %A Treiber,Frank A %A Kline,Christopher E %A Mueller,Martina %A Brunner-Jackson,Brenda %A Sox,Luke %A Cain,Mercedes %A Swem,Maria %A Diaz,Vanessa %A Chandler,Jessica %+ College of Charleston, Health and Human Performance, 24 George Street, Charleston, SC, United States, 1 843 953 6094, sieverdesjc@cofc.edu %K meditation %K sleep %K mobile phone %K prehypertension %K ethnicity %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: African Americans (AAs) experience greater sleep quality problems than non-Hispanic Whites (NHWs). Meditation may aid in addressing this disparity, although the dosage levels needed to achieve such benefits have not been adequately studied. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols. Objective: This 6-month dose-response feasibility trial investigated the effects of a breathing awareness meditation (BAM) app, Tension Tamer, on the secondary outcomes of self-reported and actigraphy measures of sleep quality and the modulating effects of ethnicity of AAs and NHWs. Methods: A total of 64 prehypertensive adults (systolic blood pressure <139 mm Hg; 31 AAs and 33 NHWs) were randomized into 3 different Tension Tamer dosage conditions (5,10, or 15 min twice daily). Sleep quality was assessed at baseline and at 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and 1-week bouts of continuous wrist actigraphy monitoring. The study was conducted between August 2014 and October 2016 (IRB #Pro00020894). Results: At baseline, PSQI and actigraphy data indicated that AAs had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep (range P=.03 to P<.001). Longitudinal generalized linear mixed modeling revealed a dose effect modulated by ethnicity (P=.01). Multimethod assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses (range P=.04 to P<.001). Actigraphy findings revealed a consistent, but not statistically significant, pattern in the 5-min group, showing lower fragmentation, longer sleep duration, and higher efficiency than the other 2 dosage conditions. Among AAs, actigraphy indicated lower sleep fragmentation with the 5-min dose compared with the 10-min and 15-min doses (P=.03 and P<.001, respectively). The 10-min dose showed longer sleep duration than the 5-min and 15-min doses (P=.02 and P<.001, respectively). The 5-min dose also exhibited significantly longer average sleep than the 15-min dose (P=.03). Conclusions: These findings indicate the need for further study of the potential modulating influence of ethnicity on the impact of BAM on sleep indices and user-centered exploration to ascertain the potential merits of refining the Tension Tamer app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints. %M 33021484 %R 10.2196/20501 %U https://formative.jmir.org/2020/10/e20501 %U https://doi.org/10.2196/20501 %U http://www.ncbi.nlm.nih.gov/pubmed/33021484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17895 %T Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study %A Green,Eric P %A Lai,Yihuan %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Jones,Rachel M %A Bhat,Chaya %A Mulinge,Antonia %A Puffer,Eve S %+ Duke Global Health Institute, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K mobile phone %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 %M 33016883 %R 10.2196/17895 %U https://formative.jmir.org/2020/10/e17895 %U https://doi.org/10.2196/17895 %U http://www.ncbi.nlm.nih.gov/pubmed/33016883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19860 %T Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study %A Gowarty,Minda A %A Kung,Nathan J %A Maher,Ashley E %A Longacre,Meghan R %A Brunette,Mary F %+ Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 6036536868, minda.a.gowarty@hitchcock.org %K smoking cessation %K mHealth %K serious mental illness %K smartphone application %K digital health %K psychiatric illness %K tobacco treatment %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with serious mental illness are over twice as likely to have tobacco use disorder than those in the general population and are less likely to utilize proven treatment methods during quit attempts. However, little research has evaluated the efficacy of interventions for this group. Smartphone apps may be an underutilized tool for tobacco use disorder among young adults with serious mental illness. Objective: The aim of this study was to explore attitudes toward smoking cessation apps and preferences regarding app design in young adult smokers with serious mental illness. Methods: Five focus groups involving 25- to 35-year-old adults with serious mental illness receiving treatment at a community mental health center were conducted between May 2019 and August 2019. Three researchers independently coded transcripts and identified themes using thematic analysis. Results: Participants (n=22) were individuals who smoke daily: 10 (46%) self-identified as female, 18 (82%) self-identified as White, and 9 (41%) had psychotic disorders. Key themes that emerged included a general interest in using health apps; a desire for apps to provide ongoing motivation during a quit attempt via social support, progress tracking, and rewards; a desire for apps to provide distraction from smoking; concerns about app effectiveness due to a lack of external accountability; and concerns that apps could trigger cravings or smoking behavior by mentioning cigarettes or the act of smoking. Conclusions: Apps have the potential to support smoking cessation or reduction efforts among young adults with serious mental illness. However, they may require tailoring, optimization, and clinical support to effectively promote cessation in this population. %M 33006560 %R 10.2196/19860 %U https://formative.jmir.org/2020/10/e19860 %U https://doi.org/10.2196/19860 %U http://www.ncbi.nlm.nih.gov/pubmed/33006560 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19880 %T A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders %A Frost,Emily %A Porat,Talya %A Malhotra,Paresh %A Picinali,Lorenzo %+ Dyson School of Design Engineering, Imperial College London, Dyson Building, Imperial College Road, London, SW7 2DB, United Kingdom, 44 2075948158, e.frost@imperial.ac.uk %K cognitive decline %K mobile phone %K hearing loss %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. %M 32996884 %R 10.2196/19880 %U http://humanfactors.jmir.org/2020/3/e19880/ %U https://doi.org/10.2196/19880 %U http://www.ncbi.nlm.nih.gov/pubmed/32996884 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e15786 %T Development of a Web-Based Resource for Parents of Young Children Newly Diagnosed With Autism: Participatory Research Design %A Rabba,Aspasia Stacey %A Dissanayake,Cheryl %A Barbaro,Josephine %+ Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, Australia, 61 3 9479 1162, c.dissanayake@latrobe.edu.au %K autism %K diagnosis %K parents %K support %K co-design %K eHealth %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The internet provides an ideal avenue to share information, advice, and support regarding autism. However, many websites lack quality control and rarely provide a one-stop resource for families to access necessary, evidence-based information. Objective: This study aims to use participatory action research (PAR) with end users (ie, parents) and clinicians to develop a web-based resource (Pathways Beyond Diagnosis) to improve timely access to quality, evidence-based information, and support for families after their child is diagnosed with autism. Methods: The PAR approach involves 4 phases: (1) cooperative researcher-stakeholder planning, (2) cooperative researcher-stakeholder–based action, (3) stakeholder observation, and (4) cooperative researcher-stakeholder reflection. A total of 15 participants (parents, n=3; clinicians, n=9; and researchers, n=3) attended individual or group participatory design workshops. This was followed by the translation of knowledge and ideas generated during the workshops to produce mockups of webpages and content, rapid prototyping, and one-on-one consultations with end users to assess the usability of the website developed. Results: A total of 3 participatory design workshops were held with the participants, each followed by a knowledge translation session. At the end of the PAR cycle, an alpha prototype of the website was built and a series of one-on-one end user consultation sessions were conducted. The PAR cycle revealed the importance of 6 key topic areas (understanding autism, accessing services, support, gaining funding, putting it all together, and looking into the future) associated with the time of diagnosis, which were incorporated into the beta version of the website. Conclusions: The development of the Pathways Beyond Diagnosis website using PAR ensures that families have ready access to practical and evidence-based information following a young child’s diagnosis. The website guides families to access relevant, reputable, and evidence-based information in addition to summarizing key challenges encountered after diagnosis (ie, grief, sharing the diagnosis) and the importance of self-care. %M 32996890 %R 10.2196/15786 %U http://pediatrics.jmir.org/2020/2/e15786/ %U https://doi.org/10.2196/15786 %U http://www.ncbi.nlm.nih.gov/pubmed/32996890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18086 %T Evaluating the Relationship Between Fitbit Sleep Data and Self-Reported Mood, Sleep, and Environmental Contextual Factors in Healthy Adults: Pilot Observational Cohort Study %A Thota,Darshan %+ Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA, 98431, United States, 1 253 968 5958, thota1@gmail.com %K Fitbit %K sleep %K healthy %K mood %K context %K waking %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders can disrupt a person’s sleep, resulting in lower quality of life. Early identification and referral to mental health services are critical for active duty service members returning from forward-deployed missions. Although technologies like wearable computing devices have the potential to help address this problem, research on the role of technologies like Fitbit in mental health services is in its infancy. Objective: If Fitbit proves to be an appropriate clinical tool in a military setting, it could provide potential cost savings, improve clinician access to patient data, and create real-time treatment options for the greater active duty service member population. The purpose of this study was to determine if the Fitbit device can be used to identify indicators of mental health disorders by measuring the relationship between Fitbit sleep data, self-reported mood, and environmental contextual factors that may disrupt sleep. Methods: This observational cohort study was conducted at the Madigan Army Medical Center. The study included 17 healthy adults who wore a Fitbit Flex for 2 weeks and completed a daily self-reported mood and sleep log. Daily Fitbit data were obtained for each participant. Contextual factors were collected with interim and postintervention surveys. This study had 3 specific aims: (1) Determine the correlation between daily Fitbit sleep data and daily self-reported sleep, (2) Determine the correlation between number of waking events and self-reported mood, and (3) Explore the qualitative relationships between Fitbit waking events and self-reported contextual factors for sleep. Results: There was no significant difference in the scores for the pre-intevention Pittsburg Sleep Quality Index (PSQI; mean 5.88 points, SD 3.71 points) and postintervention PSQI (mean 5.33 points, SD 2.83 points). The Wilcoxon signed-ranks test showed that the difference between the pre-intervention PSQI and postintervention PSQI survey data was not statistically significant (Z=0.751, P=.05). The Spearman correlation between Fitbit sleep time and self-reported sleep time was moderate (r=0.643, P=.005). The Spearman correlation between number of waking events and self-reported mood was weak (r=0.354, P=.163). Top contextual factors disrupting sleep were “pain,” “noises,” and “worries.” A subanalysis of participants reporting “worries” found evidence of potential stress resilience and outliers in waking events. Conclusions: Findings contribute valuable evidence on the strength of the Fitbit Flex device as a proxy that is consistent with self-reported sleep data. Mood data alone do not predict number of waking events. Mood and Fitbit data combined with further screening tools may be able to identify markers of underlying mental health disease. %M 32990631 %R 10.2196/18086 %U http://formative.jmir.org/2020/9/e18086/ %U https://doi.org/10.2196/18086 %U http://www.ncbi.nlm.nih.gov/pubmed/32990631 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e21155 %T Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health %A Katapally,Tarun Reddy %+ Johnson Shoyama Graduate School of Public Policy, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 3065854544, tarun.katapally@uregina.ca %K Indigenous youth %K mental health %K school policies %K health policy %K digital health interventions %K mHealth %K systems integration %K land-based learning %K physical activity %D 2020 %7 25.9.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action. %M 32975527 %R 10.2196/21155 %U http://pediatrics.jmir.org/2020/2/e21155/ %U https://doi.org/10.2196/21155 %U http://www.ncbi.nlm.nih.gov/pubmed/32975527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17424 %T Natural Language Processing Tools for Assessing Progress and Outcome of Two Veteran Populations: Cohort Study From a Novel Online Intervention for Posttraumatic Growth %A Norman,Kim P %A Govindjee,Anita %A Norman,Seth R %A Godoy,Michael %A Cerrone,Kimberlie L %A Kieschnick,Dustin W %A Kassler,William %+ Young Adult and Family Center, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 476 7402, kim.norman@ucsf.edu %K natural language analysis %K emotional tone %K personality %K values %K PTSD %K military sexual trauma %K online interventions %K internet-based cognitive behavioral therapy %K narrative therapy %K mindfulness %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 100 million Americans lack affordable access to behavioral health care. Among these, military veterans are an especially vulnerable population. Military veterans require unique behavioral health services that can address military experiences and challenges transitioning to the civilian sector. Real-world programs to help veterans successfully transition to civilian life must build a sense of community, have the ability to scale, and be able to reach the many veterans who cannot or will not access care. Digitally based behavioral health initiatives have emerged within the past few years to improve this access to care. Our novel behavioral health intervention teaches mindfulness-based cognitive behavioral therapy and narrative therapy using peer support groups as guides, with human-facilitated asynchronous online discussions. Our study applies natural language processing (NLP) analytics to assess effectiveness of our online intervention in order to test whether NLP may provide insights and detect nuances of personal change and growth that are not currently captured by subjective symptom measures. Objective: This paper aims to study the value of NLP analytics in assessing progress and outcomes among combat veterans and military sexual assault survivors participating in novel online interventions for posttraumatic growth. Methods: IBM Watson and Linguistic Inquiry and Word Count tools were applied to the narrative writings of combat veterans and survivors of military sexual trauma who participated in novel online peer-supported group therapies for posttraumatic growth. Participants watched videos, practiced skills such as mindfulness meditation, told their stories through narrative writing, and participated in asynchronous, facilitated online discussions with peers. The writings, including online postings, by the 16 participants who completed the program were analyzed after completion of the program. Results: Our results suggest that NLP can provide valuable insights on shifts in personality traits, personal values, needs, and emotional tone in an evaluation of our novel online behavioral health interventions. Emotional tone analysis demonstrated significant decreases in fear and anxiety, sadness, and disgust, as well as increases in joy. Significant effects were found for personal values and needs, such as needing or desiring closeness and helping others, and for personality traits of openness, conscientiousness, extroversion, agreeableness, and neuroticism (ie, emotional range). Participants also demonstrated increases in authenticity and clout (confidence) of expression. NLP results were generally supported by qualitative observations and analysis, structured data, and course feedback. Conclusions: The aggregate of results in our study suggest that our behavioral health intervention was effective and that NLP can provide valuable insights on shifts in personality traits, personal values, and needs, as well as measure changes in emotional tone. NLP’s sensitivity to changes in emotional tone, values, and personality strengths suggests the efficacy of NLP as a leading indicator of treatment progress. %M 32769074 %R 10.2196/17424 %U https://formative.jmir.org/2020/9/e17424 %U https://doi.org/10.2196/17424 %U http://www.ncbi.nlm.nih.gov/pubmed/32769074 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e20730 %T Ease of Use of the Electroconvulsive Therapy App by Its Users: Cross-Sectional Questionnaire Study %A Khan,Kinza %A Basavarajappa,Chethan %A Kunigiri,Girish %+ Bradgate Mental Health Unit, Leicester, Leicester, LE3 9EJ, United Kingdom, 44 1530 453827, Girish.Kunigiri@leicspart.nhs.uk %K mHealth %K depression %K apps %K electroconvulsive therapy %K smartphone %K mobile phone %K surveys %K psychiatry %D 2020 %7 22.9.2020 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Electroconvulsive therapy (ECT) is one of the oldest, most effective, and potentially life-saving noninvasive brain stimulation treatments for psychiatric illnesses such as severe depression, mania, and catatonia. The decision-making process to use ECT involves well-informed discussion between the clinician and the client. A platform, like an app, which provides this information in an easy-to-understand format may be of benefit to various stakeholders in making an informed decision. Apps developed by clinicians/hospitals taking into consideration user perspectives will filter and provide trustworthy information to the users. In this regard, the ECT app, an app which is freely available for download at the Apple Store, was developed by the Leicestershire Partnership National Health Service (NHS) Trust and Leicestershire Health Informatics Service (LHIS). Objective: The objective of this study is to evaluate and demonstrate the accessibility of the ECT app to the chosen audiences it was created for, via a paper and electronic questionnaire. Methods: A survey was conducted between January 2017 and March 2019. A survey questionnaire designed for the study was sent to mental health professionals, medical students, patients, carers, and members of the public via post, email, and SurveyMonkey or informed via posts shared in Psychiatry online groups and face-to-face contact. All participants who were willing to participate in the study were included. Results: Results were collected via paper forms, email responses, and SurveyMonkey and all were inputted into SurveyMonkey to facilitate analysis. A total of 20 responses were received during the study period (January 2017 to March 2019). The participants of the survey, which included a mixed group of professionals (12/20, 60%), patients (3/20, 15%), and carers (1/20, 5%), opined that the app was easy to download (14/20, 70%) and use (9/20, 45%); contained adequate information (19/20, 95%); they felt more informed after having used the app (9/20, 45%); and they would recommend it to others (19/20, 95%). The participants of the survey also provided suggestions on the app (10/20, 50%). Conclusions: The ECT app can be beneficial in sharing appropriate information to professionals and the public alike and help in gathering unbiased and nonjudgmental information on the current use of ECT as a treatment option. %R 10.2196/20730 %U http://biomedeng.jmir.org/2020/1/e20730/ %U https://doi.org/10.2196/20730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e20165 %T Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies %A Seppen,Bart F %A Wiegel,Jimmy %A L'ami,Merel J %A Duarte dos Santos Rico,Sharon %A Catarinella,Fabio S %A Turkstra,Franktien %A Boers,Maarten %A Bos,Wouter H %+ Amsterdam Rheumatology and Immunology Center, Reade, Dr Jan van Breemenstraat 2, Amsterdam , Netherlands, 31 616796208, b.seppen@reade.nl %K mHealth %K eHealth %K patient-reported outcome, smartphone app %K rheumatoid arthritis %K self-monitoring %K telemonitoring %K mobile phone %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective: The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods: This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results: In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions: This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway. %M 32955447 %R 10.2196/20165 %U http://formative.jmir.org/2020/9/e20165/ %U https://doi.org/10.2196/20165 %U http://www.ncbi.nlm.nih.gov/pubmed/32955447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18412 %T Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation %A Lattie,Emily G %A Bass,Michael %A Garcia,Sofia F %A Phillips,Siobhan M %A Moreno,Patricia I %A Flores,Ann Marie %A Smith,JD %A Scholtens,Denise %A Barnard,Cynthia %A Penedo,Frank J %A Cella,David %A Yanez,Betina %+ Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 3741, emily.lattie@northwestern.edu %K cancer survivorship %K eHealth %K patient-reported outcomes %K digital health %K symptom management %K supportive care %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective: This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods: A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results: Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions: Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform. %M 32955450 %R 10.2196/18412 %U http://formative.jmir.org/2020/9/e18412/ %U https://doi.org/10.2196/18412 %U http://www.ncbi.nlm.nih.gov/pubmed/32955450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e19296 %T Telerehabilitation to Address the Rehabilitation Gap in Anterior Cruciate Ligament Care: Survey of Patients %A Dunphy,Emma %A Gardner,Elizabeth C %+ eHealth Unit, Department of Primary Care and Population Health, University College London, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, United Kingdom, 44 07510146528, emmalouise75@hotmail.com %K anterior cruciate ligament %K telerehabilitation %K rehabilitation %K eHealth %K knee %K survey %K telehealth %K patient experience %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care. Objective: This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction. Methods: This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change. Results: A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60%) were younger than 30 years, 71 (74%) were recreational athletes, 24 (24%) were competitive athletes, 72 (75%) had private insurance, 74 (77%) were not familiar at all with telerehabilitation, and 89% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants’ priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress. Conclusions: These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions. %M 32945776 %R 10.2196/19296 %U http://formative.jmir.org/2020/9/e19296/ %U https://doi.org/10.2196/19296 %U http://www.ncbi.nlm.nih.gov/pubmed/32945776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e15625 %T Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups %A Engdahl,Patrik %A Svedberg,Petra %A Lexén,Annika %A Bejerholm,Ulrika %+ Mental Health, Activity and Participation, Department of Health Science, Lund University, PO Box 157, Lund, SE-22100, Sweden, 46 462221958, patrik.engdahl@med.lu.se %K qualitative method %K mental health %K mHealth %K quality improvement %K vocational rehabilitation %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. Objective: The aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods: A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results: The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent. Conclusions: This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context. %M 32936089 %R 10.2196/15625 %U http://formative.jmir.org/2020/9/e15625/ %U https://doi.org/10.2196/15625 %U http://www.ncbi.nlm.nih.gov/pubmed/32936089 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18169 %T MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study %A Backman,Chantal %A Harley,Anne %A Kuziemsky,Craig %A Mercer,Jay %A Peyton,Liam %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, RGN 3239, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800, chantal.backman@uottawa.ca %K geriatric rehabilitation %K care transition %K technology %K hip fracture %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. Objective: The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. Methods: This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. Results: In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. Conclusions: We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11031 %M 32924953 %R 10.2196/18169 %U http://formative.jmir.org/2020/9/e18169/ %U https://doi.org/10.2196/18169 %U http://www.ncbi.nlm.nih.gov/pubmed/32924953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18118 %T Protocol Development for HMU! (HIV Prevention for Methamphetamine Users), a Study of Peer Navigation and Text Messaging to Promote Pre-Exposure Prophylaxis Adherence and Persistence Among People Who Use Methamphetamine: Qualitative Focus Group and Interview Study %A McMahan,Vanessa M %A Frank,Noah %A Buckler,Smitty %A Violette,Lauren R %A Baeten,Jared M %A Banta-Green,Caleb J %A Barnabas,Ruanne V %A Simoni,Jane %A Stekler,Joanne D %+ San Francisco Department of Public Health, Center on Substance Use and Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States, 1 628 217 7469, vanessa.mcmahan@sfdph.org %K pre-exposure prophylaxis %K methamphetamine %K text messaging %K peer navigation %K men who have sex with men %K transgender people %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Cisgender men who have sex with men (MSM) and transgender people (TGP) who use methamphetamine are disproportionately impacted by HIV acquisition. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV, and interventions that support PrEP persistence and adherence should be evaluated among MSM and TGP who use methamphetamine. Objective: We conducted formative work to inform the development of text messaging and peer navigation interventions to support PrEP persistence and adherence among MSM and TGP who use methamphetamine. In this paper, we describe how the findings from these focus groups and interviews were used to refine the study interventions and protocol for the Hit Me Up! study (HMU!; HIV Prevention in Methamphetamine Users). Methods: Between October 2017 and March 2018, we conducted two focus groups and three in-depth interviews with MSM and TGP who use methamphetamine or who have worked with people who use methamphetamine. During these formative activities, we asked participants about their opinions on the proposed interventions, education and recruitment materials, and study design. We focused on how we could develop peer navigation and text messaging interventions that would be culturally appropriate and acceptable to MSM and TGP who use methamphetamine. Transcripts were reviewed by two authors who performed a retrospective content analysis to describe which specific opinions and recommendations influenced protocol development and the refinement of the interventions. Results: Overall, participants thought that MSM and TGP would be interested in participating in the study, although they expected recruitment and retention to be challenging. Participants thought that the peer navigator should be someone who is nonjudgmental, has experience with people who use methamphetamine, and is patient and flexible. There was consensus that three text messages per day were appropriate, adherence reminders should be straightforward, all messages should be nonjudgmental, and participants should be able to tailor the timing and content of the text messages. These suggestions were incorporated into the study interventions via the hiring and training process and into the development of the text library, platform selection, and customizability of messages. Conclusions: It is important to include the opinions and insights of populations most impacted by HIV to develop PrEP interventions with the greatest chance of success. Our formative work generated several recommendations that were incorporated into the interventions and protocol development for our ongoing study. Trial Registration: ClinicalTrials.gov NCT03584282; https://clinicaltrials.gov/ct2/show/NCT03584282 %M 32924952 %R 10.2196/18118 %U http://formative.jmir.org/2020/9/e18118/ %U https://doi.org/10.2196/18118 %U http://www.ncbi.nlm.nih.gov/pubmed/32924952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e19100 %T Design and Implementation of a Multilevel Intervention to Reduce Hepatitis C Transmission Among Men Who Have Sex With Men in Amsterdam: Co-Creation and Usability Study %A Prinsenberg,Tamara %A Zantkuijl,Paul %A Zuilhof,Wim %A Davidovich,Udi %A Schinkel,Janke %A Prins,Maria %A van der Valk,Marc %+ Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, PO Box 2200, Amsterdam, 1000CE, Netherlands, 31 20 555 398, tprinsenberg@ggd.amsterdam.nl %K co-creation %K mHealth %K intervention %K hepatitis C %K prevention %K risk reduction %K MSM %K HCV %D 2020 %7 11.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available. Objective: The objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation. Methods: We developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018. Results: NoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team. Conclusions: Involving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions. %M 32915157 %R 10.2196/19100 %U http://formative.jmir.org/2020/9/e19100/ %U https://doi.org/10.2196/19100 %U http://www.ncbi.nlm.nih.gov/pubmed/32915157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17154 %T eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey %A Wigfall,Lisa Tisdale %+ Division of Health Education, Department of Health and Kinesiology, Texas A&M University, 2929 Research Parkway, College Station, TX, 77843-4243, United States, 1 979 845 4779, lwigfall@tamu.edu %K eHealth %K communication %K HIV %K disparities %K inequalities %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Providing HIV/STD testing and prevention education, medical and nonmedical case management, housing assistance, transportation services, and patient navigation are just a few examples of how community-based HIV/AIDS service organizations will help the United States realize the goals of the updated National HIV/AIDS Strategy. Objective: In this study, the aim was to assess electronic data security confidence level, electronic communication behaviors, and interest in using eHealth communication tools with clients of staff at community-based HIV/AIDS service organizations. Methods: Staff were recruited from 7 community-based HIV/AIDS service organizations in the southern United States (3 in South Carolina and 4 in Texas). The principal investigator used state department of health websites to identify community-based HIV/AIDS service organizations. Staff were included if they provided HIV/STD prevention education to clients. A recruitment letter was sent to community-based HIV/AIDS service organization leaders who then used snowball sampling to recruit eligible staff. Chi-square tests were used. Results: Among staff (n=59) who participated in the study, 66% (39/59) were very or completely confident that safeguards are in place to keep electronically shared information from being seen by other people; 68% (40/59) used email, 58% (34/59) used text messages, 25% (15/59) used social media, 15% (9/59) used a mobile app, 8% (5/59) used web-enabled videoconferencing, and 3% (2/59) used other tools (eg, electronic medical record, healthnavigator.com website) to communicate electronically with their clients. More than half were very interested in using eHealth communication tools in the future for sharing appointment reminders (67%, 38/59) and general health tips (61%, 34/59) with their clients. Half were very interested in using eHealth communication tools in the future to share HIV medication reminders with their clients (50%, 29/59). Forty percent (23/59) were very interested in using eHealth communication tools to share vaccination reminders with their clients. Conclusions: Community-based HIV/AIDS service organization staff had some level of confidence that safeguards were in place to keep electronically shared information from being seen by other people. This is critically important given the sensitivity of the information shared between community-based HIV/AIDS service organization staff and their clients, and because many staff were very interested in using eHealth communication tools with their clients in the future. It is very likely that eHealth communication tools can be used in community settings to improve health outcomes across the HIV care continuum; in the interim, more research is needed to better understand factors that may facilitate or impede community-based HIV/AIDS service organization staff use and client acceptability. %M 32902395 %R 10.2196/17154 %U http://formative.jmir.org/2020/9/e17154/ %U https://doi.org/10.2196/17154 %U http://www.ncbi.nlm.nih.gov/pubmed/32902395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18456 %T Implementation of a Standardized Initial Assessment for Demand Management in Outpatient Emergency Care in Germany: Early Qualitative Process Evaluation %A Roth,Catharina %A Breckner,Amanda %A Paulus,Jan %A Wensing,Michel %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany, 49 62215635736, catharina.roth@med.uni-heidelberg.de %K emergency medical services %K outpatient emergency care service %K software %K point-of-care systems %K Germany %D 2020 %7 4.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Inadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment—Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)—aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective. Objective: This study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED. Methods: An early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data. Results: Health care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED. Conclusions: Initial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability. Trial Registration: German Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014 %M 32663159 %R 10.2196/18456 %U https://formative.jmir.org/2020/9/e18456 %U https://doi.org/10.2196/18456 %U http://www.ncbi.nlm.nih.gov/pubmed/32663159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17785 %T Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record %A Kunstler,Breanne E %A Furler,John %A Holmes-Truscott,Elizabeth %A McLachlan,Hamish %A Boyle,Douglas %A Lo,Sean %A Speight,Jane %A O'Neal,David %A Audehm,Ralph %A Kilov,Gary %A Manski-Nankervis,Jo-Anne %+ Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia, 61 3 8344 7276, j.furler@unimelb.edu.au %K type 2 diabetes %K shared decision making %K clinical decision support %K general practice %K primary care %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. Objective: This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. Methods: The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Results: Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. Conclusions: GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation. %M 32876576 %R 10.2196/17785 %U https://formative.jmir.org/2020/9/e17785 %U https://doi.org/10.2196/17785 %U http://www.ncbi.nlm.nih.gov/pubmed/32876576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17126 %T Lifestyle Interventions for Polycystic Ovary Syndrome: Cross-Sectional Survey to Assess Women's Treatment and Outcome Preferences %A Saslow,Laura R %A Aikens,James E %+ Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Room 2178, 400 N Ingalls Street, Ann Arbor, MI, 48109, United States, 1 734 764 7836, saslowl@umich.edu %K polycystic ovary syndrome %K lifestyle intervention %K online and mobile %K health psychology %K nutrition %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Diet and lifestyle programs improve health, but women’s preferences for these programs have not been formally explored. Objective: The aim of our study was to examine diet and lifestyle program preferences among women with PCOS. Methods: We conducted a cross-sectional online survey of women with PCOS. Results: At least half of the 197 respondents expressed strong interest in programs addressing energy level, anxiety, depression, weight, diabetes prevention, menstrual period regulation, and hirsutism. Similarly, at least half reported willingness to modify their sleep, stress, and physical activity; and slightly less than half reported willingness to adopt a very low-carbohydrate, paleo, or low–glycemic index diet. At least half reported interest in online or mobile programs and email-based mentoring. Younger age was associated with interest in help with acne and fertility; higher body mass index was associated with wanting help with weight loss, energy, and anxiety; and greater stress eating was associated with wanting help with depression, anxiety, and menstrual period regulation. Conclusions: To our knowledge, this is the first study to examine attitudes and preferences of women with PCOS toward such programs. Future online and mobile diet and lifestyle programs may be able to capitalize on this information to better target this population’s expressed preferences. %M 32876573 %R 10.2196/17126 %U https://formative.jmir.org/2020/9/e17126 %U https://doi.org/10.2196/17126 %U http://www.ncbi.nlm.nih.gov/pubmed/32876573 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18554 %T Investigation of a Mobile Health Texting Tool for Embedding Patient-Reported Data Into Diabetes Management (i-Matter): Development and Usability Study %A Schoenthaler,Antoinette %A Cruz,Jocelyn %A Payano,Leydi %A Rosado,Marina %A Labbe,Kristen %A Johnson,Chrystal %A Gonzalez,Javier %A Patxot,Melissa %A Patel,Smit %A Leven,Eric %A Mann,Devin %+ NYU Langone Health, Department of Population Health, Center for Healthful Behavior Change, 180 Madison Ave, 7th floor, New York, NY, 10016, United States, 1 6465013434, antoinette.schoenthaler@nyumc.org %K patient-reported outcome measures %K mobile health %K type 2 diabetes %D 2020 %7 31.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) are increasingly being used in the management of type 2 diabetes (T2D) to integrate data from patients’ perspective into clinical care. To date, the majority of PRO tools have lacked patient and provider involvement in their development, thus failing to meet the unique needs of end users, and lack the technical infrastructure to be integrated into the clinic workflow. Objective: This study aims to apply a systematic, user-centered design approach to develop i-Matter (investigating a mobile health [mHealth] texting tool for embedding patient-reported data into diabetes management), a theory-driven, mobile PRO system for patients with T2D and their primary care providers. Methods: i-Matter combines text messaging with dynamic data visualizations that can be integrated into electronic health records (EHRs) and personalized patient reports. To build i-Matter, we conducted semistructured group and individual interviews with patients with T2D and providers, a design thinking workshop to refine initial ideas and design the prototype, and user testing sessions of prototypes using a rapid-cycle design (ie, design-test-modify-retest). Results: Using an iterative user-centered process resulted in the identification of 6 PRO messages that were relevant to patients and providers: medication adherence, dietary behaviors, physical activity, sleep quality, quality of life, and healthy living goals. In user testing, patients recommended improvements to the wording and timing of the PRO text messages to increase clarity and response rates. Patients also recommended including motivational text messages to help sustain engagement with the program. The personalized report was regarded as a key tool for diabetes self-management by patients and providers because it aided in the identification of longitudinal patterns in the PRO data, which increased patient awareness of their need to adopt healthier behaviors. Patients recommended adding individualized tips to the journal on how they can improve their behaviors. Providers preferred having a separate tab built into the EHR that included the personalized report and highlighted key trends in patients’ PRO data over the past 3 months. Conclusions: PRO tools that capture patients’ well-being and the behavioral aspects of T2D management are important to patients and providers. A clinical trial will test the efficacy of i-Matter in 282 patients with uncontrolled T2D. Trial Registration: ClinicalTrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389 %M 32865505 %R 10.2196/18554 %U https://formative.jmir.org/2020/8/e18554 %U https://doi.org/10.2196/18554 %U http://www.ncbi.nlm.nih.gov/pubmed/32865505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e21784 %T Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing %A Heffner,Jaimee L %A Catz,Sheryl L %A Klasnja,Predrag %A Tiffany,Brooks %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K tobacco %K nicotine %K smoking %K cessation %K smartphone %K motivation %K mHealth %K intervention %K formative %K development %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective: The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods: We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results: In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions: This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit. %M 32852278 %R 10.2196/21784 %U http://formative.jmir.org/2020/8/e21784/ %U https://doi.org/10.2196/21784 %U http://www.ncbi.nlm.nih.gov/pubmed/32852278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e20836 %T Understanding the Experience of Cancer Pain From the Perspective of Patients and Family Caregivers to Inform Design of an In-Home Smart Health System: Multimethod Approach %A LeBaron,Virginia %A Bennett,Rachel %A Alam,Ridwan %A Blackhall,Leslie %A Gordon,Kate %A Hayes,James %A Homdee,Nutta %A Jones,Randy %A Martinez,Yudel %A Ogunjirin,Emmanuel %A Thomas,Tanya %A Lach,John %+ University of Virginia School of Nursing, 225 Jeannette Lancaster Way, McLeod Hall, Charlottesville, VA, 22908, United States, 1 434 243 9291, vtl6k@virginia.edu %K cancer %K pain %K sensors %K smart health %K caregiver %K home based %K palliative care %K opioids %K smart watch %D 2020 %7 26.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Inadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input. Objective: This study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system. Methods: This was a descriptive pilot study using a multimethod approach. Dyads of patients with cancer and difficult pain and their primary family caregivers were recruited from an outpatient oncology clinic. The participant interviews consisted of (1) open-ended questions to explore the overall experience of cancer pain at home, (2) ranking of variables on a Likert-type scale (0, no impact; 5, most impact) that may influence cancer pain at home, and (3) feedback regarding BESI-C system prototypes. Qualitative data were analyzed using a descriptive approach to identity patterns and key themes. Quantitative data were analyzed using SPSS; basic descriptive statistics and independent sample t tests were run. Results: Our sample (n=22; 10 patient-caregiver dyads and 2 patients) uniformly described the experience of managing cancer pain at home as stressful and difficult. Key themes included (1) unpredictability of pain episodes; (2) impact of pain on daily life, especially the negative impact on sleep, activity, and social interactions; and (3) concerns regarding medications. Overall, taking pain medication was rated as the category with the highest impact on a patient’s pain (=4.79), followed by the categories of wellness (=3.60; sleep quality and quantity, physical activity, mood and oral intake) and interaction (=2.69; busyness of home, social or interpersonal interactions, physical closeness or proximity to others, and emotional closeness and connection to others). The category related to environmental factors (temperature, humidity, noise, and light) was rated with the lowest overall impact (=2.51). Patients and family caregivers expressed receptivity to the concept of BESI-C and reported a preference for using a wearable sensor (smart watch) to capture data related to the abrupt onset of difficult cancer pain. Conclusions: Smart health systems to support cancer pain management should (1) account for the experience of both the patient and the caregiver, (2) prioritize passive monitoring of physiological and environmental variables to reduce burden, and (3) include functionality that can monitor and track medication intake and efficacy; wellness variables, such as sleep quality and quantity, physical activity, mood, and oral intake; and levels of social interaction and engagement. Systems must consider privacy and data sharing concerns and incorporate feasible strategies to capture and characterize rapid-onset symptoms. %M 32712581 %R 10.2196/20836 %U http://formative.jmir.org/2020/8/e20836/ %U https://doi.org/10.2196/20836 %U http://www.ncbi.nlm.nih.gov/pubmed/32712581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e19226 %T Primary Care Peer-Supported Internet-Mediated Psychological Treatment for Adults With Anxiety Disorders: Mixed Methods Study %A Nissling,Linnea %A Fahlke,Claudia %A Lilja,Josefine L %A Skoglund,Ingmarie %A Weineland,Sandra %+ Department of Psychology, University of Gothenburg, Haraldsgatan 1, Gothenburg, 413 14, Sweden, 46 725 029 216, linnea.nissling@vgregion.se %K iCBT %K cognitive behavioral therapy %K internet-based intervention %K anxiety disorders %K primary care %K treatment adherence and compliance %K peer support %D 2020 %7 20.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The effect of internet-delivered cognitive behavioral therapy (iCBT) on anxiety in adults is well-known. However, patient dropouts and poor adherence to treatment are common. Feelings of belonging and empowerment from the treatment might be key to the completion of iCBT. Peer support workers are people with a personal experience of mental health problems, trained to provide professional support to people who require mental health care. Objective: This study aims to assess patient experiences; the feasibility, safety, and acceptability; and preliminary effectiveness on anxiety and depression, empowerment, and adherence to treatment in an 8-week peer-supported iCBT program for patients with anxiety disorders treated in primary care. Methods: This was a single-arm mixed methods feasibility study. Participants were patients referred to a central unit for iCBT in primary care. Quantitative data were collected pre-, post-, and 3 months postintervention. Qualitative data were collected through semistructured interviews. Results: A total of 9 participants completed the quantitative outcome assessment. Statistically significant improvements were observed in perceived empowerment at a 3-month follow-up, and significant decreases in anxiety, depression, and psychological distress at the end of the treatment were maintained at a 3-month follow-up. In total, 8 of the 9 patients showed improvement in the severity of their symptoms of anxiety. Adherence to treatment was good among the participants. No serious adverse events were reported. Eight participants were enrolled in the qualitative analysis. The qualitative results showed 3 main themes: (1) real contact in an online world, (2) empowering experiences, and (3) being behind the wheel. Qualitative results largely emphasized the personal relationship and supported the acceptability of adding peer support to iCBT. Conclusions: Peer support in digital treatment seems to be a safe and acceptable intervention. The preliminary results suggest the effectiveness of peer support on patient empowerment, anxiety, depression, psychological distress, and adherence to treatment. The results indicate the need for future studies to evaluate the effect of adding peer support to iCBT in larger randomized controlled trials. %M 32815819 %R 10.2196/19226 %U http://formative.jmir.org/2020/8/e19226/ %U https://doi.org/10.2196/19226 %U http://www.ncbi.nlm.nih.gov/pubmed/32815819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e20679 %T A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development %A Yin,Zenong %A Errisuriz,Vanessa L %A Evans,Martin %A Inupakutika,Devasena %A Kaghyan,Sahak %A Li,Shiyu %A Esparza,Laura %A Akopian,David %A Parra-Medina,Deborah %+ Latino Research Institute, The University of Texas at Austin, 210 W 24th St, Mailcode F9200, Austin, TX, 78712, United States, 1 512 471 4557, parramedina@austin.utexas.edu %K mhealth %K digital intervention %K Latino families %K rural population %K weight %K self-management %K diet %K lifestyle %K chronic disease %D 2020 %7 20.8.2020 %9 Viewpoint %J JMIR Form Res %G English %X Rural residents face numerous challenges in accessing quality health care for management of chronic diseases (eg, obesity, diabetes), including scarcity of health care services and insufficient public transport. Digital health interventions, which include modalities such as internet, smartphones, and monitoring sensors, may help increase rural residents’ access to health care. While digital health interventions have become an increasingly popular intervention strategy to address obesity, research examining the use of technological tools for obesity management among rural Latino populations is limited. In this paper, we share our experience developing a culturally tailored, interactive health intervention using digital technologies for a family-oriented, weight management program in a rural, primarily Latino community. We describe the formative research that guided the development of the intervention, discuss the process of developing the intervention technologies including issues of privacy and data security, examine the results of a pilot study, and share lessons learned. Our experience can help others design user-centered digital health interventions to engage underserved populations in the uptake of healthy lifestyle and disease management skills. %M 32726748 %R 10.2196/20679 %U http://formative.jmir.org/2020/8/e20679/ %U https://doi.org/10.2196/20679 %U http://www.ncbi.nlm.nih.gov/pubmed/32726748 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18583 %T A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study %A Nardone,Natalie %A Giberson,Jeremy %A Prochaska,Judith J %A Jain,Shonul %A Benowitz,Neal L %+ Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, Building 30, Room 3316, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 628 206 8324, neal.benowitz@ucsf.edu %K secondhand smoke %K adolescents %K cotinine %K mHealth %K intervention %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective: In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods: For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results: Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions: In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful. %M 32812888 %R 10.2196/18583 %U http://formative.jmir.org/2020/8/e18583/ %U https://doi.org/10.2196/18583 %U http://www.ncbi.nlm.nih.gov/pubmed/32812888 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e16537 %T Formative Evaluation of Consumer-Grade Activity Monitors Worn by Older Adults: Test-Retest Reliability and Criterion Validity of Step Counts %A Maganja,Stephanie A %A Clarke,David C %A Lear,Scott A %A Mackey,Dawn C %+ Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Shrum Science Centre Building K, 8888 University Drive, Burnaby, BC, V5A 4Z2, Canada, 1 778 782 9330, dmackey@sfu.ca %K aged %K gait %K mobility limitation %K exercise %K movement %K wearable electronic devices %K mobile phone %K reproducibility of results %K bias %K dimensional measurement accuracy %D 2020 %7 18.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: To assess whether commercial-grade activity monitors are appropriate for measuring step counts in older adults, it is essential to evaluate their measurement properties in this population. Objective: This study aimed to evaluate test-retest reliability and criterion validity of step counting in older adults with self-reported intact and limited mobility from 6 commercial-grade activity monitors: Fitbit Charge, Fitbit One, Garmin vívofit 2, Jawbone UP2, Misfit Shine, and New-Lifestyles NL-1000. Methods: For test-retest reliability, participants completed two 100-step overground walks at a usual pace while wearing all monitors. We tested the effects of the activity monitor and mobility status on the absolute difference in step count error (%) and computed the standard error of measurement (SEM) between repeat trials. To assess criterion validity, participants completed two 400-meter overground walks at a usual pace while wearing all monitors. The first walk was continuous; the second walk incorporated interruptions to mimic the conditions of daily walking. Criterion step counts were from the researcher tally count. We estimated the effects of the activity monitor, mobility status, and walk interruptions on step count error (%). We also generated Bland-Altman plots and conducted equivalence tests. Results: A total of 36 individuals participated (n=20 intact mobility and n=16 limited mobility; 19/36, 53% female) with a mean age of 71.4 (SD 4.7) years and BMI of 29.4 (SD 5.9) kg/m2. Considering test-retest reliability, there was an effect of the activity monitor (P<.001). The Fitbit One (1.0%, 95% CI 0.6% to 1.3%), the New-Lifestyles NL-1000 (2.6%, 95% CI 1.3% to 3.9%), and the Garmin vívofit 2 (6.0%, 95 CI 3.2% to 8.8%) had the smallest mean absolute differences in step count errors. The SEM values ranged from 1.0% (Fitbit One) to 23.5% (Jawbone UP2). Regarding criterion validity, all monitors undercounted the steps. Step count error was affected by the activity monitor (P<.001) and walk interruptions (P=.02). Three monitors had small mean step count errors: Misfit Shine (−1.3%, 95% CI −19.5% to 16.8%), Fitbit One (−2.1%, 95% CI −6.1% to 2.0%), and New-Lifestyles NL-1000 (−4.3%, 95 CI −18.9% to 10.3%). Mean step count error was larger during interrupted walking than continuous walking (−5.5% vs −3.6%; P=.02). Bland-Altman plots illustrated nonsystematic bias and small limits of agreement for Fitbit One and Jawbone UP2. Mean step count error lay within an equivalence bound of ±5% for Fitbit One (P<.001) and Misfit Shine (P=.001). Conclusions: Test-retest reliability and criterion validity of step counting varied across 6 consumer-grade activity monitors worn by older adults with self-reported intact and limited mobility. Walk interruptions increased the step count error for all monitors, whereas mobility status did not affect the step count error. The hip-worn Fitbit One was the only monitor with high test-retest reliability and criterion validity. %M 32651956 %R 10.2196/16537 %U http://formative.jmir.org/2020/8/e16537/ %U https://doi.org/10.2196/16537 %U http://www.ncbi.nlm.nih.gov/pubmed/32651956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18518 %T How Health Care Organizations Approach Social Media Measurement: Qualitative Study %A Ukoha,Chukwuma %+ Centre for Informatics and Applied Optimisation, Federation University Australia, Level 1, T Building, University Drive, Ballarat, VIC 3350, Australia, 61 353276435, c.ukoha@federation.edu.au %K health care organization %K social media %K measurement %K benchmarking %K metrics %K analytics tools %D 2020 %7 14.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many health care organizations use social media to support a variety of activities. To ensure continuous improvement in social media performance, health care organizations must measure their social media. Objective: The purpose of this study is to explore how health care organizations approach social media measurement and to elucidate the tools they employ. Methods: In this exploratory qualitative research, Australian health care organizations that use social media, varying in size and locality, were invited to participate in the study. Data were collected through semistructured interviews, and the transcripts were analyzed using thematic analysis. Results: The study identified health care organizations’ approaches to social media measurement. While some measured their social media frequently, others used infrequent measurements, and a few did not measure theirs at all. Those that measured their social media used one or a combination of the following yardsticks: personal benchmarking, peer benchmarking, and metric benchmarking. The metrics tracked included one or more of the following: reach, engagement, and conversion rates. The tools employed to measure social media were either inbuilt or add-on analytics tools. Although many participants showed great interest in measuring their social media, they still had some unanswered questions. Conclusions: The lack of a consensus approach to measurement suggests that, unlike other industries, social media measurement in health care settings is at a nascent stage. There is a need to improve knowledge, sophistication, and integration of social media strategy through the application of theoretical and analytical knowledge to help resolve the current challenge of effective social media measurement. This study calls for social media training in health care organizations. Such training must focus on how to use relevant tools and how to measure their use effectively. %M 32795994 %R 10.2196/18518 %U http://formative.jmir.org/2020/8/e18518/ %U https://doi.org/10.2196/18518 %U http://www.ncbi.nlm.nih.gov/pubmed/32795994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18751 %T The Relationship Between Smartphone-Recorded Environmental Audio and Symptomatology of Anxiety and Depression: Exploratory Study %A Di Matteo,Daniel %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Yu,Julia %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, DL Pratt Building, 6 King's College Road, Toronto, ON, M5S 3H5, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K depression %K anxiety %K mobile phone %K ecological momentary assessment %K mobile apps %K mobile health %K digital signal processing %K acoustics %K speech recognition software %D 2020 %7 13.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Objective and continuous severity measures of anxiety and depression are highly valuable and would have many applications in psychiatry and psychology. A collective source of data for objective measures are the sensors in a person’s smartphone, and a particularly rich source is the microphone that can be used to sample the audio environment. This may give broad insight into activity, sleep, and social interaction, which may be associated with quality of life and severity of anxiety and depression. Objective: This study aimed to explore the properties of passively recorded environmental audio from a subject’s smartphone to find potential correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed, together with a centralized server system, to collect periodic measurements of the volume of sounds in the environment and to detect the presence or absence of English-speaking voices. Subjects were recruited into a 2-week observational study during which the app was run on their personal smartphone to collect audio data. Subjects also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Participants were 112 Canadian adults from a nonclinical population. High-level features were extracted from the environmental audio of 84 participants with sufficient data, and correlations were measured between the 4 audio features and the 4 self-report measures. Results: The regularity in daily patterns of activity and inactivity inferred from the environmental audio volume was correlated with the severity of depression (r=−0.37; P<.001). A measure of sleep disturbance inferred from the environmental audio volume was also correlated with the severity of depression (r=0.23; P=.03). A proxy measure of social interaction based on the detection of speaking voices in the environmental audio was correlated with depression (r=−0.37; P<.001) and functional impairment (r=−0.29; P=.01). None of the 4 environmental audio-based features tested showed significant correlations with the measures of generalized anxiety or social anxiety. Conclusions: In this study group, the environmental audio was shown to contain signals that were associated with the severity of depression and functional impairment. Associations with the severity of social anxiety disorder and generalized anxiety disorder were much weaker in comparison and not statistically significant at the 5% significance level. This work also confirmed previous work showing that the presence of voices is associated with depression. Furthermore, this study suggests that sparsely sampled audio volume could provide potentially relevant insight into subjects’ mental health. %M 32788153 %R 10.2196/18751 %U https://formative.jmir.org/2020/8/e18751 %U https://doi.org/10.2196/18751 %U http://www.ncbi.nlm.nih.gov/pubmed/32788153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18586 %T A Web-Delivered Acceptance and Commitment Therapy Intervention With Email Reminders to Enhance Subjective Well-Being and Encourage Engagement With Lifestyle Behavior Change in Health Care Staff: Randomized Cluster Feasibility Stud %A Brown,Menna %A Hooper,Nic %A James,Phillip %A Scott,Darren %A Bodger,Owen %A John,Ann %+ Swansea University Medical School, Swansea University, Singleton Park, Data Science Building, Floor 3, Swansea, SA2 8PP, United Kingdom, 44 1792 606312, menna.brown@swansea.ac.uk %K well-being %K mental health %K behavior change %K acceptance and commitment therapy %K web-delivered intervention %K gamification %K adherence and engagement %K internet-based intervention %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor mental health and emotional well-being can negatively impact ability to engage in healthy lifestyle behavior change. Health care staff have higher rates of sickness and absence than other public sector staff, which has implications at both individual and societal levels. Individual efforts to self-manage health and well-being which add to the UK mental health prevention agenda need to be supported. Objective: The objective of this study was to establish the feasibility and acceptability of the inclusion of a self-guided, automated, web-based acceptance and commitment therapy intervention in an existing health promotion program, to improve subjective well-being and encourage engagement with lifestyle behavior change. Methods: For this 12-week, 4-armed, randomized controlled cluster feasibility study, we recruited participants offline and randomly allocated them to 1 of 3 intervention arms or control (no well-being intervention) using an automated web-based allocation procedure. Eligibility criteria were current health care staff in 1 Welsh health board, age≥18 years, ability to read English, and ability to provide consent. The primary researcher was blinded to cluster allocation. Feasibility outcomes were randomization procedure, acceptance of intervention, and adherence to and engagement with the wider program. We evaluated health and well-being data via self-assessment at 2 time points, registration and postintervention, using the 14-item Warwick-Edinburgh Mental Well-Being Scale, the 4-item Patient Health Questionnaire, and the 7-item Acceptance and Action Questionnaire—Revised. Results: Of 124 participants who provided consent and were randomly allocated, 103 completed full registration and engaged with the program. Most participants (76/103) enrolled in at least one health behavior change module, and 43% (41/96) of those randomly allocated to an intervention arm enrolled in the well-being module. Adherence and engagement was low (7/103, 6.8%), but qualitative feedback was positive. Conclusions: The procedure and randomization process proved feasible, and the addition of the well-being module proved acceptable to health care staff. However, participant engagement was limited, and no one completed the full 12-week program. User feedback should be used to develop the intervention to address poor engagement. Effectiveness should then be evaluated in a full-scale randomized controlled trial, which would be feasible with additional recruitment. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 50074817; http://www.isrctn.com/ISRCTN50074817 %M 32763887 %R 10.2196/18586 %U https://formative.jmir.org/2020/8/e18586 %U https://doi.org/10.2196/18586 %U http://www.ncbi.nlm.nih.gov/pubmed/32763887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18347 %T Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study %A Holtz,Bree E %A McCarroll,Alexis M %A Mitchell,Katharine M %+ Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, United States, 1 5178844537, bholtz@msu.edu %K mental health %K mobile phone %K mHealth %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students. Objective: This qualitative study aims to better understand college students’ perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM). Methods: A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator’s guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students’ perceptions and attitudes toward MySSP. Results: The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence. Conclusions: The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students. %M 32667892 %R 10.2196/18347 %U https://formative.jmir.org/2020/8/e18347 %U https://doi.org/10.2196/18347 %U http://www.ncbi.nlm.nih.gov/pubmed/32667892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18123 %T Clinician Perspectives and Design Implications in Using Patient-Generated Health Data to Improve Mental Health Practices: Mixed Methods Study %A Wu,Danny T Y %A Xin,Chen %A Bindhu,Shwetha %A Xu,Catherine %A Sachdeva,Jyoti %A Brown,Jennifer L %A Jung,Heekyoung %+ Department of Biomedical Informatics, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0840, Cincinnati, OH, 45229, United States, 1 5135586464, wutz@ucmail.uc.edu %K patient-generated health data %K mental health %K workflow %K mobile application %K interview %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-generated health data (PGHD) have been largely collected through mobile health (mHealth) apps and wearable devices. PGHD can be especially helpful in mental health, as patients’ illness history and symptom narratives are vital to developing diagnoses and treatment plans. However, the extent to which clinicians use mental health–related PGHD is unknown. Objective: A mixed methods study was conducted to understand clinicians’ perspectives on PGHD and current mental health apps. This approach uses information gathered from semistructured interviews, workflow analysis, and user-written mental health app reviews to answer the following research questions: (1) What is the current workflow of mental health practice and how are PGHD integrated into this workflow, (2) what are clinicians’ perspectives on PGHD and how do they choose mobile apps for their patients, (3) and what are the features of current mobile apps in terms of interpreting and sharing PGHD? Methods: The study consists of semistructured interviews with 12 psychiatrists and clinical psychologists from a large academic hospital. These interviews were thematically and qualitatively analyzed for common themes and workflow elements. User-posted reviews of 56 sleep and mood tracking apps were analyzed to understand app features in comparison with the information gathered from interviews. Results: The results showed that PGHD have been part of the workflow, but its integration and use are not optimized. Mental health clinicians supported the use of PGHD but had concerns regarding data reliability and accuracy. They also identified challenges in selecting suitable apps for their patients. From the app review, it was discovered that mHealth apps had limited features to support personalization and collaborative care as well as data interpretation and sharing. Conclusions: This study investigates clinicians’ perspectives on PGHD use and explored existing app features using the app review data in the mental health setting. A total of 3 design guidelines were generated: (1) improve data interpretation and sharing mechanisms, (2) consider clinical workflow and electronic health record integration, and (3) support personalized and collaborative care. More research is needed to demonstrate the best practices of PGHD use and to evaluate their effectiveness in improving patient outcomes. %M 32763884 %R 10.2196/18123 %U https://formative.jmir.org/2020/8/e18123 %U https://doi.org/10.2196/18123 %U http://www.ncbi.nlm.nih.gov/pubmed/32763884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e15669 %T Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study %A Lortz,Julia %A Simanovski,Jan %A Kuether,Tabea %A Kreitschmann-Andermahr,Ilonka %A Ullrich,Greta %A Steinmetz,Martin %A Rammos,Christos %A Jánosi,Rolf Alexander %A Moebus,Susanne %A Rassaf,Tienush %A Paldán,Katrin %+ Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen, 45147, Germany, 49 201 723 4801, julia.lortz@uk-essen.de %K peripheral arterial disease %K mHealth %K digital intervention %K supervised exercise therapy %K smartphone usage %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective: Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods: A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results: Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions: A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived. %M 32663154 %R 10.2196/15669 %U https://formative.jmir.org/2020/8/e15669 %U https://doi.org/10.2196/15669 %U http://www.ncbi.nlm.nih.gov/pubmed/32663154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17481 %T A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) %A O'Grady,Conor %A Melia,Ruth %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Duggan,Jim %+ School of Computer Science, National University of Ireland Galway, University Road, Galway, H91 TK33, Ireland, 353 91493336, james.duggan@nuigalway.ie %K mobile apps %K suicide %K mHealth %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. %M 32729845 %R 10.2196/17481 %U http://www.jmir.org/2020/7/e17481/ %U https://doi.org/10.2196/17481 %U http://www.ncbi.nlm.nih.gov/pubmed/32729845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18157 %T Designing a Personalized Digital Patient Support Program for Patients Treated With Growth Hormone: Key Design Considerations %A Malik,Sumaira %A Moloney,Clare %A Koledova,Ekaterina %A Reston,Jonathan %A Weinman,John %+ Atlantis Healthcare, Building 5 Chiswick Park, Chiswick High Road, London, W4 5YA, United Kingdom, 44 2087474360, sumaira.malik@atlantishealthcare.com %K growth hormone %K behavior change wheel %K somatropin %K adherence %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Recombinant human growth hormone treatment can optimize growth potential; however, optimal outcomes are not always achieved for several reasons, including poor adherence. The overall objective of this project was to design a patient support program to maximize the chances of treatment success for people being treated with somatropin injection. An approach known as the behavior change wheel was used to enhance the development of the patient support program. The behavior change wheel provided a comprehensive framework to support the design of interventions. Objective: The aim of this paper was to describe how the steps of the behavior change wheel were applied to the development of a patient support program for individuals with growth hormone deficiency undergoing treatment with somatropin. Methods: We followed a series of steps that align to tenets of the behavior change wheel, namely, a narrative literature review to identify which behaviors needed to change and the potential drivers of and barriers to the behaviors, the selection of an intervention strategy and discrete behavior change techniques, and, finally, intervention specification. Results: A recent systematic review identified a range of potentially modifiable factors found to have an influence on patient adherence to growth hormone treatment. Insights from the systematic review were used to guide the development of a patient support program. The final design of the patient support program consisted of four elements: (1) a personalization questionnaire to tailor support for each individual, (2) tailored reminder and support SMS text messages, (3) nurse-led phone calls, and (4) Easypod connect, an automated electronic autoinjector drug-delivery device with a transmitter and connection platform for Saizen (somatropin) that allows automatic recording, storage, and transmission of drug-usage data, thus providing insight into suboptimal adherence. Conclusions: The patient support program that was designed is currently being piloted with patients to assess engagement with the program and determine its impact on patient outcomes. Results from the pilot will be used to further refine the program to ensure it meets user needs. %M 32723712 %R 10.2196/18157 %U http://www.jmir.org/2020/7/e18157/ %U https://doi.org/10.2196/18157 %U http://www.ncbi.nlm.nih.gov/pubmed/32723712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16687 %T Building a Successful Massive Open Online Course About Multiple Sclerosis: A Process Description %A Claflin,Suzi B %A Gates,Rachael %A Maher,Maree %A Taylor,Bruce V %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 0362267728, suzi.claflin@utas.edu.au %K multiple sclerosis %K health education %D 2020 %7 29.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: Over the course of a year, we developed and tested a 6-week massive open online course (MOOC) on multiple sclerosis (MS) in consultation with the MS community. The course targeted the MS community and interested laypeople and was titled Understanding MS. The primary purpose of the course was to improve MS knowledge, health literacy, and resilience among participants. The final version of the MOOC made available for open enrollment was ranked first among all MOOCs released in 2019 (n>2400) based on participant reviews. Objective: The aim of this study was to present a detailed description and assessment of the development process of the Understanding MS MOOC. Methods: The development process included a course development focus group; the creation of more than 50 content videos and related text, quizzes, activities, and discussion prompts; the creation of original images and animations; a pilot study; and collaborations with people living with MS, MS nurses, allied health care practitioners, and neurologists and researchers from 4 universities. Results: Overall, the process was efficient and effective. With a few small changes, we recommend this approach to those seeking to develop a similar course. This process led to the development of a highly reviewed MOOC with excellent user satisfaction. Conclusions: We identified 5 key lessons from this process: (1) community support is essential, (2) stakeholder involvement improves content quality, (3) plan for research from the beginning, (4) coordination between the academic lead and project manager team ensures a consistent voice, and (5) a network of collaborators is a key resource. %M 32723726 %R 10.2196/16687 %U https://www.jmir.org/2020/7/e16687 %U https://doi.org/10.2196/16687 %U http://www.ncbi.nlm.nih.gov/pubmed/32723726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18779 %T Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study %A Park,Bu Kyung %A Kim,Ji Yoon %A Rogers,Valerie E %+ College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaegosang-ro, Jung-gu, Daegu, 41944, Republic of Korea, 82 53 420 4929, bukpark@knu.ac.kr %K pediatric cancer patients %K childhood cancer %K social network site %K Facebook %K usability %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood cancers previously considered to be incurable now have 5-year survival rates up to 84%. Nevertheless, these patients remain at risk of morbidity and mortality from therapy-related complications. Thus, patient education and self-management strategies for promoting a healthy lifestyle are of tantamount importance for improving short- and long-term health outcomes. A Facebook-based “Healthy Teens for Soaam” (a Korean term for childhood cancers) program was developed to help improve knowledge and self-management practices of teens with cancer related to their disease and treatment. Objective: The two-fold purpose of this usability study was (1) to describe the process of developing an 8-week Facebook-based intervention program for teens with cancer, and (2) to evaluate its usability to refine the program. Methods: Multiple phases and methods were employed to develop and evaluate the usability of the program. Study phases included: (1) needs assessment through focus group interviews and qualitative content analysis, (2) development of module content, (3) expert review and feedback on module content, (4) Facebook-based program development, (5) usability evaluation by heuristic evaluation, (6) usability evaluation by targeted end-user testing, and (7) modification and final version of the program. Usability of the final version was confirmed through feedback loops of these phases. Results: Based on 6 focus group discussion sessions, it was determined that teens with cancer were interested in seeing stories of successful childhood cancer cases and self-management after discharge, and preferred multimedia content over text. Therefore, each Facebook module was redesigned to include multimedia materials such as relevant video clips tailored for teens. Usability assessed by heuristic evaluation and user testing revealed several critical usability issues, which were then revised. Potential end users tested the final program and perceived it to be usable and useful for teens with cancer. Conclusions: To our knowledge, “Healthy Teens for Soaam” is the first Facebook-based intervention program for teens with cancer. We actively worked with current childhood cancer patients and survivors to develop and improve this program, achieved good usability, and met the expressed needs and preferences of target end users. This 8-week Facebook-based educational program for teens with cancer, developed as the first step of an upcoming intervention study, will be useful for improving knowledge and self-management strategies of teens. %M 32720897 %R 10.2196/18779 %U http://www.jmir.org/2020/7/e18779/ %U https://doi.org/10.2196/18779 %U http://www.ncbi.nlm.nih.gov/pubmed/32720897 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17373 %T A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study %A Domańska,Barbara %A Vansant,Stijn %A Mountian,Irina %+ UCB Pharma, 208 Bath Road, Slough, United Kingdom, 44 1615 197676, barbara.domanska@UCB.com %K rheumatology %K internet %K digital health %K mobile health %K mHealth %K smartphone %K mobile phone %K validation human factors study %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective: This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods: We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients’ success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results: A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions: In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease. %M 32716310 %R 10.2196/17373 %U http://formative.jmir.org/2020/7/e17373/ %U https://doi.org/10.2196/17373 %U http://www.ncbi.nlm.nih.gov/pubmed/32716310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17220 %T Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study %A Wickerson,Lisa %A Fujioka,Jamie K %A Kishimoto,Vanessa %A Jamieson,Trevor %A Fine,Ben %A Bhatia,R Sacha %A Desveaux,Laura %+ Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 4163236400 ext 4302, laura.desveaux@wchospital.ca %K diagnostic imaging %K eHealth %K health care delivery %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. Objective: The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. Methods: This multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the current DICS usage data. Results: In this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. Conclusions: Suboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs. %M 32459644 %R 10.2196/17220 %U https://formative.jmir.org/2020/7/e17220 %U https://doi.org/10.2196/17220 %U http://www.ncbi.nlm.nih.gov/pubmed/32459644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18437 %T A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos %A Chandler,Rasheeta %A Hernandez,Natalie %A Guillaume,Dominique %A Grandoit,Shanaika %A Branch-Ellis,Desiré %A Lightfoot,Marguerita %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K mHealth app %K mobile technology %K Black women %K HIV prevention %K reproductive health %K women’s health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black women are an important but relatively overlooked at-risk group in HIV prevention efforts. Although there is an aggregate decline of HIV diagnoses among women in the United States, there are persistent disparate rates of new HIV infections among Black women compared to any other cisgender female subgroup. Strategies to end the HIV epidemic—as outlined in the Ending the HIV Epidemic initiative—for all communities must consider HIV prevention messaging and message delivery mediums that are created with community input. Although mobile health (mHealth) is a popular platform for delivering HIV interventions, there are currently no mobile apps that consider cisgender Black women with the goal of promoting a comprehensive women’s reproductive health and HIV prevention lifestyle. Previous research recommends inclusion of the target population from project inception and iteratively throughout development, to promote use of the intervention. Objective: The purpose of this study is to understand cisgender Black women’s preferences for functionality, format, and design of a mobile HIV prevention app and to examine their willingness to use an app for HIV prevention. Methods: We conducted a series of four focus groups with 23 Black cisgender women. Focus groups included discussion and demonstration elements to address cisgender women’s general preference for apps, HIV prevention content that would be useful in an app, and preferred app features that would promote use of an HIV-centric app. During focus group discussions, participants were shown narrated, custom wireframes of HIV prevention app prototypes to demonstrate potential app function. Results: Findings indicated the presence of eight subthemes within the coding structure of three overall themes: (1) health content within the mobile app, (2) mobile app functionality, format, and design, and (3) other suggested features. Specifically, participants detailed preferred educational content, content distribution, app aesthetics, privacy considerations, and marketing of the app. Conclusions: Findings suggest that Black cisgender women preferred an app that integrated HIV prevention and optimal sexual health promotion. Participants provided a range of preferences for content integration and facilitators of app engagement with an HIV prevention app. Preferences centered on gender and cultural congruency of information and content, evidenced by visuals, language, and resources. Black cisgender women are viable consumers for a mobile app–based HIV prevention intervention. %M 32706723 %R 10.2196/18437 %U http://mhealth.jmir.org/2020/7/e18437/ %U https://doi.org/10.2196/18437 %U http://www.ncbi.nlm.nih.gov/pubmed/32706723 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e18049 %T MyStrengths, a Strengths-Focused Mobile Health Tool: Participatory Design and Development %A Jessen,Stian %A Mirkovic,Jelena %A Nes,Lise Solberg %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Trondhjemsveien 235, Oslo, 0586, Norway, 47 98049759, stian.jessen@rr-research.no %K mHealth %K participatory design %K personal strengths %K gameful design %K gamification %K iterative development %K positive approach %K co-design %K user engagement %K mobile phone %K chronic care %K self-management %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic illnesses are an increasingly large group. Research indicates that care and self-management should not only focus on the illness and problem-oriented aspects of these individuals’ lives but also support them in recognizing and leveraging their personal strengths in daily life. Objective: This paper presents the design and developmental process of MyStrengths, a mobile health (mHealth) app designed to help its users (people with chronic conditions) both find and make use of their personal strengths in their daily lives. Through 4 consecutive phases, this paper presents participant- and researcher-driven activities, discussions regarding design, and development of both the MyStrengths app and its content. Methods: During the 4 phases, we used a range of methods and activities, including (1) an idea-generating workshop aimed at creating ideas for strengths-supporting features with different stakeholders, including patients, caregivers, relatives, and designers (N=35); (2) research seminars with an international group of experts (N=6), in which the concept, theoretical background, and design ideas for the app were discussed; (3) a series of co-design workshops with people in the user group (N=22) aiming to create ideas for how to, in an engaging manner, design the app; and (4) in 4 developmental iterations, the app was evaluated by people in the user group (N=13). Content and strengths exercises were worked on and honed by the research team, the expert groups, and our internal editorial team during the entire developmental process. Results: The first phase found a wide range of stakeholder requirements to, and ideas for, strengths-focused mHealth apps. From reviewing literature during the second phase, we found a dearth of research on personal strengths with respect to people living with chronic illnesses. Activities during the third phase creatively provided numerous ideas and suggestions for engaging and gameful ways to develop and design the MyStrengths app. The final phase saw the output from all the earlier phases come together. Through multiple increasingly complete iterations of user evaluations testing and developing, the final prototype of the MyStrengths app was created. Conclusions: Although research supports the use of strengths-focused mHealth tools to support people living with chronic illnesses, there is little guidance as to how these tools and their content should be designed. Through all activities, we found great support among participating users for strengths-focused apps, and we can consider such apps to be both appropriate and valuable. This paper illustrates how combining a range of user-, researcher-, literature-, and designer-based methods can contribute to creating mHealth tools to support people with chronic illnesses to find and use more of their own personal strengths. %M 32706651 %R 10.2196/18049 %U http://formative.jmir.org/2020/7/e18049/ %U https://doi.org/10.2196/18049 %U http://www.ncbi.nlm.nih.gov/pubmed/32706651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e12417 %T Continuous 7-Month Internet of Things–Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study %A Saarikko,Johanna %A Niela-Vilen,Hannakaisa %A Ekholm,Eeva %A Hamari,Lotta %A Azimi,Iman %A Liljeberg,Pasi %A Rahmani,Amir M %A Löyttyniemi,Eliisa %A Axelin,Anna %+ School of Nursing and Department of Computer Science, University of California, 106D Berk Hall, Irvine, CA, 92697-3959, United States, 1 949 824 3590, a.rahmani@uci.edu %K prenatal care %K postnatal care %K wearable electronics %K biosensing %K cloud computing %K mHealth %K physical activity %K sleep %K heart rate %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Monitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. Objective: This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system. Methods: This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. Results: Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. Conclusions: The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up. %M 32706696 %R 10.2196/12417 %U http://formative.jmir.org/2020/7/e12417/ %U https://doi.org/10.2196/12417 %U http://www.ncbi.nlm.nih.gov/pubmed/32706696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17712 %T Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study %A Attridge,Mark D %A Morfitt,Russell C %A Roseborough,David J %A Jones,Edward R %+ Attridge Consulting, Inc, 1129 Cedar Lake Rd S, Minneapolis, MN, United States, 1 612 889 2398, mark@attridgeconsulting.com %K anxiety %K cognitive behavioral %K college %K depression %K insomnia %K mental health %K social phobia %K stress %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective: This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods: Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results: The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions: Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers. %M 32706662 %R 10.2196/17712 %U http://formative.jmir.org/2020/7/e17712/ %U https://doi.org/10.2196/17712 %U http://www.ncbi.nlm.nih.gov/pubmed/32706662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19364 %T A Novel Educational Control Group Mobile App for Meditation Interventions: Single-Group Feasibility Trial %A Huberty,Jennifer %A Eckert,Ryan %A Puzia,Megan %A Laird,Breanne %A Larkey,Linda %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K feasibility %K smartphone %K mHealth %K digital health %K cancer %K beta test %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone ownership is becoming ubiquitous among US adults, making the delivery of health interventions via a mobile app (ie, mobile health [mHealth]) attractive to many researchers and clinicians. Meditation interventions have become popular and have been delivered to study participants via mobile apps to improve a range of health outcomes in both healthy adults and those with chronic diseases. However, these meditation mHealth interventions have been limited by a lack of high-quality control groups. More specifically, these studies have lacked consistency in their use of active, time-matched, and attention-matched control groups. Objective: The purpose of this study is to beta test a novel health education podcast control condition delivered via a smartphone app that would be a strong comparator to be used in future studies of app-based meditation interventions. Methods: Patients with myeloproliferative neoplasm (MPN) cancer were recruited nationally. Upon enrollment, participants were informed to download the investigator-developed health education podcast app onto their mobile phone and listen to ~60 min/week of cancer-related educational podcasts for 12 weeks. The benchmarks for feasibility included ≥70% of participants completing ≥70% of the prescribed 60 min/week of podcasts, ≥70% of participants reporting that they were satisfied with the intervention, and ≥70% of participants reporting that they enjoyed the health education podcasts. Results: A total of 96 patients with MPN were enrolled in the study; however, 19 never began the intervention. Of the 77 patients who participated in the intervention, 39 completed the entire study (ie, sustained participation through the follow-up period). Participation averaged 103.2 (SD 29.5) min/week. For 83.3% (10/12) of the weeks, at least 70% of participants completed at least 70% of their total prescribed use. Almost half of participants reported that they enjoyed the health education podcasts (19/39, 48.7%) and were satisfied with the intervention (17/39, 43.6%). There were no significant changes in cancer-related outcomes from baseline to postintervention. Conclusions: A 12-week, health education podcast mobile app was demanded but not accepted in a sample of patients with cancer. Using the mobile app was not associated with significant changes in cancer-related symptoms. Based on findings from this study, a health education podcast mobile app may be a feasible option as a time- and attention-matched control group for efficacy trials with more extensive formative research for the content of the podcasts and its acceptability by the specific population. Trial Registration: ClinicalTrials.gov NCT03907774; https://clinicaltrials.gov/ct2/show/NCT03907774 %M 32706719 %R 10.2196/19364 %U http://formative.jmir.org/2020/7/e19364/ %U https://doi.org/10.2196/19364 %U http://www.ncbi.nlm.nih.gov/pubmed/32706719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17441 %T A Digital Library for Increasing Awareness About Living Donor Kidney Transplants: Formative Study %A Waterman,Amy D %A Wood,Emily H %A Ranasinghe,Omesh N %A Faye Lipsey,Amanda %A Anderson,Crystal %A Balliet,Wendy %A Holland-Carter,Lauren %A Maurer,Stacey %A Aurora Posadas Salas,Maria %+ Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, 1018 Westwood Blvd, Los Angeles, CA, 90024, United States, 1 4243277278, awaterman@mednet.ucla.edu %K living donor kidney transplant %K living donation %K health education %K informed decision-making %K awareness %K health literacy %K video library %K health technology %K kidney diseases %K diffusion of innovation %K digital library %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: It is not common for people to come across a living kidney donor, let alone consider whether they would ever donate a kidney themselves while they are alive. Narrative storytelling, the sharing of first-person narratives based on lived experience, may be an important way to improve education about living donor kidney transplants (LDKTs). Developing ways to easily standardize and disseminate diverse living donor stories using digital technology could inspire more people to consider becoming living donors and reduce the kidney shortage nationally. Objective: This paper aimed to describe the development of the Living Donation Storytelling Project, a web-based digital library of living donation narratives from multiple audiences using video capture technology. Specifically, we aimed to describe the theoretical foundation and development of the library, a protocol to capture diverse storytellers, the characteristics and experiences of participating storytellers, and the frequency with which any ethical concerns about the content being shared emerged. Methods: This study invited kidney transplant recipients who had received LDKTs, living donors, family members, and patients seeking LDKTs to record personal stories using video capture technology by answering a series of guided prompts on their computer or smartphone and answering questions about their filming experience. The digital software automatically spliced responses to open-ended prompts, creating a seamless story available for uploading to a web-based library and posting to social media. Each story was reviewed by a transplant professional for the disclosure of protected health information (PHI), pressuring others to donate, and medical inaccuracies. Disclosures were edited. Results: This study recruited diverse storytellers through social media, support groups, churches, and transplant programs. Of the 137 storytellers who completed the postsurvey, 105/137 (76.6%) were white and 99/137 (72.2%) were female. They spent 62.5 min, on average, recording their story, with a final median story length of 10 min (00:46 seconds to 32:16 min). A total of 94.8% (130/137) of storytellers were motivated by a desire to educate the public; 78.1% (107/137) were motivated to help more people become living donors; and 75.9% (104/137) were motivated to dispel myths. The ease of using the technology and telling their story varied, with the fear of being on film, emotional difficulty talking about their experiences, and some technological barriers being reported. PHI, most commonly surnames and transplant center names, was present in 62.9% (85/135) of stories and was edited out. Conclusions: With appropriate sensitivity to ensure diverse recruitment, ethical review of content, and support for storytellers, web-based storytelling platforms may be a cost-effective and convenient way to further engage patients and increase the curiosity of the public in learning more about the possibility of becoming living donors. %M 32480362 %R 10.2196/17441 %U https://formative.jmir.org/2020/7/e17441 %U https://doi.org/10.2196/17441 %U http://www.ncbi.nlm.nih.gov/pubmed/32480362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17703 %T Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure %A Cornet,Victor Philip %A Toscos,Tammy %A Bolchini,Davide %A Rohani Ghahari,Romisa %A Ahmed,Ryan %A Daley,Carly %A Mirro,Michael J %A Holden,Richard J %+ Regenstrief Institute, 1101 W 10th St #421, Indianapolis, IN, 46202, United States, 1 317 278 5323, rjholden@iu.edu %K user-centered design %K research methods %K mobile health %K digital health %K mobile apps %K usability %K technology %K evaluation %K human-computer interaction %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. %M 32706745 %R 10.2196/17703 %U http://mhealth.jmir.org/2020/7/e17703/ %U https://doi.org/10.2196/17703 %U http://www.ncbi.nlm.nih.gov/pubmed/32706745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14951 %T Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping %A Berninger,Nathalie M %A ten Hoor,Gill A %A Plasqui,Guy %A Kok,Gerjo %A Peters,Gjalt-Jorn Ygram %A Ruiter,Robert A C %+ Department of Work and Social Psychology, Maastricht University, PO Box 616, WSP, Universiteitssingel 40, Maastricht, Netherlands, 31 433881908, nathalie.berninger@maastrichtuniversity.nl %K intervention mapping %K sedentary behavior %K sedentary work %K computer-based %K occupational health %K eHealth %K mHealth %K data-driven programs %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66% of their working days and only 8% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 %M 32706695 %R 10.2196/14951 %U http://formative.jmir.org/2020/7/e14951/ %U https://doi.org/10.2196/14951 %U http://www.ncbi.nlm.nih.gov/pubmed/32706695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e16455 %T Effectiveness of a Voice-Based Mental Health Evaluation System for Mobile Devices: Prospective Study %A Higuchi,Masakazu %A Nakamura,Mitsuteru %A Shinohara,Shuji %A Omiya,Yasuhiro %A Takano,Takeshi %A Mitsuyoshi,Shunji %A Tokuno,Shinichi %+ Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, , Japan, 81 3 5841 3432, higuchi@bioeng.t.u-tokyo.ac.jp %K mental health %K monitoring system %K stress evaluation %K voice analysis %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: We developed a system for monitoring mental health using voice data from daily phone calls, termed Mind Monitoring System (MIMOSYS), by implementing a method for estimating mental health status from voice data. Objective: The objective of this study was to evaluate the potential of this system for detecting depressive states and monitoring stress-induced mental changes. Methods: We opened our system to the public in the form of a prospective study in which data were collected over 2 years from a large, unspecified sample of users. We used these data to analyze the relationships between the rate of continued use, the men-to-women ratio, and existing psychological tests for this system over the study duration. Moreover, we analyzed changes in mental data over time under stress from particular life events. Results: The system had a high rate of continued use. Voice indicators showed that women have more depressive tendencies than men, matching the rate of depression in Japan. The system’s voice indicators and the scores on classical psychological tests were correlated. We confirmed deteriorating mental health for users in areas affected by major earthquakes in Japan around the time of the earthquakes. Conclusions: The results suggest that although this system is insufficient for detecting depression, it may be effective for monitoring changes in mental health due to stress. The greatest feature of our system is mental health monitoring, which is most effectively accomplished by performing long-term time-series analysis of the acquired data considering the user’s life events. Such a system can improve the implementation of patient interventions by evaluating objective data along with life events. %M 32554367 %R 10.2196/16455 %U http://formative.jmir.org/2020/7/e16455/ %U https://doi.org/10.2196/16455 %U http://www.ncbi.nlm.nih.gov/pubmed/32554367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e13650 %T What College Students Post About Depression on Facebook and the Support They Perceive: Content Analysis %A Cash,Scottye %A Schwab-Reese,Laura Marie %A Zipfel,Erin %A Wilt,Megan %A Moreno,Megan %+ College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH, 43210, United States, 1 614 292 3690, cash.33@osu.edu %K social media %K depression %K college students %K qualitative %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: College students frequently use social media sites to connect with friends. Increasingly, research suggests college students and other young adults seek mental health-related support on social media, which may present a unique venue for intervention. Objective: The purpose of this study was to examine college students’ perceptions about displaying feelings of depression on Facebook and, in turn, how their social media friends responded. Methods: A primarily quantitative online survey with open response questions was distributed to students at four US universities. Qualitative responses were analyzed using content analysis. Results: A total of 34 students provided qualitative responses for analysis, these students were 85.3% female, mean age 20.2 (SD=1.4) and 20.6% racial/ethnic minority. Students who reported posting about depression often expressed an emotion or feeling but did not use the word “depression” in the post. Approximately 20% posted language about a bad day, and 15% posted a song or music video. Only one person reported posting a statement that directly asked for help. When friends responded to the posts, students generally perceived the responses as supportive or motivating gestures. Nearly 15% of friends contacted the individual outside of Facebook. One individual received a negative response and no responses suggested that the individual seek help. Conclusions: This study found that college students who post about depression often do so without directly referencing depression and that friends were generally supportive. However, no participants reported their social network suggested they seek help, which may suggest increasing mental health literacy, for both support seekers and responders, would be an opportunity to improve online mental health-related support. %M 32706687 %R 10.2196/13650 %U https://formative.jmir.org/2020/7/e13650 %U https://doi.org/10.2196/13650 %U http://www.ncbi.nlm.nih.gov/pubmed/32706687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17293 %T Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study %A Darnall,Beth D %A Krishnamurthy,Parthasarathy %A Tsuei,Jeannette %A Minor,Jorge D %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, United States, 1 (650) 725 9642, bdarnall@stanford.edu %K chronic pain %K virtual reality %K behavioral medicine %K self-management %K mobile phone %K randomized controlled trial %D 2020 %7 7.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective: The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods: We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results: The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions: High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain. %M 32374272 %R 10.2196/17293 %U https://formative.jmir.org/2020/7/e17293 %U https://doi.org/10.2196/17293 %U http://www.ncbi.nlm.nih.gov/pubmed/32374272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14161 %T Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study %A Langer,Shelby L %A Ghosh,Neeta %A Todd,Michael %A Randall,Ashley K %A Romano,Joan M %A Bricker,Jonathan B %A Bolger,Niall %A Burns,John W %A Hagan,Rachel C %A Porter,Laura S %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ, 85004, United States, 1 6024960823, shelby.langer@asu.edu %K ecological momentary assessment %K smartphone %K mobile phone %K communication %K disclosure %K affect %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants’ own handheld devices. Methods: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results: Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one’s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood. %M 32628614 %R 10.2196/14161 %U https://formative.jmir.org/2020/7/e14161 %U https://doi.org/10.2196/14161 %U http://www.ncbi.nlm.nih.gov/pubmed/32628614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17722 %T Use of a Mobile App to Augment Psychotherapy in a Community Psychiatric Clinic: Feasibility and Fidelity Trial %A Adam,Atif %A Jain,Ameena %A Pletnikova,Alexandra %A Bagga,Rishi %A Vita,Allison %A N Richey,Lisa %A Gould,Neda %A Munshaw,Supriya %A Misrilall,Kavi %A Peters,Matthew E %+ Rose: Smarter Mental Health, 3400 Prospect St NW, Washington, DC, 20007, United States, 1 4103363626, dratif@askrose.com %K mobile app %K mental health %K depression %K anxiety %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Even though 1 in 5 Americans experience some form of mental illness each year, 80% have been shown to discontinue psychotherapy prematurely. The traditional psychotherapy service delivery model, consisting of isolated clinical sessions, lacks the ability to keep patients engaged outside clinical sessions. Newer digital mental health platforms can address the clinical need for a robust tool that tracks mental well-being and improves engagement in patients with depressive symptoms. Objective: The primary goals of this feasibility study were to (1) assess compliance among providers and their patients with a digital mental health platform protocol, and (2) examine the usability and fidelity of a mobile app through structured participant feedback. Methods: A sample of 30 participants was recruited for a 5-week study from a community-based mental health clinic in Baltimore, Maryland, USA. Inclusion criteria were: aged 18 years or older, having access to a smartphone, and having at least mild-to-moderate depression and/or anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Eligible participants were randomized into one of two study arms: (1) the intervention arm or (2) the waitlist control arm. Participants in the intervention arm were asked to download the Rose app and were prompted to complete clinical assessments (PHQ-9 and GAD-7) every other week, daily mood and anxiety Likert scales, and daily journal entries. The participants in the waitlist arm served as controls for the study and completed the clinical assessments only. Both arms engaged in weekly psychotherapy sessions, with participant in-app input informing the psychotherapy process of the intervention arm, while those in the waitlist control arm continued their standard care. Outcomes of interest included adherence to completion of in-app assessments and usability of the Rose mobile app assessed through the modified Mobile Application Rating Scale. Results: Over the study period, a sample of 30 participants used the Rose app 2834 times to complete clinical assessments. On average, 70% (21; 95% CI 61.14%-77.41%) of participants completed mood and anxiety daily check-ins and journal entries 5 days per week. Nearly all participants (29/30, 97%) completed all PHQ-9 and GAD-7 in-app scales during the study. Subjective impressions showed that 73% (22/30) of participants found the mobile app to be engaging and in line with their needs, and approximately 70% (21/30) of participants reported the app functionality and quality of information to be excellent. Additionally, more than two-thirds of the participants felt that their knowledge and awareness of depression and anxiety management improved through using the app. Conclusions: Steady compliance and high app ratings showcase the utility of the Rose mobile mental health app in augmenting the psychotherapy process for patients with mood disorders and improving mental health knowledge. Future studies are needed to further examine the impact of Rose on treatment outcomes. Trial Registration: ClinicalTrials.gov NCT04200170; https://clinicaltrials.gov/ct2/show/NCT04200170 %M 32618572 %R 10.2196/17722 %U https://formative.jmir.org/2020/7/e17722 %U https://doi.org/10.2196/17722 %U http://www.ncbi.nlm.nih.gov/pubmed/32618572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e15295 %T Patient and Parent Perspectives on Improving Pediatric Asthma Self-Management Through a Mobile Health Intervention: Pilot Study %A Nichols,Michelle %A Miller,Sarah %A Treiber,Frank %A Ruggiero,Kenneth %A Dawley,Erin %A Teufel II,Ronald %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, United States, 1 8437921802, nicholmg@musc.edu %K asthma %K mobile health %K ecological momentary assessment %K adolescents %K medication adherence %K self-management %K mobile phone %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective: This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods: Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results: A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions: Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity. %M 32442127 %R 10.2196/15295 %U https://formative.jmir.org/2020/7/e15295 %U https://doi.org/10.2196/15295 %U http://www.ncbi.nlm.nih.gov/pubmed/32442127 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14486 %T Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study %A Hewage,Sumali %A Audimulam,Jananie %A Sullivan,Emily %A Chi,Claudia %A Yew,Tong Wei %A Yoong,Joanne %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 65164988, sumali_hewage@u.nus.edu %K gestational diabetes %K pregnancy %K telemedicine %K self-management %K patient-centered care %K mobile phone %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective: This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods: This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results: The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions: A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women. %M 32602845 %R 10.2196/14486 %U http://formative.jmir.org/2020/6/e14486/ %U https://doi.org/10.2196/14486 %U http://www.ncbi.nlm.nih.gov/pubmed/32602845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e15777 %T Smartphone Self-Monitoring by Young Adolescents and Parents to Assess and Improve Family Functioning: Qualitative Feasibility Study %A Swendeman,Dallas %A Sumstine,Stephanie %A Brink,Amber %A Mindry,Deborah %A Medich,Melissa %A Russell,Michael %+ Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948158, dswendeman@mednet.ucla.edu %K adolescents %K parenting %K conflict %K self-monitoring %K smartphones %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective: This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods: Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results: The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions: The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs. %M 32574148 %R 10.2196/15777 %U http://formative.jmir.org/2020/6/e15777/ %U https://doi.org/10.2196/15777 %U http://www.ncbi.nlm.nih.gov/pubmed/32574148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e18890 %T Adherence of the #Here4U App – Military Version to Criteria for the Development of Rigorous Mental Health Apps %A Linden,Brooke %A Tam-Seto,Linna %A Stuart,Heather %+ Health Services and Policy Research Institute, Queen's University, 21 Arch Street, Kingston, ON, K7L 3L3, Canada, 1 613 533 6387, brooke.linden@queensu.ca %K mental health services %K telemedicine %K mHealth %K chatbot %K e-solutions %K Canadian Armed Forces %K military health %K mobile phone %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military. Objective: The goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate. Methods: As the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016. Results: The #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward. Conclusions: The #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery. %M 32554374 %R 10.2196/18890 %U https://formative.jmir.org/2020/6/e18890 %U https://doi.org/10.2196/18890 %U http://www.ncbi.nlm.nih.gov/pubmed/32554374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16072 %T Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study %A Brick,Timothy R %A Mundie,James %A Weaver,Jonathan %A Fraleigh,Robert %A Oravecz,Zita %+ Department of Human Development and Family Studies, Real-Time Science Laboratory, The Pennsylvania State University, 115 HHD Building, University Park, PA, , United States, 1 8148654868, tbrick@psu.edu %K smartphone apps %K ecological momentary assessment %K real-time analysis %K behavior change %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. %M 32554373 %R 10.2196/16072 %U https://formative.jmir.org/2020/6/e16072 %U https://doi.org/10.2196/16072 %U http://www.ncbi.nlm.nih.gov/pubmed/32554373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e7570 %T A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial %A Kahler,Christopher W %A Cohn,Amy M %A Costantino,Catherine %A Toll,Benjamin A %A Spillane,Nichea S %A Graham,Amanda L %+ Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, United States, 1 4018636651, Christopher_Kahler@brown.edu %K smoking cessation %K alcohol drinking %K internet %K text messaging %K therapy %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective: This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods: Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results: Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions: This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration: ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611 %M 32348286 %R 10.2196/formative.7570 %U https://formative.jmir.org/2020/6/e7570 %U https://doi.org/10.2196/formative.7570 %U http://www.ncbi.nlm.nih.gov/pubmed/32348286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16371 %T Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study %A Seelye,Adriana %A Leese,Mira Isabelle %A Dorociak,Katherine %A Bouranis,Nicole %A Mattek,Nora %A Sharma,Nicole %A Beattie,Zachary %A Riley,Thomas %A Lee,Jonathan %A Cosgrove,Kevin %A Fleming,Nicole %A Klinger,Jessica %A Ferguson,John %A Lamberty,Greg John %A Kaye,Jeffrey %+ Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN, , United States, 1 6127252000, adriana.seelye@va.gov %K aging %K mild cognitive impairment %K activities of daily living %K technology %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective: This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods: Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits. Results: Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants’ homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions: Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples. %M 32310138 %R 10.2196/16371 %U https://formative.jmir.org/2020/6/e16371 %U https://doi.org/10.2196/16371 %U http://www.ncbi.nlm.nih.gov/pubmed/32310138 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14550 %T Patients’ User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study %A Siemer,Lutz %A Ben Allouch,Somaya %A Pieterse,Marcel E %A Brusse-Keizer,Marjolein %A Sanderman,Robbert %A Postel,Marloes G %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, Postbus 70000, Enschede, 7500 KB, Netherlands, 49 17678025906, l.siemer@utwente.nl %K smoking cessation %K cognitive therapy %K blended treatment %K smoking %K user experience %K tobacco %K patient perspective %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended web-based and face-to-face (F2F) treatment is a promising electronic health service because the strengths of one mode of delivery should compensate for the weaknesses of the other. Objective: The aim of this study was to explore this compensation by examining patients’ user experience (UX) in a blended smoking cessation treatment (BSCT) in routine care. Methods: Data on patients’ UX were collected through in-depth interviews (n=10) at an outpatient smoking cessation clinic in the Netherlands. A content analysis of the semantic domains was used to analyze patients’ UX. To describe the UX, the Hassenzahl UX model was applied, examining 4 of the 5 key elements of UX from a user’s perspective: (1) patients’ standards and expectations, (2) apparent character (pragmatic and hedonic attributes), (3) usage situation, and (4) consequences (appeal, emotions, and behavior). Results: BSCT appeared to be a mostly positively experienced service. Patients had a positive-pragmatic standard and neutral-open expectation toward BSCT at the treatment start. The pragmatic attributes of the F2F sessions were mostly perceived as positive, whereas the pragmatic attributes of the web sessions were perceived as both positive and negative. For the hedonic attributes, there seemed to be a difference between the F2F and web sessions. Specifically, the hedonic attributes of the web sessions were experienced as mostly negative, whereas those of the F2F sessions were experienced as mostly positive. For the usage situation, the physical and social contexts were experienced positively, whereas the task and technical contexts were experienced negatively. Nevertheless, the consequential appeal of BSCT was positive. However, the consequential emotions and behavior varied, ultimately resulting in diverse combinations of consequential appeal, emotions, and behavior (positive, negative, and mixed). Conclusions: This study provided insights into the UX of a blended treatment, and the results support the expectation that in a blended treatment, the strengths of one mode of delivery may compensate for the weaknesses of the other. However, in this certain setting, this is mainly achieved in only one way: F2F sessions compensated for the weaknesses of the web sessions. As a practical conclusion, this may mean that the web sessions, supported by the strengths of the F2F sessions, offer an interesting approach for further improving the blended treatment. Our theoretical findings reflect the relevance of the aspects of hedonism, such as fun, joy, or happiness in the UX, which were not mentioned in relation to the web sessions and were only scarcely mentioned in relation to the F2F sessions. Future research should further investigate the role of hedonistic aspects in a blended treatment and whether increased enjoyment of a blended treatment could increase treatment adherence and, ultimately, effectiveness. %M 32343245 %R 10.2196/14550 %U https://formative.jmir.org/2020/6/e14550 %U https://doi.org/10.2196/14550 %U http://www.ncbi.nlm.nih.gov/pubmed/32343245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16420 %T A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study %A Sengupta,Avijit %A Beckie,Theresa %A Dutta,Kaushik %A Dey,Arup %A Chellappan,Sriram %+ Information Systems and Decision Sciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33620, United States, 1 8139746338, duttak@usf.edu %K coronary heart disease %K mobile health technology %K behavior change interventions %K women %K mobile phone %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective: The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods: Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results: All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions: The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings. %M 32348270 %R 10.2196/16420 %U https://formative.jmir.org/2020/6/e16420 %U https://doi.org/10.2196/16420 %U http://www.ncbi.nlm.nih.gov/pubmed/32348270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16137 %T A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study %A Bowman,Cassandra %A Lunyera,Joseph %A Alkon,Aviel %A Boulware,L Ebony %A St Clair Russell,Jennifer %A Riley,Jennie %A Fink,Jeffrey C %A Diamantidis,Clarissa %+ Division of General Internal Medicine, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27701, United States, 1 919 668 1261, clarissa.diamantidis@duke.edu %K patient safety %K chronic kidney disease %K patient education %K mhealth %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet–based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, “sick day protocol”); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked “Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?” Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as “just right” (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. %M 32463366 %R 10.2196/16137 %U http://formative.jmir.org/2020/5/e16137/ %U https://doi.org/10.2196/16137 %U http://www.ncbi.nlm.nih.gov/pubmed/32463366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e17179 %T Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study %A Zhang,Donglan %A Jin,Lan %A Liang,Di %A Geng,Ruijin %A Liu,Yun %A Ling,Yu %A Jiang,Fan %A Zhang,Yunting %+ Child Health Advocacy Institute, National Children’s Medical Center, Shanghai Children’s Medical Center, 1678 Dongfang Road, Pudong, Shanghai, China, 86 21 3862606, zhangyunting@scmc.com.cn %K mobile health %K interview %K health belief model %K early child development %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. %M 32463374 %R 10.2196/17179 %U http://formative.jmir.org/2020/5/e17179/ %U https://doi.org/10.2196/17179 %U http://www.ncbi.nlm.nih.gov/pubmed/32463374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15815 %T Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study %A Pincus,Theodore %A Castrejon,Isabel %A Riad,Mariam %A Obreja,Elena %A Lewis,Candice %A Krogh,Niels Steen %+ Rush University Medical Center, 1611 West Harrison, Suite 510, Chicago, IL, United States, 1 3129428268, tedpincus@gmail.com %K patient reported outcomes %K health status measures %K electronic version %K rapid3 %K mdhaq %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. Objective: This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. Methods: Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. Results: The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. Conclusions: The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ. %M 32459182 %R 10.2196/15815 %U http://formative.jmir.org/2020/5/e15815/ %U https://doi.org/10.2196/15815 %U http://www.ncbi.nlm.nih.gov/pubmed/32459182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15158 %T Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study %A Desai,Sonali %A Stevens,Emma %A Emani,Srinivas %A Meyers,Peter %A Iversen,Maura %A Solomon,Daniel H %+ Brigham & Women's Hospital, 60 Fenwood Road, Hale Building for Transformative Medicine, Boston, MA, Rheumatology, 3rd fl, United States, 1 6177326758, sdesai5@bwh.harvard.edu %K quality improvement %K rheumatoid arthritis %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. Objective: The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. Methods: Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. Results: From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. Conclusions: We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits. %M 32459179 %R 10.2196/15158 %U http://formative.jmir.org/2020/3/e15158/ %U https://doi.org/10.2196/15158 %U http://www.ncbi.nlm.nih.gov/pubmed/32459179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16202 %T Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study %A Laureij,Lyzette T %A Breunis,Leonieke J %A Steegers-Theunissen,Regine P M %A Rosman,Ageeth N %+ Department of Health Care Studies, Rotterdam University of Applied Sciences, IVG, RS.06.121, PO Box 25035 Rotterdam, 3001 HR, Rotterdam, 3000 CA, Netherlands, 31 6 425 27 919, a.n.rosman@hr.nl %K newborn %K focus groups %K postpartum period %K postnatal care %K eHealth %K pregnancy %K obstetrics %K qualitative research %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective: We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods: We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results: In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions: Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option. %M 32452805 %R 10.2196/16202 %U http://formative.jmir.org/2020/5/e16202/ %U https://doi.org/10.2196/16202 %U http://www.ncbi.nlm.nih.gov/pubmed/32452805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13170 %T Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study %A Hoffmann,Alexandra %A Faust-Christmann,Corinna A %A Zolynski,Gregor %A Bleser,Gabriele %+ Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Gottlieb-Daimler-Straße 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, hoffmann@cs.uni-kl.de %K mHealth %K chronic pain %K stress management %K pain management %K health app %K gamification %K health professional %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective: To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods: A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results: The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions: The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor. %M 32452803 %R 10.2196/13170 %U http://formative.jmir.org/2020/5/e13170/ %U https://doi.org/10.2196/13170 %U http://www.ncbi.nlm.nih.gov/pubmed/32452803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13388 %T Characteristics of Gamblers Who Use the French National Problem Gambling Helpline and Real-Time Chat Facility: Longitudinal Observational Study %A Darbeda,Stéphane %A Aubin,Henri-Jean %A Lejoyeux,Michel %A Luquiens,Amandine %+ Addiction Science, Paris Sud University, CESP Inserm UMR-1018, 16 Avenue Paul Vaillant Couturier, Villejuif, 94800, France, 33 145595037, stephane.darbeda@gmail.com %K gambling %K helpline %K chat %K counseling %K gender %K time-series analysis %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Problem gambling is a growing public health issue that is characterized by low rates of face-to-face help seeking. Helplines and real-time chat services could reduce shortfalls in treatment. Objective: This study aimed to (1) describe the characteristics of gamblers contacting a government-funded help service, (2) study the evolution of their characteristics over time, (3) evaluate the differences between subgroups (ie, gender, media used for gambling, and media used to contact the service), and (4) explore factors influencing referral to care. Methods: From January 2011 to December 2015, a government-funded gambling helpline and real-time chat website in France received 9474 contacts from gamblers. Counselors filled in a form for each contact, collecting demographics, gambling characteristics, and referrals. Time-series analyses were performed. Univariate logistic models were used to assess differences across subgroups. A multivariate analysis was conducted to determine the variables related to an actual referral. Results: Gamblers were predominantly men (7017/9474, 74.07%); the average age was 41 years (SD 14). Compared with the men, the women were older (mean 50.7 years, SD 14.0 vs mean 37.9 years, SD 13.0, respectively; P<.001), were more often solely offline gamblers (1922/2457, 78.23% vs 4386/7017, 62.51%, respectively; P<.001), and had different gambling patterns. Compared with helpline contacts, real-time chat contacts were more often men (124/150, 82.7% vs 3643/4881, 74.64%, respectively; P=.04), younger (mean 32.8 years, SD 12.9 vs mean 41.3 years, SD 14.3, respectively; P<.001), more often poker gamblers (41/150, 27.3% vs 592/4881, 12.13%, respectively; P<.001), and more often web-based gamblers (83/150, 55.3% vs 1462/4881, 29.95%, respectively; P<.001). Referral was positively associated with betting (adjusted odds ratio [aOR] 1.46, 95% CI 1.27-1.67; P<.001), casino gambling (aOR 1.38, 95% CI 1.21-1.57; P<.001), scratch cards (aOR 1.83, 95% CI 1.58-2.12; P<.001), poker gambling (aOR 1.35, 95% CI 1.14-1.61; P<.001), lottery (aOR 1.27, 95% CI 1.03-1.56; P=.03), weekly gambling (aOR 1.73, 95% CI 1.40-2.15; P<.001), request for referral (aOR 17.76, 95% CI 14.92-21.13; P<.001), and a history of suicide attempts (aOR 2.13, 95% CI 1.51-3.02; P<.001), and it was negatively associated with web-based gambling (aOR 0.86, 95% CI 0.75-0.98; P=.030) and refusal to be referred (aOR 0.35, 95% CI 0.26-0.49; P<.001). Conclusions: The governmental helpline and chat contacts included a broad range of sociodemographic profiles. Compared with the helpline, real-time chat exchanges reached a younger population of web-based gamblers, which was the target population. The development of the gambling helpline and help online website is a considerable challenge for the future. %M 32432554 %R 10.2196/13388 %U http://formative.jmir.org/2020/5/e13388/ %U https://doi.org/10.2196/13388 %U http://www.ncbi.nlm.nih.gov/pubmed/32432554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15094 %T Identifying Women at Risk for Polycystic Ovary Syndrome Using a Mobile Health App: Virtual Tool Functionality Assessment %A Rodriguez,Erika Marie %A Thomas,Daniel %A Druet,Anna %A Vlajic-Wheeler,Marija %A Lane,Kevin James %A Mahalingaiah,Shruthi %+ Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Ave, Building 1, Boston, MA, 02115, United States, 1 617 432 4381, shruthi@hsph.harvard.edu %K polycystic ovary syndrome %K mobile health app %K Clue %K menstrual irregularities %K telemedicine %K mHealth, mobile phone %D 2020 %7 14.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) is an endocrine disrupting disorder affecting about 10% of reproductive-aged women. PCOS diagnosis may be delayed several years and may require multiple physicians, resulting in lost time for risk-reducing interventions. Menstrual tracking apps are a potential tool to alert women of their risk while also prompting evaluation from a medical professional. Objective: The primary objective of this study was to develop and pilot test the irregular cycle feature, a predictive model that generated a PCOS risk score, in the menstrual tracking app, Clue. The secondary objectives were to run the model using virtual test subjects, create a quantitative risk score, compare the feature’s risk score with that of a physician, and determine the sensitivity and specificity of the model before empirical testing on human subjects. Methods: A literature review was conducted to generate a list of signs and symptoms of PCOS, termed variables. Variables were then assigned a probability and built into a Bayesian network. Questions were created based on these variables. A total of 9 virtual test subjects were identified using self-reported menstrual cycles and answers to the feature’s questions. Upon completion of the questionnaire, a Result Screen and Doctor’s Report summarizing the probability of having PCOS was displayed. This provided information about PCOS and data to facilitate diagnosis by a medical professional. To assess the accuracy of the feature, the same set of 9 virtual test subjects was assigned probabilities by the feature and the physician, who served as the gold standard. The feature recommended individuals with a score greater than or equal to 25% to follow-up with a physician. Differences between the feature and physician scores were evaluated using a t test and a Pearson correlation coefficient in 8 of the 9 virtual test subjects. A second iteration was conducted to assess the feature’s probability capabilities. Results: The irregular cycle feature’s first iteration produced 1 false-positive compared with the physician score and had an absolute mean difference of 15.5% (SD 15.1%) among the virtual test subjects. The second iteration had 2 false positives compared with the physician score and had an absolute mean difference of 18.8% (SD 13.6%). The feature overpredicted the virtual test subjects’ risk of PCOS compared with the physician. However, a significant positive correlation existed between the feature and physician score (Pearson correlation coefficient=0.82; P=.01). The second iteration performed worse, with a Pearson correlation coefficient of 0.73 (P=.03). Conclusions: The first iteration of the feature outperformed the second and better predicted the probability of PCOS. Although further research is needed with a more robust sample size, this pilot study indicates the potential value for developing a screening tool to prompt high-risk subjects to seek evaluation by a medical professional. %M 32406861 %R 10.2196/15094 %U https://formative.jmir.org/2020/5/e15094 %U https://doi.org/10.2196/15094 %U http://www.ncbi.nlm.nih.gov/pubmed/32406861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16297 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research %A Pfammatter,Angela Fidler %A Marchese,Sara Hoffman %A Pellegrini,Christine %A Daly,Elyse %A Davidson,Miriam %A Spring,Bonnie %+ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1574, angela@northwestern.edu %K weight loss %K body weight %K text messaging %K optimization %K automation %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. Objective: This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. Methods: On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. Results: Participants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. Conclusions: Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. Trial Registration: ClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072 %M 32347804 %R 10.2196/16297 %U http://formative.jmir.org/2020/5/e16297/ %U https://doi.org/10.2196/16297 %U http://www.ncbi.nlm.nih.gov/pubmed/32347804 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16605 %T A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation %A Stevens,Timothy %A McGinnis,Ryan S %A Hewgill,Blake %A Choquette,Rebecca H %A Tourville,Timothy W %A Harvey,Jean %A Lachapelle,Richard %A Beynnon,Bruce D %A Toth,Michael J %A Skalka,Christian %+ Department of Medicine, University of Vermont, Health Science Research Facility Rm 126B, 149 Beaumont Ave, Burlington, VT, 05405, United States, 1 (802) 656 7989, michael.toth@med.uvm.edu %K device use tracking %K internet of things %K neuromuscular electrical stimulation %K exercise %K smart devices %K mHealth %K rehabilitation %K mobile health %K digital health %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. %M 32384052 %R 10.2196/16605 %U http://humanfactors.jmir.org/2020/2/e16605/ %U https://doi.org/10.2196/16605 %U http://www.ncbi.nlm.nih.gov/pubmed/32384052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e14064 %T Privacy-Preserving Deep Learning for the Detection of Protected Health Information in Real-World Data: Comparative Evaluation %A Festag,Sven %A Spreckelsen,Cord %+ Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, Jena, , Germany, 49 3641 9 398360, Cord.Spreckelsen@med.uni-jena.de %K privacy-preserving protocols %K neural networks %K health informatics %K distributed machine learning %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Collaborative privacy-preserving training methods allow for the integration of locally stored private data sets into machine learning approaches while ensuring confidentiality and nondisclosure. Objective: In this work we assess the performance of a state-of-the-art neural network approach for the detection of protected health information in texts trained in a collaborative privacy-preserving way. Methods: The training adopts distributed selective stochastic gradient descent (ie, it works by exchanging local learning results achieved on private data sets). Five networks were trained on separated real-world clinical data sets by using the privacy-protecting protocol. In total, the data sets contain 1304 real longitudinal patient records for 296 patients. Results: These networks reached a mean F1 value of 0.955. The gold standard centralized training that is based on the union of all sets and does not take data security into consideration reaches a final value of 0.962. Conclusions: Using real-world clinical data, our study shows that detection of protected health information can be secured by collaborative privacy-preserving training. In general, the approach shows the feasibility of deep learning on distributed and confidential clinical data while ensuring data protection. %M 32369025 %R 10.2196/14064 %U https://formative.jmir.org/2020/5/e14064 %U https://doi.org/10.2196/14064 %U http://www.ncbi.nlm.nih.gov/pubmed/32369025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15083 %T A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial %A Haque,Md Sanaul %A Kangas,Maarit %A Jämsä,Timo %+ Research Unit of Medical Imaging Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, Oulu, 90014, Finland, 358 469557272, md.haque@oulu.fi %K mHealth behavioral change intervention %K persuasive app %K UCD %K game elements %K physical activity %K SDT %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. %M 32364506 %R 10.2196/15083 %U https://formative.jmir.org/2020/5/e15083 %U https://doi.org/10.2196/15083 %U http://www.ncbi.nlm.nih.gov/pubmed/32364506 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e13746 %T An Electronic Medication Module to Improve Health Literacy in Patients With Type 2 Diabetes Mellitus: Pilot Randomized Controlled Trial %A Seidling,Hanna Marita %A Mahler,Cornelia %A Strauß,Beate %A Weis,Aline %A Stützle,Marion %A Krisam,Johannes %A , %A Szecsenyi,Joachim %A Haefeli,Walter Emil %+ Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany, 49 6221 56 8740, walter.emil.haefeli@med.uni-heidelberg.de %K medication self-management %K patient empowerment %K health literacy %K chronic diseases %K type 2 diabetes mellitus %K electronic health record %K PEPA %K electronic medication module %K structured medication review %D 2020 %7 28.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In primary care, patients play a crucial role in managing care processes and handling drug treatment. A decisive factor for success is their health literacy, and several interventions have been introduced to support patients in fulfilling their responsibility. Objective: The aim of this study is to assess the influence of such an intervention (ie, a medication module) within a patient-led electronic health record on patients’ health literacy. Methods: We conducted a randomized controlled study among community-dwelling patients with type 2 diabetes mellitus. Patients were recruited from primary care practices. After randomization, patients either had access to an internet-based medication module allowing them to store their medication information, look up drug information, and print a medication schedule (intervention group), or they received an information brochure on the importance of medication schedules (control group). After 4-8 weeks, all patients were invited to attend a structured medication review (ie, follow-up visit). Data were collected via questionnaires before the start of the intervention and during the follow-up visit. The main outcome measure was the mean difference in health literacy between baseline and follow-up assessments of patients in the control and intervention groups. Results: Of 116 recruited patients, 107 (92.2%) completed the follow-up assessment and were eligible for intention-to-treat analyses. Only 73 patients, of which 29 were in the intervention group, followed the study protocol and were eligible for per-protocol analysis. No differences in overall health literacy were observed in either the intention-to-treat or in the per-protocol cohorts. Reasons for a null effect might be that the cohort was not particularly enriched with participants with low health literacy, thus precluding measurable improvement (ie, ceiling effect). Moreover, the success of implementation was considered poor because both the correct application of the study procedure (ie, randomization according to the protocol and dropout of 29 patients) and the actual interaction with the medication module was modest (ie, dropout of 9 patients). Conclusions: The conduct of this randomized controlled study was challenging, leaving it open whether inadequate implementation, too short of a duration, or insufficient efficacy of the intervention, as such, contributed to the null effect of this study. This clearly outlines the value of piloting complex interventions and the accompanying process evaluations. %M 32343246 %R 10.2196/13746 %U http://formative.jmir.org/2020/4/e13746/ %U https://doi.org/10.2196/13746 %U http://www.ncbi.nlm.nih.gov/pubmed/32343246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13188 %T Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study %A Janssen,Anna %A Donnelly,Candice %A Kay,Judy %A Thiem,Peter %A Saavedra,Aldo %A Pathmanathan,Nirmala %A Elder,Elisabeth %A Dinh,Phuong %A Kabir,Masrura %A Jackson,Kirsten %A Harnett,Paul %A Shaw,Tim %+ Research in Implementation Science and eHealth Group, Faculty of Health Sciences, The University of Sydney, Charles Perkins Centre (D17), Sydney, 2006, Australia, 61 9036 9406, anna.janssen@sydney.edu.au %K eHealth %K clinical informatics %K human-centered design %K data visualization %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. %M 32314968 %R 10.2196/13188 %U https://www.jmir.org/2020/4/e13188 %U https://doi.org/10.2196/13188 %U http://www.ncbi.nlm.nih.gov/pubmed/32314968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e12098 %T Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study %A Wong,William Chi Wai %A Song,Lin %A See,Christopher %A Lau,Stephanie Tze Hei %A Sun,Wai Han %A Choi,Kitty Wai Ying %A Tucker,Joseph %+ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, 2/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, 852 67456763, songlinhk@gmail.com %K dating apps %K intervention mapping %K crowdsourcing %K peer-led approach %K sexual health %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based dating apps are rapidly transforming how people seek potential sexual and romantic partners. However, they can also increase the risk of unsafe sexual behaviors, harassment, and infringement of personal privacy. Current research on interventions for safer dating app use remains insufficient. Objective: The goal of this study was to describe the development of an intervention for safer dating app usage using crowdsourcing and peer-led approaches. Methods: This paper describes the development of an intervention program designed to promote safer dating app use among college students. Crowdsourcing and peer-led approaches were adopted during key stages of the development process. Focus group discussions were held to assess the experience and needs of dating app users. A crowdsourcing contest then solicited ideas for performance objectives for the intervention. These objectives were grouped to further identify practical strategies. A one-day intensive workshop was subsequently held with peer mentors to brainstorm ideas for the production of creative interventional materials. The intervention programs were produced and tested in a pilot study. The app’s effectiveness will be evaluated in a cluster randomized controlled trial. Results: The intervention program consists of a risk assessment tool, a first-person scenario game, and four short videos. The risk assessment tool, comprised of 14 questions, will give the participant a score to determine their level of risk of adverse events when using dating apps. The scenario game is a first-person simulation game where the players are presented with choices when faced with different scenarios. The short videos each last 2-4 minutes, with points of discussion aimed at addressing the risks of using dating apps. The programs were piloted and were found to be relatable and helpful when further modifications were made. Conclusions: Potential challenges identified during the development process included data management and analysis, sustaining peer mentors’ interests and participation, and balancing between providing more information and perpetuating social stigma around dating app use. By integrating new approaches, such as crowdsourcing and the peer-led approach, in developing an intervention for safer dating app use, our development process provides a viable model for developing future interventions to address the risks associated with dating app use. %M 32314975 %R 10.2196/12098 %U http://formative.jmir.org/2020/4/e12098/ %U https://doi.org/10.2196/12098 %U http://www.ncbi.nlm.nih.gov/pubmed/32314975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e15534 %T Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis %A Brown,Jacqueline Marie %A Savaglio,Robert %A Watson,Graham %A Kaplansky,Allison %A LeSage,Ann %A Hughes,Janette %A Kapralos,Bill %A Arcand,JoAnne %+ Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science Building Rm 3016, Oshawa, ON, L1G 0C5, Canada, 1 (905) 7218668 ext 3796, joanne.arcand@uoit.ca %K mHealth %K children %K child nutrition sciences %K mobile apps %K health education %D 2020 %7 17.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. Objective: This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. Methods: An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. Results: The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%). Conclusions: Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition. %M 32301743 %R 10.2196/15534 %U http://formative.jmir.org/2020/4/e15534/ %U https://doi.org/10.2196/15534 %U http://www.ncbi.nlm.nih.gov/pubmed/32301743 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e16151 %T Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study %A Nicklas,Jacinda M %A Leiferman,Jenn A %A Lockhart,Steven %A Daly,Kristen M %A Bull,Sheana S %A Barbour,Linda A %+ Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E Montview Blvd, Aurora, CO, 80045, United States, 1 3037249028, Jacinda.Nicklas@cuanschutz.edu %K mobile health %K postpartum %K chronic disease %K prevention %K weight loss %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 %M 32271149 %R 10.2196/16151 %U https://formative.jmir.org/2020/4/e16151 %U https://doi.org/10.2196/16151 %U http://www.ncbi.nlm.nih.gov/pubmed/32271149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e17901 %T A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation %A Gannon,Brittany %A Davis,Rindcy %A Kuhns,Lisa M %A Rodriguez,Rafael Garibay %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K young adults %K usability %K HIV %K mHealth %K young men %K mobile phone %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. Objective: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. Methods: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. Results: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. Conclusions: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group. %M 32254043 %R 10.2196/17901 %U https://formative.jmir.org/2020/4/e17901 %U https://doi.org/10.2196/17901 %U http://www.ncbi.nlm.nih.gov/pubmed/32254043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e14504 %T Evaluation of an Educational Health Website on Infections and Antibiotics in England: Mixed Methods, User-Centered Approach %A Allison,Rosalie %A Hayes,Catherine %A Young,Vicki %A McNulty,Cliodna A M %+ Public Health England, Twyver House, Gloucester, GL1 1DQ, United Kingdom, 44 208 495 3258, rosie.allison@phe.gov.uk %K user experience %K usability %K quality %K online %K science %K health %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: e-Bug, an educational health website for teachers and students, aims to help control antibiotic resistance by educating young people about microbes, hygiene, and antibiotic resistance, reducing the incidence of infection and, therefore, the need for antibiotics. The teachers’ section of the e-Bug website has not been evaluated since it was launched in 2009, and worldwide page views have been steadily decreasing since 2013. Objective: This study aimed to apply GoodWeb, a comprehensive framework utilizing methodologies and attributes that are relevant to the digital era, to evaluate and suggest improvements to the e-Bug website. Methods: Electronic questionnaires and face-to-face completion of task scenarios were used to assess content, ease of use, interactivity, technical adequacy, appearance, effectiveness, efficiency, and learnability of the teachers’ section of the e-Bug website. Results: A total of 106 teachers evaluated the e-Bug website; 97.1% (103/106) of them reported that they would use e-Bug, and 98.1% (104/106) of them reported that they would recommend it to others. Participants thought that there was a niche for e-Bug because of the way the resources fit into the national curriculum. Suggestions for improvements included changing the menu indication by highlighting the current page or deactivating links, improving home page indication, and providing a preview of resources when hovering the mouse over hyperlinks. Additional features requested by users included a search function and access to training opportunities. Conclusions: This paper reports that the GoodWeb framework was successfully applied to evaluate the e-Bug website, and therefore, it could be used to guide future website evaluations in other fields. Results from this study will be used to appraise the current quality and inform any future changes, modifications, and additions to e-Bug. %M 32203932 %R 10.2196/14504 %U https://formative.jmir.org/2020/4/e14504 %U https://doi.org/10.2196/14504 %U http://www.ncbi.nlm.nih.gov/pubmed/32203932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15494 %T Mutual-Aid Mobile App for Emergency Care: Feasibility Study %A Chien,Shuo-Chen %A Islam,Md Mohaimenul %A Yeh,Chen-An %A Chien,Po-Han %A Chen,Chun You %A Chin,Yen-Po %A Lin,Ming-Chin %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 15F, No 172-1, Sec 2, Keelung Rd, Da’an District, Taipei, Taiwan, 886 2 6638 2736 ext 3351, arbiter@tmu.edu.tw %K technology acceptance model %K cardiopulmonary resuscitation %K mobile app %K emergency care %D 2020 %7 19.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving the quality of patient care through the use of mobile devices is one of the hot topics in the health care field. In unwanted situations like an accident, ambulances and rescuers often require a certain amount of time to arrive at the scene. Providing immediate cardiopulmonary resuscitation (CPR) to patients might improve survival. Objective: The primary objective of this study was to evaluate the feasibility of an emergency and mutual-aid app model in Taiwan and to provide a reference for government policy. Methods: A structured questionnaire was developed as a research tool. All questionnaires were designed according to the technology acceptance model, and a Likert scale was used to measure the degree of agreement or disagreement. Moreover, in-depth interviews were conducted with six experts from medical, legal, and mobile app departments. Each expert was interviewed once to discuss feasible countermeasures and suggestions. Statistical Package for the Social Sciences (SPSS version 19; IBM Corp, Armonk, New York) was used to perform all statistical analyses, including descriptive statistics, independent sample t-tests, variance analysis, and Pearson correlation analysis. Results: We conducted this study between October 20, 2017, and November 10, 2017, at the Taipei Medical University Hospital. Questionnaires were distributed to medical personnel, visiting guests, family members, and volunteers. A total of 113 valid questionnaires were finally obtained after the exclusion of incomplete questionnaires. Cronbach α values for self-efficacy (perceived ease of use), use attitude (perceived usefulness), and use willingness and frequency were above .85, meeting the criterion of greater than .70. We observed that the reliability of each subquestion was acceptable and the values for use attitude (perceive usefulness) and use willingness and frequency were more than .90. Conclusions: The findings suggest that perceived ease of use and perceived usefulness of the app model affect use willingness. However, perceived usefulness had an intermediary influence on use willingness. Experts in law, medical, and technology fields consider that an emergency and mutual-aid model can be implemented in Taiwan. Along with the development of an emergency and mutual-aid app model, we recommend an increase in the number of automated external defibrillators per region and promotion of correct knowledge about CPR in order to decrease morbidity and mortality. %M 32191212 %R 10.2196/15494 %U https://formative.jmir.org/2020/3/e15494 %U https://doi.org/10.2196/15494 %U http://www.ncbi.nlm.nih.gov/pubmed/32191212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e13900 %T A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study %A Nyenhuis,Sharmilee M %A Balbim,Guilherme Moraes %A Ma,Jun %A Marquez,David X %A Wilbur,JoEllen %A Sharp,Lisa K %A Kitsiou,Spyros %+ Department of Medicine, University of Illinois at Chicago, 840 S Wood St, MC 719, Chicago, IL, 60612, United States, 1 312 413 1655, snyenhui@uic.edu %K activity trackers %K text message %K physical activity %K asthma %K African-American %K women %K mHealth %K smartphone %K mobile phone %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA). Objective: This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma. Methods: African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity). Results: We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71% (5/7), 86% (6/7), and 86% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=−0.21, 95% CI −876.9 to 58.9). Conclusions: The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes. %M 32159520 %R 10.2196/13900 %U https://formative.jmir.org/2020/3/e13900 %U https://doi.org/10.2196/13900 %U http://www.ncbi.nlm.nih.gov/pubmed/32159520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e14652 %T Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study %A Sanchez Antelo,Victoria %A Kohler,Racquel E %A Curotto,Mariana %A Viswanath,Kasisomayajula "Vish" %A Paolino,Melisa %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante, 27, C1173AAA, Buenos Aires, Argentina, 54 1148651707, silviarrossi2020@gmail.com %K text messaging %K cell phone use %K telemedicine %K human papillomavirus DNA tests %K triage %K health behavior %K Argentina %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. %M 32032940 %R 10.2196/14652 %U https://formative.jmir.org/2020/3/e14652 %U https://doi.org/10.2196/14652 %U http://www.ncbi.nlm.nih.gov/pubmed/32032940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15962 %T Understanding Students’ Mental Well-Being Challenges on a University Campus: Interview Study %A Park,Sun Young %A Andalibi,Nazanin %A Zou,Yikai %A Ambulkar,Siddhant %A Huh-Yoo,Jina %+ School of Information, University of Michigan, Ann Arbor, MI, United States, 1 9360671, sunypark@umich.edu %K emerging adults %K university students %K life events %K mental wellbeing %K mental wellness %K mental health %K social support %D 2020 %7 5.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students’ lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students’ mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help. Objective: This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students’ mental well-being maintenance practice. Methods: Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States. Results: This study’s findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure. Conclusions: On the basis of this study’s empirical findings, we discuss how and when help should be delivered through technology to better address university students’ needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process. %M 32134393 %R 10.2196/15962 %U http://formative.jmir.org/2020/3/e15962/ %U https://doi.org/10.2196/15962 %U http://www.ncbi.nlm.nih.gov/pubmed/32134393 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e17060 %T Patients’ Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study Using the eHealth Impact Questionnaire %A Talboom-Kamp,Esther %A Tossaint-Schoenmakers,Rosian %A Goedhart,Annelijn %A Versluis,Anke %A Kasteleyn,Marise %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 30 2361170, e.talboom@saltro.nl %K patient portals %K eHealth Impact Questionnaire %K eHIQ %K laboratory test results %K attitude to health %K self efficacy %K telemedicine %K usability %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health. Objective: This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results. Methods: We used the online-administered eHealth Impact Questionnaire to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively. Results: The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales (r345=.77, P<.001). Conclusions: Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients’ self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health. %M 32024632 %R 10.2196/17060 %U https://formative.jmir.org/2020/3/e17060 %U https://doi.org/10.2196/17060 %U http://www.ncbi.nlm.nih.gov/pubmed/32024632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e16831 %T Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing %A Kristjansdottir,Olöf Birna %A Børøsund,Elin %A Westeng,Marianne %A Ruland,Cornelia %A Stenberg,Una %A Zangi,Heidi A %A Stange,Kurt %A Mirkovic,Jelena %+ Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4959 Nydalen, Oslo, 0424, Norway, 47 92433964, olof@mestring.no %K mobile app %K self-management %K strengths %K chronic illness %K rheumatology %K usability %K formative evaluation %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients’ perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients’ perceptions of the app’s usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75%) reported becoming more aware of their own strengths by using the app; 1 (8%) disagreed and 2 (17%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients’ reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. %M 32130126 %R 10.2196/16831 %U https://formative.jmir.org/2020/3/e16831 %U https://doi.org/10.2196/16831 %U http://www.ncbi.nlm.nih.gov/pubmed/32130126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14680 %T Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial %A Zárate-Bravo,Ernesto %A García-Vázquez,Juan-Pablo %A Torres-Cervantes,Engracia %A Ponce,Gisela %A Andrade,Ángel G %A Valenzuela-Beltrán,Maribel %A Rodríguez,Marcela D %+ Facultad de Ingeniería, Universidad Autónoma de Baja California, Ave Alvaro Obregón, S/N, Col Nueva, Mexicali, 21100, Mexico, 52 6865664270 ext 1301, marcerod@uabc.edu.mx %K health information systems %K family caregiver %K aged %K medication adherence %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users’ attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. Objective: This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. Methods: A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. Results: The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD’s external cues not only improved older adults’ medication adherence but also mediated family caregivers’ involvement. Conclusions: The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. Trial Registration: ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97 %M 32130164 %R 10.2196/14680 %U http://mhealth.jmir.org/2020/3/e14680/ %U https://doi.org/10.2196/14680 %U http://www.ncbi.nlm.nih.gov/pubmed/32130164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e15919 %T Effectiveness of the Fun for Wellness Web-Based Behavioral Intervention to Promote Physical Activity in Adults With Obesity (or Overweight): Randomized Controlled Trial %A Myers,Nicholas D %A McMahon,Adam %A Prilleltensky,Isaac %A Lee,Seungmin %A Dietz,Samantha %A Prilleltensky,Ora %A Pfeiffer,Karin A %A Bateman,André G %A Brincks,Ahnalee M %+ Michigan State University, 201 IM Sports Circle Building, 308 W Circle Drive, East Lansing, MI, 48824, United States, 1 5174325380, myersni1@msu.edu %K eHealth %K mHealth %K self-efficacy theory %K physical activity self-efficacy level %K self-regulatory efficacy %K mediation %D 2020 %7 27.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity in the adult population is a global pandemic. Fun for Wellness (FFW) is a self-efficacy theory- and Web-based behavioral intervention developed to promote growth in well-being and physical activity by providing capability-enhancing opportunities to participants. Objective: This study aimed to evaluate the effectiveness of FFW to increase physical activity in adults with obesity in the United States in a relatively uncontrolled setting. Methods: This was a large-scale, prospective, double-blind, parallel-group randomized controlled trial. Participants were recruited through an online panel recruitment company. Adults with overweight were also eligible to participate, consistent with many physical activity–promoting interventions for adults with obesity. Also consistent with much of the relevant literature the intended population as simply adults with obesity. Eligible participants were randomly assigned to the intervention (ie, FFW) or the usual care (ie, UC) group via software code that was written to accomplish equal allocations to the FFW and UC groups. Data collection was Web based, fully automated, and occurred at three time points: baseline, 30 days after baseline (T2), and 60 days after baseline (T3). Participants (N=461) who were assigned to the FFW group (nFFW=219) were provided with 30 days of 24-hour access to the Web-based intervention. A path model was fit to the data consistent with the FFW conceptual model for the promotion of physical activity. Results: There was evidence for a positive direct effect of FFW on transport-related physical activity self-efficacy (beta=.22, P=.02; d=0.23), domestic-related physical activity self-efficacy (beta=.22, P=.03; d=0.22), and self-efficacy to regulate physical activity (beta=.16, P=.01; d=0.25) at T2. Furthermore, there was evidence for a positive indirect effect of FFW on physical activity at T3 through self-efficacy to regulate physical activity at T2 (beta=.42, 95% CI 0.06 to 1.14). Finally, there was evidence for a null direct effect of FFW on physical activity (beta=1.04, P=.47; d=0.07) at T3. Conclusions: This study provides some initial evidence for both the effectiveness (eg, a positive indirect effect of FFW on physical activity through self-efficacy to regulate physical activity) and the ineffectiveness (eg, a null direct effect of FFW on physical activity) of the FFW Web-based behavioral intervention to increase physical activity in adults with obesity in the United States. More broadly, FFW is a scalable Web-based behavioral intervention that may effectively, although indirectly, promote physical activity in adults with obesity and therefore may be useful in responding to the global pandemic of insufficient physical activity in this at-risk population. Self-efficacy to regulate physical activity appears to be a mechanism by which FFW may indirectly promote physical activity in adults with obesity. Trial Registration: ClinicalTrials.gov NCT03194854; https://clinicaltrials.gov/ct2/show/NCT03194854. %R 10.2196/15919 %U http://formative.jmir.org/2020/2/e15919/ %U https://doi.org/10.2196/15919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16410 %T A Patient-Centered Information System (myED) for Emergency Care Journeys: Design, Development, and Initial Adoption %A Westphal,Monika %A Yom-Tov,Galit Bracha %A Parush,Avi %A Carmeli,Nitzan %A Shaulov,Alina %A Shapira,Chen %A Rafaeli,Anat %+ Technion - Israel Institute of Technology, Technion City, Haifa, 3200003, Israel, 972 48294510, gality@technion.ac.il %K technology %K medical records %K access to information %K patient participation %K electronic patient-provider communication %K user-centered design %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical care is highly complex in that it addresses patient-centered health goals that require the coordination of multiple care providers. Emergency department (ED) patients currently lack a sense of predictability about ED procedures. This increases frustration and aggression. Herein, we describe a system for providing real-time information to ED patients regarding the procedures in their ED medical journey. Objective: This study aimed to develop a system that provides patients with dynamically updated information about the specific procedures and expected waiting times in their personal ED journey, and to report initial evaluations of this system. Methods: To develop the myED system, we extracted information from hospital databases and translated it using process mining and user interface design into a language that is accessible and comprehensible to patients. We evaluated the system using a mixed methods approach that combined observations, interviews, and online records. Results: Interviews with patients, accompanying family members, and health care providers (HCPs) confirmed patients’ needs for information about their personal ED journey. The system developed enables patients to access this information on their personal mobile phones through a responsive website. In the third month after deployment, 492 of 1614 (30.48%) patients used myED. Patients’ understanding of their ED journey improved significantly (F8,299=2.519; P=.01), and patients showed positive reactions to the system. We identified future challenges, including achieving quick engagement without delaying medical care. Salient reasons for poor system adoption were patients’ medical state and technological illiteracy. HCPs confirmed the potential of myED and identified means that could improve patient experience and staff cooperation. Conclusions: Our iterative work with ED patients, HCPs, and a multidisciplinary team of developers yielded a system that provides personal information to patients about their ED journey in a secure, effective, and user-friendly way. MyED communicates this information through mobile technology. This improves health care by addressing patients’ psychological needs for information and understanding, which are often overlooked. We continue to test and refine the system and expect to find positive effects of myED on patients’ ED experience and hospital operations. %M 32130144 %R 10.2196/16410 %U http://formative.jmir.org/2020/2/e16410/ %U https://doi.org/10.2196/16410 %U http://www.ncbi.nlm.nih.gov/pubmed/32130144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14888 %T Using an Electronic Medication Event–Monitoring System for Antiretroviral Therapy Self-Management Among African American Women Living With HIV in Rural Florida: Cohort Study %A Lucero,Robert %A Williams,Renessa %A Esalomi,Tanisia %A Alexander-Delpech,Paula %A Cook,Christa %A Bjarnadottir,Ragnhildur I %+ Department of Family, Community, and Health Systems Science, Southern HIV & Alcohol Research Consortium, University of Florida, College of Nursing, 1225 Center Drive, Gainesville, FL, United States, 1 3522736370, rlucero@ufl.edu %K medication adherence %K medication therapy management %K self-management %K HIV %K African Americans %D 2020 %7 19.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV remains a significant health issue in the United States and disproportionately affects African Americans. African American women living with HIV (AAWH) experience a particularly high number of barriers when attempting to manage their HIV care, including antiretroviral therapy (ART) adherence. To enable the development and assessment of effective interventions that address these barriers to support ART adherence, there is a critical need to understand more fully the use of objective measures of ART adherence among AAWH, including electronic medication dispensers for real-time surveillance. Objective: This study aimed to evaluate the use of the Wisepill medication event–monitoring system (MEMS) and compare the objective and subjective measures of ART adherence. Methods: We conducted a 30-day exploratory pilot study of the MEMS among a convenience sample of community-dwelling AAWH (N=14) in rural Florida. AAWH were trained on the use of the MEMS to determine the feasibility of collecting, capturing, and manipulating the MEMS data for an objective measure of ART adherence. Self-reported sociodemographic information, including a self-reported measure of ART adherence, was also collected from AAWH. Results: We found that the majority of participants were successful at using the electronic MEMS. Daily use of the MEMS tended to be outside of the usual time participants took their medication. Three 30-day medication event patterns were found that characterized ART adherence, specifically uniform and nonuniform medication adherence and nonuniform medication nonadherence. There were relatively few MEMS disruptions among study participants. Overall, adjusted daily ART adherence was 81.08% and subjective ART adherence was 77.78%. Conclusions: This pilot study on the use and evaluation of the Wisepill MEMS among AAWH in rural Florida is the first such study in the United States. The findings of this study are encouraging because 10 out of 12 participants consistently used the MEMS, there were relatively few failures, and objective adjusted daily and overall subjective ART adherence were very similar. On the basis of these findings, we think researchers should consider using the Wisepill MEMS in future studies of AAWH and people living with HIV in the United States after taking into account our practical suggestions. The following practical considerations are suggested when measuring objective medication adherence: (1) before using an MEMS, be familiar with the targeted populations’ characteristics; (2) choose an MEMS that aligns with the participants’ day-to-day activities; (3) ensure the MEMS’ features and resulting data support the research goals; (4) assess the match among the user’s ability, wireless features of the MEMS, and the geographic location of the participants; and (5) consider the cost of MEMS and the research budget. %M 32130114 %R 10.2196/14888 %U http://formative.jmir.org/2020/2/e14888/ %U https://doi.org/10.2196/14888 %U http://www.ncbi.nlm.nih.gov/pubmed/32130114 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e16762 %T A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Carbone,Sara %A Donisi,Valeria %+ eHealth Unit, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312477, sgabrielli@fbk.eu %K life skills %K chatbots %K conversational agents %K mental health %K participatory design %K adolescence %K bullying %K cyberbullying %K well-being intervention %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Adolescence is a challenging period, where youth face rapid changes as well as increasing socioemotional demands and threats, such as bullying and cyberbullying. Adolescent mental health and well-being can be best supported by providing effective coaching on life skills, such as coping strategies and protective factors. Interventions that take advantage of online coaching by means of chatbots, deployed on Web or mobile technology, may be a novel and more appealing way to support positive mental health for adolescents. Objective: In this pilot study, we co-designed and conducted a formative evaluation of an online, life skills coaching, chatbot intervention, inspired by the positive technology approach, to promote mental well-being in adolescence. Methods: We co-designed the first life skills coaching session of the CRI (for girls) and CRIS (for boys) chatbot with 20 secondary school students in a participatory design workshop. We then conducted a formative evaluation of the entire intervention—eight sessions—with a convenience sample of 21 adolescents of both genders (mean age 14.52 years). Participants engaged with the chatbot sessions over 4 weeks and filled in an anonymous user experience questionnaire at the end of each session; responses were based on a 5-point Likert scale. Results: A majority of the adolescents found the intervention useful (16/21, 76%), easy to use (19/21, 90%), and innovative (17/21, 81%). Most of the participants (15/21, 71%) liked, in particular, the video cartoons provided by the chatbot in the coaching sessions. They also thought that a session should last only 5-10 minutes (14/21, 66%) and said they would recommend the intervention to a friend (20/21, 95%). Conclusions: We have presented a novel and scalable self-help intervention to deliver life skills coaching to adolescents online that is appealing to this population. This intervention can support the promotion of coping skills and mental well-being among youth. %M 32130128 %R 10.2196/16762 %U http://humanfactors.jmir.org/2020/1/e16762/ %U https://doi.org/10.2196/16762 %U http://www.ncbi.nlm.nih.gov/pubmed/32130128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14189 %T Usability of the Turkish Translation of the Dutch Talking Touch Screen Questionnaire for Physical Therapy Patients With a Turkish Background: Qualitative Study %A Welbie,Marlies %A Wittink,Harriet %A Bozkurt,Sahin %A Coban,Tugba %A Devillé,Walter LJM %+ Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Postbus 12011, Utrecht, 3501 AA Utrecht, Netherlands, 31 638192100, marlies.welbie@hu.nl %K mHealth %K eHealth %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The Turkish translation of the Dutch Talking Touch Screen Questionnaire (TTSQ) has been developed to help physical therapy patients with a Turkish background in the Netherlands to autonomously elucidate their health problems and impairments and set treatment goals, regardless of their level of health literacy. Objective: The aim of this study was to evaluate the usability of the Turkish TTSQ for physical therapy patients with a Turkish background with diverse levels of health literacy and experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method was carried out to gain insight into the usability of the Turkish TTSQ. A total of 10 physical therapy patients participated. The interview data were analyzed using a thematic content analysis approach aimed at determining the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating, which was used to provide a rough estimate of the need for additional usability improvements. Results: No participant in this study was able to complete the questionnaire without encountering at least one usability problem. A total of 17 different kinds of problems were found. On the basis of their severity score, 3 problems that should be addressed during future development of the tool were “Not using the navigation function of the photo gallery in Question 4 causing the participant to not see all presented response items;” “Touching the text underneath a photo in Question 4 to select an activity instead of touching the photo itself, causing the activity not to be selected;” and “Pushing too hard or tapping too softly on the touch screen causing the touch screen to not respond.” The data on efficiency within this study were not valid and are, therefore, not reported in this study. No participant was completely satisfied or dissatisfied with the overall ease of use of the Turkish TTSQ. Two participants with no prior experience of using tablet computers felt that, regardless of what kinds of improvement might be made, it would just be too difficult for them to learn to work with the device. Conclusions: As with the Dutch TTSQ, the Turkish TTSQ needs improvement before it can be released. The results of this study confirm the conclusion of the Dutch TTSQ study that participants with low levels of education and little experience in using mobile technology are less able to operate the TTSQ effectively. Using a Dutch speaking interviewer and Turkish interpreter has had a negative effect on data collection in this study. %M 32053112 %R 10.2196/14189 %U http://formative.jmir.org/2020/2/e14189/ %U https://doi.org/10.2196/14189 %U http://www.ncbi.nlm.nih.gov/pubmed/32053112 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14496 %T A Weekly, Evidence-Based Health Letter for Caregivers (90Second Caregiver): Usability Study %A Milios,Athena %A McGrath,Patrick %A Baillie,Hannah %+ Centre for Research in Family Health, IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, 1 9025790269, athena.milios1@gmail.com %K caregivers %K mental health %K usability %K depression %K anxiety %K stigma %K hope %K health information %K persuasive design %D 2020 %7 12.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers are family members or close friends who provide unpaid help to individuals with acute or chronic health conditions so that they can manage daily life tasks. The greatest source of health information is the internet for meeting the needs of caregivers. However, information on the internet may not be scientifically valid, it may be written in language that is difficult to read, and is often in very large doses. 90Second Caregiver is a health letter whose aim is to disseminate knowledge to caregivers in a user-friendly, weekly format, in order to improve their wellbeing. Objective: The main objective was to test a sample of 90Second Caregiver health letters in order to assess their usability and to optimize the design and content of the health letters. Methods: Usability research themes were assessed using semi-structured phone interviews, incorporating the Think Aloud method with retrospective questioning. Results: Usability was assessed in the context of five main themes: understandability and learnability, completeness, relevance, and quality and credibility of the health letter content, as well as design and format. Caregivers generally provided positive feedback regarding the usability of the letters. The usability feedback was used to refine 90Second Caregiver in order to improve the design and content of the series. Based on the results of this study, it may be of maximum benefit to target the series towards individuals who are new to caregiving or part-time caregivers, given that these caregivers of the sample found the letters more useful and relevant and had the most positive usability experiences. Conclusions: The findings assisted in the improvement of the 90Second Caregiver template, which will be used to create future health letters and refine the letters that have already been created. The findings have implications for who the 90Second Caregiver series should be targeting (ie, newer or part-time caregivers) in order to be maximally impactful in improving mental health and wellbeing-related outcomes for caregivers, such as self-efficacy and caregiving knowledge. The results of this study may be generalizable to the examination of other electronic health information formats, making them valuable to future researchers testing the usability of health information products. In addition, the methods used in this study are useful for usability hypothesis generation. Lastly, our 90Second delivery approach can generate information useful for a set of similar products (eg, weekly health letters targeted towards other conditions/populations). %M 32049064 %R 10.2196/14496 %U https://formative.jmir.org/2020/2/e14496 %U https://doi.org/10.2196/14496 %U http://www.ncbi.nlm.nih.gov/pubmed/32049064 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16807 %T Feasibility and Acceptability of an Electronic Health HIV Prevention Toolkit Intervention With Concordant HIV-Negative, Same-Sex Male Couples on Sexual Agreement Outcomes: Pilot Randomized Controlled Trial %A Mitchell,Jason William %A Lee,Ji-Young %A Wu,Yanyan %A Sullivan,Patrick S %A Stephenson,Rob %+ Office of Public Health Studies, Myron B Thompson School of Social Work, University of Hawaii, 1960 East-West Rd, Suite T103, Honolulu, HI, 96822, United States, 1 8082196729, jasonmit@hawaii.edu %K telemedicine %K HIV %K couples %K sexual and gender minorities %D 2020 %7 11.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need to develop innovative and accessible dyadic interventions that provide male couples with the behavioral skills to manage the risk of HIV transmission within their relationship. Objective: We conducted a pilot randomized controlled trial (RCT) to assess the feasibility and acceptability of the electronic health (eHealth) HIV prevention toolkit intervention to encourage seroconcordant negative male couples in the United States to establish and adhere to a sexual agreement (SA). Methods: Eligible, consented couples were randomly assigned to the intervention or education control and followed up for 6 months, with assessments occurring every 3 months after baseline. Acceptability items were assessed at both follow-up assessments. Descriptive and comparative statistics summarized cohort characteristics, relationship dynamics, and SA outcomes for the entire cohort and by trial arm. To examine the association between couples’ relationship dynamics and their establishment of an SA over time and by trial arm, multilevel logistic regression analyses were performed with a random intercept to account for correlations of repeated measurements of relationship dynamics at months 3 and 6; the odds ratio (OR) of establishment of an SA and the corresponding 95% confidence interval were then reported. Results: Overall, 7959 individuals initiated screening. Reasons for individual ineligibility varied. An electronic algorithm was used to assess couple-level eligibility, which identified 1080 ineligible and 266 eligible dyads. Eligible couples (n=149) were enrolled in the pilot RCT: 68 received the intervention and 81 received the education control. Retention was 71.5% (213/298 partnered men) over the 6 months. Participants reported high acceptability of the intervention along with some areas for improvement. A significantly higher proportion of couples who received the intervention established an SA at 6 months compared with those who received the education control (32/43, 74% vs 27/50, 54%; P=.05). The OR of establishing an SA for couples in the intervention versus those in the control condition was greater than 2 when controlling for a number of different relationship dynamics. In addition, the odds of establishing an SA increased by 88% to 322% for each unit increase in a variety of averaged relationship dynamic scores; the opposite result was found for dynamics of stigma. Differences between trial arms for SA type and adherence were nonsignificant at each assessment. However, changes in these 2 SA aspects were noted over time. The average number of items couples included in their SA was 18, and about one-fourth to one-third of couples included HIV prevention items. Conclusions: The findings demonstrate strong evidence for the acceptability and feasibility of the eHealth toolkit as a brief, stand-alone, couples-based HIV prevention intervention. These findings support the need to update the toolkit and evaluate it in a larger clinical trial powered for efficacy. Trial Registration: ClinicalTrials.gov NCT02494817; http://clinicaltrials.gov/ct2/show/NCT02494817 %R 10.2196/16807 %U https://formative.jmir.org/2020/2/e16807 %U https://doi.org/10.2196/16807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13197 %T A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach %A Pekmezaris,Renee %A Kozikowski,Andrzej %A Pascarelli,Briana %A Wolf-Klein,Gisele %A Boye-Codjoe,Eugenia %A Jacome,Sonia %A Madera,Danielle %A Tsang,Donna %A Guerrero,Brenda %A Medina,Richard %A Polo,Jennifer %A Williams,Myia %A Hajizadeh,Negin %+ Northwell Health, 600 Community Dr, Manhasset, NY, 11030, United States, 1 5166001402, RPekmeza@northwell.edu %K COPD %K pulmonary rehabilitation %K telehealth %K CPBR %K disparities %K telemonitoring %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. Results: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. Conclusions: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. Trial Registration: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485 %M 32012039 %R 10.2196/13197 %U https://formative.jmir.org/2020/1/e13197 %U https://doi.org/10.2196/13197 %U http://www.ncbi.nlm.nih.gov/pubmed/32012039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13495 %T “Positive Peers”: Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care %A Step,Mary M %A McMillen Smith,Jennifer %A Kratz,Joshua %A Briggs,Julia %A Avery,Ann %+ College of Public Health, Kent State University, 321 Lowry Hall, 750 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 2164036048, MSTEP@KENT.EDU %K HIV %K young adults %K mobile applications %K self-management %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. Objective: The objective of this study was to describe the “Positive Peers” app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. Methods: “Positive Peers” was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. Results: The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The “Positive Peers” mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. Conclusions: Successful development of the “Positive Peers” mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator. %M 32012035 %R 10.2196/13495 %U http://formative.jmir.org/2020/1/e13495/ %U https://doi.org/10.2196/13495 %U http://www.ncbi.nlm.nih.gov/pubmed/32012035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14111 %T Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study %A Kim,Minjin %A Lee,Haeok %A Allison,Jeroan %+ University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation Street, Worcester, MA, 01605, United States, 1 7202095559, minjin.kim2@umassmed.edu %K mHealth %K Web-based intervention %K fraud %K experimental design %D 2020 %7 29.1.2020 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285; http://www.isrctn.com/ISRCTN12175285 %M 32012036 %R 10.2196/14111 %U http://formative.jmir.org/2020/1/e14111/ %U https://doi.org/10.2196/14111 %U http://www.ncbi.nlm.nih.gov/pubmed/32012036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12917 %T Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study %A Nielsen,Anna %A Bågenholm,Aspasia %A De Costa,Ayesha %+ Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, 17176, Sweden, 46 704078496, anna.nielsen.1@ki.se %K mHealth %K youth %K sexual health %K condoms %K Sweden %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. %M 32012038 %R 10.2196/12917 %U https://formative.jmir.org/2020/1/e12917 %U https://doi.org/10.2196/12917 %U http://www.ncbi.nlm.nih.gov/pubmed/32012038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13207 %T A Co-Designed Social Media Intervention to Satisfy Information Needs and Improve Outcomes of Patients With Chronic Kidney Disease: Longitudinal Study %A Vasilica,Cristina Mihaela %A Brettle,Alison %A Ormandy,Paula %+ The University of Salford, School of Health and Society, Room 192, Mary Seacole Building, Salford, M6 6PU, United Kingdom, 44 0161 295 5342, C.M.Vasilica1@salford.ac.uk %K social media %K patients outcomes %K long term condition %K chronic kidney disease %K self-efficacy %K patients information needs %K co-design %D 2020 %7 27.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of people living with a long-term condition is increasing worldwide. Social media offers opportunities for patients to exchange information and experiences with others with the same condition, potentially leading to better self-management and improved patient outcomes, at minimal costs to health service providers. Objective: This paper describes how an online network with a range of social media platforms was created, with the help of a group of patients with chronic kidney disease and specialist professionals. The project considered whether information needs and health-related and social outcomes were met. Methods: We performed a longitudinal in-depth evaluation of the creation of the moderated network, observation of the use of the platforms, self-efficacy surveys (at baseline and 6 months), and semistructured interviews (at baseline and 6 months). Results: A total of 15 patients and professionals participated in the co-design of the network (hub), which was initially launched with 50 patients. Several platforms were needed to engage patients at different levels and encourage generation of information, with the support of moderators. In addition, 14 separate patients participated in the evaluation. Satisfaction of information needs through social engagement improved self-efficacy (n=13) with better self-care and management of illness. Social outcomes included seeking employment and an increase in social capital. Conclusions: An online network (hub) with several social media platforms helped patients with chronic kidney disease manage their condition. Careful co-designing with users resulted in a sustainable network with wider applicability across health and social care. %M 32012040 %R 10.2196/13207 %U https://formative.jmir.org/2020/1/e13207 %U https://doi.org/10.2196/13207 %U http://www.ncbi.nlm.nih.gov/pubmed/32012040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12618 %T Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach %A Doty,Jennifer L %A Brady,Sonya S %A Monardez Popelka,Javiera %A Rietveld,Laura %A Garcia-Huidobro,Diego %A Doty,Matthew J %A Linares,Roxana %A Svetaz,Maria Veronica %A Allen,Michele L %+ Department of Family, Youth and Community Sciences, University of Florida, 3038D McCarty Hall D, PO Box, Gainesville, FL, 32611-0001, United States, 1 3522733543, jennifer.doty@ufl.edu %K mobile application %K eHealth %K community-based participatory research %K Hispanic Americans, family %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent’s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents’ technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. %M 32012034 %R 10.2196/12618 %U https://formative.jmir.org/2020/1/e12618 %U https://doi.org/10.2196/12618 %U http://www.ncbi.nlm.nih.gov/pubmed/32012034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12538 %T The Use and Effects of an App-Based Physical Activity Intervention “Active2Gether” in Young Adults: Quasi-Experimental Trial %A Middelweerd,Anouk %A Mollee,Julia %A Klein,Michel MCA %A Manzoor,Adnan %A Brug,Johannes %A te Velde,Saskia J %+ Research Center for Healthy and Sustainable Living, Hogeschool Utrecht University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 614752495, saskia.tevelde@hu.nl %K physical activity %K smartphone %K mobile app %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. Objective: This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. Methods: Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. Results: Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI −6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI −8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. Conclusions: This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems. %M 31961330 %R 10.2196/12538 %U http://formative.jmir.org/2020/1/e12538/ %U https://doi.org/10.2196/12538 %U http://www.ncbi.nlm.nih.gov/pubmed/31961330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14780 %T A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study %A Støme,Linn Nathalie %A Moger,Tron %A Kidholm,Kristian %A Kværner,Kari J %+ Centre for Connected Care, Oslo University Hospital, Kirkeveien 166, Oslo, , Norway, 47 94880825, linast@ous-hf.no %K early health technology assessment %K eHealth %K primary care %K innovation %K behavioral data %D 2020 %7 20.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. Objective: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. Methods: Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. Results: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. Conclusions: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service. %M 31958062 %R 10.2196/14780 %U http://formative.jmir.org/2020/1/e14780/ %U https://doi.org/10.2196/14780 %U http://www.ncbi.nlm.nih.gov/pubmed/31958062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16652 %T A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness %A Bricker,Jonathan B %A Watson,Noreen L %A Heffner,Jaimee L %A Sullivan,Brianna %A Mull,Kristin %A Kwon,Diana %A Westmaas,Johann Lee %A Ostroff,Jamie %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K smartphone app %K mHealth %K tobacco %K smoking %K cancer patient %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36%) and breast (10/59, 17%) cancers. The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% [19/21] for Quit2Heal vs 65% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86% [18/21] for Quit2Heal vs 62% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% (5/25) for Quit2Heal versus 7% (2/29) for QuitGuide (odds ratio 5.16, 95% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 %M 31951215 %R 10.2196/16652 %U http://formative.jmir.org/2020/1/e16652/ %U https://doi.org/10.2196/16652 %U http://www.ncbi.nlm.nih.gov/pubmed/31951215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13296 %T Using Natural Language Processing to Examine the Uptake, Content, and Readability of Media Coverage of a Pan-Canadian Drug Safety Research Project: Cross-Sectional Observational Study %A Mohammadhassanzadeh,Hossein %A Sketris,Ingrid %A Traynor,Robyn %A Alexander,Susan %A Winquist,Brandace %A Stewart,Samuel Alan %+ Dalhousie University, 5790 University Ave, Room 408, Halifax, NS, B3H 4R2, Canada, 1 902 494 6287, sam.stewart@dal.ca %K natural language processing %K mass media %K readability %K pharmacoepidemiology %K knowledge translation %D 2020 %7 14.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Isotretinoin, for treating cystic acne, increases the risk of miscarriage and fetal abnormalities when taken during pregnancy. The Health Canada–approved product monograph for isotretinoin includes pregnancy prevention guidelines. A recent study by the Canadian Network for Observational Drug Effect Studies (CNODES) on the occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy estimated poor adherence to these guidelines. Media uptake of this study was unknown; awareness of this uptake could help improve drug safety communication. Objective: The aim of this study was to understand how the media present pharmacoepidemiological research using the CNODES isotretinoin study as a case study. Methods: Google News was searched (April 25-May 6, 2016), using a predefined set of terms, for mention of the CNODES study. In total, 26 articles and 3 CNODES publications (original article, press release, and podcast) were identified. The article texts were cleaned (eg, advertisements and links removed), and the podcast was transcribed. A dictionary of 1295 unique words was created using natural language processing (NLP) techniques (term frequency-inverse document frequency, Porter stemming, and stop-word filtering) to identify common words and phrases. Similarity between the articles and reference publications was calculated using Euclidian distance; articles were grouped using hierarchical agglomerative clustering. Nine readability scales were applied to measure text readability based on factors such as number of words, difficult words, syllables, sentence counts, and other textual metrics. Results: The top 5 dictionary words were pregnancy (250 appearances), isotretinoin (220), study (209), drug (201), and women (185). Three distinct clusters were identified: Clusters 2 (5 articles) and 3 (4 articles) were from health-related websites and media, respectively; Cluster 1 (18 articles) contained largely media sources; 2 articles fell outside these clusters. Use of the term isotretinoin versus Accutane (a brand name of isotretinoin), discussion of pregnancy complications, and assignment of responsibility for guideline adherence varied between clusters. For example, the term pregnanc appeared most often in Clusters 1 (14.6 average times per article) and 2 (11.4) and relatively infrequently in Cluster 3 (1.8). Average readability for all articles was high (eg, Flesch-Kincaid, 13; Gunning Fog, 15; SMOG Index, 10; Coleman Liau Index, 15; Linsear Write Index, 13; and Text Standard, 13). Readability increased from Cluster 2 (Gunning Fog of 16.9) to 3 (12.2). It varied between clusters (average 13th-15th grade) but exceeded the recommended health information reading level (grade 6th to 8th), overall. Conclusions: Media interpretation of the CNODES study varied, with differences in synonym usage and areas of focus. All articles were written above the recommended health information reading level. Analyzing media using NLP techniques can help determine drug safety communication effectiveness. This project is important for understanding how drug safety studies are taken up and redistributed in the media. %M 31934872 %R 10.2196/13296 %U https://formative.jmir.org/2020/1/e13296 %U https://doi.org/10.2196/13296 %U http://www.ncbi.nlm.nih.gov/pubmed/31934872 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16424 %T An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify %A Herbuela,Von Ralph Dane Marquez %A Karita,Tomonori %A Francisco,Micanaldo Ernesto %A Watanabe,Kozo %+ Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama, Japan, 81 89-927-9847, watanabe_kozo@cee.ehime-u.ac.jp %K dengue fever %K mHealth %K real-time surveillance %K health communication %K behavior modification %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: For the last 10 years, mobile phones have provided the global health community with innovative and cost-effective strategies to address the challenges in the prevention and management of dengue fever. Objective: The aim is to introduce and describe the design and development process of Mozzify, an integrated mobile health (mHealth) app that features real-time dengue fever case reporting and mapping system, health communication (real-time worldwide news and chat forum/timeline, within-app educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system), and behavior modification (reminders alert program on the preventive practices against dengue fever). We also aim to assess Mozzify in terms of engagement and information-sharing abilities, functionality, aesthetics, subjective quality, and perceived impact. Methods: The main goals of the Mozzify app were to increase awareness, improve knowledge, and change attitudes about dengue fever, health care-seeking behavior, and intention-to-change behavior on preventive practices for dengue fever among users. It was assessed using the Mobile Application Rating Scale (MARS) among 50 purposively sampled individuals: public health experts (n=5), environment and health-related researchers (n=23), and nonclinical (end users) participants (n=22). Results: High acceptability and excellent satisfaction ratings (mean scores ≥4.0 out of 5) based on the MARS subscales indicate that the app has excellent user design, functionality, usability, engagement, and information among public health experts, environment and health-related researchers, and end users. The app’s subjective quality (recommending the app to other people and the app’s overall star rating), and specific quality (increase awareness, improve knowledge, and change attitudes about dengue fever; health care-seeking behavior; and intention-to-change behavior on preventive practices for dengue fever) also obtained excellent satisfaction ratings from the participants. Some issues and suggestions were raised during the focus group and individual discussions regarding the availability of the app for Android devices, language options limitations, provision of predictive surveillance, and inclusion of other mosquito-borne diseases. Conclusions: Mozzify may be a promising integrated strategic health intervention system for dengue fever case reporting and mapping; increase awareness, improve knowledge, and change attitude about dengue fever; and disseminating and sharing information on dengue fever among the general population and health experts. It also can be an effective aid in the successful translation of knowledge on preventive measures against dengue fever to practice. %M 31913128 %R 10.2196/16424 %U https://formative.jmir.org/2020/1/e16424 %U https://doi.org/10.2196/16424 %U http://www.ncbi.nlm.nih.gov/pubmed/31913128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13224 %T A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study %A Kool,Bridget %A Dobson,Rosie %A Sharpe,Sarah %A Humphrey,Gayl %A Whittaker,Robyn %A Ameratunga,Shanthi %+ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 021524802, b.kool@auckland.ac.nz %K alcohol drinking %K risk assessment %K risk communication %K harm minimization, primary care %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). Objective: This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced. Methods: Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool’s performance in real-world settings as well as its relevance, ease of use, and any suggested refinements. Results: In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided all the pieces in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues. Conclusions: The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI. %M 31895043 %R 10.2196/13224 %U https://formative.jmir.org/2020/1/e13224 %U https://doi.org/10.2196/13224 %U http://www.ncbi.nlm.nih.gov/pubmed/31895043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15466 %T Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews %A Dobson,Rosie %A Herbst,Pauline %A Candy,Sarah %A Brott,Tamzin %A Garrett,Jeffrey %A Humphrey,Gayl %A Reeve,Julie %A Tawhai,Merryn %A Taylor,Denise %A Warren,Jim %A Whittaker,Robyn %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1072, New Zealand, 64 9 3737599, r.dobson@auckland.ac.nz %K mHealth %K rehabilitation %K COPD %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. Objective: The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. Methods: A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. Results: Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. Conclusions: These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population. %M 31859681 %R 10.2196/15466 %U http://formative.jmir.org/2019/4/e15466/ %U https://doi.org/10.2196/15466 %U http://www.ncbi.nlm.nih.gov/pubmed/31859681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15013 %T Web-Based Module for the Collection of Electronic Patient-Reported Outcomes in People Living With HIV in Nouvelle Aquitaine, France: Usability Evaluation %A Barger,Diana %A Leleux,Olivier %A Conte,Valérie %A Sapparrart,Vincent %A Gapillout,Marie %A Crespel,Isabelle %A Erramouspe,Marie %A Delveaux,Sandrine %A Wittkop,Linda %A Dabis,François %A Bonnet,Fabrice %+ University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, 146 rue Leo Saignat CS61292, Bordeaux, F-33000, France, 33 0557579291, diana.barger@u-bordeaux.fr %K patient reported outcome measures %K patient generated health data %K quality of life %D 2019 %7 18.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) can be of great value for both research and chronic disease management. We developed a new module of the ANRS CO3 Aquitaine cohort study’s Web-based data capture and visualization solution (APPEGE 2.0) for the collection of electronic PROs among people living with HIV cared for in Nouvelle Aquitaine, France. Objective: This study aimed to evaluate the usability of 2 successively developed prototypes of ARPEGE 2.0’s electronic PROs module before launching a pilot study, owing to the novelty of the proposed data collection method for our setting and specific characteristics of the target population. Methods: A total of 2 sequential rounds of empirical, task-based usability evaluations were conducted, involving 8 research staff and then 7 people living with HIV. Evaluators provided written feedback during round 1 and oral feedback during round 2. Evaluators who completed the full set of tasks responded to the System Usability Scale (SUS). We assessed changes in SUS scores between rounds and concluded usability testing when SUS scores reached a ceiling effect, defining good usability a priori as a usability score of 70. Results: Insights were generated regarding the visibility of system status and the match between the system and the real world that improved the module’s usability. Research staff evaluators reported mean SUS scores of 65 (SD 18.87) and patient evaluators reported mean SUS scores of 85 (SD 5.4; P=.032). Conclusions: Software modifications, informed by successive rounds of usability testing, resulted in sufficient gains in usability to undertake piloting. Insights generated during evaluations prompted us to find the appropriate balance between optimal security and ease of use. Trial Registration: ClinicalTrials.gov NCT03296202; https://clinicaltrials.gov/ct2/show/NCT03296202 International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/resprot.9439 %M 31850847 %R 10.2196/15013 %U http://formative.jmir.org/2019/4/e15013/ %U https://doi.org/10.2196/15013 %U http://www.ncbi.nlm.nih.gov/pubmed/31850847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13854 %T Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study %A Côté,Mélina %A Lapointe,Annie %A Laramée,Catherine %A Lemieux,Simone %A Desroches,Sophie %A Belanger-Gravel,Ariane %A Lamarche,Benoît %+ Centre Nutrition, Santé, et Société, Institute of Nutrition and Functional Foods, Université Laval, 2440 Hochelaga Boulevard, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 404355, benoit.lamarche@fsaa.ulaval.ca %K focus groups %K qualitative research %K social class %K research subject %K retention %D 2019 %7 10.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. Methods: A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants’ beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet. %M 31821149 %R 10.2196/13854 %U http://formative.jmir.org/2019/4/e13854/ %U https://doi.org/10.2196/13854 %U http://www.ncbi.nlm.nih.gov/pubmed/31821149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15000 %T Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study %A Ssemugabo,Charles %A Rutebemberwa,Elizeus %A Kajungu,Dan %A Pariyo,George W %A Hyder,Adnan A %A Gibson,Dustin G %+ Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, New Mulago Hill Road, Kampala, Uganda, 256 779625182, cssemugabo@gmail.com %K mobile phones %K interactive voice response %K surveillance %K behavioral risk factors %K noncommunicable diseases %K Uganda %D 2019 %7 3.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective: This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods: This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results: Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions: Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors. %M 31793889 %R 10.2196/15000 %U http://formative.jmir.org/2019/4/e15000/ %U https://doi.org/10.2196/15000 %U http://www.ncbi.nlm.nih.gov/pubmed/31793889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13728 %T A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Mull,Kristin E %A MacPherson,Laura %A Gasser,Melissa %A Bricker,Jonathan B %+ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA, , United States, 1 206 667 7314, jheffner@fredhutch.org %K tobacco %K nicotine %K smoking cessation %K depression %K smartphone %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment). %M 31774405 %R 10.2196/13728 %U http://formative.jmir.org/2019/4/e13728/ %U https://doi.org/10.2196/13728 %U http://www.ncbi.nlm.nih.gov/pubmed/31774405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13786 %T A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study %A Therkildsen,Signe Bülow %A Hansen,Linda Houlind %A Jensen,Laura Emilie Dinesen %A Finderup,Jeanette %+ Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, 45 78452525, jeajee@rm.dk %K mobile phone %K app %K patient decision aid %K dialysis %K decisional conflict %K usability %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents’ average age. Thus, the applicability of the DG cannot be definitively determined. %M 31750836 %R 10.2196/13786 %U http://formative.jmir.org/2019/4/e13786/ %U https://doi.org/10.2196/13786 %U http://www.ncbi.nlm.nih.gov/pubmed/31750836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12883 %T The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study %A van der Vaart,Rosalie %A van Driel,Dorine %A Pronk,Kristel %A Paulussen,Suzan %A te Boekhorst,Selma %A Rosmalen,Judith G M %A Evers,Andrea W M %+ Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Wassenaarseweg 52, Leiden, Netherlands, 31 071 5276633, r.vandervaart@fsw.leidenuniv.nl %K internet-based cognitive behavior therapy %K chronic pain %K usability %K digital health literacy skills %K eHealth literacy %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based cognitive behavior therapy (iCBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Studies with a focus on the patient regarding usability of interventions and digital health literacy skills are especially lacking. Objective: The goal of this study was to assess the usability of an iCBT for chronic pain, Master Your Pain, and the relationship between its usability outcomes and the factors age, educational level, and digital health literacy skills. The aims were to determine what changes were needed in the program for sufficient usability and which individual characteristics were related to the usability of the program. Methods: Patients were recruited from two mental health care practices. A mixed methods approach was used in this study. A qualitative observational study comprising performance tasks in the iCBT program was used to test usability. A quantitative questionnaire was used to measure possible related constructs. Usability was operationalized as the number of tasks that could be completed and the type and number of problems that occurred while doing so. Performance tasks were set up to measure 6 digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) using search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. The qualitative observational data was coded using inductive analysis by two independent researchers. Correlational analyses were performed to test how usability relates to sociodemographics and digital health literacy. Results: A total of 32 patients participated, with a mean age of 49.9 years and 84% (27/32) being female. All performance tasks except one (fill in a diary registration) could be completed independently by more than 50% of the participants. On operational, navigation, and search levels, participants struggled most with logging in, logging out, and finding specific parts of the intervention. Half of the sample experienced problems evaluating the relevance and adding content to the program to some extent. Usability correlated moderately negatively with age and moderately positively with digital health literacy skills but not with educational level. Conclusions: The results provide insight into what is essential for proper usability regarding the design of an iCBT program considering variations in age, educational level, and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Tailoring support among the needs of certain age groups or skill levels could be beneficial and could range from no extra support (only online feedback, as intended) to practical support (an additional usability introduction session) to blended care (combined face-to-face sessions throughout the therapy). %M 31750839 %R 10.2196/12883 %U http://formative.jmir.org/2019/4/e12883/ %U https://doi.org/10.2196/12883 %U http://www.ncbi.nlm.nih.gov/pubmed/31750839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15190 %T Feasibility and Acceptability of an Interactive Mental Well-Being Intervention for People With Intellectual Disabilities: Pilot Mixed Methods Study %A Vereenooghe,Leen %A Westermann,Kristian %+ Faculty of Psychology and Sports Science, Bielefeld University, PO Box 10 01 31, Bielefeld, D-33501, Germany, 49 521106 ext 67521, leen.vereenooghe@uni-bielefeld.de %K intellectual disabilities %K feasibility studies %K tablet computer %K mental health %D 2019 %7 14.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of both digital and traditional mental well-being interventions is rising, but these interventions typically do not consider people with intellectual disabilities as potential users. Objective: The study aimed to explore the acceptability and feasibility of a new digital intervention, developed with and for people with intellectual disabilities, to improve their subjective well-being. Methods: Using a single-group pre-post design, participants with intellectual disabilities and their caregivers completed the 4-week intervention. Mixed methods questionnaires assessed the acceptability of the intervention, in addition to self-report and proxy-report measures of subjective well-being and behavioral problems. Results: A total of 12 men with mild to moderate intellectual disabilities enrolled in and completed the study alongside 8 caregivers. Participant acceptability of the intervention was high, and feedback covered multiple aspects of the intervention, including (1) program concept and design, (2) program content, and (3) intervention usage. Self-rated mood barometers indicated mood improvements for 5 participants, deteriorations for 2 participants, and no observed changes for the remaining participants. Statistical analyses yielded no difference from pretest (median=79; range 39-86) to posttest (median=79; range 21-96) for subjective well-being in people with intellectual disabilities (W=10.5; P=.17) and for behavioral problems (W=14; P=.05). Conclusions: People with intellectual disabilities and their caregivers are receptive to using digital well-being interventions, and this research shows such interventions to be feasible in routine practice. Given the acceptability of the intervention, its potential efficacy can now be evaluated in people with intellectual disabilities and symptoms of reduced mental well-being. %M 31724954 %R 10.2196/15190 %U http://formative.jmir.org/2019/4/e15190/ %U https://doi.org/10.2196/15190 %U http://www.ncbi.nlm.nih.gov/pubmed/31724954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14906 %T Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study %A Scheier,Lawrence Matthew %A Kumpfer,Karol L %A Brown,Jaynie Litster %A Hu,QingQing %+ LARS Research Institute, 15029 North Thompson Peak Blvd, Suite B111-443, Scottsdale, AZ, 85260, United States, 1 702 630 7584, scheier@larsri.org %K formative evaluation %K parenting skills %K drug prevention %K focus groups %K key stakeholders %K consumer preference survey %K internet intervention %D 2019 %7 5.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. Objective: The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. Methods: We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. Results: Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). Conclusions: Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention. %M 31687934 %R 10.2196/14906 %U http://formative.jmir.org/2019/4/e14906/ %U https://doi.org/10.2196/14906 %U http://www.ncbi.nlm.nih.gov/pubmed/31687934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12966 %T A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation %A Appleton,Katherine Marie %A Bray,Jeff %A Price,Sarah %A Liebchen,Gernot %A Jiang,Nan %A Mavridis,Ioannis %A Saulais,Laure %A Giboreau,Agnès %A Perez-Cueto,Federico J A %A Coolen,Rebecca %A Ronge,Manfred %A Hartwell,Heather %+ Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 965985, k.appleton@bournemouth.ac.uk %K eating %K eating behavior %K food %K diet %K mhealth %K mobile app %K digitalhealth %K smartphone %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. %M 31682575 %R 10.2196/12966 %U http://formative.jmir.org/2019/4/e12966/ %U https://doi.org/10.2196/12966 %U http://www.ncbi.nlm.nih.gov/pubmed/31682575 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e13560 %T Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation %A Campeau-Vallerand,Charles %A Michaud,François %A Routhier,François %A Archambault,Philippe S %A Létourneau,Dominic %A Gélinas-Bronsard,Dominique %A Auger,Claudine %+ School of Rehabilitation, Faculty of Medicine, Université de Montréal, PO Box 6128 Centre-ville Station, Montreal, QC, H3C 3J7, Canada, 1 514 340 2085 ext 4723, claudine.auger@umontreal.ca %K wheelchairs %K eHealth %K health behavior %K pressure ulcers %K self-help devices %K remote sensing technology %K technology assessment %D 2019 %7 26.10.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up. Objective: This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians. Methods: On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts. Results: A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up. Conclusions: On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype. %M 31674918 %R 10.2196/13560 %U https://rehab.jmir.org/2019/2/e13560 %U https://doi.org/10.2196/13560 %U http://www.ncbi.nlm.nih.gov/pubmed/31674918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14327 %T Web-Based Health Information Seeking Among Students at Kuwait University: Cross-Sectional Survey Study %A Ashkanani,Hasan %A Asery,Rabab %A Bokubar,Fajer %A AlAli,Noor %A Mubarak,Shahad %A Buabbas,Ali %A Almajran,Abdullah %+ Faculty of Medicine, Kuwait University, Block 4, Fourth Ring Road, Health Sciences Center, Jabriyah, Kuwait, 965 246 36559, hasanashkanani@hotmail.com %K Kuwait %K online %K health care %D 2019 %7 31.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Owing to the revolution in technology, the internet has become an important aspect of people’s lives. Modern technology is enabling people from diverse educational backgrounds to use the internet for several purposes, one of which is health information seeking. Recently, Web-based health information has become more popular among patients all over the world and among the general public. Objective: This study aimed to investigate the use of Web-based health resources among undergraduate students from different faculties at Kuwait University. Methods: The study employed a cross-sectional design with students selected from 8 faculties of Kuwait University, 4 faculties of Literature and 4 faculties of Science. Data were collected using structured questionnaires, and analysis was done using a chi-square test and binary logistic regression to determine the factors associated with seeking health information on the Web. Results: The sample size obtained was 1132 with a response rate of 90.27% (1132/1254). Overall, the prevalence of students seeking Web-based health information was 92.66%. (1049/1132) The most significant factors associated with seeking health information on the Web were age, gender, faculty, year of study, primary source of internet, and level of experience with internet use. In total, 90.0% (325/361) of students who were aged older than 21 years used Web-based health information compared with 82.8% (275/332) of those who were aged 18 years. In addition, female students showed a higher prevalence (829/934, 88.8%) of Web-based health information seeking than males (210/270, 77.8%). Students who majored in faculties of Science were more likely to seek health information than those who majored in faculties of Literature. All the differences found in the study were statistically significant (P<.05). Conclusions: The study concluded that many people use the internet for seeking health information. Sociodemographic factors have a significant association with Web-based health information seeking. Therefore, doctors must educate the public about the health information websites that can be trusted. %M 31473592 %R 10.2196/14327 %U http://formative.jmir.org/2019/4/e14327/ %U https://doi.org/10.2196/14327 %U http://www.ncbi.nlm.nih.gov/pubmed/31473592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e11266 %T Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study %A Fowler,Christopher A %A Ballistrea,Lisa M %A Mazzone,Kerry E %A Martin,Aaron M %A Kaplan,Howard %A Kip,Kevin E %A Ralston,Katherine %A Murphy,Jennifer L %A Winkler,Sandra L %+ Research and Development Service, James A Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL, 33705, United States, 1 813 558 3904, christopher.fowler3@va.gov %K chronic pain %K virtual reality %K Veterans %K pain management %K rehabilitation %K fear of movement %K kinesiophobia %K exposure therapy %K distraction therapy %D 2019 %7 30.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual reality (VR) has demonstrated efficacy for distraction from pain-related thoughts and exposure to feared movements. Little empirical VR research has focused on chronic pain management. Objective: The purpose of this study was to examine the feasibility of VR as an adjunctive intervention for Veterans with chronic pain. We designed a hierarchy ranging from low-intensity pain distraction to high-intensity movement-based exposure for this purpose. VR apps were mapped onto the hierarchy. Methods: Sixteen Veterans receiving inpatient chronic pain rehabilitation participated in daily VR sessions over a 3-week period. Trajectories across the distraction-to-exposure hierarchy and Veteran-reported intensity ratings were described and evaluated over time. Minimum clinically important differences (MCIDs), pre-post effect sizes, and 95% confidence intervals were examined for fear of movement using the Fear of Daily Activities Questionnaire (FDAQ) and Pain Outcomes Questionnaire-VA (POQ-VA; fear scale). This approach was applied to secondary outcomes: POQ-VA (pain intensity, interference, negative affect), Pain Catastrophizing Scale, and Patient-Specific Functioning Scale (PSFS). Session attendance, completion, and VR experiences were described. Results: Ten of 14 Veterans (71%) who participated in three or more VR sessions completed the distraction-to-exposure hierarchy. Only three trajectories emerged more than once. Due to high completion rates, Veterans that completed the hierarchy could self-select nonhierarchy apps. Veterans rated all hierarchy levels (low, medium, high) near medium intensity. Self-selected activities were rated as high intensity. For kinesiophobia, six Veterans (38%) exceeded the MCID on the FDAQ and a small effect size improvement was observed (Cohen d=−0.35). The confidence interval (95% CI −0.71 to 0.01) indicated the possibility of a null effect. The POQ-VA fear scale yielded no effect (Cohen d=0.06, 95% CI −0.43 to 0.54). For secondary outcomes, Veterans exceeding MCID were calculated with complete data: pain intensity (1/15, 7%), pain catastrophizing (5/14, 36%), and patient-specific functioning (10/15, 67%). Effect sizes were large for patient-specific functioning (Cohen d=1.14, 95% CI 0.50-1.78), medium for mobility interference (Cohen d=−0.56, 95% CI −0.96 to −0.16), and small for pain intensity (Cohen d=−0.40, 95% CI −0.69 to −0.12) and catastrophizing (Cohen d=−0.41, 95% CI −0.79 to −0.02). No effects were observed for interference in daily activities (Cohen d=0.10, 95% CI −0.27 to 0.47) and negative affect (Cohen d=0.07, 95% CI −0.26 to 0.40). Veterans attended 85.2% (98/108) of VR sessions and completed 95% (93/96) of sessions attended. Twenty-minute sessions were rated as too short. No significant adverse events were reported. Conclusions: Findings support the feasibility of VR as an adjunct for Veterans with chronic pain. However, the hierarchy will require modification, as evidenced by homogeneous intensity ratings. Veteran-selected activities presented the highest intensity ratings, largest outcome effect size (PSFS), and MCID. This highlights the important role of utilizing Veteran stakeholders in hierarchy modification, design of VR interventions, and outcome selection. %M 31670696 %R 10.2196/11266 %U http://formative.jmir.org/2019/4/e11266/ %U https://doi.org/10.2196/11266 %U http://www.ncbi.nlm.nih.gov/pubmed/31670696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13863 %T Accuracy of a Chatbot (Ada) in the Diagnosis of Mental Disorders: Comparative Case Study With Lay and Expert Users %A Jungmann,Stefanie Maria %A Klan,Timo %A Kuhn,Sebastian %A Jungmann,Florian %+ Department of Psychology, Johannes Gutenberg-University Mainz, Wallstraße 3, Mainz, 55122, Germany, 49 61313939201, jungmann@uni-mainz.de %K artificial intelligence %K eHealth %K mental disorders %K mHealth %K screening %K (mobile) app %K diagnostic %D 2019 %7 29.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Health apps for the screening and diagnosis of mental disorders have emerged in recent years on various levels (eg, patients, practitioners, and public health system). However, the diagnostic quality of these apps has not been (sufficiently) tested so far. Objective: The objective of this pilot study was to investigate the diagnostic quality of a health app for a broad spectrum of mental disorders and its dependency on expert knowledge. Methods: Two psychotherapists, two psychology students, and two laypersons each read 20 case vignettes with a broad spectrum of mental disorders. They used a health app (Ada—Your Health Guide) to get a diagnosis by entering the symptoms. Interrater reliabilities were computed between the diagnoses of the case vignettes and the results of the app for each user group. Results: Overall, there was a moderate diagnostic agreement (kappa=0.64) between the results of the app and the case vignettes for mental disorders in adulthood and a low diagnostic agreement (kappa=0.40) for mental disorders in childhood and adolescence. When psychotherapists applied the app, there was a good diagnostic agreement (kappa=0.78) regarding mental disorders in adulthood. The diagnostic agreement was moderate (kappa=0.55/0.60) for students and laypersons. For mental disorders in childhood and adolescence, a moderate diagnostic quality was found when psychotherapists (kappa=0.53) and students (kappa=0.41) used the app, whereas the quality was low for laypersons (kappa=0.29). On average, the app required 34 questions to be answered and 7 min to complete. Conclusions: The health app investigated here can represent an efficient diagnostic screening or help function for mental disorders in adulthood and has the potential to support especially diagnosticians in their work in various ways. The results of this pilot study provide a first indication that the diagnostic accuracy is user dependent and improvements in the app are needed especially for mental disorders in childhood and adolescence. %M 31663858 %R 10.2196/13863 %U http://formative.jmir.org/2019/4/e13863/ %U https://doi.org/10.2196/13863 %U http://www.ncbi.nlm.nih.gov/pubmed/31663858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13013 %T A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App %A Li,Ling-Jun %A Aris,Izzuddin M %A Han,Wee Meng %A Tan,Kok Hian %+ Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower Level 3, Singapore, 229899, Singapore, 65 63941099, queenie.li.l.j@gmail.com %K overweight, obesity, pregnant women %K gestational weight gain %K food diary %K randomized controlled trial %K smartphone app %K food coaching %K dietary recommendation %K feasibility %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective: In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods: We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results: Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group. Conclusions: Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. %M 31651407 %R 10.2196/13013 %U http://formative.jmir.org/2019/4/e13013/ %U https://doi.org/10.2196/13013 %U http://www.ncbi.nlm.nih.gov/pubmed/31651407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15738 %T Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial %A Hamatani,Sayo %A Numata,Noriko %A Matsumoto,Kazuki %A Sutoh,Chihiro %A Ibuki,Hanae %A Oshiro,Keiko %A Tanaka,Mari %A Setsu,Rikukage %A Kawasaki,Yohei %A Hirano,Yoshiyuki %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, 1-8-1, Chuo-ku, Chiba, Japan, 81 43 226 207, n_numata@chiba-u.jp %K bulimia nervosa %K binge-eating disorder %K cognitive behavioral therapy %K internet-based cognitive behavioral therapy %K videoconference %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory–Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=–0.76), there was no significant reduction in the combined episodes (EDE 16D –41; 95% CI –2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419 %M 31647472 %R 10.2196/15738 %U http://formative.jmir.org/2019/4/e15738/ %U https://doi.org/10.2196/15738 %U http://www.ncbi.nlm.nih.gov/pubmed/31647472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13286 %T Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis %A Chen,Jessica %A Kaye,Leanne %A Tuffli,Michael %A Barrett,Meredith A %A Jones-Ford,Shelanda %A Shenouda,Tina %A Gondalia,Rahul %A Henderson,Kelly %A Combs,Veronica %A Van Sickle,David %A Stempel,David A %+ Propeller Health, 47 Maiden Lane, 3rd Floor, San Francisco, CA, United States, 1 608 251 0470, leanne.kaye@propellerhealth.com %K chronic obstructive pulmonary disease %K telemedicine %K quality improvement, feasibility %K nebulizers and vaporizers %K health services %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health programs assist patients with chronic obstructive pulmonary disease (COPD) to better manage their disease. Technological and adoption barriers have been perceived as a limitation. Objective: The aim of the research was to evaluate a digital quality improvement pilot in Medicare-eligible patients with COPD. Methods: COPD patients were enrolled in a digital platform to help manage their medications and symptoms as part of their routine clinical care. Patients were provided with electronic medication monitors (EMMs) to monitor short-acting beta-agonist (SABA) use passively and a smartphone app to track use trends and receive feedback. Providers also had access to data collected via a secure website and were sent email notifications if a patient had a significant change in their prescribed inhaler use. Providers then determined if follow-up was needed. Change in SABA use and feasibility outcomes were evaluated at 3, 6, and 12 months. Results: A total of 190 patients enrolled in the pilot. At 3, 6, and 12 months, patients recorded significant reductions in daily and nighttime SABA use and increases in SABA-free days (all P<.001). Patient engagement, as measured by the ratio of daily active use to monthly active use, was >90% at both 6 and 12 months. Retention at 6 months was 81% (154/190). Providers were sent on average two email notifications per patient during the 12-month program. Conclusions: A digital health program integrated as part of standard clinical practice was feasible and had low provider burden. The pilot demonstrated significant reduction in SABA use and increased SABA-free days among Medicare-eligible COPD patients. Further, patients readily adopted the digital platform and demonstrated strong engagement and retention rates at 6 and 12 months. %M 31647471 %R 10.2196/13286 %U http://formative.jmir.org/2019/4/e13286/ %U https://doi.org/10.2196/13286 %U http://www.ncbi.nlm.nih.gov/pubmed/31647471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12346 %T Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series %A Thorpe,Julia %A Forchhammer,Birgitte Hysse %A Maier,Anja M %+ Engineering Systems Design, DTU Management, Technical University of Denmark, Diplomvej, Building 317, Kongens Lyngby, 2800, Denmark, 45 45256045, amai@dtu.dk %K dementia %K cognitive rehabilitation %K mobility %K activity %K mHealth %K uHealth %K pervasive health care %K P4 health care %K health care design %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. Objective: The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. Methods: A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. Results: Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants’ self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. Conclusions: Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come. %M 31625951 %R 10.2196/12346 %U http://formative.jmir.org/2019/4/e12346/ %U https://doi.org/10.2196/12346 %U http://www.ncbi.nlm.nih.gov/pubmed/31625951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14052 %T Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions %A Cole-Lewis,Heather %A Ezeanochie,Nnamdi %A Turgiss,Jennifer %+ Johnson and Johnson Health and Wellness Solutions, Inc, 1 Johnson and Johnson Plaza, New Brunswick, NJ, 08933, United States, 1 7209330786, nezeanoc@its.jnj.com %K engagement %K user engagement %K health behavior %K health determinants %K digital behavior change intervention %K measurements %D 2019 %7 10.10.2019 %9 Viewpoint %J JMIR Form Res %G English %X Researchers and practitioners of digital behavior change interventions (DBCI) use varying and, often, incongruent definitions of the term “engagement,” thus leading to a lack of precision in DBCI measurement and evaluation. The objective of this paper is to propose discrete definitions for various types of user engagement and to explain why precision in the measurement of these engagement types is integral to ensuring the intervention is effective for health behavior modulation. Additionally, this paper presents a framework and practical steps for how engagement can be measured in practice and used to inform DBCI design and evaluation. The key purpose of a DBCI is to influence change in a target health behavior of a user, which may ultimately improve a health outcome. Using available literature and practice-based knowledge of DBCI, the framework conceptualizes two primary categories of engagement that must be measured in DBCI. The categories are health behavior engagement, referred to as “Big E,” and DBCI engagement, referred to as “Little e.” DBCI engagement is further bifurcated into two subclasses: (1) user interactions with features of the intervention designed to encourage frequency of use (ie, simple login, games, and social interactions) and make the user experience appealing, and (2) user interactions with behavior change intervention components (ie, behavior change techniques), which influence determinants of health behavior and subsequently influence health behavior. Achievement of Big E in an intervention delivered via digital means is contingent upon Little e. If users do not interact with DBCI features and enjoy the user experience, exposure to behavior change intervention components will be limited and less likely to influence the behavioral determinants that lead to health behavior engagement (Big E). Big E is also dependent upon the quality and relevance of the behavior change intervention components within the solution. Therefore, the combination of user interactions and behavior change intervention components creates Little e, which is, in turn, designed to improve Big E. The proposed framework includes a model to support measurement of DBCI that describes categories of engagement and details how features of Little e produce Big E. This framework can be applied to DBCI to support various health behaviors and outcomes and can be utilized to identify gaps in intervention efficacy and effectiveness. %M 31603427 %R 10.2196/14052 %U https://formative.jmir.org/2019/4/e14052 %U https://doi.org/10.2196/14052 %U http://www.ncbi.nlm.nih.gov/pubmed/31603427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14493 %T Development of a Digital Decision Support Tool to Aid Participation of Children With Disabilities in Pediatric Rehabilitation Services: Explorative Qualitative Study %A Vinblad,Elin %A Larsson,Ingrid %A Lönn,Maria %A Olsson,Emma %A Nygren,Jens M %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, S-30118, Sweden, 46 35167693, petra.svedberg@hh.se %K child %K child care %K decision making %K eHealth %K disabled children %K patient participation %K rehabilitation %K qualitative research %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation. Objective: The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services. Methods: The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services. Results: A total of 3 categories emerged reflecting the participants’ possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme moving toward empowerment of children in pediatric rehabilitation, a true feeling of participation can be experienced. Conclusions: The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children’s needs and perspectives. %M 31579015 %R 10.2196/14493 %U https://formative.jmir.org/2019/4/e14493 %U https://doi.org/10.2196/14493 %U http://www.ncbi.nlm.nih.gov/pubmed/31579015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13610 %T Use of Patient-Reported Data to Match Depression Screening Intervals With Depression Risk Profiles in Primary Care Patients With Diabetes: Development and Validation of Prediction Models for Major Depression %A Jin,Haomiao %A Wu,Shinyi %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S Olive St, Suite 1400, Los Angeles, CA, 90015, United States, 1 213 821 6441, haomiaoj@usc.edu %K patient-reported data %K patient-centered decision making %K depression screening %K depression %K diabetes %K health information technology %K data analytics %K predictive modeling %K machine learning %K data mining %D 2019 %7 1.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical guidelines recommend screening for depression in the general adult population but recognizes that the optimum interval for screening is unknown. Ideal screening intervals should match the patient risk profiles. Objective: This study describes a predictive analytics approach for mining clinical and patient-reported data from a large clinical study for the identification of primary care patients at high risk for depression to match depression screening intervals with patient risk profiles. Methods: This paper analyzed data from a large safety-net primary care study for diabetes and depression. A regression-based data mining technique was used to examine 53 demographics, clinical variables, and patient-reported variables to develop three prediction models for major depression at 6, 12, and 18 months from baseline. Predictors with the strongest predictive power that require low information collection efforts were selected to develop the prediction models. Predictive accuracy was measured by the area under the receiver operating curve (AUROC) and was evaluated by 10-fold cross-validation. The effectiveness of the prediction algorithms in supporting clinical decision making for six “typical” types of patients was demonstrated. Results: The analysis included 923 patients who were nondepressed at the study baseline. Five patient-reported variables were selected in the prediction models to predict major depression at 6, 12, and 18 months: (1) Patient Health Questionnaire 2-item score; (2) the Sheehan Disability Scale; (3) previous problems with depression; (4) the diabetes symptoms scale; and (5) emotional burden of diabetes. All three depression prediction models had an AUROC>0.80, comparable with published depression prediction studies. Among the 6 “typical” types of patients, the algorithms suggest that patients who reported impaired daily functioning by health status are at an elevated risk for depression in all three periods. Conclusions: This study demonstrated that leveraging patient-reported data and prediction models can help improve identification of high-risk patients and clinical decisions about the depression screening interval for diabetes patients. Implementation of this approach can be coupled with application of modern technologies such as telehealth and mobile health assessment for collecting patient-reported data to improve privacy, reducing stigma and costs, and promoting a personalized depression screening that matches screening intervals with patient risk profiles. %M 31573900 %R 10.2196/13610 %U https://formative.jmir.org/2019/4/e13610 %U https://doi.org/10.2196/13610 %U http://www.ncbi.nlm.nih.gov/pubmed/31573900 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12852 %T Using a Mobile Diary App in the Treatment of Borderline Personality Disorder: Mixed Methods Feasibility Study %A Helweg-Joergensen,Stig %A Schmidt,Thomas %A Lichtenstein,Mia Beck %A Pedersen,Susanne S %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 6550 2740, stighj@rsyd.dk %K borderline personality disorder %K mHealth %K implementation %K focus groups %K e-diary %K mobile app %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Borderline personality disorder (BPD) is a disorder characterized by difficulties with regulating emotions and impulsive behavior. Long-term monitoring of progress during BPD psychotherapy constitutes a challenge using paper and pencil registration. Hence, a mobile app assessing emotions and progress in treatment may be useful. Objective: The aim of this study was to examine the feasibility of using the mDiary app as an adjunct to dialectical behavior therapy (DBT) for the treatment of BPD. Methods: A total of 9 focus group interviews were conducted and analyzed according to the grounded theory approach. Furthermore, the usability of the mDiary app was examined using the System Usability Scale (SUS). The app was implemented in a standard DBT program as an adjunct to DBT. In total, 16 patients (age range 19-41 years) and 23 therapists (age range 25-64 years) from 5 Danish public outpatient psychiatric treatment facilities participated in the study. Results: Overall, patients were satisfied with the mDiary app, as it was “easy to use” and “always there.” Inside-out innovation, meaning new work tasks generated during implementation and communication of modifications needed in the app, was found to influence the perceived usability negatively among the interviewed therapists. The patients rated the usability as high (mean SUS score 81.2, SD 9.9), whereas therapists rated the mDiary app at an average level (mean 68.3, SD 14.3). Older age of the users correlated with lower usability ratings on the SUS score (Pearson r=−0.60). Conclusions: The mDiary app was considered as an acceptable and relevant way of registering DBT diary data for both patients and therapists generating increased long-term overview. Older users were overall more reluctant to accept this new technology in clinical practice. Time to align expectations among involved parties needs to be set aside when implementing this new approach to patient monitoring. Here, the focus should be on the realistic use of resources and expected impact on present clinical work. %M 31573910 %R 10.2196/12852 %U http://formative.jmir.org/2019/3/e12852/ %U https://doi.org/10.2196/12852 %U http://www.ncbi.nlm.nih.gov/pubmed/31573910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11617 %T A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment %A Welbie,Marlies %A Wittink,Harriet %A Westerman,Marjan J %A Topper,Ilse %A Snoei,Josca %A Devillé,Walter L J M %+ Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Postbus 12011, Utrecht, 3501 AA, Netherlands, 31 638192100, marlies.welbie@hu.nl %K mHealth %K eHealth %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies. %M 31573909 %R 10.2196/11617 %U https://formative.jmir.org/2019/3/e11617 %U https://doi.org/10.2196/11617 %U http://www.ncbi.nlm.nih.gov/pubmed/31573909 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13662 %T Technology-Enabled Mental Health Service Reform for Open Arms – Veterans and Families Counselling: Participatory Design Study %A LaMonica,Haley M %A Davenport,Tracey A %A Burns,Jane %A Cross,Shane %A Hodson,Stephanie %A Veitch,Jennifer %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 286276939, haley.lamonica@sydney.edu.au %K veterans %K mental health %K technology %K community-based participatory research %K health care reform %K stakeholder participation %D 2019 %7 19.09.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of mental ill-health on every aspect of the lives of a large number of Australian Defence Force (ADF) personnel, their partners, and their families is widely recognized. Recent Senate inquiries have highlighted gaps in service delivery as well as the need for service reform to ensure appropriate care options for individuals who are currently engaged with mental health and support services as well as for those who, for a variety of reasons, have not sought help. To that end, successive Australian governments generally and the Department of Veterans’ Affairs specifically have prioritized veteran-centric reform. Open Arms is an Australia-wide service that provides counseling and support to current and former ADF personnel, and their family members, for mental health conditions. Objective: The aim of this study was to develop and configure a prototypic Web-based platform for Open Arms – Veterans & Families Counselling (formerly Veterans and Veterans Families Counselling Service) with the Open Arms community to enhance the quality of mental health services provided by Open Arms. Methods: The study aimed to recruit up to 100 people from the Open Arms community (current and former ADF personnel and their families, health professionals, service managers, and administrators) in regions of New South Wales, including Sydney, Canberra, Maitland, Singleton, and Port Stephens. Participants were invited to participate in 4-hour participatory design workshops. A variety of methods were used within the workshops, including prompted discussion, review of working prototypes, creation of descriptive artifacts, and group-based development of user journeys. Results: Seven participatory design workshops were held, including a total of 49 participants. Participants highlighted that the prototype has the potential to (1) provide the opportunity for greater and better-informed personal choice in relation to options for care based on the level of need and personal preferences; (2) ensure transparency in care by providing the individual with access to all of their personal health information; and (3) improve collaborative care and care continuity by allowing information to be shared securely with current and future providers. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the development and configuration of new technologies. %M 31538937 %R 10.2196/13662 %U http://formative.jmir.org/2019/3/e13662/ %U https://doi.org/10.2196/13662 %U http://www.ncbi.nlm.nih.gov/pubmed/31538937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14329 %T Psychiatry Outpatients’ Willingness to Share Social Media Posts and Smartphone Data for Research and Clinical Purposes: Survey Study %A Rieger,Agnes %A Gaines,Averi %A Barnett,Ian %A Baldassano,Claudia Frances %A Connolly Gibbons,Mary Beth %A Crits-Christoph,Paul %+ University of Pennsylvania, Suite 650, 3535 Market Street, Philadelphia, PA, 19104, United States, 1 215 662 7993, crits@pennmedicine.upenn.edu %K social media %K smartphone %K outpatients %K psychiatry %K psychotherapy %K digital health %K mhealth %K digital phenotyping %K privacy %K user preferences %D 2019 %7 29.8.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychiatry research has begun to leverage data collected from patients’ social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited. Objective: This study aimed at understanding the outpatients’ willingness to have information from their social media posts and their smartphones used for clinical or research purposes. Methods: In this survey study, we surveyed patients (N=238) in an outpatient clinic waiting room. Willingness to share social media and passive smartphone data was summarized for the sample as a whole and broken down by sex, age, and race. Results: Most patients who had a social media account and who were receiving talk therapy treatment (74.4%, 99/133) indicated that they would be willing to share their social media posts with their therapists. The percentage of patients willing to share passive smartphone data with researchers varied from 40.8% (82/201) to 60.7% (122/201) depending on the parameter, with sleep duration being the parameter with the highest percentage of patients willing to share. A total of 30.4% of patients indicated that media stories of social media privacy breaches made them more hesitant about sharing passive smartphone data with researchers. Sex and race were associated with willingness to share smartphone data, with men and whites being the most willing to share. Conclusions: Our results indicate that most patients in a psychiatric outpatient setting would share social media and passive smartphone data and that further research elucidating patterns of willingness to share passive data is needed. %M 31493326 %R 10.2196/14329 %U http://formative.jmir.org/2019/3/e14329/ %U https://doi.org/10.2196/14329 %U http://www.ncbi.nlm.nih.gov/pubmed/31493326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14530 %T Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study %A Gilson,Aaron %A Dodds,Debby %A Kaur,Arveen %A Potteiger,Michael %A Ford II,James H %+ University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K mood change %K caregiver interactions %K older adults %K Alzheimer disease %K dementia %K computer tablets %K person-centered care %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective: This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients’ mood changes and caregivers’ daily interactions. Methods: The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers’ assessment of care recipients’ mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers’ daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers’ daily activities. Results: The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers’ day, the largest effect was observed when care recipients’ mood was considered to have improved following the session (χ24=234.7; P<.001). Conclusions: The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers’ perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT’s impact on additional clinical outcomes is needed to confirm these preliminary findings. %M 31482847 %R 10.2196/14530 %U http://formative.jmir.org/2019/3/e14530/ %U https://doi.org/10.2196/14530 %U http://www.ncbi.nlm.nih.gov/pubmed/31482847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11555 %T Developing a Digital Solution for Dengue Through Epihack: Qualitative Evaluation Study of a Five-Day Health Hackathon in Sri Lanka %A Panchapakesan,Chitra %A Sheldenkar,Anita %A Wimalaratne,Prasad %A Wijayamuni,Ruwan %A Lwin,May Oo %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore,, Singapore, 65 9446 6036, chitra002@e.ntu.edu.sg %K Epihack %K civic engagement %K dengue %K digital epidemiology %K participatory surveillance %K participatory epidemiology %K participatory design %K workshop %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Dengue is a mosquito-borne viral disease that has increasingly affected Sri Lanka in recent years. To address this issue, dengue surveillance through increasingly prevalent digital surveillance applications has been suggested for use by health authorities and the general public. Epihack Sri Lanka was a 5-day hackathon event organized to develop a digital dengue surveillance tool. Objective: The goal of the research was to examine the effectiveness of a collaborative hackathon that brought together information technology (IT) and health experts from around the globe to develop a solution to the dengue pandemic in Sri Lanka. Methods: Ethnographic observation and qualitative informal interviews were conducted with 58 attendees from 11 countries over the 5-day Epihack to identify the main factors that influence a collaborative hackathon. Interviews were transcribed and coded based on grounded theory. Results: Three major themes were identified during the Epihack Sri Lanka event: engagement, communication, and current disease environment. Unlike other hackathons, Epihack had no winners or prizes and was collaborative rather than competitive, which worked well in formulating a variety of ideas and bringing together volunteers with a sense of civic duty to improve public health. Having health and IT experts work together concurrently was received positively and considered highly beneficial to the development of the product. Participants were overall very satisfied with the event, although they thought it could have been longer. Communication issues and cultural differences were observed but continued to decrease as the event progressed. This was found to be extremely important to the efficiency of the event, which highlighted the benefit of team-bonding exercises. Bringing expert knowledge and examples of systems from around the world benefited the creation of new ideas. However, developing a system that can adapt and cater to the local disease environment is important in successfully developing the concepts. Conclusions: Epihack Sri Lanka was successful in bringing together health and IT experts to develop a digital solution for dengue surveillance. The collaborative format achieved a variety of fruitful ideas and may lead to more hackathons working in this way in the future. Good communication, participant engagement, and stakeholder interest with adaptation of ideas to complement the current environment are vital to achieve the goals of the event. %M 31469074 %R 10.2196/11555 %U http://formative.jmir.org/2019/3/e11555/ %U https://doi.org/10.2196/11555 %U http://www.ncbi.nlm.nih.gov/pubmed/31469074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13411 %T Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm, Prospective Feasibility Study %A Holzman,Samuel B %A Atre,Sachin %A Sahasrabudhe,Tushar %A Ambike,Sunil %A Jagtap,Deepak %A Sayyad,Yakub %A Kakrani,Arjun Lal %A Gupta,Amita %A Mave,Vidya %A Shah,Maunank %+ Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1550 Orleans St, Cancer Research Building, Room 1M-10, Baltimore, MD,, United States, 1 443 287 0401, mshah28@jhmi.edu %K Video DOT %K mHealth %K tuberculosis %K medication adherence %K telemedicine %K India %K mobile phone %K smartphone %D 2019 %7 27.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: India accounts for nearly one-quarter of the global tuberculosis (TB) burden. Directly observed treatment (DOT) through in-person observation is recommended in India, although implementation has been heterogeneous due largely to resource limitations. Video DOT (vDOT) is a novel, smartphone-based approach that allows for remote treatment monitoring through patient-recorded videos. Prior studies in high-income, low disease burden settings, such as the United States, have shown vDOT to be feasible, although little is known about the role it may play in resource-limited, high-burden settings. Objective: The goal of the research was to assess the feasibility and acceptability of vDOT for adherence monitoring within a resource-limited, high TB burden setting of India. Methods: We conducted a prospective, single-arm, pilot implementation of vDOT in Pune, India. Outcome measures included adherence (proportion of prescribed doses observed by video) and verifiable fraction (proportion of prescribed doses observed by video or verbally confirmed with the patient following an incomplete/unverifiable video submission). vDOT acceptability among patients was assessed using a posttreatment survey. Results: A total of 25 patients enrolled. The median number of weeks on vDOT was 13 (interquartile range [IQR] 11-16). Median adherence was 74% (IQR 62%-84%), and median verifiable fraction was 86% (IQR 74%-98%). More than 90% of patients reported recording and uploading videos without difficulty. Conclusions: We have demonstrated that vDOT may be a feasible and acceptable approach to TB treatment monitoring in India. Our work expands the evidence base around vDOT by being one of the first efforts to evaluate vDOT within a resource-limited, high TB burden setting. To our knowledge, this is the first reported use of vDOT in India. %M 31456581 %R 10.2196/13411 %U http://formative.jmir.org/2019/3/e13411/ %U https://doi.org/10.2196/13411 %U http://www.ncbi.nlm.nih.gov/pubmed/31456581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12216 %T An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation %A Bandong,Aila Nica %A Mackey,Martin %A Leaver,Andrew %A Ingram,Rodney %A Sterling,Michele %A Ritchie,Carrie %A Kelly,Joan %A Rebbeck,Trudy %+ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, 2141, Australia, 61 452578705, aban9213@uni.sydney.edu.au %K primary health care %K whiplash injuries %K clinical decision support %K clinical pathways %K rehabilitation %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective: The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods: This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results: The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions: A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators. %M 31452515 %R 10.2196/12216 %U http://formative.jmir.org/2019/3/e12216/ %U https://doi.org/10.2196/12216 %U http://www.ncbi.nlm.nih.gov/pubmed/31452515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14788 %T An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study %A Wilroy,Jereme D %A Martin Ginis,Kathleen A %A Rimmer,James H %A Wen,Huacong %A Howell,Jennifer %A Lai,Byron %+ Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, 1717 6th Avenue South, Birmingham, AL, 35233, United States, 1 205 934 9754, jdwilroy@uab.edu %K physical activity %K mhealth %K ehealth %K people with disabilities %K spinal cord injuries %D 2019 %7 21.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. Objective: The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. Methods: The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. Results: The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0. Conclusions: This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial. %M 31436161 %R 10.2196/14788 %U http://formative.jmir.org/2019/3/e14788/ %U https://doi.org/10.2196/14788 %U http://www.ncbi.nlm.nih.gov/pubmed/31436161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12972 %T The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care %A Kip,Hanneke %A Kelders,Saskia M %A Bouman,Yvonne H A %A van Gemert-Pijnen,Lisette J E W C %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534896536, h.kip@utwente.nl %K eHealth %K technology development %K virtual reality %K forensic psychiatry %K community-based participatory research %K human-centered design %K case study %D 2019 %7 19.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. Objective: The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). Methods: In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. Results: Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. Conclusions: Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed. %M 31429415 %R 10.2196/12972 %U http://www.jmir.org/2019/8/e12972/ %U https://doi.org/10.2196/12972 %U http://www.ncbi.nlm.nih.gov/pubmed/31429415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14438 %T Validity of the Polar M430 Activity Monitor in Free-Living Conditions: Validation Study %A Henriksen,André %A Grimsgaard,Sameline %A Horsch,Alexander %A Hartvigsen,Gunnar %A Hopstock,Laila %+ Department of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 77645214, andre.henriksen@uit.no %K actigraphy %K fitness trackers %K motor activity %K validation studies %D 2019 %7 16.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Accelerometers, often in conjunction with heart rate sensors, are extensively used to track physical activity (PA) in research. Research-grade instruments are often expensive and have limited battery capacity, limited storage, and high participant burden. Consumer-based activity trackers are equipped with similar technology and designed for long-term wear, and can therefore potentially be used in research. Objective: We aimed to assess the criterion validity of the Polar M430 sport watch, compared with 2 research-grade instruments (ActiGraph and Actiheart), worn on 4 different locations using 1- and 3-axis accelerometers. Methods: A total of 50 participants wore 2 ActiGraphs (wrist and hip), 2 Actihearts (upper and lower chest position), and 1 Polar M430 sport watch for 1 full day. We compared reported time (minutes) spent in sedentary behavior and in light, moderate, vigorous, and moderate to vigorous PA, step counts, activity energy expenditure, and total energy expenditure between devices. We used Pearson correlations, intraclass correlations, mean absolute percentage errors (MAPEs), and Bland-Altman plots to assess criterion validity. Results: Pearson correlations between the Polar M430 and all research-grade instruments were moderate or stronger for vigorous PA (r range .59-.76), moderate to vigorous PA (r range .51-.75), steps (r range .85-.87), total energy expenditure (r range .88-.94), and activity energy expenditure (r range .74-.79). Bland-Altman plots showed higher agreement for higher intensities of PA. MAPE was high for most outcomes. Only total energy expenditure measured by the hip-worn ActiGraph and both Actiheart positions had acceptable or close to acceptable errors with MAPEs of 6.94% (ActiGraph, 3 axes), 8.26% (ActiGraph, 1 axis), 14.54% (Actiheart, upper position), and 14.37% (Actiheart, lower position). The wrist-worn ActiGraph had a MAPE of 15.94% for measuring steps. All other outcomes had a MAPE of 22% or higher. For most outcomes, the Polar M430 was most strongly correlated with the hip-worn triaxial ActiGraph, with a moderate or strong Pearson correlation for sedentary behavior (r=.52) and for light (r=.7), moderate (r=.57), vigorous (r=.76), and moderate to vigorous (r=.75) PA. In addition, correlations were strong or very strong for activity energy expenditure (r=.75), steps (r=.85), and total energy expenditure (r=.91). Conclusions: The Polar M430 can potentially be used as an addition to established research-grade instruments to collect some PA variables over a prolonged period. However, due to the high MAPE of most outcomes, only total energy expenditure can be trusted to provide close to valid results. Depending on the variable, the Polar M430 over- or underreported most metrics, and may therefore be better suited to report changes in PA over time for some outcomes, rather than as an accurate instrument for PA status in a population. %M 31420958 %R 10.2196/14438 %U http://formative.jmir.org/2019/3/e14438/ %U https://doi.org/10.2196/14438 %U http://www.ncbi.nlm.nih.gov/pubmed/31420958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13643 %T Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers %A Hall,Cougar %A Hoj,Taylor H %A Julian,Clark %A Wright,Geoff %A Chaney,Robert A %A Crookston,Benjamin %A West,Joshua %+ Department of Public Health, Brigham Young University, 2140 Life Science Building, Provo, UT, 84602, United States, 1 8014225656, cougar_hall@byu.edu %K public health %K physical activity %K heart rate %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. Objective: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? Methods: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. Results: The average heart rate during eMTB use was 94% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. Conclusions: Despite the measured benefit, participants’ perceived exertion while riding the eMTB was low. %M 31411139 %R 10.2196/13643 %U http://formative.jmir.org/2019/3/e13643/ %U https://doi.org/10.2196/13643 %U http://www.ncbi.nlm.nih.gov/pubmed/31411139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12824 %T A Health Education Website Developed to Meet Young People’s Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study %A Davis,Angela C %A Wright,Cassandra J C %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, megan.lim@burnet.edu.au %K adolescent %K pornography %K health promotion %K internet %K sex education %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. %M 31411140 %R 10.2196/12824 %U http://formative.jmir.org/2019/3/e12824/ %U https://doi.org/10.2196/12824 %U http://www.ncbi.nlm.nih.gov/pubmed/31411140 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12675 %T Use of Short Messaging Service to Improve Follow-Up for Abnormal Pap Test Results in Minority and Medically Underserved Women in North Carolina: Questionnaire on Attitudes and Acceptability %A Romocki,LaHoma Smith %A Des Marais,Andrea %A Cofie,Leslie %A Anderson,Chelsea %A Curington,Theresa %A Smith,Jennifer Susan %+ Department of Public Health Education, North Carolina Central University, 1801 Fayetteville Street, Durham, NC, 27707, United States, 1 919 530 6404, lromocki@nccu.edu %K cervical cancer %K Pap tests %K abnormal results %K text messaging %K appointment reminders %D 2019 %7 06.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap test results. Low rates of completion of follow-up care particularly affect low-income minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after obtaining abnormal screening results. Objective: Our aims were to determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following abnormal cervical cancer screening (Pap test) results and to examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP) and low-income minority women. Methods: The study participants were 15 low-income women who had undergone a Pap test within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Responses to closed-ended survey items were tabulated, and descriptive statistics were generated using Microsoft Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software. Results: Nearly all participants (14/15, 93%) were comfortable receiving a text message from an HCP stating that their Pap test results were available (<40 years: 100%; ≥40 years: 86%). Over half (8/15; 53%) of the participants were comfortable receiving a text message stating that their Pap test results were abnormal, although many preferred to receive such information via a phone call (6/15; 40%). Most participants (9/15; 60%) believed that receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders over text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to its wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging. Conclusions: Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by excluding explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to unauthorized individuals. Although text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications. %M 31389334 %R 10.2196/12675 %U https://formative.jmir.org/2019/3/e12675/ %U https://doi.org/10.2196/12675 %U http://www.ncbi.nlm.nih.gov/pubmed/31389334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13621 %T Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study %A Weichelt,Bryan %A Heimonen,Tomi %A Gorucu,Serap %A Redmond,Emily %A Vechinski,Josef %A Pflughoeft,Kurt %A Bendixsen,Casper %A Salzwedel,Marsha %A Scott,Erika %A Namkoong,Kang %A Purschwitz,Mark %A Rautiainen,Risto %A Murphy,Dennis J %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 7152217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K risk %K wounds and injuries %K safety %K farms %K news %K newspaper article %D 2019 %7 02.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry. Objective: The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports. Methods: Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report. Results: AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post. Conclusions: The new system’s features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.  %M 31376278 %R 10.2196/13621 %U http://formative.jmir.org/2019/3/e13621/ %U https://doi.org/10.2196/13621 %U http://www.ncbi.nlm.nih.gov/pubmed/31376278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13898 %T The Internet-Based Cognitive Assessment Tool: System Design and Feasibility Study %A Hafiz,Pegah %A Miskowiak,Kamilla Woznica %A Kessing,Lars Vedel %A Elleby Jespersen,Andreas %A Obenhausen,Kia %A Gulyas,Lorant %A Zukowska,Katarzyna %A Bardram,Jakob Eyvind %+ Digital Health Section, Department of Health Technology, Technical University of Denmark, Richard Petersens Plads, Building 324, 2nd Floor, Room 270, Kongens Lyngby, 2800, Denmark, 45 91858371, pegh@dtu.dk %K screening %K memory %K executive function %K bipolar disorder %K depression %K cognitive impairments %K neuropsychological tests %K computer software %K speech recognition software %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent cognitive impairment is prevalent in unipolar and bipolar disorders and is associated with decreased quality of life and psychosocial dysfunction. The screen for cognitive impairment in psychiatry (SCIP) test is a validated paper-and-pencil instrument for the assessment of cognition in affective disorders. However, there is no digital cognitive screening tool for the brief and accurate assessment of cognitive impairments in this patient group. Objective: In this paper, we present the design process and feasibility study of the internet-based cognitive assessment tool (ICAT) that is designed based on the cognitive tasks of the SCIP. The aims of this feasibility study were to perform the following tasks among healthy individuals: (1) evaluate the usability of the ICAT, (2) investigate the feasibility of the ICAT as a patient-administered cognitive assessment tool, and (3) examine the performance of automatic speech recognition (ASR) for the assessment of verbal recall. Methods: The ICAT was developed in a user-centered design process. The cognitive measures of the ICAT were immediate and delayed recall, working memory, and psychomotor speed. Usability and feasibility studies were conducted separately with 2 groups of healthy individuals (N=21 and N=19, respectively). ICAT tests were available in the English and Danish languages. The participants were asked to fill in the post study system usability questionnaire (PSSUQ) upon completing the ICAT test. Verbal recall in the ICAT was assessed using ASR, and the performance evaluation criterion was word error rate (WER). A Pearson 2-tailed correlation analysis significant at the .05 level was applied to investigate the association between the SCIP and ICAT scores. Results: The overall psychometric factors of PSSUQ for both studies gave scores above 4 (out of 5). The analysis of the feasibility study revealed a moderate to strong correlation between the total scores of the SCIP and ICAT (r=0.63; P=.009). There were also moderate to strong correlations between the SCIP and ICAT subtests for immediate verbal recall (r=0.67; P=.002) and psychomotor speed (r=0.71; P=.001). The associations between the respective subtests for working memory, executive function, and delayed recall, however, were not statistically significant. The corresponding WER for English and Danish responses were 17.8% and 6.3%, respectively. Conclusions: The ICAT is the first digital screening instrument modified from the SCIP using Web-based technology and ASR. There was good accuracy of the ASR for verbal memory assessment. The moderate correlation between the ICAT and SCIP scores suggests that the ICAT is a valid tool for assessing cognition, although this should be confirmed in a larger study with greater statistical power. Taken together, the ICAT seems to be a valid Web-based cognitive assessment tool that, after some minor modifications and further validation, may be used to screen for cognitive impairment in clinical settings. %M 31350840 %R 10.2196/13898 %U http://formative.jmir.org/2019/3/e13898/ %U https://doi.org/10.2196/13898 %U http://www.ncbi.nlm.nih.gov/pubmed/31350840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12507 %T A Web-Based Physical Activity Portal for Individuals Living With a Spinal Cord Injury: Qualitative Study %A Pancer,Max %A Manganaro,Melissa %A Pace,Isabella %A Marion,Patrick %A Gagnon,Dany H %A Laramée,Marie-Thérèse %A Messier,Frédéric %A Amari,Fatima %A Ahmed,Sara %+ School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 487 1891 ext 185, sara.ahmed@mcgill.ca %K spinal cord injuries %K self-management %K internet %K exercise %K motivation %K volition %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The population with a spinal cord injury (SCI) largely remains inactive following discharge from rehabilitation despite evidence on the benefits of physical activity. These individuals need to develop skills to self-manage their condition in order to prevent secondary comorbidities and rehospitalization. A Web-based physical activity portal can address this need. Few Web-based interventions incorporate theoretical frameworks, behavior change techniques, and modes of delivery into their design. Objective: This study aimed to identify the preferred features of a Web-based self-management physical activity portal through stakeholder engagement with individuals with a spinal cord injury and health care professionals (HCPs). Methods: An interpretative phenomenology methodology and participatory design, along with an integrated knowledge translation approach, were used to conduct this study. Convenience sampling was used to recruit individuals with an SCI living in the community, who were either interested or already engaging in physical activity, and HCPs working with individuals with an SCI, from three city-based rehabilitation sites. Individual 1-hour sessions involving navigation of an existing website and a semistructured interview were conducted with all participants. Individuals with an SCI completed a demographics questionnaire prior to the individual sessions, while demographic information of the HCPs was collected during their interviews. Additionally, all participants were asked a question on their intention to use or recommend a portal. An in-depth thematic analysis was used to derive themes from participants’ responses. Results: Thirteen individuals with an SCI and nine HCPs participated in the study. Five core themes emerged: (1) knowledge: guidance and barrier management; (2) possibility of achievement: the risks and benefits of physical activity and modelling; (3) self-regulation strategies: action planning, goal setting, tracking, rewards, and reminders; (4) interactivity: peers and professionals; and (5) format: appearance, language, and ease of use. The mean (median) ratings of the likelihood of promoting and using a Web-based portal tailored to individuals’ needs were 9.00 (8.78) and 7.75 (7.88) for HCPs and individuals with an SCI, respectively. Conclusions: This study highlights features of an online self-management platform that can provide individuals with an SCI the motivation and volition to engage in physical activity. These findings will inform the design of a Web-based self-management physical activity portal to increase physical activity adherence and behavior change. %M 31350835 %R 10.2196/12507 %U http://formative.jmir.org/2019/3/e12507/ %U https://doi.org/10.2196/12507 %U http://www.ncbi.nlm.nih.gov/pubmed/31350835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12389 %T Web-Based Prescription Opioid Abuse Prevention for Adolescents: Program Development and Formative Evaluation %A Moore,Sarah K %A Grabinski,Michael %A Bessen,Sarah %A Borodovsky,Jacob T %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Suite 315, Lebanon, NH, 03766, United States, 1 9176789280, sarah.k.moore@dartmouth.edu %K opioids %K prevention and control %K adolescent %K randomized controlled trial %K internet %D 2019 %7 19.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented number of youths engaged in nonmedical use of prescription opioids (POs), as well as the myriad negative consequences of such misuse, emphasizes the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive drug abuse prevention programs focused on preventing the use of nonprescription drugs in youths, to our knowledge, there are no science-based interactive programs that focus on the prevention of PO abuse among adolescents. Objective: The aim of this study was to develop and conduct a formative evaluation of a science-based interactive Web-based program focused on the prevention of PO abuse among adolescents aged 12 to 17 years (Pop4Teens). This study was conducted to prepare for a randomized controlled trial designed to evaluate the effectiveness of Pop4Teens compared with an active control website, JustThinkTwice.com (Drug Enforcement Administration), in impacting knowledge and attitudes about POs and perceptions of risk associated with the abuse of POs, as well as intentions to use and actual use of POs. Methods: We conducted 6 focus groups with 30 youths (a mean of 5 per group: the eligibility being aged 12-19 years) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid-naïve) and writing sessions with 30 youths in treatment for opioid use disorder (12-19 years) to inform the development of the Web-based prevention tool. Feasibility and acceptability of a prototype of the Web-based intervention were then assessed through individual feedback sessions with 57 youths (drawn from the same populations as the focus groups). Results: We successfully completed the development of a Web-based PO abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (eg, quiz content/format, script writing, and story editing). Selected writing session narratives anchored the planned scientific content by lending credibility and informing the development of compelling storylines intended to motivate the youth to engage with the program. Feedback session data indicated that the Web-based tool could be potentially useful and acceptable. In addition, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of PO abuse after the exposure to sections of the Web-based program. Conclusions: The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multipronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youths. %M 31325289 %R 10.2196/12389 %U http://formative.jmir.org/2019/3/e12389/ %U https://doi.org/10.2196/12389 %U http://www.ncbi.nlm.nih.gov/pubmed/31325289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13798 %T Audience Response Systems and Missingness Trends: Using Interactive Polling Systems to Gather Sensitive Health Information From Youth %A Toscos,Tammy %A Drouin,Michelle %A Flanagan,Mindy %A Carpenter,Maria %A Kerrigan,Connie %A Carpenter,Colleen %A Mere,Cameron %A Haaff,Marcia %+ Parkview Research Center, 10622 Parkview Plaza Dr, Fort Wayne, IN, 46845, United States, 1 260 266 5586, Tammy.Toscos@parkview.com %K mental health %K youth %K surveys and questionnaires %K health care %K software %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread availability and cost-effectiveness of new-wave software-based audience response systems (ARSs) have expanded the possibilities of collecting health data from hard-to-reach populations, including youth. However, with all survey methods, biases in the data may exist because of participant nonresponse. Objective: The aims of this study were to (1) examine the extent to which an ARS could be used to gather health information from youths within a large-group school setting and (2) examine individual- and survey-level response biases stemming from this Web-based data collection method. Methods: We used an ARS to deliver a mental health survey to 3418 youths in 4 high schools in the Midwestern United States. The survey contained demographic questions, depression, anxiety, and suicidality screeners, and questions about their use of offline resources (eg, parents, peers, and counselors) and Web-based resources (ie, telemental health technologies) when they faced stressful life situations. We then examined the response rates for each survey item, focusing on the individual- and survey-level characteristics that related to nonresponse. Results: Overall, 25.39% (868/3418) of youths answered all 38 survey questions; however, missingness analyses showed that there were some survey structure factors that led to higher rates of nonresponse (eg, questions at the end of survey, sensitive questions, and questions for which precise answers were difficult to provide). There were also some personal characteristics that were associated with nonresponse (eg, not identifying as either male or female, nonwhite ethnicity, and higher levels of depression). Specifically, a multivariate model showed that male students and students who reported their gender as other had significantly higher numbers of missed items compared with female students (B=.30 and B=.47, respectively, P<.001). Similarly, nonwhite race (B=.39, P<.001) and higher depression scores (B=.39, P<.001) were positively related to the number of missing survey responses. Conclusions: Although our methodology-focused study showed that it is possible to gather sensitive mental health data from youths in large groups using ARSs, we also suggest that these nonresponse patterns need to be considered and controlled for when using ARSs for gathering population health data. %M 31313658 %R 10.2196/13798 %U https://formative.jmir.org/2019/3/e13798/ %U https://doi.org/10.2196/13798 %U http://www.ncbi.nlm.nih.gov/pubmed/31313658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13417 %T Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease %A van Maurik,Ingrid S %A Visser,Leonie NC %A Pel-Littel,Ruth E %A van Buchem,Marieke M %A Zwan,Marissa D %A Kunneman,Marleen %A Pelkmans,Wiesje %A Bouwman,Femke H %A Minkman,Mirella %A Schoonenboom,Niki %A Scheltens,Philip %A Smets,Ellen MA %A van der Flier,Wiesje M %+ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440816, i.vanmaurik@vumc.nl %K Alzheimer’s disease %K biomarkers %K decision aids %K mild cognitive impairment %K precision medicine %K risk %K shared decision making %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: As a result of advances in diagnostic testing in the field of Alzheimer disease (AD), patients are diagnosed in earlier stages of the disease, for example, in the stage of mild cognitive impairment (MCI). This poses novel challenges for a clinician during the diagnostic workup with regard to diagnostic testing itself, namely, which tests are to be performed, but also on how to engage patients in this decision and how to communicate test results. As a result, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective: The aim of this study was to present the design, development, and testing of a Web-based tool for clinicians in a memory clinic setting and to ascertain whether this tool can (1) facilitate the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, (2) support clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and (3) support clinicians in a process of shared decision making regarding the diagnostic workup of AD. Methods: A multiphase mixed-methods approach was used. Phase 1 consisted of a qualitative needs assessment among professionals, patients, and caregivers; phase 2, consisted of an iterative process of development and the design of the tool (ADappt); and phase 3 consisted of a quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered qualitative approach with clinicians, patients, and caregivers. Results: In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing 3 modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic workup. In phase 3, ADappt was considered to be clear and user-friendly. Conclusions: Clinicians in a memory clinic setting can use ADappt, a Web-based tool, developed using multiphase design and co-creation, for support that includes an individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing. %M 31287061 %R 10.2196/13417 %U https://formative.jmir.org/2019/3/e13417/ %U https://doi.org/10.2196/13417 %U http://www.ncbi.nlm.nih.gov/pubmed/31287061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12657 %T Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up %A Pima,Francis Maganga %A Oshosen,Martha %A Ngowi,Kennedy Michael %A Habte,Bruck Messele %A Maro,Eusebious %A Teffera,Belete Eshete %A Kisigo,Godfrey %A Swai,Iraseni Ufoo %A Msangi,Salim Semvua %A Ermias,Amha %A Mmbaga,Blandina T %A Both,Rosalijn %A Sumari-de Boer,Marion %+ Department of Clinical Trials, Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi,, United Republic of Tanzania, 255 754331948, m.sumari@kcri.ac.tz %K SMS %K contraceptives %K sexual behavior %K feasibility %K young unmarried men %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. %M 31244476 %R 10.2196/12657 %U http://formative.jmir.org/2019/2/e12657/ %U https://doi.org/10.2196/12657 %U http://www.ncbi.nlm.nih.gov/pubmed/31244476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13558 %T The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback %A Bartlett Ellis,Rebecca J %A Hill,James H %A Kerley,K Denise %A Sinha,Arjun %A Ganci,Aaron %A Russell,Cynthia L %+ Science of Nursing Care Department, Indiana University School of Nursing, 600 Barnhill Drive, E423, Indianapolis, IN, 46202, United States, 1 (317) 274 0047, rjbartle@iu.edu %K medication adherence %K medication compliance %K behavior change %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. Objective: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. Methods: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. Results: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. Conclusions: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases. %M 31237568 %R 10.2196/13558 %U http://formative.jmir.org/2019/2/e13558/ %U https://doi.org/10.2196/13558 %U http://www.ncbi.nlm.nih.gov/pubmed/31237568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13633 %T Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers %A Ose,Solveig Osborg %A Færevik,Hilde %A Kaasbøll,Jannike %A Lindgren,Martin %A Thaulow,Kristin %A Antonsen,Stig %A Burkeland,Olav %+ SINTEF AS Digital, Klaebuveien 153, Trondheim,, Norway, 47 90728684, solveig.ose@sintef.no %K virtual reality %K severe mental illness %K collaborative research %K technology %K social work %D 2019 %7 10.6.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. Objective: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. Methods: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians—four from specialist mental health services and four from municipal mental health services—was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR’s potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. Results: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. Conclusions: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation. %M 31199315 %R 10.2196/13633 %U http://formative.jmir.org/2019/2/e13633/ %U https://doi.org/10.2196/13633 %U http://www.ncbi.nlm.nih.gov/pubmed/31199315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13916 %T Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study %A Huppelschoten,Aleida Gerarda %A de Bruin,Jan Peter %A Kremer,Jan AM %+ Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, Netherlands, 31 615339787, dana.huppelschoten@radboudumc.nl %K patient-centered care %K remote consultation %K decision making %K telemedicine %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. Objective: The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. Methods: This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. Results: Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. Conclusions: Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care. %M 31165714 %R 10.2196/13916 %U http://formative.jmir.org/2019/2/e13916/ %U https://doi.org/10.2196/13916 %U http://www.ncbi.nlm.nih.gov/pubmed/31165714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12550 %T A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial %A Gulliver,Amelia %A Banfield,Michelle %A Morse,Alyssa R %A Reynolds,Julia %A Miller,Sarah %A Galati,Connie %+ Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton, ACT, Canberra, 2601, Australia, 61 261259472, amelia.gulliver@anu.edu.au %K peer work %K computers, handheld %K pilot study %K mental health recovery %K mental health services, community %K mental disorders %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. Objective: This exploratory proof-of-concept study aimed to determine if a peer worker–led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. Methods: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. Results: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. Conclusions: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit. %M 31165708 %R 10.2196/12550 %U http://formative.jmir.org/2019/2/e12550/ %U https://doi.org/10.2196/12550 %U http://www.ncbi.nlm.nih.gov/pubmed/31165708 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12940 %T iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway %A Grasaas,Erik %A Fegran,Liv %A Helseth,Sølvi %A Stinson,Jennifer %A Martinez,Santiago %A Lalloo,Chitra %A Haraldstad,Kristin %+ Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Universitetsveien 25, Kristiansand, 4630, Norway, 47 97524422, erik.grasaas@uia.no %K health %K self-management %K adolescent %K chronic pain %K translating %K mobile app %D 2019 %7 03.06.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. Objective: The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app’s usability using a phased approach. Methods: Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app’s usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. Results: End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. Conclusions: This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample. %M 31162132 %R 10.2196/12940 %U https://www.researchprotocols.org/2019/6/e12940/ %U https://doi.org/10.2196/12940 %U http://www.ncbi.nlm.nih.gov/pubmed/31162132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e9995 %T Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey %A Bond,Keosha T %A Ramos,S Raquel %+ Department of Public Health, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, United States, 1 594 2830, kbond@nymc.edu %K eHealth interventions %K heterosexual %K African American women %K HIV risk behaviors, HIV prevention %K entertainment-education %K postexposure prophylaxis %K pre-exposure prophylaxis %K internet %K videos %D 2019 %7 29.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective: The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods: A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results: Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions: Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women. %M 31144667 %R 10.2196/formative.9995 %U http://formative.jmir.org/2019/2/e9995/ %U https://doi.org/10.2196/formative.9995 %U http://www.ncbi.nlm.nih.gov/pubmed/31144667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10388 %T Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers %A Rodriguez,Sarah %A Hwang,Kevin %A Wang,Jing %+ School of Nursing, The University of Texas Health Science Center at San Antonio, MSC 7851, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K patient-generated health data %K connected health %K remote monitoring %K electronic health record %K hypertension %K patient reported outcome %K self-measured blood pressure %K self-monitoring of blood pressure %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. %M 31124468 %R 10.2196/10388 %U http://formative.jmir.org/2019/2/e10388/ %U https://doi.org/10.2196/10388 %U http://www.ncbi.nlm.nih.gov/pubmed/31124468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10951 %T Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews %A Thomas,Sarah %A Pulman,Andy %A Thomas,Peter %A Collard,Sarah %A Jiang,Nan %A Dogan,Huseyin %A Davies Smith,Angela %A Hourihan,Susan %A Roberts,Fiona %A Kersten,Paula %A Pretty,Keith %A Miller,Jessica K %A Stanley,Kirsty %A Gay,Marie-Claire %+ Bournemouth University Clinical Research Unit, Faculty of Health & Social Sciences, Bournemouth University, R506, Royal London House, Bournemouth,, United Kingdom, 44 1202961953, saraht@bournemouth.ac.uk %K multiple sclerosis %K fatigue %K telemedicine %K mobile health %K FACETS %K fatigue management %D 2019 %7 22.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS—a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)—developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. Objective: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. Methods: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. Results: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS’ weekly homework tasks and symptom monitoring and management. Conclusions: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution. %M 31120021 %R 10.2196/10951 %U http://formative.jmir.org/2019/2/e10951/ %U https://doi.org/10.2196/10951 %U http://www.ncbi.nlm.nih.gov/pubmed/31120021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12635 %T Treatment Preferences for Internet-Based Cognitive Behavioral Therapy for Insomnia in Japan: Online Survey %A Sato,Daisuke %A Sutoh,Chihiro %A Seki,Yoichi %A Nagai,Eiichi %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan, 81 43 226 2027, daisuke-sato@umin.ac.jp %K patient preference %K insomnia %K internet-based cognitive behavioral therapy %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet has the potential to increase individuals’ access to cognitive behavioral therapy (CBT) for insomnia at low cost. However, treatment preferences regarding internet-based computerized CBT for insomnia have not been fully examined. Objective: The aim was to conduct an anonymous online survey to evaluate treatment preferences for insomnia among patients with insomnia and individuals without insomnia. Methods: We developed an online survey to recruit a total of 600 participants living in the Kanto district in Japan. There were three subgroups: 200 medicated individuals with insomnia, 200 unmedicated individuals with insomnia, and 200 individuals without insomnia. The survey asked questions about the severity of the respondent’s insomnia (using the Athens Insomnia Scale), the frequency of sleep medication use and the level of satisfaction with sleep medication use, the respondent’s knowledge of CBT, his or her preference for CBT for insomnia before drug therapy, preference for CBT versus drug therapy, and preference for internet-based CBT versus face-to-face CBT. Results: Of the 600 respondents, 47.7% (286/600) indicated that they received CBT before drug therapy, and 57.2% (343/600) preferred CBT for insomnia to drug therapy. In addition, 47.0% (282/600) preferred internet-based CBT for insomnia to face-to-face CBT. Although the respondents with insomnia who were taking an insomnia medication had a relatively lower preference for internet-based CBT (40.5%, 81/200), the respondents with insomnia who were not taking an insomnia medication had a relatively higher preference for internet-based CBT (55.5%, 111/200). Conclusions: The results of our online survey suggest that approximately half of the people queried preferred CBT for insomnia to drug therapy, and half of the respondents preferred internet-based CBT for insomnia to face-to-face CBT. %M 31094319 %R 10.2196/12635 %U http://formative.jmir.org/2019/2/e12635/ %U https://doi.org/10.2196/12635 %U http://www.ncbi.nlm.nih.gov/pubmed/31094319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12664 %T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases %A Ponum,Mahvish %A Hasan,Osman %A Khan,Saadia %+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk %K infectious diseases %K mHealth %K causes of death %D 2019 %7 14.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. %M 31094329 %R 10.2196/12664 %U http://www.i-jmr.org/2019/2/e12664/ %U https://doi.org/10.2196/12664 %U http://www.ncbi.nlm.nih.gov/pubmed/31094329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13882 %T Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study %A Smelror,Runar Elle %A Bless,Josef Johann %A Hugdahl,Kenneth %A Agartz,Ingrid %+ Department of Psychiatric Research, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo, 0319, Norway, 47 95744029, runar.smelror@medisin.uio.no %K experience sampling method %K ecological momentary assessment %K schizophrenia %K mHealth %K health care technology %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74% (SD 30%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients’ experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. %M 31094321 %R 10.2196/13882 %U http://formative.jmir.org/2019/2/e13882/ %U https://doi.org/10.2196/13882 %U http://www.ncbi.nlm.nih.gov/pubmed/31094321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12426 %T Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review %A O'Donoghue,Odhran %A Vazirani,Anuraag A %A Brindley,David %A Meinert,Edward %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K blockchain %K interoperability %K distributed ledger technology %K scalability %K health information exchange %D 2019 %7 10.05.2019 %9 Review %J J Med Internet Res %G English %X Background: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” Objective: This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” Methods: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. International Registered Report Identifier (IRRID): RR2-10.2196/10994 %M 31094344 %R 10.2196/12426 %U https://www.jmir.org/2019/5/e12426/ %U https://doi.org/10.2196/12426 %U http://www.ncbi.nlm.nih.gov/pubmed/31094344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13324 %T Young Adults’ Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study %A Nour,Monica %A Chen,Juliana %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4 EAST, Charles Perkins Centre D17 The University of Sydney, Camperdown, 2006, Australia, 61 403094095, mnou2973@uni.sydney.edu.au %K vegetables %K young adults %K mHealth %K social media %K experimental game %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement. Objective: This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake. Methods: A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 × 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts. Results: Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed. Conclusions: As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery. %M 31094322 %R 10.2196/13324 %U http://formative.jmir.org/2019/2/e13324/ %U https://doi.org/10.2196/13324 %U http://www.ncbi.nlm.nih.gov/pubmed/31094322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12132 %T An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media %A Ray,Anne E %A Greene,Kathryn %A Hecht,Michael L %A Barriage,Sarah C %A Miller-Day,Michelle %A Glenn,Shannon D %A Banerjee,Smita C %+ Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, United States, 1 732 235 5716, aer108@sph.rutgers.edu %K substance use %K prevention %K media literacy %K e-learning %K adaptation %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. Objective: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. Methods: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. Results: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. Conclusions: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations. %M 31094328 %R 10.2196/12132 %U http://formative.jmir.org/2019/2/e12132/ %U https://doi.org/10.2196/12132 %U http://www.ncbi.nlm.nih.gov/pubmed/31094328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11890 %T Barriers and Facilitators for Implementing a Decision Support System to Prevent and Treat Disease-Related Malnutrition in a Hospital Setting: Qualitative Study %A Paulsen,Mari Mohn %A Varsi,Cecilie %A Paur,Ingvild %A Tangvik,Randi Julie %A Andersen,Lene Frost %+ National Advisory Unit on Disease-related Malnutrition, Department of Cancer Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo, 0372, Norway, 47 22851103, m.m.paulsen@medisin.uio.no %K malnutrition %K implementation science %K eHealth %K qualitative research %K decision support systems, clinical %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan. %M 31094333 %R 10.2196/11890 %U http://formative.jmir.org/2019/2/e11890/ %U https://doi.org/10.2196/11890 %U http://www.ncbi.nlm.nih.gov/pubmed/31094333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11364 %T The Use of Smart Technology in an Online Community of Patients With Degenerative Cervical Myelopathy %A Mowforth,Oliver Daniel %A Davies,Benjamin Marshall %A Kotter,Mark Reinhard %+ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge,, United Kingdom, 44 1223 763366, mrk25@cam.ac.uk %K spinal cord diseases %K cervical vertebrae %K spinal osteophytosis %K spondylosis %K biomedical technology %K chronic disease %K follow-up studies %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a prevalent and progressively disabling neurological condition. Treatment is currently limited to surgery, the timing of which is not without controversy. New international guidelines recommend that all patients should undergo lifelong surveillance and those with moderate-to-severe or progressive disease should be offered surgery. Long-term surveillance will place substantial burden on health services and short clinic assessments may risk misrepresenting disease severity. The use of smart technology to monitor disease progression could provide an invaluable opportunity to lessen this burden and improve patient care. However, given the older demographic of DCM, the feasibility of smart technology use is unclear. Objective: The aim of this study was to investigate current usage of smart technology in patients with self-reported DCM to inform design of smart technology apps targeted at monitoring DCM disease progression. Methods: Google Analytics from the patient section of Myelopathy.org, an international DCM charity with a large online patient community, was analyzed over a 1-year period. A total of 15,761 sessions were analyzed. Results: In total, 39.6% (295/744) of visitors accessed the website using a desktop computer, 35.1% (261/744) using mobile, and 25.3% (188/744) using a tablet. Of the mobile and tablet visitors, 98.2% (441/449) utilized a touchscreen device. A total of 51.3% (141/275) of mobile and tablet visitors used iPhone Operating System (iOS) and 45.8% (126/275) used an Android operating system. Apple and Samsung were the most popular smart devices, utilized by 53.6% (241/449) and 25.8% (116/449) of visitors, respectively. The overall visitor age was representative of DCM trials. Smart technology was widely used by older visitors: 58.8% (113/192) of mobile visitors and 84.2% (96/114) of tablet visitors were aged 45 years or older. Conclusions: Smart technology is commonly used by DCM patients. DCM apps need to be iOS and Android compatible to be accessible to all patients. %M 31094330 %R 10.2196/11364 %U http://formative.jmir.org/2019/2/e11364/ %U https://doi.org/10.2196/11364 %U http://www.ncbi.nlm.nih.gov/pubmed/31094330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12679 %T Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study %A Lunde,Pernille %A Nilsson,Birgitta Blakstad %A Bergland,Astrid %A Bye,Asta %+ Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, P50, PB 4, St Olavs Plass, Oslo,, Norway, 47 48 06 35 37, plunde@oslomet.no %K mHealth %K eHealth %K mobile phone app %K cardiac rehabilitation %D 2019 %7 19.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients’ adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. %M 31066684 %R 10.2196/12679 %U http://formative.jmir.org/2019/2/e12679/ %U https://doi.org/10.2196/12679 %U http://www.ncbi.nlm.nih.gov/pubmed/31066684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12406 %T Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study %A Theis,Ryan P %A Malik,Ali M %A Thompson,Lindsay A %A Shenkman,Elizabeth A %A Pbert,Lori %A Salloum,Ramzi G %+ Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, Suite 2252, Gainesville, FL, 32610, United States, 1 352 294 5973, rtheis@ufl.edu %K clinical decision support %K adolescent %K primary care %K tobacco use %K confidentiality %K implementation science %K qualitative research %D 2019 %7 28.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective: This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods: A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results: Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions: This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice. %M 31066687 %R 10.2196/12406 %U http://formative.jmir.org/2019/2/e12406/ %U https://doi.org/10.2196/12406 %U http://www.ncbi.nlm.nih.gov/pubmed/31066687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13415 %T Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis %A Zhao,Yinan %A Feng,Hui %A Hu,Mingyue %A Hu,Hengyu %A Li,Hui %A Ning,Hongting %A Chen,Huijing %A Liao,Lulu %A Peng,Linlin %+ Xiangya School of Nursing, Central South University, No 172 Tongzipo Road, Changsha,, China, 86 82650292, feng.hui@csu.edu.cn %K internet %K education %K mental health %K caregivers %K dementia %D 2019 %7 6.5.2019 %9 Review %J J Med Internet Res %G English %X Background: Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care. Objective: The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role. Methods: A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95% CI −0.38 to −0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI −0.50 to −0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers’ mental health. Conclusions: Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required. %M 31066680 %R 10.2196/13415 %U http://www.jmir.org/2019/5/e13415/ %U https://doi.org/10.2196/13415 %U http://www.ncbi.nlm.nih.gov/pubmed/31066680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11958 %T The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People %A Edridge,Chloe %A Deighton,Jessica %A Wolpert,Miranda %A Edbrooke-Childs,Julian %+ Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, United Kingdom, 44 020 7433 6191, chloe.edridge@annafreud.org %K cluster trial %K behavioural difficulties %K schools %K mHealth, digital %K mental health %K mobile phone %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. Objective: The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. Methods: Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. Results: ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. Conclusions: Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. Trial Registration: International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994 %M 31045499 %R 10.2196/11958 %U http://formative.jmir.org/2019/2/e11958/ %U https://doi.org/10.2196/11958 %U http://www.ncbi.nlm.nih.gov/pubmed/31045499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11242 %T An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study %A Newby,Katie %A Crutzen,Rik %A Brown,Katherine %A Bailey,Julia %A Saunders,John %A Szczepura,Ala %A Hunt,Jonny %A Alston,Tim %A Sadiq,S Tariq %A Das,Satyajit %+ Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Coventry University, RC Building (4th Floor), Priory St, Coventry, CV1 5FB, United Kingdom, 44 02477 657459, k.newby@coventry.ac.uk %K sexually transmitted infection %K condoms %K sexual behavior %K young adult %K intervention development %K internet %K eHealth %K co-design %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status. %M 31042156 %R 10.2196/11242 %U http://formative.jmir.org/2019/2/e11242/ %U https://doi.org/10.2196/11242 %U http://www.ncbi.nlm.nih.gov/pubmed/31042156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11586 %T Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults %A van Beurden,Samantha B %A Smith,Jane R %A Lawrence,Natalia S %A Abraham,Charles %A Greaves,Colin J %+ College of Medicine and Health, University of Exeter, Smeall Building, Heavitree Road, Exeter, EX1 2LU, United Kingdom, 44 139272 ext 6440, s.b.vanbeurden@exeter.ac.uk %K weight loss %K mHealth %K digital behavior change %K obesity %K dual-process %D 2019 %7 30.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective: The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions: The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51) %M 31038464 %R 10.2196/11586 %U https://formative.jmir.org/2019/2/e11586/ %U https://doi.org/10.2196/11586 %U http://www.ncbi.nlm.nih.gov/pubmed/31038464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12662 %T Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials %A Huberty,Jennifer %A Eckert,Ryan %A Larkey,Linda %A Kurka,Jonathan %A Rodríguez De Jesús,Sue A %A Yoo,Wonsuk %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd St, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K mindfulness %K meditation %K smartphone %K mHealth %K cancer %K quality of life %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=−0.43), depression (P=.02; d=−0.38), sleep disturbance (P=.01; d=−0.40), total symptom burden (P=.13; d=−0.27), and fatigue (P=.06; d=−0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=−0.22), depression (P=.09; d=−0.29), sleep disturbance (P=.002; d=−0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=−0.27), and fatigue (P=.13; d=−0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) %M 31033443 %R 10.2196/12662 %U http://formative.jmir.org/2019/2/e12662/ %U https://doi.org/10.2196/12662 %U http://www.ncbi.nlm.nih.gov/pubmed/31033443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12982 %T An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies %A Setiawan,I Made Agus %A Zhou,Leming %A Alfikri,Zakiy %A Saptono,Andi %A Fairman,Andrea D %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K mHealth %K adaptive mHealth %K mobile apps %K telemedicine %K personalized medicine %K self-management %K self-care %K caregivers %K chronic disease %K persons with disabilities %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs’ self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs’ evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. %M 31021324 %R 10.2196/12982 %U http://formative.jmir.org/2019/2/e12982/ %U https://doi.org/10.2196/12982 %U http://www.ncbi.nlm.nih.gov/pubmed/31021324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11489 %T Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study %A Breteler,Martine JM %A Janssen,Joris H %A Spiering,Wilko %A Kalkman,Cor J %A van Solinge,Wouter W %A Dohmen,Daan AJ %+ Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht,, Netherlands, 31 647396841, m.j.m.breteler@umcutrecht.nl %K activity trackers %K telemedicine %K exercise %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote monitoring of physical activity in patients with chronic conditions could be useful to offer care professionals real-time assessment of their patient’s daily activity pattern to adjust appropriate treatment. However, the validity of commercially available activity trackers that can be used for telemonitoring purposes is limited. Objective: The purpose of this study was to test usability and determine the validity of 3 consumer-level activity trackers as a measure of free-living activity. Methods: A usability evaluation (study 1) and validation study (study 2) were conducted. In study 1, 10 individuals wore one activity tracker for a period of 30 days and filled in a questionnaire on ease of use and wearability. In study 2, we validated three selected activity trackers (Apple Watch, Misfit Shine, and iHealth Edge) and a fourth pedometer (Yamax Digiwalker) against the reference standard (Actigraph GT3X) in 30 healthy participants for 72 hours. Outcome measures were 95% limits of agreement (LoA) and bias (Bland-Altman analysis). Furthermore, median absolute differences (MAD) were calculated. Correction for bias was estimated and validated using leave-one-out cross validation. Results: Usability evaluation of study 1 showed that iHealth Edge and Apple Watch were more comfortable to wear as compared with the Misfit Flash. Therefore, the Misfit Flash was replaced by Misfit Shine in study 2. During study 2, the total number of steps of the reference standard was 21,527 (interquartile range, IQR 17,475-24,809). Bias and LoA for number of steps from the Apple Watch and iHealth Edge were 968 (IQR −5478 to 7414) and 2021 (IQR −4994 to 9036) steps. For Misfit Shine and Yamax Digiwalker, bias was −1874 and 2004, both with wide LoA of (13,869 to 10,121) and (−10,932 to 14,940) steps, respectively. The Apple Watch noted the smallest MAD of 7.7% with the Actigraph, whereas the Yamax Digiwalker noted the highest MAD (20.3%). After leave-one-out cross validation, accuracy estimates of MAD of the iHealth Edge and Misfit Shine were within acceptable limits with 10.7% and 11.3%, respectively. Conclusions: Overall, the Apple Watch and iHealth Edge were positively evaluated after wearing. Validity varied widely between devices, with the Apple Watch being the most accurate and Yamax Digiwalker the least accurate for step count in free-living conditions. The iHealth Edge underestimates number of steps but can be considered reliable for activity monitoring after correction for bias. Misfit Shine overestimated number of steps and cannot be considered suitable for step count because of the low agreement. Future studies should focus on the added value of remotely monitoring activity patterns over time in chronic patients. %M 31017587 %R 10.2196/11489 %U http://formative.jmir.org/2019/2/e11489/ %U https://doi.org/10.2196/11489 %U http://www.ncbi.nlm.nih.gov/pubmed/31017587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12028 %T iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents %A Birnie,Kathryn A %A Campbell,Fiona %A Nguyen,Cynthia %A Lalloo,Chitra %A Tsimicalis,Argerie %A Matava,Clyde %A Cafazzo,Joseph %A Stinson,Jennifer %+ Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada, 1 416 813 7654, kathryn.birnie@sickkids.ca %K postoperative pain %K smartphone %K mobile applications %K mHealth %K pain management %K self-management %K adolescent %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. %M 31008704 %R 10.2196/12028 %U http://formative.jmir.org/2019/2/e12028/ %U https://doi.org/10.2196/12028 %U http://www.ncbi.nlm.nih.gov/pubmed/31008704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10880 %T AO Patient Outcomes Center: Design, Implementation, and Evaluation of a Software Application for the Collection of Patient-Reported Outcome Measures in Orthopedic Outpatient Clinics %A Rothrock,Nan E %A Bass,Michael %A Blumenthal,Andrea %A Gershon,Richard C %A Hanson,Beate %A Joeris,Alexander %A Kaat,Aaron %A Morrison,Suzanne %A O'Toole,Robert V %A Patel,Shalini %A Stover,Michael %A Weaver,Michael J %A White,Raymond %A Varela Diaz,Maria %A Vrahas,Mark S %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, United States, 1 312 503 3514, n-rothrock@northwestern.edu %K orthopedics %K patient reported outcome measures %K tablet computers %D 2019 %7 12.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available. Objective: Our objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics. Methods: AO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured. Results: Patient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement. Conclusion: AOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients’ voices are to be better integrated in clinical care. %M 30977735 %R 10.2196/10880 %U https://formative.jmir.org/2019/2/e10880/ %U https://doi.org/10.2196/10880 %U http://www.ncbi.nlm.nih.gov/pubmed/30977735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10990 %T Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings %A Heynsbergh,Natalie %A Heckel,Leila %A Botti,Mari %A O,Seung Chul %A Livingston,Patricia M %+ School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong,, Australia, 61 392446333, n.heynsbergh@deakin.edu.au %K cancer %K carer %K smartphone %K mobile applications %K technology %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers. Objective: The aim of this study was to design a smartphone app prototype for carers of adults with cancer. Methods: A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers’ feedback, a smartphone app was designed and tested. Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app’s design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages—a paper-based version of the app and an app-based test using the participants’ preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017. Results: A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60% (27/45) were female. The majority of carers (76%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30%, 3/10), 30 to 49 years (30%, 3/10), and 50 years or above (40%, 4/10), and 60% (6/10) were male. Participants found the app user-friendly and pleasing in appearance. App-based testing included the following: participants (N=10) were aged above 30 years (20%, 2/10), 30 to 49 years (30%, 3/10), and 50 years or above (50%, 5/10), and 50% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone. Conclusions: Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type. %M 30973346 %R 10.2196/10990 %U http://formative.jmir.org/2019/2/e10990/ %U https://doi.org/10.2196/10990 %U http://www.ncbi.nlm.nih.gov/pubmed/30973346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e9910 %T A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study %A Harrington,Richard A %A Scarborough,Peter %A Hodgkins,Charo %A Raats,Monique M %A Cowburn,Gill %A Dean,Moira %A Doherty,Aiden %A Foster,Charlie %A Juszczak,Edmund %A Ni Mhurchu,Cliona %A Winstone,Naomi %A Shepherd,Richard %A Timotijevic,Lada %A Rayner,Mike %+ Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom, 44 1865289248, peter.scarborough@dph.ox.ac.uk %K diet %K randomized controlled trial %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. Objective: The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). Conclusions: Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. Trial Registration: ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK) International Registered Report Identifier (IRRID): RR2-10.1186/s40814-015-0015-1 %M 30958277 %R 10.2196/formative.9910 %U http://formative.jmir.org/2019/2/e9910/ %U https://doi.org/10.2196/formative.9910 %U http://www.ncbi.nlm.nih.gov/pubmed/30958277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11342 %T Developing a Data Dashboard Framework for Population Health Surveillance: Widening Access to Clinical Trial Findings %A Concannon,David %A Herbst,Kobus %A Manley,Ed %+ Centre for Advanced Spatial Analysis, University College London, Gower Street, London,, United Kingdom, 44 02031083884, ed.manley@ucl.ac.uk %K data visualization %K data dashboards %K health and demographic surveillance %K sub-Saharan Africa %K treatment as prevention %K clinical trials %K demographics %K real-time %K data literacy %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Population surveillance sites generate many datasets relevant to disease surveillance. However, there is a risk that these data are underutilized because of the volumes of data gathered and the lack of means to quickly disseminate analysis. Data visualization offers a means to quickly disseminate, understand, and interpret datasets, facilitating evidence-driven decision making through increased access to information. Objectives: This paper describes the development and evaluation of a framework for data dashboard design, to visualize datasets produced at a demographic health surveillance site. The aim of this research was to produce a comprehensive, reusable, and scalable dashboard design framework to fit the unique requirements of the context. Methods: The framework was developed and implemented at a demographic surveillance platform at the Africa Health Research Institute, in KwaZulu-Natal, South Africa. This context represents an exemplar implementation for the use of data dashboards within a population health-monitoring setting. Before the full launch, an evaluation study was undertaken to assess the effectiveness of the dashboard framework as a data communication and decision-making tool. The evaluation included a quantitative task evaluation to assess usability and a qualitative questionnaire exploring the attitudes to the use of dashboards. Results: The evaluation participants were drawn from a diverse group of users working at the site (n=20), comprising of community members, nurses, scientific and operational staff. Evaluation demonstrated high usability for the dashboard across user groups, with scientific and operational staff having minimal issues in completing tasks. There were notable differences in the efficiency of task completion among user groups, indicating varying familiarity with data visualization. The majority of users felt that the dashboards provided a clear understanding of the datasets presented and had a positive attitude to their increased use. Conclusions: Overall, this exploratory study indicates the viability of the data dashboard framework in communicating data trends within population surveillance setting. The usability differences among the user groups discovered during the evaluation demonstrate the need for the user-led design of dashboards in this context, addressing heterogeneous computer and visualization literacy present among the diverse potential users present in such settings. The questionnaire highlighted the enthusiasm for increased access to datasets from all stakeholders highlighting the potential of dashboards in this context. %M 30946016 %R 10.2196/11342 %U https://formative.jmir.org/2019/2/e11342/ %U https://doi.org/10.2196/11342 %U http://www.ncbi.nlm.nih.gov/pubmed/30946016 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11397 %T Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy %A DeJonckheere,Melissa %A Nichols,Lauren P %A Vydiswaran,VG Vinod %A Zhao,Xinyan %A Collins-Thompson,Kevyn %A Resnicow,Kenneth %A Chang,Tammy %+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, mjdejonckheere@gmail.com %K methods %K adolescents %K weight gain %K pregnancy %K text messaging %K social media %K natural language processing %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth’s perceptions of and knowledge about weight gain during pregnancy. Objective: The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. Methods: To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. Results: Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. Conclusions: This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth. %M 30932869 %R 10.2196/11397 %U https://formative.jmir.org/2019/2/e11397/ %U https://doi.org/10.2196/11397 %U http://www.ncbi.nlm.nih.gov/pubmed/30932869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11600 %T Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers %A Garabiles,Melissa R %A Harper Shehadeh,Melissa %A Hall,Brian J %+ Global and Community Mental Health Research Group, The University of Macau, E21-3040, Avenida da Universidade, Macau, 99908, China, 86 62899837, brianhall@um.edu.mo %K cultural adaptation %K migrant workers %K e-mental health %K overseas Filipino workers %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. %M 30924784 %R 10.2196/11600 %U https://formative.jmir.org/2019/1/e11600/ %U https://doi.org/10.2196/11600 %U http://www.ncbi.nlm.nih.gov/pubmed/30924784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11300 %T Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care %A Doarn,Charles R %A Vonder Meulen,Mary Beth %A Pallerla,Harini %A Acquavita,Shauna P %A Regan,Saundra %A Elder,Nancy %A Tubb,Matthew R %+ Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0582, Cincinnati, OH, 45267, United States, 1 5135586148, charles.doarn@uc.edu %K mobile health %K smoking cessation %K primary care %K decision aid %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. %M 30924783 %R 10.2196/11300 %U https://formative.jmir.org/2019/1/e11300/ %U https://doi.org/10.2196/11300 %U http://www.ncbi.nlm.nih.gov/pubmed/30924783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11374 %T Pregnant Users’ Perceptions of the Birth Plan Interface in the “My Prenatal Care” App: Observational Validation Study %A Moraes Carrilho,Juliana %A Oliveira,Isaias José Ramos %A Santos,Dimitri %A Osanan,Gabriel Costa %A Cruz-Correia,Ricardo João %A Reis,Zilma Silveira Nogueira %+ Informatics Center in Health, Universidade Federal de Minas Gerais, Faculty of Medicine, Av Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30140070, Brazil, 55 31985177473, zilma.medicina@gmail.com %K birth plan %K perinatal care %K usability, mobile health %K mobile app %K pregnancy %K prenatal care %K mobile phone %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users’ positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women’s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user’s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users’ performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. %M 30920372 %R 10.2196/11374 %U http://formative.jmir.org/2019/1/e11374/ %U https://doi.org/10.2196/11374 %U http://www.ncbi.nlm.nih.gov/pubmed/30920372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10731 %T The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults %A Hendrie,Gilly A %A James-Martin,Genevieve %A Williams,Gemma %A Brindal,Emily %A Whyte,Ben %A Crook,Anna %+ Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 88305 ext 0662, gilly.hendrie@csiro.au %K mHealth %K mobile applications %K vegetables %K adult %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective: This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods: To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification—which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results: The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions: Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA) %M 30916653 %R 10.2196/10731 %U http://formative.jmir.org/2019/1/e10731/ %U https://doi.org/10.2196/10731 %U http://www.ncbi.nlm.nih.gov/pubmed/30916653 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11852 %T High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation %A Mugisha,Alice %A Babic,Ankica %A Wakholi,Peter %A Tylleskär,Thorkild %+ Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21 Overlege Danielssens building, Bergen, 5020, Norway, 47 99884851, mugishaalice@gmail.com %K high-fidelity prototype %K group user testing %K mobile electronic data collection forms %K usability evaluation %D 2019 %7 22.03.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges. Objective: The main objective of this study was to assess the guidelines for form design using high-fidelity prototypes developed based on end-user preferences. We also sought to investigate the association between the results from the System Usability Scale (SUS) and those from the Study Tailored Evaluation Questionnaire (STEQ) after the evaluation. In addition, we sought to recommend some practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. Methods: We developed a Web-based high-fidelity prototype using Axure RP 8. A total of 30 research assistants (RAs) evaluated this prototype in March 2018 by completing the given tasks during 1 common session. An STEQ comprising 13 affirmative statements and the commonly used and validated SUS were administered to evaluate the usability and user experience after interaction with the prototype. The STEQ evaluation was summarized using frequencies in an Excel sheet while the SUS scores were calculated based on whether the statement was positive (user selection minus 1) or negative (5 minus user selection). These were summed up and the score contributions multiplied by 2.5 to give the overall form usability from each participant. Results: Of the RAs, 80% (24/30) appreciated the form progress indication, found the form navigation easy, and were satisfied with the error messages. The results gave a SUS average score of 70.4 (SD 11.7), which is above the recommended average SUS score of 68, meaning that the usability of the prototype was above average. The scores from the STEQ, on the other hand, indicated a 70% (21/30) level of agreement with the affirmative evaluation statements. The results from the 2 instruments indicated a fair level of user satisfaction and a strong positive association as shown by the Pearson correlation value of .623 (P<.01). Conclusions: A high-fidelity prototype was used to give the users experience with a product they would likely use in their work. Group testing was done because of scarcity of resources such as costs and time involved especially in low-income countries. If embraced, this approach could help assess user needs of the diverse user groups. With proper preparation and the right infrastructure at an affordable cost, usability testing could lead to the development of highly usable forms. The study thus makes recommendations on the practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. %M 30900995 %R 10.2196/11852 %U http://humanfactors.jmir.org/2019/1/e11852/ %U https://doi.org/10.2196/11852 %U http://www.ncbi.nlm.nih.gov/pubmed/30900995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11578 %T Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV %A Laurence,Colleen %A Wispelwey,Erin %A Flickinger,Tabor E %A Grabowski,Marika %A Waldman,Ava Lena %A Plews-Ogan,Erin %A Debolt,Claire %A Reynolds,George %A Cohn,Wendy %A Ingersoll,Karen %A Dillingham,Rebecca %+ Department of Medicine, University of Virginia School of Medicine, PO Box 801379, Charlottesville, VA, 22908, United States, 1 434 982 0103, Rd8v@hscmail.mcc.virginia.edu %K mHealth %K HIV %K treatment adherence and compliance %K retention in care %D 2019 %7 20.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective: This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods: App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results: A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions: The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV. %M 30892269 %R 10.2196/11578 %U http://formative.jmir.org/2019/1/e11578/ %U https://doi.org/10.2196/11578 %U http://www.ncbi.nlm.nih.gov/pubmed/30892269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12489 %T An mHealth Assistive System “MyLung” to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research %A Alharbey,Riad %A Chatterjee,Samir %+ Information Systems and Technology, College of Computer Science and Engineering, University of Jeddah, Asfan 21959, Jeddah,, Saudi Arabia, 966 545593498, ralharbi@uj.edu.sa %K assistive technology %K patient empowerment %K chronic obstructive pulmonary disease %K design science research %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients’ lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. Objective: The objective of this study is to design an innovative mobile health (mHealth) app system called “MyLung” that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. Methods: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). Results: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as “meta-inferences” in this study. Conclusions: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease. %M 30888329 %R 10.2196/12489 %U http://formative.jmir.org/2019/1/e12489/ %U https://doi.org/10.2196/12489 %U http://www.ncbi.nlm.nih.gov/pubmed/30888329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11689 %T A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study %A Lai,Byron %A Wilroy,Jereme %A Young,Hui-Ju %A Howell,Jennifer %A Rimmer,James H %A Mehta,Tapan %A Thirumalai,Mohanraj %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K exercise %K telehealth %K rehabilitation %K mHealth %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. Objective: The aim of this study was to examine the usability of a mobile exercise app in PWD. Methods: A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. Results: A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). Conclusions: The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants’ preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. Trial Registration: Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH). %M 30888325 %R 10.2196/11689 %U http://formative.jmir.org/2019/1/e11689/ %U https://doi.org/10.2196/11689 %U http://www.ncbi.nlm.nih.gov/pubmed/30888325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9922 %T What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys %A Ng,Denise %A McMurray,Josephine %A Wallace,James %A Morita,Plinio %+ Business Technology Management, Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K quality of healthcare %K surveys and questionnaires %K patient satisfaction %K data collection %K smartphone %K mobile phone %K risk %K privacy %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy. Objective: This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences. Methods: We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys. Results: Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients’ adoption of smart surveys. Conclusions: On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies. %M 30882354 %R 10.2196/formative.9922 %U http://formative.jmir.org/2019/1/e9922/ %U https://doi.org/10.2196/formative.9922 %U http://www.ncbi.nlm.nih.gov/pubmed/30882354 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9858 %T The Learning Exchange, a Community Knowledge Commons for Learning Networks: Qualitative Evaluation to Test Acceptability, Feasibility, and Utility %A McLinden,Daniel %A Myers,Sarah %A Seid,Michael %A Busch,Melida %A Davis,David %A Murphy,John %+ Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH,, United States, 1 513 803 0083, Michael.Seid@cchmc.org %K quality improvement %K knowledge management %K community networks %K intersectoral collaboration %K database management systems %K patient-centered care %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Learning Networks are distributed learning health systems that enable collaboration at scale to improve health and health care. A key requirement for such networks is having a way to create and share information and knowledge in furtherance of the work of the community. Objective: We describe a Learning Exchange—a bespoke, scalable knowledge management and exchange platform initially built and tested for improving pediatric inflammatory bowel disease outcomes in the ImproveCareNow (ICN) Network—and assess evidence of its acceptability, feasibility, and utility in facilitating creation and sharing of information in furtherance of the work of the community and as a model for other communities. Methods: Acceptability was assessed via growth in active users and activity. Feasibility was measured in terms of the percentage of users with a log-in who became active users as well as user surveys and a case study. Utility was measured in terms of the type of work that the Learning Exchange facilitated for the community. Results: The ICNExchange has over 1000 users and supported sharing of resources across all care centers in ICN. Users reported that the Learning Exchange has facilitated their work and resulted in increased ability to find resources relevant to local information needs. Conclusions: The ICNExchange is acceptable, feasible, and useful as a knowledge management and exchange platform in service of the work of ICN. Experience with the ICNExchange suggests that the design principles are extensible to other chronic care Learning Networks. %M 30869643 %R 10.2196/formative.9858 %U http://formative.jmir.org/2019/1/e9858/ %U https://doi.org/10.2196/formative.9858 %U http://www.ncbi.nlm.nih.gov/pubmed/30869643 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11785 %T The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results %A Alturki,Ryan %A Gay,Valerie %+ School of Electrical and Data Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, 81 Broadway, Ultimo, Sydney, 2007, Australia, 61 410583330, ryan.m.alturki@student.uts.edu.au %K weight loss %K mobile app %K obesity %K physical activity %K smartphone %K mHealth %K motivation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. %M 30869639 %R 10.2196/11785 %U http://formative.jmir.org/2019/1/e11785/ %U https://doi.org/10.2196/11785 %U http://www.ncbi.nlm.nih.gov/pubmed/30869639 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11111 %T Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App %A Lipson-Smith,Ruby %A White,Fiona %A White,Alan %A Serong,Lesley %A Cooper,Guy %A Price-Bell,Georgia %A Hyatt,Amelia %+ Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia, 61 3 8559 7837, amelia.hyatt@petermac.org %K referral and consultation %K adult %K humans %K cancer %K audiovisual aids %K mobile apps %K community-based participatory research %K health behavior %K psychological theory %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients’ recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient’s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. %M 30860487 %R 10.2196/11111 %U http://formative.jmir.org/2019/1/e11111/ %U https://doi.org/10.2196/11111 %U http://www.ncbi.nlm.nih.gov/pubmed/30860487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11950 %T Using Exploratory Trials to Identify Relevant Contexts and Mechanisms in Complex Electronic Health Interventions: Evaluating the Electronic Patient-Reported Outcome Tool %A Steele Gray,Carolyn %A Gravesande,Janelle %A Hans,Parminder Kaur %A Nie,Jason X %A Sharpe,Sarah %A Loganathan,Mayura %A Lyons,Renee %A Cott,Cheryl %+ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 416 461 8252 ext 2908, Carolyn.SteeleGray@sinaihealthsystem.ca %K eHealth %K mHealth %K multiple chronic conditions %K clinical trial, phase III %K health care evaluation mechanisms %K quantitative evaluation %K qualitative evaluation %K narrative analysis %D 2019 %7 27.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Designing appropriate studies for evaluating complex interventions, such as electronic health solutions to support integrated care, remains a methodological challenge. With the many moving parts of complex interventions, it is not always clear how program activities are connected to anticipated and unanticipated outcomes. Exploratory trials can be used to uncover determinants (or mechanisms) to inform content theory that underpins complex interventions before designing a full evaluation plan. Objective: A multimethod exploratory trial of the electronic patient-reported outcome (ePRO) tool was conducted to uncover contexts, processes and outcome variables, and the mechanisms that link these variables before full-scale evaluation. ePRO is a mobile app and portal designed to support goal-oriented care in interdisciplinary primary health care practices (clinical-level integration). This paper offers evaluation findings and methodological insight on how to use exploratory trial data to identify relevant context, process, and outcome variables, as well as central (necessary to achieving outcomes) versus peripheral (less critical and potentially context dependent) mechanisms at play. Methods: The 4-month trial was conducted in 2 primary health care practices in Toronto, Canada. The patients were randomized into control and intervention groups and compared pre and post on quality of life and activation outcome measures. Semistructured interviews were conducted with providers and patients in the intervention group. Narrative analysis was used to uncover dominant mechanisms that inform the intervention’s content theory (how context and process variables are linked to outcomes). Results: Overall, 7 providers, 1 administrator, and 16 patients (7-control, 9-intervention) participated in the study. This study uncovered many complex and nuanced context, process, and outcome variables at play in the intervention. Narrative analysis of patient and provider interviews revealed dominant story lines that help to tease apart central and peripheral mechanisms driving the intervention. Provider and patient story lines centered around fitting the new intervention into everyday work and life of patients and providers and meaningfulness of the intervention. These themes were moderated by patient-provider relationships going into and throughout the intervention, their comfort with technology, and the research process. Conclusions: Identifying dominant story lines using narrative analysis helps to identify the most relevant context and process variables likely to influence study outcomes. Normalization process theory emerges as a useful theory to uncover underlying mechanisms because of its emphasis on the social production and normalization of technological, processual, and social aspects of work; all found to be critical to our intervention. The number of complex, overlapping influencing variables suggests that complex interventions such as ePRO require us to pay careful attention to central versus peripheral mechanisms that will influence study outcomes. The narrative methods presented here are shown to be useful in uncovering these mechanisms and help to guide subsequent larger evaluation studies. %M 30810532 %R 10.2196/11950 %U http://formative.jmir.org/2019/1/e11950/ %U https://doi.org/10.2196/11950 %U http://www.ncbi.nlm.nih.gov/pubmed/30810532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9435 %T Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial %A Subasinghe,Asvini Kokila %A Garland,Suzanne Marie %A Gorelik,Alexandra %A Tay,Ilona %A Wark,John Dennis %+ Infection and Immunity Theme, Murdoch Children's Research Institute, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville,, Australia, 61 03 8345 3692, asvini.subasinghe@gmail.com %K behavior therapy methods %K mobile phones %K health behavior %K primary prevention methods %K self-care methods %D 2019 %7 25.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. Objective: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. Methods: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health–related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. Conclusions: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition. %M 30801253 %R 10.2196/formative.9435 %U http://formative.jmir.org/2019/1/e9435/ %U https://doi.org/10.2196/formative.9435 %U http://www.ncbi.nlm.nih.gov/pubmed/30801253 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10284 %T Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents %A Holzmann,Sophie Laura %A Dischl,Felicitas %A Schäfer,Hanna %A Groh,Georg %A Hauner,Hans %A Holzapfel,Christina %+ Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital “Klinikum rechts der Isar”, Technical University of Munich, Georg-Brauchle-Ring 62, 5th Floor, Munich, 80992, Germany, 49 89 289 249 23, christina.holzapfel@tum.de %K adolescents %K children %K communication %K motives %K mobile phone %K needs %K nutrition %K obesity %K overweight %K preferences %K serious games %K survey %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective: This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods: We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results: In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions: This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents. %M 30758290 %R 10.2196/10284 %U http://formative.jmir.org/2019/1/e10284/ %U https://doi.org/10.2196/10284 %U http://www.ncbi.nlm.nih.gov/pubmed/30758290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12528 %T A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease %A Dubin,Ruth %A Rubinsky,Anna %+ San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Box 111J, San Francisco, CA, 94121, United States, 1 5108474955, ruth.dubin@ucsf.edu %K chronic kidney disease %K end-stage renal disease %K online social networking %K patient education %K renal dialysis %D 2019 %7 06.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies. Objective: This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options. Methods: We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care. Results: Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m2. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001). Conclusions: Implementation of a digital ESRD education program is feasible and may facilitate patients’ decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes. Trial Registration: ClinicalTrials.gov NCT02976220; https://clinicaltrials.gov/ct2/show/NCT02976220 %M 30724735 %R 10.2196/12528 %U http://formative.jmir.org/2019/1/e12528/ %U https://doi.org/10.2196/12528 %U http://www.ncbi.nlm.nih.gov/pubmed/30724735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12508 %T Impact of Food Preparation Video Exposure on Online Nutrition Education in Women, Infants, and Children (WIC) Program Participants: Retrospective Study %A Bensley,Robert J %A Brusk,John J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Building, 1903 W Michigan Avenue, Kalamazoo, MI, 49008, United States, 1 269 716 2301, bensley@wmich.edu %K internet %K online video %K WIC %K engagement %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner’s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner’s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking. Objective: This study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC). Methods: This study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators. Results: A greater stage of change progression was observed for both food preparation (χ2=12.6, P<.001) and non-food preparation (χ2=62.8, P<.001) lessons among early stage users who had viewed a Health eKitchen video before completing a lesson. Time spent viewing educational learning resource links within the lesson was also significantly longer for both food preparation (t=7.8, P<.001) and non-food preparation (t=2.5, P=.01) lessons. Logistic regression analysis corroborated these results while controlling for known confounding factors. The odds of user progression were nearly three times greater among those who viewed a Health eKitchen video prior to lesson completion (odds ratio=2.61; 95% CI=2.08-3.29). Type of lesson (food vs non-food preparation) was the strongest predictor of progression odds (odds ratio=3.12; 95% CI=2.47-3.95). Conclusions: User access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons. %R 10.2196/12508 %U http://formative.jmir.org/2019/1/e12508/ %U https://doi.org/10.2196/12508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10978 %T Design, Development, and Evaluation of an Injury Surveillance App for Cricket: Protocol and Qualitative Study %A Soomro,Najeebullah %A Chhaya,Meraj %A Soomro,Mariam %A Asif,Naukhez %A Saurman,Emily %A Lyle,David %A Sanders,Ross %+ Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill, 2880, Australia, 61 880801282, naj.soomro@sydney.edu.au %K cricket %K injury surveillance %K mobile app %K mobile phone %K TeamDoc %K mHealth %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. Objective: The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. Methods: TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evaluated by administrating a modified user version of the Mobile App Rating Scale (uMARS; maximum score: 5). Results: TeamDoc is the first complementary, standalone mobile app that records cricket injuries through a smartphone. It can also record cricketing workloads, which is a known risk factor for injury. The app can be used without the need for supplementary computer devices for synchronization. The uMARS scores showed user satisfaction (overall mean score 3.6 [SD 0.5]), which demonstrates its acceptability by cricketers. Conclusions: Electronic injury surveillance systems have been shown to improve data collection during competitive sports. Therefore, TeamDoc may assist in improving injury reporting and may also act as a monitoring system for coaching staff to adjust individual training workloads. The methods described in this paper provide a template for researchers to develop similar apps for other sports. %M 30668516 %R 10.2196/10978 %U http://mhealth.jmir.org/2019/1/e10978/ %U https://doi.org/10.2196/10978 %U http://www.ncbi.nlm.nih.gov/pubmed/30668516 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11509 %T Feasibility of a Therapist-Supported, Mobile Phone–Delivered Online Intervention for Depression: Longitudinal Observational Study %A Goldin,Philippe R %A Lindholm,Riku %A Ranta,Kristian %A Hilgert,Outi %A Helteenvuori,Tiia %A Raevuori,Anu %+ Betty Irene Moore School of Nursing, University of California Davis, 4610 X Street, Sacramento, CA, 95817, United States, 1 4156769793, philippegoldin@gmail.com %K cognitive therapy %K depression %K digital health %K digital therapeutics %K mindfulness %K online intervention %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone–delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively). Conclusions: This therapist-supported, mobile phone–delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention. %R 10.2196/11509 %U http://formative.jmir.org/2019/1/e11509/ %U https://doi.org/10.2196/11509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12227 %T Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study %A Plans,David %A Morelli,Davide %A Sütterlin,Stefan %A Ollis,Lucie %A Derbyshire,Georgia %A Cropley,Mark %+ Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, School of Psychology, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 01483686928, mark.cropley@surrey.ac.uk %K biofeedback %K breathing %K heart rate variability %K recovery %K rumination %K stress %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. Objective: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. Methods: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). Results: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. Conclusions: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress. %M 30684437 %R 10.2196/12227 %U https://formative.jmir.org/2019/1/e12227/ %U https://doi.org/10.2196/12227 %U http://www.ncbi.nlm.nih.gov/pubmed/30684437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10246 %T Evaluation of a Mobile Device Survey System for Behavioral Risk Factors (SHAPE): App Development and Usability Study %A Oakley-Girvan,Ingrid %A Lavista,Juan M %A Miller,Yasamin %A Davis,Sharon %A Acle,Carlos %A Hancock,Jeffrey %A Nelson,Lorene M %+ Public Health Institute, 555 12th Street, 10th Floor, Oakland, CA,, United States, 1 4086562948, oakley@stanford.edu %K mobile phone %K demographic characteristics %K health surveys %K risk behaviors %K mobile apps %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Risk factors, including limited exercise, poor sleep, smoking, and alcohol and drug use, if mitigated early, can improve long-term health. Risk prevalence has traditionally been measured using methods that now have diminished participation rates. With >75% of American citizens owning smartphones, new data collection methods using mobile apps can be evaluated. Objective: The objective of our study was to describe the development, implementation, and evaluation of a mobile device–based survey system for behavioral risk assessment. Specifically, we evaluated its feasibility, usability, acceptability, and validity. Methods: We enrolled 536 students from 3 Vermont State Colleges. Iterative mobile app development incorporated focus groups, extensive testing, and the following 4 app versions: iOS standard, iOS gamified, Android standard, and Android gamified. We aimed to capture survey data, paradata, and ambient data such as geolocation. Using 3 separate surveys, we asked a total of 27 questions that included demographic characteristics, behavioral health, and questions regarding the app’s usability and survey process. Results: Planned enrollment was exceeded in just a few days. There were 1392 “hits” to the landing page where the app could be downloaded. Excluding known project testers and others not part of the study population, 670 participants downloadeded the SHAPE app. Of those, 94.9% of participants (636/670) agreed to participate by providing in-app consent. Of the 636 who provided consent, 84.3% (536/636) were deemed eligible for the study. The majority of eligible respondents completed the initial survey (459/536, 85.6%), whereas 29.9% (160/536) completed the second survey and 28.5% (153/536) completed the third survey. The SHAPE survey obtained 414 participants on the behavioral risk items in survey 1, which is nearly double the 209 participants who completed the traditional Vermont College Health Survey in 2014. SHAPE survey responses were consistent with the traditionally collected Vermont College Health Survey data. Conclusions: This study provides data highlighting the potential for mobile apps to improve population-based health, including an assessment of recruitment methods, burden and response rapidity, and future adaptations. Although gamification and monetary rewards were relatively unimportant to this study population, item response theory may be technologically feasible to reduce individual survey burden. Additional data collected by smartphones, such as geolocation, could be important in additional analysis, such as neighborhood characteristics and their impact on behavioral risk factors. Mobile tools that offer rapid adaptation for specific populations may improve research data collection for primary prevention and could be used to improve engagement and health outcomes. %M 30684441 %R 10.2196/10246 %U https://formative.jmir.org/2019/1/e10246/ %U https://doi.org/10.2196/10246 %U http://www.ncbi.nlm.nih.gov/pubmed/30684441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12456 %T A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability %A Allman-Farinelli,Margaret %A Ijaz,Kiran %A Tran,Helen %A Pallotta,Hermes %A Ramos,Sidney %A Liu,Junya %A Wellard-Cole,Lyndal %A Calvo,Rafael A %+ Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Building D17, NSW, 2006, Australia, 61 0290367045, margaret.allmanfarinelli@sydney.edu.au %K virtual reality %K nutrition promotion %K food policy %K take-out food %K obesity %K young adults %D 2019 %7 09.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective: The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods: Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results: One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions: Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy. %M 30684440 %R 10.2196/12456 %U http://formative.jmir.org/2019/1/e12456/ %U https://doi.org/10.2196/12456 %U http://www.ncbi.nlm.nih.gov/pubmed/30684440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10944 %T Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study %A Ceasar,Joniqua Nashae %A Claudel,Sophie Elizabeth %A Andrews,Marcus R %A Tamura,Kosuke %A Mitchell,Valerie %A Brooks,Alyssa T %A Dodge,Tonya %A El-Toukhy,Sherine %A Farmer,Nicole %A Middleton,Kimberly %A Sabado-Liwag,Melanie %A Troncoso,Melissa %A Wallen,Gwenyth R %A Powell-Wiley,Tiffany M %+ National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, MSC 1454, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell-wiley@nih.gov %K cardiovascular health %K community-based participatory research %K health behaviors %K mHealth %K mobile phone %K physical activity %K qualitative data %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. %M 30684422 %R 10.2196/10944 %U https://formative.jmir.org/2019/1/e10944/ %U https://doi.org/10.2196/10944 %U http://www.ncbi.nlm.nih.gov/pubmed/30684422 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10858 %T Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers’ Physical Activity: Qualitative Study %A McCloskey,Morgan L %A Thompson,Darcy A %A Chamberlin,Barbara %A Clark,Lauren %A Johnson,Susan L %A Bellows,Laura L %+ Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO, 80523 1571, United States, 1 9704911305, laura.bellows@colostate.edu %K smartphone %K mobile apps %K families %K child, preschool %K physical activity %K rural population %K poverty %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers. Objective: The aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers’ physical activity with both parents and children. Methods: Parents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers’ mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app. Results: Five key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families’ everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child’s mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app. Conclusions: Mobile devices are already integrated into most families’ daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills. %M 31518295 %R 10.2196/10858 %U http://pediatrics.jmir.org/2018/2/e10858/ %U https://doi.org/10.2196/10858 %U http://www.ncbi.nlm.nih.gov/pubmed/31518295 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e12077 %T The Internet of Things in Health Care in Oxford: Protocol for Proof-of-Concept Projects %A Meinert,Edward %A Van Velthoven,Michelle %A Brindley,David %A Alturkistani,Abrar %A Foley,Kimberley %A Rees,Sian %A Wells,Glenn %A de Pennington,Nick %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe, Oxford, OX3 9DU, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K Internet %K computer systems %K computing methodologies %K information systems %K information storage and retrieval %K dataset %K patient care %K health services %K Internet of Things %K Internet of Medical Things %D 2018 %7 04.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services. Objective: The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects. Methods: This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records. Results: This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019. Conclusions: Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband services, and the rapidly expanding medical device industry centered on mobile and wearable technologies. Oxford University Hospitals and its partner providers, patients, and stakeholders are building on their leading position as an exemplar site for digital maturity in the National Health Service to implement and evaluate technologies and solutions that will capitalize on the IoT. Although early in the application to health, the IoT and the potential it provides to make the patient a partner at the center of decisions about care represent an exciting opportunity. If achieved, a fully connected and interoperable health care environment will enable continuous acquisition and real-time analysis of patient data, offering unprecedented ability to monitor patients, manage disease, and potentially deliver early diagnosis. The clinical benefit of this is clear, but additional patient benefit and value will be gained from being able to provide expert care at home or close to home. International Registered Report Identifier (IRRID): DERR1-10.2196/12077 %M 30514695 %R 10.2196/12077 %U http://www.researchprotocols.org/2018/12/e12077/ %U https://doi.org/10.2196/12077 %U http://www.ncbi.nlm.nih.gov/pubmed/30514695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e25 %T Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) %A Warren,Ian %A Meads,Andrew %A Whittaker,Robyn %A Dobson,Rosie %A Ameratunga,Shanthi %+ Department of Computer Science, University of Auckland, Science Centre Building, 38 Princess Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 88784, ian-w@cs.auckland.ac.nz %K smartphone %K public health %K telemedicine %K telemetry %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness. %M 30684435 %R 10.2196/formative.9660 %U http://formative.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/formative.9660 %U http://www.ncbi.nlm.nih.gov/pubmed/30684435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e22 %T Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study %A Metting,Esther %A Schrage,Aaltje Jantine %A Kocks,Janwillem WH %A Sanderman,Robbert %A van der Molen,Thys %+ Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 4, Groningen, 9713 AW, Netherlands, 31 6 2564 7087, e.i.metting@umcg.nl %K asthma %K chronic obstructive pulmonary disease %K health care %K health literacy %K internet %K electronic medical record %K self-management %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: This study aimed to obtain and present an overview of patients’ perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. Conclusions: Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers. %M 30684436 %R 10.2196/formative.8822 %U http://formative.jmir.org/2018/2/e22/ %U https://doi.org/10.2196/formative.8822 %U http://www.ncbi.nlm.nih.gov/pubmed/30684436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e24 %T The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing %A Lo,Louisa L %A Collins,Ian M %A Bressel,Mathias %A Butow,Phyllis %A Emery,Jon %A Keogh,Louise %A Weideman,Prue %A Steel,Emma %A Hopper,John L %A Trainer,Alison H %A Mann,Gregory B %A Bickerstaffe,Adrian %A Antoniou,Antonis C %A Cuzick,Jack %A Phillips,Kelly-Anne %+ Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia, 61 3 85597860, Kelly.Phillips@petermac.org %K clinical decision support %K breast cancer %K BRCA1 gene %K BRCA2 gene %K risk %K preventive health %K screening %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as “about right” by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. %M 30684421 %R 10.2196/formative.9935 %U http://formative.jmir.org/2018/2/e24/ %U https://doi.org/10.2196/formative.9935 %U http://www.ncbi.nlm.nih.gov/pubmed/30684421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10945 %T Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study %A Kim,Rebecca H %A Patel,Mitesh S %+ Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA,, United States, 1 2678720364, rebecca.kim@uphs.upenn.edu %K veterans %K wearable devices %K connected health device %K physical activity %K mobile phone %D 2018 %7 06.11.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few studies have examined the use of wearable devices among the veteran population. Objective: The objective of this study was to evaluate veterans’ perceptions of and experiences with wearable devices and identify the potential barriers and opportunities to using such devices to increase physical activity levels in this population. Methods: Veterans able to ambulate with or without assistance completed surveys about their mobile technology use and physical activity levels. They were then given the option of using a wearable device to monitor their activity levels. Follow-up telephone interviews were conducted after 2 months. Results: A total of 16 veterans were enrolled in this study, and all of them agreed to take home and use the wearable device to monitor their activity levels. At follow-up, 91% (10/11) veterans were still using the device daily. Veterans identified both opportunities and barriers for incorporating these devices into interventions to increase physical activity. Conclusions: Veterans engaged in using wearable devices at high rates. %M 30684414 %R 10.2196/10945 %U http://formative.jmir.org/2018/2/e10945/ %U https://doi.org/10.2196/10945 %U http://www.ncbi.nlm.nih.gov/pubmed/30684414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11062 %T Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study %A Comulada,W Scott %A Swendeman,Dallas %A Rezai,Roxana %A Ramanathan,Nithya %+ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948278, wcomulada@mednet.ucla.edu %K changepoint %K diet quality %K mobile phone %K moving average %K physical activity %K stress %K time series %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals’ daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=−.14) and diet quality (r=−.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. %M 30684407 %R 10.2196/11062 %U https://formative.jmir.org/2018/2/e11062/ %U https://doi.org/10.2196/11062 %U http://www.ncbi.nlm.nih.gov/pubmed/30684407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11025 %T Web-Delivered Multimedia Training Materials for the Self-Collection of Dried Blood Spots: A Formative Project %A Allen,Alicia M %A Lundeen,Kim %A Murphy,Sharon E %A Spector,Logan %A Harlow,Bernard L %+ Department of Family & Community Medicine, College of Medicine, University of Arizona, Suite 300, 3950 South Country Club Road, Tucson, AZ, 85713, United States, 1 5206268157, aliciaallen@email.arizona.edu %K dried blood spot %K internet %K feasibility studies %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The use of dried blood spots (DBS) in biomedical research has been increasing as an objective measure for variables that are typically plagued by self-report, such as smoking status and medication adherence. The development of training materials for the self-collection of DBS that can be delivered through the Web would allow for broader use of this methodology. Objective: The objective of this study was to evaluate the acceptability and feasibility of the self-collection of DBS using newly developed multimedia training materials that were delivered through the Web. We also aimed to assess the usability of the collected DBS samples. Methods: We recruited participants through Facebook advertising for two distinct studies. The first study evaluated the acceptability of our newly developed DBS training materials, while the second assessed the implementation of this protocol into a larger Web-based study. Results: In the first study, participants (N=115) were aged, on average, 26.1 (SD 6.4) years. Training materials were acceptable (113/115, 98.2%, of participants were willing to collect DBS again) and produced usable samples (110/115, 95.7%, collected DBS were usable). In the second study, response rate was 25.0% (41/164), with responders being significantly younger than nonresponders (20.3 [SD 0.2] vs 22.0 [SD 0.4]; P<.001), and 92% (31/41) of collected DBS samples were usable by the laboratory. Conclusions: Overall, while the protocol is acceptable, feasible, and produced usable samples, additional work is needed to improve response rates. %M 30684406 %R 10.2196/11025 %U http://formative.jmir.org/2018/2/e11025/ %U https://doi.org/10.2196/11025 %U http://www.ncbi.nlm.nih.gov/pubmed/30684406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e23 %T Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study %A Elsbernd,Abbey %A Hjerming,Maiken %A Visler,Camilla %A Hjalgrim,Lisa Lyngsie %A Niemann,Carsten Utoft %A Boisen,Kirsten Arntz %A Jakobsen,Jens %A Pappot,Helle %+ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 3545 8403, helle.pappot@regionh.dk %K adolescent and young adult %K cancer %K cocreation %K mHealth %K oncology %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective: The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods: Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results: Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions: The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions. %M 30684439 %R 10.2196/formative.9842 %U http://formative.jmir.org/2018/2/e23/ %U https://doi.org/10.2196/formative.9842 %U http://www.ncbi.nlm.nih.gov/pubmed/30684439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e21 %T A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study %A Verdaguer,Sandra %A Mateo,Katrina F %A Wyka,Katarzyna %A Dennis-Tiwary,Tracy A %A Leung,May May %+ School of Urban Public Health, Hunter College, The City University of New York, 2180 Third Avenue, New York, NY, 10035, United States, 1 212 396 7774, maymay.leung@hunter.cuny.edu %K usability testing %K interactive technology %K mHealth, childhood obesity %K minority %K health nutrition %K health education %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth. %M 30684417 %R 10.2196/formative.9747 %U http://formative.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/formative.9747 %U http://www.ncbi.nlm.nih.gov/pubmed/30684417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10025 %T Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study %A Balls-Berry,Joyce %A Sinicrope,Pamela %A Valdez Soto,Miguel %A Brockman,Tabetha %A Bock,Martha %A Patten,Christi %+ Center for Clinical and Translational Science, Mayo Clinic, 200 First Street SW, Rochester, MN,, United States, 1 507 538 3755, ballsberry.joyce@mayo.edu %K biomedical research %K community health %K community and patient engagement in research %K podcast %K social media %D 2018 %7 24.10.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography. Objective: To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community. Methods: We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others. Results: In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page. Conclusions: This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics. %M 30684430 %R 10.2196/10025 %U http://formative.jmir.org/2018/2/e10025/ %U https://doi.org/10.2196/10025 %U http://www.ncbi.nlm.nih.gov/pubmed/30684430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10257 %T Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial %A Jungmann,Manuela %A Vencatachellum,Shervin %A Van Ryckeghem,Dimitri %A Vögele,Claus %+ Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Campus Belval, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, 4366, Luxembourg, 352 4666449755, manuela.jungmann@uni.lu %K cold stimulation %K heart rate reduction %K lateral neck region %K diving reflex %K stress reduction %K wearable electronic devices %K thermode-based stimulation %K acute stress %K technology for stress relief %K vagus nerve stimulation %K psychological stress %D 2018 %7 09.10.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The experience of psychological stress has not yet been adequately tackled with digital technology by catering to healthy individuals who wish to reduce their acute stress levels. For the design of digitally mediated solutions, physiological mechanisms need to be investigated that have the potential to induce relaxation with the help of technology. Research has shown that physiological mechanisms embodied in the face and neck regions are effective for diminishing stress-related symptoms. Our study expands on these areas with the design for a wearable in mind. As this study charts new territory in research, it also is a first evaluation of the viability for a wearables concept to reduce stress. Objective: The objectives of this study were to assess whether (1) heart rate variability would increase and (2) heart rate would decrease during cold stimulation using a thermode device compared with a (nonstimulated) control condition. We expected effects in particular in the neck and cheek regions and less in the forearm area. Methods: The study was a fully randomized, within-participant design. Volunteer participants were seated in a laboratory chair and tested with cold stimulation on the right side of the body. A thermode was placed on the neck, cheek, and forearm. We recorded and subsequently analyzed participants’ electrocardiogram. The cold stimulation was applied in 16-second intervals over 4 trials per testing location. The control condition proceeded exactly like the cold condition, except we manipulated the temperature variable to remain at the baseline temperature. We measured heart rate as interbeat intervals in milliseconds and analyzed root mean square of successive differences to index heart rate variability. We analyzed data using a repeated-measures ANOVA (analysis of variance) approach with 2 repeated-measures factors: body location (neck, cheek, forearm) and condition (cold, control). Results: Data analysis of 61 participants (after exclusion of outliers) showed a main effect and an interaction effect for body location and for condition, for both heart rate and heart rate variability. The results demonstrate a pattern of cardiovascular reactivity to cold stimulation, suggesting an increase in cardiac-vagal activation. The effect was significant for cold stimulation in the lateral neck area. Conclusions: The results confirmed our main hypothesis that cold stimulation at the lateral neck region would result in higher heart rate variability and lower heart rate than in the control condition. This sets the stage for further investigations of stress reduction potential in the neck region by developing a wearable prototype that can be used for cold application. Future studies should include a stress condition, test for a range of temperatures and durations, and collect self-report data on perceived stress levels to advance findings. %M 30684416 %R 10.2196/10257 %U http://formative.jmir.org/2018/2/e10257/ %U https://doi.org/10.2196/10257 %U http://www.ncbi.nlm.nih.gov/pubmed/30684416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e20 %T A Locally Developed Electronic Health Platform in Uganda: Development and Implementation of Stre@mline %A Liang,Li %A Wiens,Matthew O %A Lubega,Phaisal %A Spillman,Ian %A Mugisha,Samuel %+ Innovation Streams Limited, Plot 76/78 High Street, Mbarara La Grand Mall Room L2-03, Mbarara, PO Box 1340, Uganda, 256 704899935, samuel.gisha@gmail.com %K electronic health record %K locally developed technology %K appropriate technology %K eHealth in low-resource settings %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Electronic health records (EHRs) are especially important in low-resource settings due to their potential to address unique challenges such as a high number of patients requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records, and inefficient clinical triaging. However, there is a lack of affordable and practical EHR solutions. Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Stre@mline is currently used by over 60,000 patients at 2 hospitals, with plans to expand across Uganda. Objective: The purpose of this article is to describe the key opportunities and challenges in EHR development in sub-Saharan Africa and to summarize the development and implementation of a “Made-for-Africa” EHR, Stre@mline, and how it has led to improved care for over 60,000 vulnerable patients in a rural region of Southwestern Uganda. Methods: A quantitative user survey consisting of a set of 33 questions on usability and performance was conducted at Kisiizi Hospital. Users responded to each question through a Likert scale with the values of strongly disagree, disagree, agree, and strongly agree. Through purposive sampling, 30 users were identified and 28 users completed the survey. Results: We found that users were generally very satisfied with the ease of use of Stre@mline, with 96% (27/28) finding it easy to learn and 100% (28/28) finding it easy to use. Users found that Stre@mline was helpful in improving both clinical efficiency and enhancing patient care. Conclusions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future technologies suitable for developing countries. %M 30684419 %R 10.2196/formative.9658 %U http://formative.jmir.org/2018/2/e20/ %U https://doi.org/10.2196/formative.9658 %U http://www.ncbi.nlm.nih.gov/pubmed/30684419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10055 %T Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study %A Roberts,Courtney %A Sage,Adam %A Geryk,Lorie %A Sleath,Betsy %A Carpenter,Delesha %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, Chapel Hill, NC, 27599, United States, 1 919 843 2278, carrinde@live.unc.edu %K asthma %K mHealth %K mobile app %K patient engagement %K self-management %K usability %D 2018 %7 13.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective: The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods: A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results: Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions: Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors. %M 30684424 %R 10.2196/10055 %U http://formative.jmir.org/2018/2/e10055/ %U https://doi.org/10.2196/10055 %U http://www.ncbi.nlm.nih.gov/pubmed/30684424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e16 %T Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research %A Lopez,Keila N %A O'Connor,Michael %A King,Jason %A Alexander,James %A Challman,Melissa %A Lovick,Donna K %A Goodly,Nicole %A Smith,Amelia %A Fawcett,Elliott %A Mulligan,Courtney %A Thompson,Debbe %A Fordis,Michael %+ Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin Street, MC 19-345, Houston, TX, 77030, United States, 1 832 826 5600, knlopez@bcm.edu %K adolescent health %K chronic disease %K transitions of care %K health disparities %K mobile health %K mHealth %K patient empowerment %K patient involvement %K self-efficacy %K user-centered design %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, “Can I exercise?”), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. %R 10.2196/formative.9963 %U http://formative.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/formative.9963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e18 %T Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women %A Silfee,Valerie J %A Lopez-Cepero,Andrea %A Lemon,Stephenie C %A Estabrook,Barbara %A Nguyen,Oanh %A Wang,Monica L %A Rosal,Milagros C %+ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3173, Milagros.Rosal@umassmed.edu %K Facebook %K health disparities %K postpartum women %K social media %K weight loss %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. Objective: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. Methods: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. Results: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. Conclusions: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention. %M 30684423 %R 10.2196/formative.9597 %U http://formative.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/formative.9597 %U http://www.ncbi.nlm.nih.gov/pubmed/30684423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e19 %T A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing %A Børøsund,Elin %A Mirkovic,Jelena %A Clark,Matthew M %A Ehlers,Shawna L %A Andrykowski,Michael A %A Bergland,Anne %A Westeng,Marianne %A Solberg Nes,Lise %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 92667262, elin.borosund@rr-research.no %K stress management %K mindfulness %K cancer %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mobile phones %D 2018 %7 06.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) %M 30684438 %R 10.2196/formative.9954 %U http://formative.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/formative.9954 %U http://www.ncbi.nlm.nih.gov/pubmed/30684438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11138 %T Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis %A McKelvey,Karma %A Ramo,Danielle %+ Weill Institute for Neurosciences, Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, United States, 1 4154767695, danielle.ramo@ucsf.edu %K Facebook %K intervention %K qualitative analysis %K smoking cessation %K social media %K young adults %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Smoking cessation interventions delivered through social media have the potential to engage young people in behavior change. Objective: The aim of this study was to describe participant-posted messages in a Facebook smoking cessation intervention for young adults to discern support for behavior change. Methods: We qualitatively analyzed data from the treatment arm of a randomized trial testing the efficacy of the Tobacco Status Project Facebook intervention. Young adults (N=138) aged 18-25 years (female: 81/138, 58.7%; white: 101/138, 73.2%; mean age 21 years) were recruited using Facebook and placed into one of the 15 secret Facebook groups based on readiness-to-quit smoking. Messages posted to groups for 90 consecutive days were tailored to readiness-to-quit: Not Ready (46/138, 33.3%), Thinking (66/138, 47.8%), and Getting Ready (26/138, 18.8%). Groups were randomized to receive up to US $90 for posting or no incentive. Two independent coders conducted open coding of user posts. We considered content by readiness-to-quit group and incentive condition. Results: There were 4 dominant themes across all groups: coping skills, friends and family, motivation to quit, and benefits of quitting. The dominant themes in Not Ready groups were friends and family (incentive) and motivation to quit (no incentive), whereas coping skills was the dominant theme in Thinking and Getting Ready groups. The expression of themes varied by readiness-to-quit group but not by incentive condition. Conclusions: Intervention messages tailored to readiness-to-quit appear useful in eliciting the desired responses from young adult smokers, with limited influence by monetary incentive. Trial Registration: ClinicalTrials.gov NCT02207036; https://clinicaltrials.gov/ct2/show/NCT02207036 (Archived by WebCite at http://www.webcitation.org/722XAEAAz) %M 30684432 %R 10.2196/11138 %U http://formative.jmir.org/2018/2/e11138/ %U https://doi.org/10.2196/11138 %U http://www.ncbi.nlm.nih.gov/pubmed/30684432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e17 %T Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study %A Healy,Genevieve Nissa %A Eakin,Elizabeth G %A Winkler,Elisabeth AH %A Hadgraft,Nyssa %A Dunstan,David W %A Gilson,Nicholas D %A Goode,Ana D %+ School of Public Health, The University of Queensland, 266 Herston Road, Herston, Brisbane, 4006, Australia, 61 733655528, g.healy@uq.edu.au %K BeUpstanding Champion Toolkit %K implementation %K physical activity %K sedentary %K workplace sitting %D 2018 %7 28.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a “train-the-champion approach”) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ≈600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (−6.3%, 95% CI −10.1 to −2.5; n=85) equating to ≈30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. %M 30684420 %R 10.2196/formative.9343 %U http://formative.jmir.org/2018/2/e17/ %U https://doi.org/10.2196/formative.9343 %U http://www.ncbi.nlm.nih.gov/pubmed/30684420 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e54 %T A Mobile App–Based Intervention for Depression: End-User and Expert Usability Testing Study %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Klein,Britt %A Skouteris,Helen %A Christensen,Helen %A Austin,David %A Castle,David %A Mihalopoulos,Cathrine %A O'Donnell,Renee %A Arulkadacham,Lilani %A Shatte,Adrian %A Ware,Anna %+ School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392517344, matthewf@deakin.edu.au %K depression %K eHealth %K mHealth %K young adult %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. %M 30139722 %R 10.2196/mental.9445 %U http://mental.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mental.9445 %U http://www.ncbi.nlm.nih.gov/pubmed/30139722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e172 %T A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study %A Martínez-Alcalá,Claudia I %A Rosales-Lagarde,Alejandra %A Hernández-Alonso,Esmeralda %A Melchor-Agustin,Roberto %A Rodriguez-Torres,Erika E %A Itzá-Ortiz,Benjamín A %+ Consejo Nacional de Ciencia y Tecnología, Av Insurgentes Sur 1582, Col Crédito Constructor, Del Benito Juárez, Ciudad de México, 03940, Mexico, 52 (771) 71 72 000 ext 4332, c_isabel_alcala@hotmail.com %K mobile application %K cognitive stimulation %K cognitive impairment %K older adults %K neuropsychological evaluation. %D 2018 %7 21.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 %M 30131319 %R 10.2196/resprot.9603 %U http://www.researchprotocols.org/2018/8/e172/ %U https://doi.org/10.2196/resprot.9603 %U http://www.ncbi.nlm.nih.gov/pubmed/30131319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e15 %T Electronic Swallowing Intervention Package to Support Swallowing Function in Patients With Head and Neck Cancer: Development and Feasibility Study %A Cowie,Julie %A Boa,Sally %A King,Emma %A Wells,Mary %A Cairns,David %+ Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 141 331 8100, julie.cowie@gcu.ac.uk %K head and neck cancer %K eHealth %K self-management %K mHealth %K chemoradiotherapy %K mobile phones %D 2018 %7 17.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemoradiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: The objective of our study was to develop and conduct a preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for HNC. Methods: The study was conducted using a recognized mHealth development and evaluation framework and involved health professionals and patients who were undergoing CRT for HNC. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SiP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype, which was then evaluated using a series of steering group meetings, semistructured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive, and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the 10 patients who were offered e-SiP, only 2 opted to use it. For these patients, the aspects of the e-SiP app were considered useful, in particular, the ease of keeping a diary of exercises performed. Interviews with users and nonusers suggested significant barriers to its use. Most significantly, the lack of flexibility of the platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: The results suggest that further research needs to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care and through patient training and staff engagement, can be perceived as a beneficial tool to help support patients in conducting swallowing exercises. %R 10.2196/formative.9703 %U http://formative.jmir.org/2018/2/e15/ %U https://doi.org/10.2196/formative.9703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10411 %T Utilizing a Prototype Patient-Controlled Electronic Health Record in Germany: Qualitative Analysis of User-Reported Perceptions and Perspectives %A Poss-Doering,Regina %A Kunz,Aline %A Pohlmann,Sabrina %A Hofmann,Helene %A Kiel,Marion %A Winkler,Eva C %A Ose,Dominik %A Szecsenyi,Joachim %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Tower West, 4th Floor, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K personal patient-controlled electronic health record %K eHealth %K nationwide implementation %K continuity of care %D 2018 %7 03.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Personal electronic health records (PHR) are considered instrumental in improving health care quality and efficiency, enhancing communication between all parties involved and strengthening the patient’s role. Technical architectures, data privacy, and applicability issues have been discussed for many years. Nevertheless, nationwide implementation of a PHR is still pending in Germany despite legal regulations provided by the eHealth Act passed in 2015. Within the information technology for patient-oriented care project funded by the Federal Ministry of Education and Research (2012-2017), a Web-based personal electronic health record prototype (PEPA) was developed enabling patient-controlled information exchange across different care settings. Gastrointestinal cancer patients and general practitioners utilized PEPA during a 3-month trial period. Both patients and physicians authorized by them could view PEPA content online and upload or download files. Objective: This paper aims to outline findings of the posttrial qualitative study carried out to evaluate user-reported experiences, perceptions, and perspectives, focusing on their interpretation of PEPA beyond technical usability and views on a future nationwide implementation. Methods: Data were collected through semistructured guide-based interviews with 11 patients and 3 physicians (N=14). Participants were asked to share experiences, views of perceived implications, and perspectives towards nationwide implementation. Further data were generated through free-text fields in a subsequent study-specific patient questionnaire and researcher’s notes. Data were pseudonymized, audiotaped, and transcribed verbatim. Content analysis was performed through the Framework Analysis approach. All qualitative data were systemized by using MAXQDA Analytics PRO 12 (Rel.12.3.1). Additionally, participant characteristics were analyzed descriptively using IBM SPSS Statistics Version 24. Results: Users interpreted PEPA as a central medium containing digital chronological health-related documentation that simplifies information sharing across care settings. While patients consider the implementation of PEPA in Germany in the near future, physicians are more hesitant. Both groups believe in PEPA’s concept, but share awareness of concerns about data privacy and older or impaired people’s abilities to manage online records. Patients perceive benefits for involvement in treatment processes and continuity of care but worry about financing and the implementation of functionally reduced versions. Physicians consider integration into primary systems critical for interoperability but anticipate technical challenges, as well as resistance from older patients and colleagues. They omit clear positioning regarding PEPA’s potential incremental value for health care organizations or the provider-patient relationship. Conclusions: Digitalization in German health care will continue to bring change, both organizational and in the physician-patient relationship. Patients endorse and expect a nationwide PEPA implementation, anticipating various benefits. Decision makers and providers need to contribute to closing modernization gaps by committing to new concepts and by invigorating transformed roles. %M 30684411 %R 10.2196/10411 %U http://formative.jmir.org/2018/2/e10411/ %U https://doi.org/10.2196/10411 %U http://www.ncbi.nlm.nih.gov/pubmed/30684411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e14 %T Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial %A Côté,José %A Fortin,Marie-Chantal %A Auger,Patricia %A Rouleau,Geneviève %A Dubois,Sylvie %A Boudreau,Nathalie %A Vaillant,Isabelle %A Gélinas-Lemay,Élisabeth %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 St-Denis, Tour St-Antoine, Door S01-128, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 15536, jose.cote@umontreal.ca %K medication adherence %K transplant recipient %K self-management %K nursing %K Web-based tailored intervention %K randomized controlled trial %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence. Objective: The objective of our study was to evaluate the Transplant-TAVIE intervention’s acceptability, feasibility, and preliminary efficacy. Methods: In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time. Results: After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable—33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time. Conclusions: The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services. %M 30684400 %R 10.2196/formative.9707 %U http://formative.jmir.org/2018/2/e14/ %U https://doi.org/10.2196/formative.9707 %U http://www.ncbi.nlm.nih.gov/pubmed/30684400 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e165 %T The Development of Complex Digital Health Solutions: Formative Evaluation Combining Different Methodologies %A Lee,Anne %A Sandvei,Marianne %A Asmussen,Hans Christian %A Skougaard,Marie %A Macdonald,Joanne %A Zavada,Jakub %A Bliddal,Henning %A Taylor,Peter C %A Gudbergsen,Henrik %+ Centre for Innovative Medical Technology, Odense University Hospital, Kloevervanget 8, Odense, 5000, Denmark, 45 21656406, anne.lee@rsyd.dk %K eHealth %K telemedicine %K stakeholder participation %K formative evaluation %K participatory design %K intervention theories %D 2018 %7 16.07.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The development of digital health solutions for current health care settings requires an understanding of the complexities of the health care system, organizational setting, and stakeholder groups and of the underlying interplay between stakeholders and the technology. The digital health solution was founded on the basis of an information and communication technology platform and point-of-care devices enabling home-based monitoring of disease progression and treatment outcome for patients with rheumatoid arthritis (RA). Objective: The aim of this paper is to describe and discuss the applicability of an iterative evaluation process in guiding the development of a digital health solution as a technical and organizational entity in three different health care systems. Methods: The formative evaluation comprised the methodologies of contextual understanding, participatory design, and feasibility studies and included patients, healthcare professionals, and hardware and software developers. In total, the evaluation involved 45 patients and 25 health care professionals at 3 clinical sites in Europe. Results: The formative evaluation served as ongoing and relevant input to the development process of the digital health solution. Through initial field studies key stakeholder groups were identified and knowledge obtained about the different health care systems, the professional competencies involved in routine RA treatment, the clinics’ working procedures, and the use of communication technologies. A theory-based stakeholder evaluation achieved a multifaceted picture of the ideas and assumptions held by stakeholder groups at the three clinical sites, which also represented the diversity of three different language zones and cultures. Experiences and suggestions from the patients and health care professionals were sought through participatory design processes and real-life testing and actively used for adjusting the visual, conceptual, and practical design of the solution. The learnings captured through these activities aided in forming the solution and in developing a common understanding of the overall vision and aim of this solution. During this process, the 3 participating sites learned from each other’s feed-back with the ensuing multicultural inspiration. Moreover, these efforts also enabled the consortium to identify a ‘tipping point’ during a pilot study, revealing serious challenges and a need for further development of the solution. We achieved valuable learning during the evaluation activities, and the remaining challenges have been clarified more extensively than a single-site development would have discovered. The further obstacles have been defined as has the need to resolve these before designing and conducting a real-life clinical test to assess the outcome from a digital health solution for RA treatment. Conclusions: A formative evaluation process with ongoing involvement of stakeholder groups from 3 different cultures and countries have helped to inform and influence the development of a novel digital health solution, and provided constructive input and feedback enabling the consortium to control the development process. %M 30012548 %R 10.2196/resprot.9521 %U http://www.researchprotocols.org/2018/7/e165/ %U https://doi.org/10.2196/resprot.9521 %U http://www.ncbi.nlm.nih.gov/pubmed/30012548 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 3 %P e10431 %T Design and Development of a Context-Aware Knowledge-Based Module for Identifying Relevant Information and Information Gaps in Patients With Type 1 Diabetes Self-Collected Health Data %A Giordanengo,Alain %A Øzturk,Pinar %A Hansen,Anne Helen %A Årsand,Eirik %A Grøttland,Astrid %A Hartvigsen,Gunnar %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Postboks 35, Tromsø, 9038, Norway, 47 91715718, alain.giordanengo@ehealthresearch.no %K context aware %K knowledge-based system %K diabetes %K self-collected health data %K information gaps %D 2018 %7 11.07.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patients with diabetes use an increasing number of self-management tools in their daily life. However, health institutions rarely use the data generated by these services mainly due to (1) the lack of data reliability, and (2) medical workers spending too much time extracting relevant information from the vast amount of data produced. This work is part of the FullFlow project, which focuses on self-collected health data sharing directly between patients’ tools and EHRs. Objective: The main objective is to design and implement a prototype for extracting relevant information and documenting information gaps from self-collected health data by patients with type 1 diabetes using a context-aware approach. The module should permit (1) clinicians to assess the reliability of the data and to identify issues to discuss with their patients, and (2) patients to understand the implication their lifestyle has on their disease. Methods: The identification of context and the design of the system relied on (1) 2 workshops in which the main author participated, 1 patient with type 1 diabetes, and 1 clinician, and (2) a co-design session involving 5 patients with type 1 diabetes and 4 clinicians including 2 endocrinologists and 2 diabetes nurses. The software implementation followed a hybrid agile and waterfall approach. The testing relied on load, and black and white box methods. Results: We created a context-aware knowledge-based module able to (1) detect potential errors, and information gaps from the self-collected health data, (2) pinpoint relevant data and potential causes of noticeable medical events, and (3) recommend actions to follow to improve the reliability of the data issues and medical issues to be discussed with clinicians. The module uses a reasoning engine following a hypothesize-and-test strategy built on a knowledge base and using contextual information. The knowledge base contains hypotheses, rules, and plans we defined with the input of medical experts. We identified a large set of contextual information: emotional state (eg, preferences, mood) of patients and medical workers, their relationship, their metadata (eg, age, medical specialty), the time and location of usage of the system, patient-collected data (eg, blood glucose, basal-bolus insulin), patients’ goals and medical standards (eg, insulin sensitivity factor, in range values). Demonstrating the usage of the system revealed that (1) participants perceived the system as useful and relevant for consultation, and (2) the system uses less than 30 milliseconds to treat new cases. Conclusions: Using a knowledge-based system to identify anomalies concerning the reliability of patients’ self-collected health data to provide information on potential information gaps and to propose relevant medical subjects to discuss or actions to follow could ease the introduction of self-collected health data into consultation. Combining this reasoning engine and the system of the FullFlow project could improve the diagnostic process in health care. %M 30291097 %R 10.2196/10431 %U http://diabetes.jmir.org/2018/3/e10431/ %U https://doi.org/10.2196/10431 %U http://www.ncbi.nlm.nih.gov/pubmed/30291097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e13 %T A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study %A Power,Julianne Mary %A Bersamin,Andrea %+ Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, 902 N Koyukuk Drive, PO Box 757000, Fairbanks, AK, 99775, United States, 1 907 474 6129, abersamin@alaska.edu %K fruits and vegetables %K nutrition education %K nutrition intervention %K young children %K text messaging %D 2018 %7 06.07.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective: The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods: The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results: Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions: A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted. %M 30684412 %R 10.2196/formative.8544 %U http://formative.jmir.org/2018/2/e13/ %U https://doi.org/10.2196/formative.8544 %U http://www.ncbi.nlm.nih.gov/pubmed/30684412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10457 %T An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia %A Williamson,Esther %A Cranston,Tim %A Hunter,John %A Adams,Jo %A Lamb,Sarah E %+ Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, United Kingdom, 44 01865737907, cynthia.srikesavan@ndorms.ox.ac.uk %K rheumatoid arthritis %K hand joints %K exercise training %K web-based %D 2018 %7 27.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective: We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods: We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results: A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions: mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences. %M 29950288 %R 10.2196/10457 %U http://www.jmir.org/2018/6/e10457/ %U https://doi.org/10.2196/10457 %U http://www.ncbi.nlm.nih.gov/pubmed/29950288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e12 %T Investigating Associations Between Changes in Mobile Phone Use and Emotions Using the Experience Sampling Method: Pilot Study %A Roggeveen,Suzanne %A van Os,Jim %A Bemelmans,Kelly %A van Poll,Mikal %A Lousberg,Richel %+ Department of Psychiatry and Psychology, Maastricht University, Vijverdalseweg 1, Maastricht,, Netherlands, 31 43 3884111, s.roggeveen@maastrichtuniversity.nl %K mobile phone %K experience sampling method %K emotions %K affect %K concentration %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The use of mobile phones has become, especially for young people, an integrated part of everyday life. Using the experience sampling method (ESM) may provide further insight on the association between mobile phone use and mental health. Objective: The objective of this study was to examine associations between mobile phone use and subtle changes in mental state. Methods: The ESM-based PsyMate app was installed on the mobile phones of 2 healthy 20-year-old participants. Over a period of 3 months, participants rated their mental states at 10 semirandom moments in the flow of daily life. Each assessment included present state emotions, environmental circumstances, and phone use. Results: Multilevel regression analyses indicated that an increase in mobile phone use was associated with a small increase in negative affect (particularly feeling bored and feeling lonely; P<.001) and small decreases in positive affect (P=.002) and concentration (P=.001). Treating the data as 2 separate N=1 studies revealed that the association with negative affect was present in both participants, whereas the associations with positive affect and concentration were evident in only 1 of the 2 participants. Conclusions: This pilot study suggests that mobile phone use may be associated with person-specific and group-level changes in emotional state. A larger study is required to study these associations, possible causality, and factors driving underlying heterogeneity in the pattern of associations. Trial registration: ClinicalTrials.gov NCT03221985; https://clinicaltrials.gov/ct2/show/NCT03221985 (archived by WebCite at http://www.webcitation.org/6zJnp61Wj) %M 30684428 %R 10.2196/formative.8499 %U http://formative.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/formative.8499 %U http://www.ncbi.nlm.nih.gov/pubmed/30684428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e154 %T Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study %A Van de Velde,Stijn %A Kortteisto,Tiina %A Spitaels,David %A Jamtvedt,Gro %A Roshanov,Pavel %A Kunnamo,Ilkka %A Aertgeerts,Bert %A Vandvik,Per Olav %A Flottorp,Signe %+ Centre for Informed Health Choices, Norwegian Institute of Public Health, Postboks 4404 Nydalen, Oslo, 0403, Norway, 47 46 40 04 75, stijn.vandevelde@med.kuleuven.be %K decision support systems, clinical %K practice guidelines as topic %K guideline adherence %K evidence-based medicine %K osteoarthritis, knee %K focus groups %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. Objective: This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. Methods: Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. Results: The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. Conclusions: The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time. %M 29891466 %R 10.2196/resprot.9927 %U http://www.researchprotocols.org/2018/6/e154/ %U https://doi.org/10.2196/resprot.9927 %U http://www.ncbi.nlm.nih.gov/pubmed/29891466 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e10525 %T A Digital Decision Support Tool to Enhance Decisional Capacity for Clinical Trial Consent: Design and Development %A Furberg,Robert D %A Ortiz,Alexa M %A Moultrie,Rebecca R %A Raspa,Melissa %A Wheeler,Anne C %A McCormack,Lauren A %A Bailey Jr,Donald B %+ Digital Health and Clinical Informatics, RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC, 27709-2194, United States, 1 919 316 3726, rfurberg@rti.org %K decision support %K informed consent %K digital health %K intellectual disability %K fragile X syndrome %K telemedicine %D 2018 %7 06.06.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Challenges in the clinical and research consent process indicate the need to develop tailored, supportive interventions for all individuals, especially those with limited decisional capacity. We developed a tool to enhance shared decision making and the decisional capacity for individuals with fragile X syndrome engaged in the informed consent process for a clinical trial. Objective: We describe the design and development process of a tablet-based decision support tool. Methods: Our development process for the decision support tool employed a user-centered, feature-driven design approach. We began with an environmental scan to catalog relevant mobile apps, and we conducted interviews with people with a diagnosis of fragile X syndrome and clinicians at fragile X syndrome clinics. To develop content for the decision support tool, we extracted key concepts and elements from a real clinical trial consent form and rewrote it using plain-language principles. Results: We used iterative testing to continuously evaluate and revise the decision support tool content. The tool was finalized in 2016 and contained a series of vignettes, quiz questions, and a sorting activity. A randomized controlled trial was then conducted to compare the efficacy of the decision support tool with a standard verbal presentation of material that mimicked typical informed consent practice. Conclusions: The informed consent process is primed to leverage digital health resources that promote increased understanding and engagement of research participants in the consent and research process. The process and experiences we describe may provide a model for other digital health design and development initiatives seeking to create more interactive and accessible decision support resources. Trial Registration: ClinicalTrials.gov NCT02465931; https://www.clinicaltrials.gov/ct2/show/NCT02465931 (Archived by WebCite at http://www.webcitation.org/6zx2KY9YW) %R 10.2196/10525 %U http://www.researchprotocols.org/2018/6/e10525/ %U https://doi.org/10.2196/10525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10774 %T Developing Technology to Mobilize Personal Strengths in People with Chronic Illness: Positive Codesign Approach %A Mirkovic,Jelena %A Jessen,Stian %A Kristjansdottir,Olöf Birna %A Krogseth,Tonje %A Koricho,Absera Teshome %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hostipal, Box 4950 Nydalen, Oslo, 0424, Norway, 47 46343869, Jelena.Mirkovic@rr-research.no %K patient personal strengths %K participatory design %K codesign %K appreciative inquiry %K service design %K positive computing %K positive technology %K chronic disease %K eHealth %K mHealth %K patient requirements %K patient participation %D 2018 %7 05.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Emerging research from psychology and the bio-behavioral sciences recognizes the importance of supporting patients to mobilize their personal strengths to live well with chronic illness. Positive technology and positive computing could be used as underlying design approaches to guide design and development of new technology-based interventions for this user group that support mobilizing their personal strengths. Objective: A codesigning workshop was organized with the aim to explore user requirements and ideas for how technology can be used to help people with chronic illness activate their personal strengths in managing their everyday challenges. Methods: Thirty-five participants from diverse backgrounds (patients, health care providers, designers, software developers, and researchers) participated. The workshop combined principles of (1) participatory and service design to enable meaningful participation and collaboration of different stakeholders and (2) an appreciative inquiry methodology to shift participants’ attention to positive traits, values, and aspects that are meaningful and life-giving and stimulate participants’ creativity, engagement, and collaboration. Utilizing these principles, participants were engaged in group activities to develop ideas for strengths-supportive tools. Each group consisted of 3-8 participants with different backgrounds. All group work was analysed using thematic analyses. Results: Participants were highly engaged in all activities and reported a wide variety of requirements and ideas, including more than 150 personal strength examples, more than 100 everyday challenges that could be addressed by using personal strengths, and a wide range of functionality requirements (eg, social support, strength awareness and reflection, and coping strategies). 6 concepts for strength-supportive tools were created. These included the following: a mobile app to support a person to store, reflect on, and mobilize one’s strengths (Strengths treasure chest app); “empathy glasses” enabling a person to see a situation from another person’s perspective (Empathy Simulator); and a mobile app allowing a person to receive supportive messages from close people in a safe user-controlled environment (Cheering squad app). Suggested design elements for making the tools engaging included: metaphors (eg, trees, treasure island), visualization techniques (eg, dashboards, color coding), and multimedia (eg, graphics). Maintaining a positive focus throughout the tool was an important requirement, especially for feedback and framing of content. Conclusions: Combining participatory, service design, and appreciative inquiry methods were highly useful to engage participants in creating innovative ideas. Building on peoples’ core values and positive experiences empowered the participants to expand their horizons from addressing problems and symptoms, which is a very common approach in health care today, to focusing on their capacities and that which is possible, despite their chronic illness. The ideas and user requirements, combined with insights from relevant theories (eg, positive technology, self-management) and evidence from the related literature, are critical to guide the development of future more personalized and strengths-focused self-management tools. %M 30684404 %R 10.2196/10774 %U http://formative.jmir.org/2018/1/e10774/ %U https://doi.org/10.2196/10774 %U http://www.ncbi.nlm.nih.gov/pubmed/30684404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e11 %T Feasibility of a Proactive Text Messaging Intervention for Smokers in Community Health Centers: Pilot Study %A Kruse,Gina %A Kelley,Jennifer HK %A Chase,Karen %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, United States, 1 6177243157, gkruse@partners.org %K smoking cessation %K primary health care %K text messaging %D 2018 %7 31.05.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few smokers receive evidence-based cessation services during primary care visits. Objective: We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods: We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results: Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions: A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office. %R 10.2196/formative.9608 %U http://formative.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/formative.9608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10 %T A Multimedia Support Skills Intervention for Female Partners of Male Smokeless Tobacco Users: Use and Perceived Acceptability %A Akers,Laura %A Andrews,Judy A %A Gordon,Judith S %+ Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, United States, 1 541 484 2123, lauraa@ori.org %K tobacco cessation %K social support %K multimedia %K website design %K website development %K website use assessment %K usability testing %D 2018 %7 28.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: UCare is a new multimedia (website+booklet) intervention for women who want their male partner to quit their use of smokeless tobacco. The intervention is based on research showing that perceived partner responsiveness to social support is highest when the supporter conveys respect, understanding, and caring in their actions. The website included both didactic and interactive features, with optional video components, and special activities to help women develop empathy for nicotine addiction. The booklet reinforced the website content, encouraged women to use the website, and served both as a physical reminder of the intervention and a convenient way to share the information with her partner. Objective: The objective of this study was to describe the utilization and acceptability of a multimedia intervention among women seeking to support their partner in quitting smokeless tobacco. Lessons learned with respect to design considerations for online interventions are also summarized. Methods: We present the evaluation of the intervention components’ use and usefulness in a randomized trial. Results: In the randomized clinical trial, more than 250,000 visits were made to the website in a 2-year period, with the vast majority from mobile devices. Of the 552 women randomized to receive the intervention, 96.9% (535/552) visited the website at least once, and 30.8% (170/552) completed the core website component, “The Basics.” About half of the women (287/552) used the interactive “Take Notes” feature, and 37% (204/552) used the checklists. Few women used the post-Basics features. At 6 weeks, 40.7% (116/285) reported reading the printed and mailed booklet. Website and booklet use were uncorrelated. User ratings for the website and booklet were positive overall. Conclusions: Intervention website designers should consider that many users will access the program only once or twice, and many will not complete it. It is also important to distinguish between core and supplemental features and to consider whether the primary purpose is training or support. Furthermore, printed materials still have value. Trial Registration: ClinicalTrials.gov NCT01885221; https://clinicaltrials.gov/ct2/show/NCT01885221 (Archived by WebCite at http://www.webcitation.org/6zdIgGGtx) %R 10.2196/formative.9948 %U http://formative.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/formative.9948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e9 %T Developing a Self-Administered Decision Aid for Fecal Immunochemical Test–Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study %A Gabel,Pernille %A Kirkegaard,Pia %A Larsen,Mette Bach %A Edwards,Adrian %A Andersen,Berit %+ Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, Randers NØ, DK-8930, Denmark, 45 78420185, pergab@rm.dk %K colorectal neoplasms %K mass screening %K decision support techniques %K socioeconomic factors %K qualitative research %D 2018 %7 22.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. Objective: The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test–based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. Methods: The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. Results: The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a “choice-indicator” on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. Conclusions: We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA. %M 30684402 %R 10.2196/formative.9696 %U http://formative.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/formative.9696 %U http://www.ncbi.nlm.nih.gov/pubmed/30684402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10323 %T A Hybrid Web-Based and In-Person Self-Management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma: Feasibility and Acceptability of iPACT-E-Trauma %A Bérubé,Mélanie %A Gélinas,Céline %A Feeley,Nancy %A Martorella,Géraldine %A Côté,José %A Laflamme,G Yves %A Rouleau,Dominique M %A Choinière,Manon %+ Centre intégré universitaire du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Trauma Program and Department of Nursing, 5400 Boulevard Gouin Ouest, Montreal, QC, H4J 1C5, Canada, 1 514 338 2222 ext 2654, melanie.berube2@mail.mcgill.ca %K Acute pain %K chronic pain %K wound and injuries %K lower extremity %K self-care %K health promotion %K feasibility studies %K patient acceptance of health care %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). Objective: This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma. Methods: Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% of participants could complete the intervention. The rates for both these variables were calculated. The E-Health Acceptability Questionnaire and the Treatment Acceptability and Preference Questionnaire were used to assess acceptability. Mean scores were computed to determine the intervention’s acceptability. Results: More than 80% of participants received the session components relevant to their condition. However, the Web pages for session 2, on the analgesics prescribed, were accessed by 71% of participants. Most sessions were delivered according to the established timeline for ≥80% of participants. Session 3 and in-person coaching meetings had to be provider earlier for ≥35% of participants. Session duration was 30 minutes or less on average, as initially planned. More than 80% of participants attended sessions and <20% did not apply self-management behaviors relevant to their condition, with the exception of deep breathing relaxation exercises which was not applied by 40% of them. Web and in-person sessions were assessed as very acceptable (mean scores ≥3 on a 0 to 4 descriptive scale) across nearly all acceptability attributes. Conclusions: Findings showed that the iPACT-E-Trauma intervention is feasible and was perceived as highly acceptable by participants. Further tailoring iPACT-E-Trauma to patient needs, providing more training time for relaxation techniques, and modifying the Web platform to improve its convenience could enhance the feasibility and acceptability of the intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6ynibjPHa) %M 30684418 %R 10.2196/10323 %U http://formative.jmir.org/2018/1/e10323/ %U https://doi.org/10.2196/10323 %U http://www.ncbi.nlm.nih.gov/pubmed/30684418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e8 %T MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development %A Duff,Orlaith %A Walsh,Deirdre %A Malone,Shauna %A McDermott,Lauri %A Furlong,Brona %A O'Connor,Noel %A Moran,Kieran %A Woods,Catherine %+ School of Health and Human Performance, Dublin City University, Glasnevin,, Dublin, 9, Ireland, 353 17008011, kieran.moran@dcu.ie %K app development %K cardiac rehabilitation %K telemedicine %K exercise %K mHealth %K focus groups %K usability testing %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. %M 30684426 %R 10.2196/formative.9550 %U http://formative.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/formative.9550 %U http://www.ncbi.nlm.nih.gov/pubmed/30684426 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e78 %T A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation %A Pereira-Salgado,Amanda %A Mader,Patrick %A O'Callaghan,Clare %A Boyd,Leanne %+ Centre for Nursing Research, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia, 61 395083436, apereira-salgado@cabrini.com.au %K advance care planning %K ehealth %K religion %K culture %K health personnel %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. Objective: The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. Methods: The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. Results: Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions: The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study. %M 29661749 %R 10.2196/resprot.8572 %U http://www.researchprotocols.org/2018/4/e78/ %U https://doi.org/10.2196/resprot.8572 %U http://www.ncbi.nlm.nih.gov/pubmed/29661749 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e7 %T Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study %A Katapodi,Maria C %A Jung,Miyeon %A Schafenacker,Ann M %A Milliron,Kara J %A Mendelsohn-Victor,Kari E %A Merajver,Sofia D %A Northouse,Laurel L %+ Department of Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, Room 113, Basel, 4056, Switzerland, 41 79 109 5163, maria.katapodi@unibas.ch %K BRCA families %K family-based intervention study %K Web-based intervention study %K psycho-educational and skills-building intervention study %K communication and coping %K patient decision-aid %K genetic testing %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) %M 29653920 %R 10.2196/cancer.9210 %U http://cancer.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/cancer.9210 %U http://www.ncbi.nlm.nih.gov/pubmed/29653920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e61 %T Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study %A AlJaberi,Hana %+ Purdue Polytechnic Institute, Department of Computer Graphics Technology, Purdue University, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 7654947505, aljaberi.hana@gmail.com %K mHealth %K mobile health %K participatory design %K pregnancy %K Caribbean %K immigrant women %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women’s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women’s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. %M 29653919 %R 10.2196/mhealth.7708 %U http://mhealth.jmir.org/2018/4/e61/ %U https://doi.org/10.2196/mhealth.7708 %U http://www.ncbi.nlm.nih.gov/pubmed/29653919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e7 %T User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study %A Rivera,Jordan %A McPherson,Amy C %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Peters,Michelle %A Iyer,Sindoora %A George,Tessy %A Nguyen,Cynthia %A Stinson,Jennifer %+ The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K obesity %K weight loss %K adolescent %K mobile apps %D 2018 %7 04.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs. %M 30684409 %R 10.2196/formative.8248 %U http://formative.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/formative.8248 %U http://www.ncbi.nlm.nih.gov/pubmed/30684409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e5 %T A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck Pilot Study %A Le,Daisy %A Aldoory,Linda %A Garza,Mary A %A Fryer,Craig S %A Sawyer,Robin %A Holt,Cheryl L %+ Department of Behavioral and Community Health, School of Public Health, University of Maryland, 1101H School of Public Health Building (255), College Park, MD, 20742, United States, 1 415 385 7330, drdaisyle@gmail.com %K short message service %K text messaging %K African Americans %K women’s health %K cervical cancer %K health status disparities %K pap test %K cancer screening %K health information technology %K spirituality %K community-based participatory research %D 2018 %7 29.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities. %M 30684433 %R 10.2196/formative.8112 %U http://formative.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/formative.8112 %U http://www.ncbi.nlm.nih.gov/pubmed/30684433 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e4 %T Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial %A McBain,Thomas %A Weston,Matthew %A Crawshaw,Paul %A Haighton,Catherine %A Spears,Iain %+ Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S102BP, United Kingdom, 44 1142255805, t.mcbain@shu.ac.uk %K high-intensity interval training %K video games %K heart rate %K boxing %K metabolic syndrome %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males. Objective: The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation. Methods: We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25. Results: Retention to the intervention was 87.5% (21/24). Over the duration of the intervention, session attendance was 67.5% (170/252); repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4%), 89.9 (6.1%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO2 max, 3.0; 90% confidence limits ±2.6%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear. Conclusions: Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population. Trial Registration: ClinicalTrials.gov NCT03477773; https://clinicaltrials.gov/ct2/show/NCT03477773 (Archived by WebCite at http://www.webcitation.org/6yDLgVs35) %M 29588271 %R 10.2196/games.7758 %U http://games.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/games.7758 %U http://www.ncbi.nlm.nih.gov/pubmed/29588271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e6 %T Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study %A Kim,Juhee %A Mathews,Holly %A Cortright,Lindsay M %A Zeng,Xiaoming %A Newton,Edward %+ Department of Public Health, Brody School of Medicine, East Carolina University, 1600 Moye Blvd, Lakeside Annex 7, Greenville, NC, 27858, United States, 1 252 744 5575, kimju@ecu.edu %K patient portals %K digital divide %K pregnancy %K poverty %K health literacy %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use. %M 30684413 %R 10.2196/formative.5322 %U http://formative.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/formative.5322 %U http://www.ncbi.nlm.nih.gov/pubmed/30684413 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e21 %T A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice %A Champion,Katrina Elizabeth %A Chapman,Cath %A Newton,Nicola Clare %A Brierley,Mary-Ellen %A Stapinski,Lexine %A Kay-Lambkin,Frances %A Nagle,Jack %A Teesson,Maree %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, Sydney, 2052, Australia, 61 293850333, k.champion@unsw.edu.au %K methamphetamine %K substance-related disorders %K internet %K preventive psychiatry %K health education %D 2018 %7 20.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective: This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods: Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit’s acceptability, relevance, and appeal. Results: Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were “to get information for myself” (185/451, 41.0%) and “to find out how to help a friend or a family member” (136/451, 30.2%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a “low prevalence of use, yet high impact” message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions: The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. %M 29559427 %R 10.2196/mental.8891 %U http://mental.jmir.org/2018/1/e21/ %U https://doi.org/10.2196/mental.8891 %U http://www.ncbi.nlm.nih.gov/pubmed/29559427 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e66 %T An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial %A Somers,Tamara J %A Kelleher,Sarah A %A Dorfman,Caroline S %A Shelby,Rebecca A %A Fisher,Hannah M %A Rowe Nichols,Krista %A Sullivan,Keith M %A Chao,Nelson J %A Samsa,Gregory P %A Abernethy,Amy P %A Keefe,Francis J %+ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W Main St, Ste 340, Durham, NC, 27705, United States, 1 919 416 3408, tamara.somers@duke.edu %K stem cell transplantation %K hematopoietic stem cell %K cancer-related pain %K coping skills %D 2018 %7 19.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. Methods: Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. Results: Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants’ experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. Conclusions: Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. Trial Registration: ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ) %M 29555620 %R 10.2196/mhealth.8565 %U http://mhealth.jmir.org/2018/3/e66/ %U https://doi.org/10.2196/mhealth.8565 %U http://www.ncbi.nlm.nih.gov/pubmed/29555620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e4 %T A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability %A Zafeiridi,Paraskevi %A Paulson,Kevin %A Dunn,Rosie %A Wolverson,Emma %A White,Caroline %A Thorpe,Jonathan Adrian %A Antomarini,Marco %A Cesaroni,Francesca %A Scocchera,Francesca %A Landrin-Dutot,Isabelle %A Malherbe,Laëtitia %A Lingiah,Hendi %A Bérard,Marie %A Gironès,Xavier %A Quintana,Maria %A Cortés,Ulises %A Barrué,Cristian %A Cortés,Atia %A Paliokas,Ioannis %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ School of Engineering and Computer Science, University of Hull, Aire Building, Cottingham Road, Hull, HU67RX, United Kingdom, 44 01482464571 ext 4571, P.Zafeiridi@hull.ac.uk %K dementia %K technology %K social support %K caregivers %D 2018 %7 12.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10% (6/58). Results: After 1 week of platform use, the system was useful for 90% (20.75/23) of the caregivers and for 89% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82%, 18.75/23; professionals: 97%, 5.82/6) and their satisfaction with the platform (caregivers: 79%, 18.08/23; professionals: 73%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57%, 13/23), ease of use (41%, 9.4/23), and overall satisfaction (47%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. %M 30684403 %R 10.2196/formative.9083 %U http://formative.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/formative.9083 %U http://www.ncbi.nlm.nih.gov/pubmed/30684403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e52 %T Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation %A Baskerville,Neill B %A Struik,Laura L %A Dash,Darly %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2M 3G1, Canada, 1 519 888 4567 ext 35236, nbbaskerville@uwaterloo.ca %K mobile app %K smoking cessation %K young adult %K software design %K formative feedback %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective: The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results: LISTEN—focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN—informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO—focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT—refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY—a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 29500157 %R 10.2196/mhealth.9011 %U http://mhealth.jmir.org/2018/3/e52/ %U https://doi.org/10.2196/mhealth.9011 %U http://www.ncbi.nlm.nih.gov/pubmed/29500157 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 1 %N 1 %P e1 %T Acceptability and Feasibility of a Trial Testing Allocation to Sunscreen and a Smartphone App for Sun Protection: Discontinued Randomized Controlled Trial %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 191 208 8974, angela.rodrigues@newcastle.ac.uk %K sunscreening agents %K sun protection factor %K smartphone %K mobile applications %K feasibility studies %K randomized controlled trial %K skin neoplasms %K melanoma %K skin aging %K holidays %K health promotion %K health behavior %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Dermatol %G English %X Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8) %R 10.2196/derma.8608 %U https://derma.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/derma.8608 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e45 %T Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study %A Kessel,Kerstin A %A Vogel,Marco ME %A Alles,Anna %A Dobiasch,Sophie %A Fischer,Hanna %A Combs,Stephanie E %+ Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 0894140 ext 4502, kerstin.kessel@tum.de %K radiation oncology %K healthcare surveys %K mobile applications %K mobile apps %K telemedicine %K health-related quality of life %K questionnaires %K oncology  %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are evolving in the medical field. However, ongoing discussions have questioned whether such apps are really valuable and whether patients will accept their use in day-to-day clinical life. Therefore, we initiated a usability study in our department. Objective: We present our results of the first app prototype and patient testing of health-related quality of life (HRQoL) assessment in oncological patients. Methods: We developed an app prototype for the iOS operating system within eight months in three phases: conception, initial development, and pilot testing. For the HRQoL assessment, we chose to implement only the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30; German version 3). Usability testing was conducted for three months. Participation was voluntary and pseudonymized. After completion of the QLQ-C30 questionnaire using iPads provided by our department, we performed a short survey with 10 questions. This survey inquired about patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, and the app-specific functions (eg, interface and navigation). Results: After logging into the app, the user can choose between starting a questionnaire, reviewing answers (administrators only), and logging out. The questionnaire is displayed with the same information, questions, and answers as on the original QLQ-C30 sheet. No alterations in wording were made. Usability was tested with 81 patients; median age was 55 years. The median time for completing the HRQoL questionnaire on the iPad was 4.0 minutes. Of all participants, 84% (68/81) owned a mobile device. Similarly, 84% (68/81) of participants would prefer a mobile version of the HRQoL questionnaire instead of a paper-based version. Using the app in daily life during and after cancer treatment would be supported by 83% (67/81) of participants. In the prototype version of the app, data were stored on the device; in the future, 79% (64/81) of the patients would agree to transfer data via the Internet. Conclusions: Our usability test showed good results regarding attractiveness, operability, and understandability. Moreover, our results demonstrate a high overall acceptance of mobile apps and telemedicine in oncology. The HRQoL assessment via the app was accepted thoroughly by patients, and individuals are keen to use it in clinical routines, while data privacy and security must be ensured. %M 29463489 %R 10.2196/mhealth.9486 %U http://mhealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/mhealth.9486 %U http://www.ncbi.nlm.nih.gov/pubmed/29463489 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e54 %T Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability %A Stapleton,Jerod L %A Manne,Sharon L %A Day,Ashley K %A Levonyan-Radloff,Kristine %A Pagoto,Sherry L %+ Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, 195 Little Albany Street, New Brunswick, NJ, 08901, United States, 1 732 235 8112, staplejl@cinj.rutgers.edu %K body image %K dissonance-based intervention %K indoor tanning bed %K social media %K Facebook %K behavioral intervention %K prevention %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective: To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods: Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results: The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions: This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (ie, likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs. %M 29463495 %R 10.2196/resprot.9429 %U http://www.researchprotocols.org/2018/2/e54/ %U https://doi.org/10.2196/resprot.9429 %U http://www.ncbi.nlm.nih.gov/pubmed/29463495 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e44 %T A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Health Promotion and Education Unit, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K young adult %K mobile applications %K physical activity %K active transport %K health promotion %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. %M 29463491 %R 10.2196/mhealth.8287 %U http://mhealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mhealth.8287 %U http://www.ncbi.nlm.nih.gov/pubmed/29463491 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e13 %T A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb %A Bevan Jones,Rhys %A Thapar,Anita %A Rice,Frances %A Beeching,Harriet %A Cichosz,Rachel %A Mars,Becky %A Smith,Daniel J %A Merry,Sally %A Stallard,Paul %A Jones,Ian %A Thapar,Ajay K %A Simpson,Sharon A %+ Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Maindy Rd, Cardiff, Wales, CF24 4HQ, United Kingdom, 44 02920688451, bevanjonesr1@cardiff.ac.uk %K adolescent %K depression %K internet %K education %K preventive psychiatry %K early medical intervention %D 2018 %7 15.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is common in adolescence and leads to distress and impairment in individuals, families and carers. Treatment and prevention guidelines highlight the key role of information and evidence-based psychosocial interventions not only for individuals but also for their families and carers. Engaging young people in prevention and early intervention programs is a challenge, and early treatment and prevention of adolescent depression is a major public health concern. There has been growing interest in psychoeducational interventions to provide accurate information about health issues and to enhance and develop self-management skills. However, for adolescents with, or at high risk of depression, there is a lack of engaging Web-based psychoeducation programs that have been developed with user input and in line with research guidelines and targeted at both the individual and their family or carer. There are also few studies published on the process of development of Web-based psychoeducational interventions. Objective: The aim of this study was to describe the process underlying the design and development of MoodHwb (HwbHwyliau in Welsh): a Web-based psychoeducation multimedia program for young people with, or at high risk of, depression and their families, carers, friends, and professionals. Methods: The initial prototype was informed by (1) a systematic review of psychoeducational interventions for adolescent depression; (2) findings from semistructured interviews and focus groups conducted with adolescents (with depressive symptoms or at high risk), parents or carers, and professionals working with young people; and (3) workshops and discussions with a multimedia company and experts (in clinical, research, and multimedia work). Twelve interviews were completed (four each with young people, parents or carers, and professionals) and six focus groups (three with young people, one with parents and carers, one with professionals, and one with academics). Results: Key themes from the interviews and focus groups were: aims of the program, design and content issues, and integration and context of the program. The prototype was designed to be person-centered, multiplatform, engaging, interactive, and bilingual. It included mood-monitoring and goal-setting components and was available as a Web-based program and an app for mobile technologies. Conclusions: MoodHwb is a Web-based psychoeducational intervention developed for young people with, or at high risk of, depression and their families and carers. It was developed with user input using qualitative methods as well as user-centered design and educational and psychological theory. Further research is needed to evaluate the effectiveness of the program in a randomized controlled trial. If found to be effective, it could be implemented in health, education, youth and social services, and charities, to not only help young people but also families, carers, friends, and professionals involved in their care. %M 29449202 %R 10.2196/mental.8894 %U http://mental.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/mental.8894 %U http://www.ncbi.nlm.nih.gov/pubmed/29449202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e3 %T A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest %A Oremus,Mark %A Sharafoddini,Anis %A Morgano,Gian Paolo %A Jin,Xuejing %A Xie,Feng %+ School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON,, Canada, 1 519 888 4567 ext 35129, moremus@uwaterloo.ca %K computer-assisted personal interview %K health-related quality-of-life %K REDCap %K time trade-off %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods: We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions: We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes. %M 30684429 %R 10.2196/formative.8202 %U http://formative.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/formative.8202 %U http://www.ncbi.nlm.nih.gov/pubmed/30684429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e25 %T Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study %A Waite-Jones,Jennifer M %A Majeed-Ariss,Rabiya %A Smith,Joanna %A Stones,Simon R %A Van Rooyen,Vanessa %A Swallow,Veronica %+ Faculty of Science, Charles Sturt University, Building 1293 Room 2, Bathurst,, Australia, 61 0419 490 431, v.m.swallow@leeds.ac.uk %K Adolescent %K young people %K juvenile arthritis %K mobile apps %K self-management %K qualitative research %D 2018 %7 19.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications. %M 29351898 %R 10.2196/mhealth.9179 %U http://mhealth.jmir.org/2018/1/e25/ %U https://doi.org/10.2196/mhealth.9179 %U http://www.ncbi.nlm.nih.gov/pubmed/29351898 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e2 %T Digital Health Innovation: A Toolkit to Navigate From Concept to Clinical Testing %A Marvel,Francoise Adeline %A Wang,Jane %A Martin,Seth Shay %+ Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD, 21287, United States, 1 4105020469, fmarvel1@jhmi.edu %K digital health innovation models %K mHealth %K innovation framework %K development of smartphone applications %K wearable technology %K healthcare transformation %D 2018 %7 18.01.2018 %9 Viewpoint %J JMIR Cardio %G English %X Digital health technologies such as smartphone apps, Web-based platforms, and wearable devices are rapidly emerging as promising interventions for acute and chronic disease management, particularly in the field of cardiovascular medicine. However, there is limited guidance on how to effectively develop and rigorously test digital health interventions (DHIs). Through our experience with innovating Corrie, a smartphone-based app paired with a smartwatch and blood pressure monitor for myocardial infarction recovery in the acute setting, we aim to provide a toolkit for navigating the digital health technology development and clinical testing processes. The toolkit consists of 6 steps: step one emphasizes concept generation by defining a specific clinical problem and the existing solutions aimed to address it; step two aims to recruit a multidisciplinary team within an academic institution; step three leverages technology accelerators and industry partnerships; step four develops the digital health technology with continuous feedback from patient and family end-users; step five solicits feedback from a diverse array of stakeholders; and step six performs a clinical study at a single site that, if successful, rapidly scales to multiple sites. DHI development is often a complex and vastly uncharted territory. By exploring the steps we took from concept to clinical testing with the first cardiology CareKit app, we hope to provide useful insights to teams that are starting out on their path to digital health innovation. We emphasize the central importance of embracing transdisciplinary work to move from silos to synergy. %M 31758761 %R 10.2196/cardio.7586 %U http://cardio.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cardio.7586 %U http://www.ncbi.nlm.nih.gov/pubmed/31758761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e6 %T Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project %A McBride,Bronwyn %A Nguyen,Liem Thanh %A Wiljer,David %A Vu,Nguyen C %A Nguyen,Cuong K %A O'Neil,John %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada, 1 778 782 5361, joneil@sfu.ca %K mobile health %K Vietnam %K maternal health %K reproductive health %K health equity %D 2018 %7 11.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective: The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods: This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system. Results: The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions: This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. %M 29326095 %R 10.2196/resprot.7912 %U http://www.researchprotocols.org/2018/1/e6/ %U https://doi.org/10.2196/resprot.7912 %U http://www.ncbi.nlm.nih.gov/pubmed/29326095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e11 %T Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study %A Danbjørg,Dorthe Boe %A Villadsen,Allan %A Gill,Ester %A Rothmann,Mette Juel %A Clemensen,Jane %+ Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 26202186, dortheboe@gmail.com %K arthritis %K rehabilitation %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors. %M 29326092 %R 10.2196/mhealth.7734 %U https://mhealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mhealth.7734 %U http://www.ncbi.nlm.nih.gov/pubmed/29326092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e1 %T Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups %A Freyne,Jill %A Bradford,Dana %A Pocock,Courtney %A Silvera-Tawil,David %A Harrap,Karen %A Brinkmann,Sally %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Queensland Centre for Advanced Technologies, 1 Technology Court, Pullenvale, 4069, Australia, 61 733274404, dana.bradford@csiro.au %K mobile apps %K cultural diversity %K culturally appropriate technology %K cross-cultural care %K language barriers %K health care delivery %K ehealth allied health %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians’ inability to communicate directly with them. Objective: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. Methods: CALD Assist’s design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. Results: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians’ confidence in their assessment increased with use of the CALD Assist app: clinicians’ reports of “complete confidence” increased from 10% (3/30) to 42% (5/12), and assessment reports of “no confidence” decreased from 57% (17/30) to 17% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. Conclusions: Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store. %M 30684405 %R 10.2196/formative.8032 %U http://formative.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/formative.8032 %U http://www.ncbi.nlm.nih.gov/pubmed/30684405 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e1 %T Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability %A Levesque,Deborah %A Umanzor,Cindy %A de Aguiar,Emma %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2975, dlevesque@prochange.com %K pilot projects %K substance use disorders %K primary care %K behavioral medicine %K expert system %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. %M 29295811 %R 10.2196/medinform.7355 %U http://medinform.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/medinform.7355 %U http://www.ncbi.nlm.nih.gov/pubmed/29295811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e7 %T Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App %A Govorko,Matthew Hayden %A Fritschi,Lin %A White,James %A Reid,Alison %+ School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 1361, alison.reid@curtin.edu.au %K application development %K asbestos %K asbestos-containing materials %K mobile phones %K smartphone %K residential environment %K mobile applications %K environment and public health %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Asbestos-containing materials (ACMs) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, community members lack knowledge and awareness about asbestos identification and its safe management in residential settings. Objective: The objective of our study was to describe the process of developing a mobile phone app, ACM Check, that incorporates a questionnaire designed to identify and assess ACMs located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process comprised 6 steps: defining the scope of the app; conducting a comprehensive desktop review by searching online literature databases, as well as a wider online search for gray literature; drafting and revising the content, questionnaire, conditional branching rules, and scoring algorithms; obtaining expert input; manually pretesting the questionnaire; and formulating a final content document to be provided to the software development company. We then constructed ACM Check on the iOS platform for use in a validation study, and then updated the app, replicated it on Android, and released it to the public. Results: The ACM Check app identifies potential ACMs, prioritizes the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiologic research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards. %M 30684427 %R 10.2196/formative.8370 %U http://formative.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/formative.8370 %U http://www.ncbi.nlm.nih.gov/pubmed/30684427 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e30 %T An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study %A Fagher,Kristina %A Jacobsson,Jenny %A Dahlström,Örjan %A Timpka,Toomas %A Lexell,Jan %+ Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, PO Box 157, Lund,, Sweden, 46 46 222 1991, kristina.fagher@med.lu.se %K epidemiology %K feasibility studies %K sports medicine %K sports for persons with disabilities %K telemedicine %D 2017 %7 29.11.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained. Objective: The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS. Methods: An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods. Results: The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents. Conclusions: The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS. Trial Registration: ClinicalTrials.gov NCT02788500; https://clinicaltrials.gov/ct2/show/NCT02788500 (Archived by WebCite at http://www.webcitation.org/6v56OqTeP) %M 29187343 %R 10.2196/humanfactors.8117 %U http://humanfactors.jmir.org/2017/4/e30/ %U https://doi.org/10.2196/humanfactors.8117 %U http://www.ncbi.nlm.nih.gov/pubmed/29187343 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e230 %T An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping %A Boekhout,Janet M %A Peels,Denise A %A Berendsen,Brenda AJ %A Bolman,Catherine AW %A Lechner,Lilian %+ Faculty of Psychology and Educational Science, Open University of the Netherlands, Postbus 2960, Valkenburgerweg 177, Heerlen, 6401 DL, Netherlands, 31 455762448, janet.boekhout@ou.nl %K exercise %K older adults %K single %K chronic disease %K eHealth %K social network %K Intervention Mapping %D 2017 %7 23.11.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. Objective: The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. Methods: The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. Results: As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. Conclusions: This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. %M 29170146 %R 10.2196/resprot.8093 %U http://www.researchprotocols.org/2017/11/e230/ %U https://doi.org/10.2196/resprot.8093 %U http://www.ncbi.nlm.nih.gov/pubmed/29170146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e6 %T A Health Professional–Led Synchronous Discussion on Facebook: Descriptive Analysis of Users and Activities %A Grainger,Rebecca %A White,Bonnie %A Morton,Catherine %A Day,Karen %+ Rehabilitation Research and Teaching Unit, Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Wellington South, 6242, New Zealand, 64 43855541 ext 4031, rebecca.grainger@otago.ac.nz %K social media %K arthritis %K patient education %K patient engagement %D 2017 %7 22.11.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand (Arthritis NZ) is a nongovernmental organization that provides advocacy, information, and advice and support services for people with arthritis in New Zealand. Since many people seek health information on the Web, Arthritis NZ has a webpage and a Facebook page. In addition to static content, Arthritis NZ provides synchronous discussions with an arthritis educator each week via Facebook. Objective: The aim of this study was to describe participation and structure of synchronous discussion with a health educator on a social media platform and the type of information and support provided to people with arthritis during discussions on this social media platform. Methods: Interpretive multimethods were used. Facebook Analytics were used to describe the users of the Arthritis NZ Facebook page and to provide descriptive summary statistics. Graphic analysis was used to summarize activity during a convenience sample of 10 arthritis educator–led synchronous discussions. Principles of thematic analysis were used to interpret transcripts of all comments from these 10 weekly arthritis educator–led discussions. Results: Users of the Arthritis NZ Facebook page were predominantly female (1437/1778, 80.82%), aged 18 to 54 years. Three major activities occurred during arthritis educator–led synchronous discussions: (1) seeking or giving support; (2) information enquiry; and (3) information sharing across a broad range of topic areas, largely related to symptoms and maintaining physical functioning. There was limited peer-to-peer interaction, with most threads consisting of two-comment exchanges between the users and arthritis educators. Conclusions: Arthritis educator–led discussions provided a forum for informational and emotional support for users. The facilitated discussion forum for people with arthritis on Facebook could be enhanced by encouraging increased user participation and increasing peer-to-peer interactions and further training of arthritis educators in facilitation of Web-based discussion. Future research should focus on addressing barriers to user participation and assessing the impact of arthritis educator facilitation training, with the latter leveraging the Action Research paradigm. %M 30684425 %R 10.2196/formative.7257 %U http://formative.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/formative.7257 %U http://www.ncbi.nlm.nih.gov/pubmed/30684425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e5 %T Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model %A Park,Daniel Y %A Goering,Elizabeth M %A Head,Katharine J %A Bartlett Ellis,Rebecca J %+ Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Boulevard, Indianapolis, IN, 46202, United States, 1 317 278 3136, bgoering@iupui.edu %K chronic disease %K education of patients %K medication adherence %K mHealth %K mobile apps %K smartphone %D 2017 %7 10.11.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients’ smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients’ app use. Objective: The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients’ intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. Methods: A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. Results: Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=−1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants’ perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants’ SMRA use in primary care settings (or during routine medical checkups). Conclusions: Intervention training session, guided by TAM, appeared feasible in targeting patients’ perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients’ perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app. %M 30684397 %R 10.2196/formative.8027 %U http://formative.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/formative.8027 %U http://www.ncbi.nlm.nih.gov/pubmed/30684397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e4 %T Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh %A Biswas,Kamal Kanti %A Hossain,Altaf %A Chowdhury,Rezwana %A Andersen,Kathryn %A Sultana,Sharmin %A Shahidullah,S M %A Pearson,Erin %+ Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, United States, 919 967 7052, andersenk@Ipas.org %K mHealth %K Bangladesh %K contraceptive usage %K postabortion contraception %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies. Objective: This study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns. Methods: This feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages. Results: Almost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children. Conclusions: In this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns. %M 30684398 %R 10.2196/formative.5151 %U http://formative.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/formative.5151 %U http://www.ncbi.nlm.nih.gov/pubmed/30684398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e3 %T Videoconferencing-Based Treatment of Alcohol Use Disorders: Analyses of Nonparticipation %A Tarp,Kristine %A Mejldal,Anna %A Nielsen,Anette Søgaard %+ Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, Indgang 220B, Odense C, 5000, Denmark, 45 6550 9359, ktarp@health.sdu.dk %K nonparticipation %K refusal to participate %K barriers %K treatment of alcohol use disorders %K alcoholism %K treatment refusal %K videoconferencing %K effectiveness %K treatment outcome %D 2017 %7 28.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: We recently conducted a small randomized controlled trial (RCT) aiming to examine the effectiveness of videoconferencing-based treatment of alcohol use disorders in a real-life setting. The patient and participation rates were lower than anticipated. Objective: The objectives of our study were (1) to examine differences between participants and nonparticipants, and (2) to examine the characteristics of nonparticipants and their reported reasons for not participating. Methods: First, we analyzed nonparticipation through a comparative analysis of participants and nonparticipants using data from a clinical database, covering all patients starting treatment at the clinic. Second, on the basis of data from an anonymous questionnaire filled out by nonparticipants, we analyzed barriers to participating and the descriptive sociodemographics of nonparticipants who reported technical barriers versus those who did not. Results: Of 128 consecutive patients starting treatment during the study period, we found no significant differences between participants (n=71) and nonparticipants (n=51) according to sociodemographics, alcohol measures, and composite scores. Of 51 nonparticipants, 43 filled out the questionnaire with reasons for not participating. We derived 2 categories of barriers from the questionnaire: scientific barriers, which were barriers to the scientific study in general (n=6), and technical barriers, which were barriers to using a laptop or videoconferencing specifically (n=27). We found no significant differences in sociodemographics between nonparticipants who reported technical barriers to participating in the study and those who did not note technical barriers. A total of 13 patients elaborated on technical barriers, and 9 patients found videoconferencing impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic. Conclusions: Patient barriers to participating in the RCT were mainly concerned with the technology. There were no significant differences between participants and nonparticipants, nor between nonparticipants who noted technical barriers to participating and those who did not. If a similar study is to be conducted or the solution is to be upscaled and implemented, attention should be given to the user friendliness of the technical equipment and the recruitment process, preparing the patients by emphasizing the information given to them about the technical equipment and its advantages. %M 30684431 %R 10.2196/formative.6715 %U http://formative.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/formative.6715 %U http://www.ncbi.nlm.nih.gov/pubmed/30684431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e2 %T A Novel Patient Engagement Platform Using Accessible Text Messages and Calls (Epharmix): Feasibility Study %A Som,Avik %A Patel,Kunjan %A Sink,Eric %A Peters,Robert Mattson %A Javaherian,Kavon %A Groenendyk,Jacob %A An,Tonya %A Xu,Zhuchen %A Polites,Gregory M %A Blanchard,Melvin %A Ross,Will %+ Department of Internal Medicine, Renal Division, Washington University School of Medicine, Box 8023, 660 South Euclid Avenue, St. Louis, MO,, United States, 1 314 362 6861, rossw@wustl.edu %K telemedicine %K mobile health %K eHealth %K telehealth %K mHealth innovations %K bioinformatics %K multiple chronic conditions %D 2017 %7 18.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. One method to improve therapeutic adherence is to improve feedback loops in getting clinically acute events and issues to the relevant clinical providers as necessary (ranging from detecting hypoglycemic events for patients with diabetes to notifying the provider when patients are out of medications). Patients often don’t know which information should prompt a call to their physician and proactive checks by the clinics themselves can be very resource intensive. We hypothesized that a two-way SMS system combined with a platform web service for providers would enable both high patient engagement but also the ability to detect relevant clinical alerts. Objective: The objectives of this study are to develop a feasible two-way automated SMS/phone call + web service platform for patient-provider communication, and then study the feasibility and acceptability of the Epharmix platform. First, we report utilization rates over the course of the first 18 months of operation including total identified clinically significant events, and second, review results of patient user-satisfaction surveys for interventions for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Methods: To test this question, we developed a web service + SMS/phone infrastructure (“Epharmix”). Utilization results were measured based on the total number of text messages or calls sent and received, with percentage engagement defined as a patient responding to a text message at least once in a given week, including the number of clinically significant alerts generated. User satisfaction surveys were sent once per month over the 18 months to measure satisfaction with the system, frequency and degree of communication. Descriptive statistics were used to describe the above information. Results: In total, 28,386 text messages and 24,017 calls were sent to 929 patients over 9 months. Patients responded to 80% to 90% of messages allowing the system to detect 1164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions to over 10 on average in any given month for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Conclusions: Engaging high-risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement with very low risk to improve clinical outcomes. We demonstrated that engagement among high-risk populations is possible when health care comes conveniently to where they are. %M 30684401 %R 10.2196/formative.7211 %U http://formative.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/formative.7211 %U http://www.ncbi.nlm.nih.gov/pubmed/30684401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e161 %T Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity %A Pope,Lizzy %A Garnett,Bernice %A Dibble,Marguerite %+ University of Vermont, 533 Waterman Building, 85 South Prospect St, Burlington, VT, 05405, United States, 1 802 656 2187, bgarnett@uvm.edu %K adolescents %K qualitative research %K mHealth %K physical activity %D 2017 %7 29.08.2017 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. Objective: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. Methods: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 “losing” artwork and game concepts into the winning ideas. Results: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53%) and playful art (27/71, 38%). Conclusions: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development. %M 28851676 %R 10.2196/resprot.8113 %U http://www.researchprotocols.org/2017/8/e161/ %U https://doi.org/10.2196/resprot.8113 %U http://www.ncbi.nlm.nih.gov/pubmed/28851676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e1 %T The Impact of Participant Characteristics on Use and Satisfaction of a Web-Based Computer-Tailored Chronic Obstructive Pulmonary Disease Self-Management Intervention: A Process Evaluation %A Voncken-Brewster,Viola %A Amoureus,Mylène %A de Vries,Hein %A Nagykaldi,Zsolt %A Winkens,Bjorn %A van der Weijden,Trudy %A Tange,Huibert %+ Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht University, PO Box 616, Maastricht,, Netherlands, 31 43 388 2230, viola.voncken@maastrichtuniversity.nl %K Internet intervention %K computer tailoring %K application use %K participant characteristics %K COPD %K self-management %K behavior change %K process evaluation %D 2017 %7 21.08.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: A randomized controlled trial (RCT) showed that a Web-based computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease (COPD) did not have a significant treatment effect. Process evaluation measures such as application use and satisfaction with the intervention can help understand these results. Objectives: The aim of this paper is to uncover reasons for suboptimal application use, evaluate satisfaction with the intervention, and investigate which participant characteristics predict application use and user satisfaction. Methods: Participants were recruited through 2 different channels: an online panel and general practice. The intervention group received the intervention, which consisted of 2 modules (smoking cessation and physical activity). The control group received no intervention. The study employed a mixed methods design. Quantitative and qualitative data were gathered assessing participant characteristics, application use, reasons for not using the application, and satisfaction with the intervention. Results: The RCT included 1325 participants. The proportion of individuals who participated was significantly higher in the online group (4072/6844, 59.5%) compared to the general practice group (43/335, 12.8%) (P<.001). Application use was low. Of all participants in the intervention group, 52.9% (348/658) initiated use of one or both modules, 36.0% (237/658) completed an intervention component (prolonged use), and 16.6% (109/658) revisited one of the modules after completing an intervention component (sustained use). Older age, established diagnosis of COPD, or experiencing breathlessness predicted sustained use. Participant satisfaction with the 2 modules was 6.7 (SD 1.6) on a scale from 0 to 10. The interviews revealed that a computer application was believed not to be sufficient and the help of a health care professional was necessary. Participants with a greater intention to change were more satisfied with the application. Conclusions: The application was not used sufficiently. Study materials should be further tailored to younger individuals, those at risk for COPD, and those who do not experience breathlessness in order to increase sustained use among them. Involvement of a health care professional could improve satisfaction with the intervention and potentially increase engagement with the intervention materials. However, to make this possible, recruitment in general practice needs to be improved. Recommendations are made for improving the study design, strengthening the intervention (eg, practice facilitation), and linking the computer application to interaction with a health care provider. %M 30684399 %R 10.2196//formative.6585 %U https://formative.jmir.org/2017/1/e1/ %U https://doi.org/10.2196//formative.6585 %U http://www.ncbi.nlm.nih.gov/pubmed/30684399